The Foundation

I have been asked by people involved in the Floyd Memorial Foundation fundraising efforts why more people don’t donate to such a worthy cause.

The Foundation supports most of the local health-screenings, free cholesterol and diabetic checks and many educational functions. The Foundation is a wonderful organization providing a very good community service.

So the question remains; why don’t more people donate and specifically why don’t more physicians?

Having more than 5000 active patients and many contacts with local leaders, businessmen etc., the answer seems very clear to me. The Foundation is perceived by most people to be part of the Hospital, even though this is inacurate, and certain people in the management of the hospital are not well-liked. These potential contributors do not feel the hospital is being managed well and therefore do not feel donating money is a worthwhile cause. Many feel that some in administration control the money (directly or indirectly) and are not confident in their decisions.

The end result is poor donations. I have heard this personally by at least a dozen local businessmen and many physicians.

Since money dictates most policies, programs and resources, sooner or later, I am hopeful enough people will acknowledge and fix the real underlying problem.

For now, the Foundation will continue to feel the impact.

Employee satisfaction

A little over a year ago, the hospital performed an employee satisfaction survey because of the perceived morale problems. This survey, in my opinion, was very revealing but again marginalized when presented to the Board. As a board member, I questioned the consulting firm about some of the data and the way it was being presented. I felt the results were poor yet they were describing it with a very positive spin.

The results were presented to the staff and employees in a fairly positive light even though I felt it validated some of the known problems. Since most everyone agreed there were problems before the survey took place and hence the reason for the survey, spinning the data in the positive direction fails to properly acknowledge and thereby fix the problems. I personally reviewed the data from the survey and some of the key indicators that came out of the survey are as follows. I believe the data speaks for itself.

It is of note that according to the consultant, any value more than 5% above or below the database is considered statistically significant. I summarized the data and sent it to my fellow board members at the time and voiced my concerns. These are some of the key indicators the survey highlighted and in my opinion reflect some serious problems at FMHHS.

11% of total employees feel the hospital is not headed in a positive direction and of these, 69.7% feel it is because of the quality of leadership.

More than 43% of employees feel they cannot initiate an action to change things that need changed. 5% below database

More than 32% of employees feel that there is not effective leadership. 7.5% below database

More than 32 % are uncomfortable expressing their thoughts. 5.5% below database. Of these, 87% feel it doesn’t do any good; managers do not want to hear it, fear it will be used against them or fear there will be repercussions.

More than 44% feel they are not involved in decision making. 5% below database.

More than 32% feel that management is not fair to all associates. 7.7% below database

31% feel management does not make sure problems are solved in their department. 6.7% below

More than 43% stated that management does not ask for their input. 16.4% below

More than 43% stated that management does not use their input. 15.1% below

More than 36% feel that communication has not improved in the past 3 years in their departments

More than 40% feel that communication has not improved from Executive leadership

More than 48% feel that trust has not improved in the Leadership, 44% feel fairness has not improved, and 46% feel consistency has not improved.

Of the more than 10% who feels that the Floyd Memorial Way does not move the organization in a positive direction, more than 53% believe it is because the Leadership does not practice the Floyd Memorial Way.

What is more worrisome, in my opinion, is the fact that the breakdown in the Management Work Environment Index shows significant problem areas. This is very reflective of middle-management's view of Senior Leadership and is one of the reasons why the overall employee survey shows the problems in these areas. Examples as follows:

I feel appreciated for what I do. 5.7% below database

Senior Leadership tries to be sensitive to each director/ manager’s individual situation. 10.1% below database

At FMHHS we have a smooth efficient way of getting the job done. 11.5% below database

I am comfortable expressing my thoughts and opinions at FMHHS. 17.6% below database

The management council meetings are good for positive communications. 9.4% below database

New ideas are welcome in my division. 3.9% below database

I feel there is a strong sense of teamwork within the Management Council. 4.2% below database

Generally speaking, I am satisfied with my job in management at this organization. 4.5% below the database

My statements to the other Board members were as follows:

If our goal as a board for FMHHS is to be just barely average in employee satisfaction, physician satisfaction, work environment, and Leadership then I think we are successful.

If our goal is to move FMHHS forward in the 21st century to become the Regional Health Care facility and the preferred choice as stated in our mission, then I do not feel we are not on the correct path in any of the above areas and we will not financially survive in the long-run.

The response to the survey was to hire another consultant to help fix the problem. We had the opportunity to hire the consultant that worked with us on the strategic planning and who already had a good understanding of the issues, but if you will remember, she was discredited when some of the problems pointed at the CEO.

If you recall she spent 3 overnight retreat days in Henryville with many staff, physicians, 2 board members and several in administration and had a very close working relationship. She also spent several other days working on the project and she probably had the most knowledge of any consultant. She was not hired and a separate consultant with no knowledge of this was contracted.

I believe the survey supports the leadership style as one that is less than healthy. Many decisions are made out of fear. I believe the responsibility for this environment begins and continues because of the administration's style of management. In my opinion, the work environment will not change until there is leadership change.

Not having a physician on the Board because of Chuck Freiberger and John Resiert’s decision on reappointment prevents employees from having an advocate that they see and talk with every day. Concerns, morale and problems will not be identified or addressed because there is no one readily available who isn't afraid to confront the issues. There were many physicians willing to serve on the Board. Commissioners Freiberger and Reisert as well as the administration made no efforts to seek out other qualified individuals and should be held accountable for such a poor decision.

The Board was informed in December that a followup survey completed this year showed some tentative improvement in a few areas. But no statistical data has been compiled or given to the Board and how it still compared to the database standards was not offered. How the data will be spun is also a question based on my prior experience.

Consultants

Disagreements were not uncommon amongst Board members. That in my opinion is healthy. But there was one issue that all Board members consistently had agreement.

The hospital spent way too much money every year on consultants. In fact, I cannot remember a single issue of significant importance that it was not recommended by the CEO to hire a consultant. We spent hundreds of thousands of dollars on these fees.

We had consultants for employee satisfaction, physician satisfaction, strategic planning, finances, marketing, salary surveys, goal setting and a host of other issues. Our question always remained; “we spend nearly $1 million annually on salaries and benefits for the top 5 administrators. What are we paying the CEO for if we continue need consultants to tell us what to do?"

At one point, the board decided to make a point with the CEO. He repeatedly would bring issues up at the Board meeting and want approval without giving us proper notice or adequate information. So, at one meeting, he wanted approval to hire a particular consultant for strategic planning and had already given her the indication it was a “done-deal”. We decided to deny the request and table the issue until we could discuss it further and make an informed decision. The CEO was not happy. He got angry and was telling us that the dates were already in place, and we were jeopardizing the plans, etc. We did approve it later in the month, but it did send a fairly strong message that we were tired of the same manipulation of information.

What’s more ironic about this particular consultant is the fact that when he didn’t get his way with initial approval, he gave this consultant outstanding reviews stating her company was the best around, etc. etc.

During the strategic planning retreat, the consultant determined very early on that there was a significant trust issue amongst the staff, physicians and the CEO. In fact, we had to spend nearly the entire morning on one of the days and dedicate it to the discussion on the lack of trust related to the administration with specific issues about the CEO.

Needless to say, this consultant determined early on that the strategic planning process was hampered because of this issue. After the process was completed, the consultant was willing to help us work on the trust and morale issue. But the CEO presented her at the next Board meeting as not very competent in her field and didn’t think we should proceed in that direction. This was a stark contrast to how he earlier portrayed her when he wanted things his way.

Being part of that strategic planning process, it is my opinion that this particular consultant grasped some of the real problems in the organization early on and since the problem was directed at the CEO, he immediately discredited her. We never had any further contact with her by the Board.

In my 13 years plus on the Medical Staff, I cannot remember one single new original idea developed by the CEO. It always appeared to me that the continued advances, programming, strategic moves and successes were always someone else’s ideas. But he was never bashful about taking the credit for the ideas and successes. It is also my opinion, that this is a major contributor to the lack of true respect he garnishes from those working alongside him. Many respect the position but not the individual.

Letter from Commissioner

Today’s blog analyzes the letter sent from Commissioner Freiberger related to my not being reappointed to the Hospital Board. Certainly letters may not reflect the competence of the individual, but it certainly says something to the integrity they hold for the office they serve. I am sure he didn’t personally type the letter, but I would think he should have read it before allowing it to be sent.

First off is the date that shows it was typed on January 12th. It arrived at my office on January 24th after the Board had already met once. There was never a phone call or any other correspondence from Commissioner Freiberger related to my not being reappointed.

Next, you will notice that the zip code for Floyds Knobs is incorrect. He is the Commissioner for Floyd County and lives in Floyds Knobs from my understanding, and I would think he knows the zip code.

I was the only physician on the Board but was addressed as Mr. rather than Dr. This certainly is not inappropriate, but it leads one to wonder if he was making a statement, or clueless as to the fact he was removing the only physician on the Board.

And lastly, he misspelled the newest Board member’s name. The last name is Megraw and not McGraw.

Does this really matter? Probably not, but I do think it says a lot for the integrity of the individual that signed his name to this letter.

I many times jokingly use the phrase "you'd better keep your day job" when someone isn't very good at a secondary activity, but since he teaches our kids as his primary job; I am reluctant to consider this phrase with him.

Bylaws

Hospital Board Bylaws specifically state in Section 1, paragraph 3:
…No substantial part of the activities of the hospital shall be the carrying on of propaganda or otherwise attempting to influence legislation, and the hospital shall not participate in or intervene in (including the publishing or distribution of statements) any political campaign on behalf of any candidate for public office…….

These caused me much concern with 2 specific issues. (1)My belief that the CEO was strong-arming employees in certain levels of the organization (managers, directors etc.) to donate money to Political Action Committees and (2) the hospital financing the legal fees to fight the County’s lawsuit on the moratorium it issued over the new hospital wanting to come in town.

I was in favor of making it a policy that employees were not to be encouraged, coerced or forced to donate their own money to any organization. This did not have enough support with the rest of the Board for a formal policy and so Mr. Hanson was told that the Board would like to see that activity cease. I was informed by an employee that at the very next administrative council meeting, the issue was addressed and Mr. Hanson made a comment to the effect that “it wasn’t mandatory, but you knew what was expected”.

Doesn’t sound to me like Mr. Hanson had any regard for the Board’s consensus.

In addition, reportedly, the CEO has strong-armed employees to contribute to United Way when he was involved with that organization and had made hospital departments participate in fundraising events for the American Heart Association when he was affiliated with that group. Employees were upset because some of them have charitable organizations they are involved with but cannot use hospital time and money for their interests. In my opinion, these things were done so that he would look better at the expense of the hospital employees doing the work. Double standards run amok under this leadership. This has been typical of his style over his tenure. Usually taking credit but never blame or responsibility. From what I see and hear, he is not a respected leader by many of those who work closely with him although most cannot voice their opinions for fear of reprisals.

The second issue regarding the moratorium also caused me concern. I am very much an advocate of the free market and competition. I understand fully how a specialty hospital may potentially harm the financial security of a County-owned hospital. There are ways to create fair and equitable practices for all involved and to continue to allow growth in new business all while increasing the tax base. There was a supposedly non-partisan task force formed to look at this issue, and one of the members just happens to be the newly appointed Board Member to the hospital. I am hopeful but at the same time a little skeptical that the recommendations coming from this committee will be biased.

The hospital has already spent in excess of $100,000 in legal fees for the defense of the moratorium and will likely spend in excess of $250,000 if they appeal the recent ruling overturning the moratorium the County placed. I voted against Hospital money being spent for this endeavor because of the Bylaw language listed above and I did not feel we could or should prevent competition. The hospital needs to learn how to compete and the County needs to ensure fair competition amongst all the players involved.

I continue to find it distasteful for a CEO or organization to coerce employees to donate their personal income to a certain cause.

Moving Day

Monday was the official moving day to begin occupying the new Intensive Care units and the new step-down monitored units at Floyd Memorial Hospital. Patients began moving around 9:00 a.m. on Monday morning.

All the staff seemed very excited about the move, even if a little nervous. Two of my patients also were excited to know that they would be the first patients ever in the new rooms. It made the hospital experience a little less anxiety-provoking for both of them.

The staff worked very hard over the weekend doing last minute preparations. Our vice-president Mrs. Quillman also was on hand Sunday rolling her sleeves up and pitching in with the hard work. She has been very dedicated to the project and was the administrative lead since its inception. She had the tremendous job of managing the project, working with the builders and project manager to keep things on-time and on-budget. Overall she did an excellent job and should be complimented on the success. The staff also should be complimented for their tremendous efforts preparing for the move and changes. I cannot say enough how proud we are to work with such great staff.

The employees continue to show their enthusiasm with excitement and positive attitudes. Everyone is hopeful that the growing pains of the new addition will not disrupt the forward momentum.

Diversion

Many people have heard the term “on diversion” related to the hospital and not accepting patients. What does this actually mean?

Diversion is a term used when a hospital has no available beds. It does not specify why the diversion has occurred. At Floyd, every diversion last year was due to one of two reasons. Either all beds were occupied or there were no available monitored beds. Monitored beds are those in which a heart monitors or other monitoring equipment can be placed on a patient and observed from the central monitoring station. These are limited in every hospital.

Other hospitals occasionally go “on-diversion” when they don’t have adequate nursing staff to care for patients. This has not occurred at Floyd in the past year.

When a hospital is “on-diversion”, ambulances are informed and they then divert patients to the next closest available hospital that can meet the needs of the patient. Physicians are informed and they are instructed not to electively admit patients or are told they have to send them elsewhere.

If patients arrive to the emergency room when the hospital is “on-diversion” and the patient later needs to be admitted, the emergency room will hold the patient until a room becomes available. This puts a burden on the emergency room and its staff as they lose access to that emergency room bed. In addition, the nurses have to tend to routine in-patient care not normally provided by emergency room personnel.

This is a daily occurrence at University Hospital and occurred dozens of times at Floyd and Clark in the past years. Diversion does have seasonal variations with winter flu being the most common.

Increasing the number of monitored beds with the newest addition at Floyd should theoretically help with this problem. Unfortunately, the total number of beds is changing very little and we will therefore likely be “on-diversion” when all the beds are occupied during peak seasons.

Parking

I’ve been asked about the parking situation at the hospital. Many wonder why with such a large addition that a parking garage was not built.

The answer is complicated but it was considered thoroughly. Consultants crunched numbers, discussed ideas, offered different scenarios and in the end made the recommendation to the Board that it was not the best option.

Parking structures are a lot more expensive than ground parking. Maintenance fees and upkeep is costly in the long-run, and security is a major issue in parking structures. These were some of the reasons for not building a garage at the present time.

The hospital had acquired more land from the Dunbar properties and it was felt that with shuttle services and valet services it would be a better financial decision at the present time to continue utilizing ground parking.

If continued expansion with other projects occurs, then, the parking structure idea will be re-visited.

Useless Trivia

As a break from the recent hospital related information, here is some absolutely useless trivia sent by a friend that may bring a smile.

• The first couple to be shown in bed together on prime time TV were Fred and Wilma Flintstone.

• Every day more money is printed for Monopoly than the U.S.Treasury.

• Men can read smaller print than women can; women can hear better.

• Coca-Cola was originally green.

• It is impossible to lick your elbow.

• The State with the highest percentage of people who walk to work: Alaska

• The percentage of Africa that is wilderness: 28% (now get this...)

• The percentage of North America that is wilderness: 38%

• The cost of raising a medium-size dog to the age of eleven: $6,400

• The average number of people airborne over the U.S. in any given hour: 61,000

• Intelligent people have more zinc and copper in their hair.

• The first novel ever written on a typewriter: Tom Sawyer.

• The San Francisco Cable cars are the only mobile National Monuments.

• Each king in a deck of playing cards represents a great king from history:
Spades - King David
Hearts – Charlemagne
Clubs -Alexander, the Great
Diamonds - Julius Caesar

• 111,111,111 x 111,111,111 = 12,345,678,987,654,321

• If a statue in the park of a person on a horse has both front legs in the air, the person died in battle. If the horse has one front leg in the air the person died as a result of wounds received in battle. If the horse has all four legs on the ground, the person died of natural causes.

• Only two people signed the Declaration of Independence on July 4th, John Hancock and Charles Thomson. Most of the rest signed on August 2, but the last signature wasn't added until 5 years later.

• Q. Half of all Americans live within 50 miles of what?

Their birthplace

• Q. Most boat owners name their boats. What is the most popular boat name requested?
A. Obsession

• Q. If you were to spell out numbers, how far would you have to go until you would find the letter "A"?
A. One thousand

• Q. What do bulletproof vests, fire escapes, windshield wipers, and laser printers all have in common?
All were invented by women.

• Q. What is the only food that doesn't spoil?
• Honey

• Q. Which day are there more collect calls than any other day of the year?
• Father's Day

~~~~~~~~~~~AND FINALLY~~~~~~~~~~~~
• At least 75% of people who read this will try to lick their elbow!

BREAKING NEWS

The decision from Indianapolis is in and the Judge has ruled against the Floyd County Moratorium placed against the competing hospital. This is a big win for the new hospital and a huge loss for the County and the Hospital. The judge reportedly wrote a 38 page ruling and I am in the process of obtaining a copy.

I was asked to give a short opinion on the current members of the Board and how they vote related to most issues and how they voted supporting the financing of the legal defense for the moratorium. The vote related to the defense of the moratorium was 6 voting for and 1 opposed. I was the lone dissenter on this particular issue.

The following is a list of the Board Members I had the pleasure of working with. I also am giving my opinion of how they voted based on my experience. I disagreed with some of them often, but I consider them all friends and respect their opinions. I did feel that at times, some of them overlooked obvious issues related to administration. The reason for this was never clear.

Kay Garry—a truly great lady. Full of knowledge, dedicated, brilliant in oversight and finances and has become a good friend. It has been a pleasure working with her and getting to know her. She votes based on principles and the facts and always in what she felt was the best interest of the hospital.

Von Marshall—a true gentleman. Always concerned about etiquette and has been a very strong Chairman. He held each of us accountable for statements and decisions and I also have enjoyed his company and friendship. He votes on issues relative to their merit and in the best interest of the community and hospital.

Darrell Mills—always cares about the employees and is easily approachable to listen to problems and concerns. Not afraid of controversy and has some political aspirations. This has been manipulated by some commissioners but Darrell was a stand-up guy and willing to work around the issue for the betterment of the hospital. Again, he is a friend whom I will continue to work closely with. He votes on issues based on what he feels is best for the hospital and the employees.

Bob Kleehammer—intelligent and very mild mannered. Never seems to get frustrated. He is in the banking business and brings that expertise to the Board. He usually votes and sides with administration.

David Atkins—retired from a large business in Louisville. Has experience in blue collar and white collar careers as well as union issues. He is very personable. Usually votes with the CEO's recommendation.

Mary Garner—retired nurse. Widow of Dr. Garner and mother of Dr. Bill Garner and the Mayor. She is very outgoing. She nearly always votes based on the CEO's recommendation.

Newest appointee is Keith Megraw. His wife was the CEO's secretary in the past. He is in the insurance business and has been a member of the commissioner-appointed task force to look at the competing hospital issue. From what I've been told, he will likely vote based on the CEO's direction.

This is the view from my seat. We can certainly disagree on this as well.

Physicians

Physicians at Floyd Memorial are another extremely important reason why Floyd Memorial continues to thrive.

Most people do not realize that hospitals absolutely cannot thrive without physician leadership, support, and affiliation.

Compared to Clark Memorial, we are virtually the same size in patients and gross revenues. But Floyd has continued to financially thrive while Clark has been in the red for the past 2 years. They appear to be further in the red for 2005.

The reason is simple. Their largest primary care physician group does not support the hospital like physicians in Floyd County. Their largest group is owned by Norton’s. The office has its own lab, x-ray, and CAT scan facility. They rarely need the services of the hospital and when they do need to admit patients, they are directed to a Norton facility.

Without a primary care physician base, it is very difficult to survive. Hospitals rely on outpatient services to financially support the losing inpatient services. Hospitals have huge fixed overhead expenses that pure inpatient reimbursement cannot cover.

Twenty to 30 years ago, there was plenty of money for hospitals and physicians. Services were paid without significant discounts or write-offs. Hospitals didn’t need to establish close ties with physicians to survive. Money was not usually a problem. But today is completely different. There are limited resources and physicians and hospitals are constantly competing for the same revenue.

This is why it is imperative that physicians and hospitals learn to work together. There has to be an attitude of having a win-win relationship. Physicians will continue to transition to outpatient settings they own themselves. This is done because it is the only way to maintain income. Just providing office services cannot maintain the overhead and salaries. Insurance companies continue to cut fee schedules and have not kept pace with inflation, all while requiring more hurdles to jump.

Twenty years ago, most eye surgeries were done in the hospital. Not any more. Today, colonoscopies and other scoping procedures, stress tests, ultrasounds, EMG’s, x-rays, Cat Scans, MRI’s and many others are done in outpatient facilities.

Some of these are owned by physicians, some by hospitals and some by others. The bottom line is that if physicians and hospitals don’t learn to partner rather than compete, the hospital will lose. Hospitals have patients for one reason. Physicians send them there or give the orders for the tests. If physicians do not have a good working relationship with their hospital, they will eventually do things themselves. This is the paradigm shift. This is why CEO’s taught 20 years ago will have to adjust and change or face the downward trends in their facilities. Some CEO’s may be able to make this transition, but others will not.

Board Members also are typically from the same generation as the CEO. They too must understand the implications of this scenario and paradigm shift and make appropriate decisions for the benefit and future success of the hospital. Waiting until there is a problem, not only is failing to do their jobs, but it is a disaster for the long-term goals of the hospital.

Physicians can be a hospital’s greatest asset or as Clark County is learning, they can be their biggest adversary. The choice belongs not to employees who make hospitals what they are, but to the CEO and Boards who must understand this paradigm shift.

Positive Aspects

I have stated before that Floyd Memorial is the best hospital in the area in my opinion. That comes from personal experience practicing in many of the local hospitals. I want to concentrate on why Floyd Memorial is the wonderful hospital I believe it is.

The reason the hospital is outstanding is very simple. It has little to do with the building or location. It is not because of administration. It is because of the employees. They are the most caring, considerate, dedicated and compassionate staff of any hospital I have been affiliated with.

Starting with the Emergency Room. Even though our facility is too small at the present time, patients get excellent care. Within just a few weeks, it will be moving to the new and much larger facility. Their workups are efficient and thorough and the Emergency physicians are extremely knowledgeable and competent. The nursing staff truly cares about the patients and families. Emergency room visits are stressful for families, but I believe the staff does a great job.

The Intensive Care Units truly are second to none. We have staff that is extremely well-managed and all of the nurses are excellent in their knowledge and patient care. They make patients and families feel very comfortable and give TLC like no other hospital I have worked.

Our Medical and Surgical floors also have competent and caring nurses and staff that strive for perfection. Patient care is their number 1 issue and it shows by their enthusiasm and compassion.

Every other department has staff that really does care about their jobs and want to do their very best.

They continue to overcome the shortcomings of the CEO and his administrative style and accomplish great things. They move the hospital forward in spite of the CEO, not because of the CEO. They truly are the heart and soul of Floyd Memorial and the real reason it continues to succeed.

Goals not reached

Over the 4 years I served on the Board, there was really very little accomplished,in my opinion, as far as changes in the organization structure and attitudes. It was mainly because of a lackadaisical attitude amongst members and the same good-ol-boy attitude. For some reason, we have adults that cannot disagree agreeably. If you disagree, you automatically become the enemy. Therefore problems were rarely addressed and rarely fixed. Here is a simple list of items I wanted to accomplish in 2005 but because of lack of support from certain Board members, many did not get completed.

• Mr. Hanson (CEO) strong arms the employees in management to contribute money to Political Action Committees. There was never an official policy about donations at the hospital and he therefore has employees contributing to organizations he was affiliated with or had interest in to make himself look better. I had several employees tell me it created a financial burden on their families to contribute the amounts that are expected. I believe this is wrong for the CEO to mandate this. The board agreed but never made an official policy. I was told that the very next management council meeting, Mr. Hanson made a statement to the affect stating it was not mandatory, but he told the employees they knew what was expected. Typical example of his management style.
• I believe that every letter that comes to the Board should have a written reply back to the individual from the Board at least acknowledging we received and considered it. Too many letters have been received over the years with no response given and it looks like we do not care or take it in consideration.
• I have always advocated that the Board should have time alone each month with just Board members and our attorney Scott Waters. I believe we should be able to meet without the CEO to discuss issues privately. This was threatening to the CEO and we never consistently were able to do this because of other Board members not thinking it was important and the CEO not complying.
• I had always been opposed to the way the organizational goals and individual goals were made for the hospital and CEO. Many were not real goals that could be measured. Others were so vague that anyone could accomplish them. But this was what determined their bonuses and the CEO certainly did not want to be held accountable for real goals, with real measurements. Otherwise his large annual bonus would be in jeopardy. “Getting rewarded for outcomes. Is that fair?”
• I wanted the Board to have quarterly physician meetings without the CEO. Many physicians are unhappy but most do not want any more conflict and therefore continue to just keep quiet. If the CEO was not at the meetings, the Board members would hear a whole different viewpoint. But again, accountability is at issue. If the Board heard these things, they would then be obligated to do something to fix them. More conflict would ensue and therefore, as usual less action was taken.
• I wanted to see the County commissioners meet with the Board at least twice/year without the CEO. But again, this caused conflict and meant that we may actually have to address and resolve some issues. Who wanted to do that?
• I have been a firm believer that we needed to begin a transition process for a smooth leadership change. There are dozens of reasons why this makes since. But without consistency in the Board, this will probably not occur as soone as it should.

As you can see, most of these are common sense issues that should not cause much conflict. But when an organization has its leadership managing employees based on fear and reprisals when authority is challenged; even simple things become huge hurdles.

Looking forward to old age

How about a little lighter side for the weekend!

Did you know:

There is more money being spent on breast implants and Viagra today than on Alzheimer's research.

This means that by 2040, there should be a large elderly population with perky boobs and huge erections and absolutely no recollection of what to do with them.

JCAHO

For many every day citizens, JCAHO (Joint Commission
on Accreditation of Healthcare Organizations) means virtually nothing.

To physicians, it is a necessary evil. More government regulations in an already over-regulated field. It does not equate to quality of care in most physician's minds, but it is a tool that is used to standardize care, grade hospitals and create havoc to normal functioning. It is a very poor tool in our minds, but it is the system enjoy (or not).

But to hospitals, it has been the gold-standard for accreditation. Without it, the organization could not obtain federal funds through Medicare and Medicaid. It is always a major task to prepare for and pass the accreditation process.

In 2004, Floyd Memorial received a letter stating that our lab would be receiving a preliminary denial of accreditation because of having too many deficiencies during the inspection. This was “briefly” mentioned to the Board and I do mean briefly. We were given assurance by the CEO that the problems would be rectified and it would not affect the hospital. Months went by and nothing else was mentioned until the Board was informed that JCAHO did in fact intend to uphold the preliminary finding and not give accreditation to the hospital.

When questioned why so much time had passed and why we were just hearing about this, the backpedaling, excuses and passing blame immediately began by the CEO. It was always someone else’s fault for his failures. But as always, he made excuses and all of a sudden wanted to dump JCAHO and become accredited with a secondary organization through the American Osteopathic Association that none of us had heard of before. This was called the Healthcare Facilities Accreditation Program (HFAP)

He made comments condemning JCAHO and how they had changed and were all about money. He commented how JCAHO was in hot water with the Federal Government for not being strict enough and accrediting organizations that were later found to have significant problems. There was some truth to these statements, but it only mattered when we were at risk of not being accredited. There was never any mention of even considering switching accreditation organizations until we were failing with JCAHO.

He wanted to appeal the JCAHO ruling which eventually cost the Hospital more than $100,000. The result after all legal challenges remained the same. DENIED ACCREDITATION.

Information obtained from an individual who actually was at the final hearing in Chicago stated the issue was never totally about the Hospital’s standards. The hospital had a good lab and in virtually all other cases, these minor deficiencies would have been allowed to be rectified. But it had evidently become a personal issue. Reportly, some of the evaluators were treated poorly or disrespected and the manner in which the denial of accredtaiton was challenged by the administration seemed to bruise some egos. This was the responsibility of the CEO although it never got talked about. (Sweep it under the rug and don’t talk about it. That way you don’t have to address the “white elephant” in the room. The typical modus operandi)

Too much energy was now being focused on complete overhaul of our accreditation. Employees worked tirelessly to accomplish the enormous task of a new accreditation process all while the CEO continued finding ways to pass blame and take credit for others successes. After all, if we didn’t pass this hospital-wide accreditation process, we would lose Medicare and Medicaid dollars. That could be financial devastation to the hospital especially in the midst of the new Heart Center.

During this fiasco, the CEO had to get the Board to change it’s bylaws as well because they specifically stated we would be accredited by JCAHO. The CEO had to change his personal goals so he could still get his large year-end bonus because it also stated we would maintain JCAHO accreditation.

The County Commissioners were informed about these events, but really didn’t voice any major concerns because the CEO continued to provide the same lip-service, as usual, with blind reassurances and promises.

We now are a hospital no longer accredited by JCAHO but by the American Osteopathic Association.

As a Board Member, I voiced my discontent with the manner in which the situation was handled and the poor communication to the Board by the CEO. I had heard from hospital employees of how some of the JCAHO evaluators were treated and felt early on that the hospital would not be able to overcome the ruling because of this. We were going to be used as an example by JCAHO.

I did vote to proceed with the secondary accreditation because I knew the chances of overturning the JCAHO ruling were slim. The hospital could not afford to lose Medicare and Medicaid dollars.

Does it affect patient care?

Not yet, but that is not the point. Our CEO, with the Board and Commissioners knowledge, failed a major part of running a hospital. Rather than addressing the underlying problem, the issue was once again marginalized and trivialized. How many more events will need to occur before there are enough people to make the changes necessary to have our hospital grow and prosper?

This is another reason to hold Commissioner’s Freiberger and Reisert accountable for their poor decisions. Removing the only physician from the Board was not a good decision. If they really cared about the hospital, the employees, and the community, they would appoint individuals willing to do what is right; not political cronies, personal friends or pressured appointments from the CEO.

Days in accounts receivable

As a Board member, each of us were sworn in and promised to meet fiduciary responsibilities to the hospital. One of those responsibilities involves ensuring that bills are collected and paid. Days in accounts receivables is one of the measurements used to assess this responsibility. It is an area that directly affects the financial security of the hospital. Again, Mr. Freiberger and Mr. Reisert need to be held accountable if this problem is not addressed and fixed by the Board they appointed.

The goal set by the CEO and his administration was for the "days in accounts recievable" not to exceed 70 days. We never once in 2005 met this goal. I would repeatedly question why the number was trending up rather than down. The prior year (2004), the average was 79.7 and by November 2005, this had risen to 85.6 days.

Again the CEO and CFO were tired of the monthly questioning without having an adequate answer. The financial department continued to spend more and more money trying to fix the problem and continued to fall further behind. There were always excuses about indigent care, more self-paying patients etc., but the bottom line remained. We were not meeting the stated goals. Other hospitals seem to be meeting the goal. Why can’t we?

At the end of 2004, the CEO and CFO entered the hospital into plans to spend in excess of $100,000 related to software and a company that was supposed to help fix this problem. This contract in its totality was in excess of the limit that the CEO could approve without board consent. But the contract was split into parts and it appeared to have been hidden in routine financials and was brought to my attention by a concerned employee placing the information in my mailbox. This employee knew that the administration continued to throw money at a problem that was not being fixed and they did not want it to go unnoticed. The employees are wonderful people and they care what happens.

Now that a physician is no longer on the board, problems like these will likely revert to the days when the CEO and his administration could secretly do things without board approval or even their knowledge.

Accountability is the issue!!

Hope you're listening Mr. Freiberger, Mr. Reisert and Mr. Hanson.

Patient Satisfaction

Mr. Freiberger’s and Mr. Reisert’s decision to place politics over reason will lead to continued problems of poor accountability. I was always challenging the data presented at Board meetings and wanted accountability for the results.

Each month, we were given a report with 15 goals and their associated acceptable levels. Most months of the year, more than 10 of these goals were never met. Each month I would question the reasoning and was given excuses each time for why they weren’t being met.

The first set of goals was patient satisfaction. We contracted with Press Ganey to perform the ongoing survey. They were chosen according the CEO because they have a large database of other hospitals to compare. This meant that our results were going to be compared with other hospitals and therefore we could see where we ranked.

The problem has continued to be that our ranking rarely met the hospitals reported goal of 75% and we were therefore ranked lower than other hospitals. By the end of November, the results were as follows:
Inpatient satisfaction percentile ranking 75%
Outpatient surgery satisfaction 70%
Emergency Room satisfaction 50%
Outpatient satisfaction ranking 50%

There were many months that none of the 4 rankings met the 75th percentile. Each month I would question what was being done and why these numbers were not improving. I know the problem remains that administration is not supportive of the needs of employees on the "front-line" who actually care for the patients. The answer always came back from the CEO that we were being given 4’s rather than 5’s by the patients. This meant they ranked us very good rather than excellent. But the question remained; why do other hospitals, using this same tool, get more excellent ratings? What were they doing different? The CEO always minimized these results and kept saying that if only 5-10 more people put 5’s rather than 4’s we would be at our goal.

The hospital spends nearly $100,000/year on this Press Ganey survey. If the data is going to be marginalized when the results don’t validate the set goals, then why do we continue spending the money? This became an ongoing conflict at each meeting and the CEO was tiring of the repeated onslaught with no rational explanation. Our hospital was only average at best when it came to patient satisfaction. This was not and is not acceptable in my opinion.

The County Commissioners should be held accountable for this ongoing problem.

Hospital Board

Four years ago, two County Commissioners showed up in my office and asked me if I would consider serving as a Board member to the hospital. I had never sought the position or voiced an interest in the position.

But because of my reputation for being an advocate of patient care and employee concerns, and an outspoken critic of the current hospital administration along with my involvement in many committees at the hospital, they felt I would aggressively and actively deal with the issues and help improve the perception of the hospital.

They were tired of appointing Board members that were “yes men” to the CEO. They knew that I was known for “conflict resolutions, rather than conflict avoidance”. They also knew the vast majority of employees and community leaders trusted me. There was little trust in the administration and trust has been an ongoing problem as was shown in surveys and strategic planning sessions conducted by outside consultant firms.

I made it very clear to the Commissioners that my serving would be under no conditions other than what was best for patient care and the hospital. My primary responsibility was for the well-being of my patients and I knew there were many problems that needed to be addressed. Addressing these problems would cause a lot of conflict and a lot of tension. I made it clear that if we started down this path, things would get heated. In my opinion, there needed to be a major paradigm shift in how the hospital was managed and the relationship with the physicians. I was not confident that the future success of the hospital could be sustained unless this shift took place.

The commissioners had a few key issues they wanted accomplished initially and those included the following:
(1) assurance the hospital would not be sold to any organization and that it remain a county-owned facility
(2) that employee morale and satisfaction be addressed and improved because it was perceived to be at an all-time low
(3) that more money from the hospital would be directed toward funding of the county owned ambulance service through the fire department
(4) That better open communication be established with the hospital and the county.
(5) Lastly, the issue was the concern that there needed to be leadership change

When the CEO got initial word they were considering me as one of the two appointments, he immediately started behind the scenes tactics to prevent the appointment. One example of things he did was to meet with a group of physicians called the Past Chiefs of Staff. He led them to believe that the commissioners were considering appointing an elderly chiropractor or another local physician and he convinced them to draft a letter to the commissioners in support of the one local physician. He intentionally withheld the information that I was being considered. When they later found out I was also on the slate of candidates and that he intentionally withheld that information, many were angry. One actually resigned from this committee.

There are numerous other examples of mistruths, or misrepresentations done to subvert the appointment. Needless to say, I was appointed and it has been a very tumultuous four years. During this past year when we finally had a majority of open-minded board members willing to do what was right, we have accomplished a lot. In fact, in my opinion, there has been more accountability in this one year than all the others combined.

But due to the fact that I confronted two of the Commissioners (Chuck Freiberger and John Reisert) last year because of their meddling and interference into our election process, I sealed my fate on re-appointment. Freiberger made it very clear to many people that he was offended by my phone call confronting him personally on the issue. Sure, he denied actually threatening our board member if he voted a certain way, but it was very plain on what was expected of this board member. This type of political manipulation is all too common and needs to cease. Doing what is right is not always politically correct.

As this blog is being written, I am told that the CEO is meeting and talking individually with certain Board members he has in his pocket, manipulating the chairmanship vote for 2006. He would prefer Mr. Kleehammer regain chairmanship over the current chairman Mr. Marshall. Again, accountability and his ability to manipulate agendas is too important to allow another year like he had in 2005.

Serving on the Board consisted of countless hours of reviewing data, reading reports, listening to speakers, attending 4-6 hour board meetings, attending conferences, strategic planning sessions, and other hospital functions. On top of this, I continually held people accountable for their decisions leading to continual conflict. The pay was $300/month. I had to alter my office schedule and lost, on the average, 5 hours out of my office evaluating patients each of these months. This meant that I was actually paying to serve on the board. I also lost these hours with my family.

In the end, I look back and know that my serving has significantly changed the structure and accountability of the CEO and Board. We made significant advances and had made significant strides in changing the direction of the hospital.

It is disappointing to know that within a few more years, and future reappointments, these accomplishments could be reversed. Commissioners like Freiberger who have their “egos get in the way of their better judgment” are doing a disservice to our community!!

Over the next few days, I will give examples of some of the accountability issues that these two commissioners should be held responsible because of their poor judgment.

Lack of integrity with Commissioners

The County Commissioners met on Tuesday January 3, 2006 and made the reappointments to the Floyd Memorial Hospital Board. They chose to re-appoint Kay Garry and remove Dr. Daniel Eichenberger. They replaced his position with Keith Megraw who is a personal friend of the CEO Bryant Hanson. The vote was 2-1 against Dr. Eichenberger with Steve Bush voting in favor of Dr. Eichenberger and Chuck Freiberger and John Reisert in opposition.

Why does this matter? There are many reasons that will be discussed.

The success or failure of any hospital is directly related to the physician involvement and their referral patterns.

Keeping abreast of problems and addressing them appropriately is key to maintaining good relations.

Without a physician intricately involved on the Board, the board members will only here the information presented by the CEO and with his spin on the situation. This is always biased.

CEO’s from the previous generation were trained during a time when physicians and hospital CEO’s were more adversarial and not accustomed to working together. But with the current healthcare environment, there has to be paradigm shift in order to succeed. The CEO at Floyd is from the “old school of thought” and he has a history of having difficult physician relations.

The Board had just hired a consultant to review and work on transition planning and really needed a consistency in the Board makeup. Dr. Eichenberger had the most knowledge of the current situation as well as being the impetus for the changes being made.

There are many other issues involved, but politics once again intervened and egos were challenged and therefore changes were made that were not in the best interest of Floyd Memorial or the community.

Why did this happen?

The reason is simple. Two county commissioners placed politics and egos over their duty to the Hospital and the community.

One year ago, the seven Board members were going to choose a new chairman because they believed a new direction was needed. It was felt that there was not enough accountability and the CEO had far too much freedom in his decisions. Four of the board members would have selected Dr. Eichenberger and would have had the majority needed. A few days prior to the vote, there was pressure placed on one of the four members by County Commissioner Chuck Freiberger and John Reisert. They, in so many words, told this member that if he wanted his political aspirations of becoming sheriff to be a reality, he should not vote for Dr. Eichenberger.

After discussions between these four members, they decided to choose Von Marshall as Chairman. This allowed a change in leadership without placing the one member in a political problem.

Dr. Eichenberger personally called both Chuck Freiberger and John Reisert and confronted them about the interference in the board’s plans. He informed them that if they didn’t allow the majority to do what was in the best interest of the hospital, he would resign his position and go public about the interference and all the problems within the hospital, the finances, administration etc. It would not have looked good politically for either of them if the only physician would have resigned and made public this information.

Chuck Freiberger had his ego threatened when held accountable for his actions, and not re-appointing Dr. Eichenberger is the retaliation. Other Board members sent letters to the county commissioners asking them to re-appoint Dr. Eichenberger, but they chose not to follow the advice of those who knew what was in the Hospital’s best interest.

Bryant Hanson (CEO) during this time had also been meeting privately behind the scenes to encourage the replacement of Dr. Eichenberger because his decisions were being challenged and he was being held accountable for the ongoing hospital problems.

Even the Board’s attorney has stated it will be tough without a physician on the Board.

Integrity is important and two of three of our County Commissioners have shown their lack thereof.

Some have questioned the identity of the Healthblogger, but it has not been made public because of the potential reappointments and his candid discussion on the issues involved. Since the appointments have now been completed, I am comfortable stating that Healthblogger and Daniel Eichenberger M.D. are one in the same.

It is disappointing that holding people accountable for their decisions is not politically correct. Progress in Floyd County has taken another step backwards. I will continue to share information that is relevant to the taxpayers of the County-owned hospital and show the partisanship and politics that some of our local leaders continue to display at our expense.

Toilet Troubles

With the 1 gallon flush toilets, manufactures have developed more ingenious designs in toilet flushes. Now the pressure assisted toilets really do the job.

But did you know that every time you flush with the lid open, the flush creates an invisible cloud of bacteria and viruses in the hundreds of water droplets that spray out of the bowl. This cloud can travel as far as eight feet or more and is referred to as the “aerosol effect”

Everything in the bathroom can be affected including the lid, seat, walls and nearby toothbrushes. If cleaning the bathroom is neglected, some of these germs can persist for a lengthy period of time. Inhaling the air after the flush can also cause bacteria to enter your upper airways and lungs.

Charles Gerba, a University of Arizona biologist, has studied the aerosol effect for years and found all sorts of bacteria including E. coli, shigella, streptococcus, staphylococcus, hepatitis A, and the common cold virus to name just a few.

You can test for the aerosol effect by placing food coloring in the toilet bowl and then hold a piece of white paper at different angles and in different locations.

So remember to always put the seat (lid) down!

I am sure the guys out there have heard that said once or twice.

Healthcare Climate

Dan Varga M.D. accurately describes the problems in the Kentuckiana area regarding physicians and the medical climate. [State's 'negative medical climate']

The only additional comment is that some of the physicians that actually left the state, practice here in southern Indiana. Therefore they still are a major referral source for some Louisville area hospitals.

The more concerning trend is the decline in overall physicians practicing and graduating from Medical School. There has not been a substantial increase in class sizes for years. The rate at which physicians are choosing not to practice certain areas of medicine is becoming a critical problem.

Insurance companies continue to cut the fees paid to physicians and continually require more hurdles to get anything accomplished adding to the growing overhead in the office expenses. With declining reimbursements and increasing overhead, physicians will continue to make tough choices on which services they can and cannot perform. The average insurance write-off for primary care physicians is 35% and for specialists like cardiology it may reach 65 percent. This means that for every 100 dollars billed, the maximum return you can expect is 65 dollars. That is if the patient pays their copay and the Insurance doesn’t find a reason to reject the claim or delay the payment. The healthcare crisis will get worse!!

A Lileks Perspective on 2005

2005 will likely go down in history as a year with a variety of ups and downs. Many accomplishments but also many tragedies.

James Lileks has a very good lighter perspective on events from 2005.

A 2005 Rollick
By James Lileks
Behold: 2005 was the most important year in human history.

Okay, maybe not. There have been better years, and worse ones. The Goths did not sack New York City. No plague. Asteroids didn’t deform the globe. The center held, and if some rough beast was slouching toward Bethlehem it appears he was diverted to a time-share in Branson for the season.

Nothing blew up—over here at least. Despite the usual rash of false alarms, Americans no longer seem to be waiting for the other shoe bomber to drop. The economy grew much more than gloomy reporters expected. The Batman movie was good, for a change. No one on the Supreme Court tested positive for steroids. Politically, the Administration seemed determined to get the third year of its second term out of the way in the first.

All in all, not bad. If something wretched happens in 2006, Aught-Five will be regarded like 2000, another year when we blithely sailed along, amusing ourselves with gaudy TV, insouciant Internet amusements, Powerball, and the transient couplings of toothsome thespians. Athens reborn!

It certainly didn’t feel like a golden age. It’s difficult to believe you live in the best of times when Hollywood recreates The Dukes of Hazzard and the producers are not stoned in the public square on general principle. We all recognize hard times—when you’re in a gas line, you feel it. But good times we sometimes notice only in the rearview mirror.

There was something of a peevish quality to 2005. Perhaps it’s the year itself; odd-numbered years sound indecisive and inconclusive—shave-and-a-haircut without the two bits. Odd- numbered years never have an Olympics. No great clanging election campaigns. They slump and wander. By contrast, even-numbered 2006 has a hard, clear sound to it, a ring of promise and purpose.

Most of what occurs in any given year will be forgotten. 2006 will be the same, unless aliens land, or someone perfects cold fusion, or North America is depopulated by bird flu and tumbleweeds bounce down the streets of Fargo (more than the usual number, that is). But toting up tomorrow’s details will have to wait. For now, let us review what was memorable and forgettable in the year just now ending.

Iraqis voted in record numbers in January. Actually, any number would’ve been a record; apart from Israel’s perennial political tussles, this is the first real election in the Middle East since the Pharaoh’s stone masons voted to unionize. (All were slaughtered.) Coupled with a popular headcount in Afghanistan and rumblings all through the Levant and Central Asia, it seems for a moment that democracy is on the march. This global advance will soon screech to a halt, however, when the world learns that prisoners in Gitmo are kept awake with loud Madonna music. This grave atrocity will keep some politicians busy for months, for instance in comparing American troops to Nazis. You know, the ones who blasted Lotte Lenya tunes in the gas chambers.

The President makes a pitch for Social Security reform in his State of the Union speech. The reform would allow some workers to direct a miniscule percentage of their mandatory, government-run pensions into private funds. Within 48 hours, Bush foes have many citizens convinced his plan will force all seniors to exchange their checks for vouchers good at Cat Food Distribution Centers run by the Enron corporation. The President also makes a pitch for a Constitutional Amendment to prevent the redefinition of marriage. It soon becomes the Amendment That Dares Not Speak Its Name.

Superbowl Sunday. After Janet Jackson's 2004 nipple debacle left scientists wondering whether she might have the power to slow the spin of hurricanes or stop the mutation of deadly viruses, all other world controversies are temporarily knocked off stage to see if she would return. Sadly, Paul McCartney kept his shirt on.

Social Security reform is declared dead. But no one can find the body. The White House will later insist that reform is merely missing; it slipped out the back of the executive mansion, bolted through the Rose Garden, and was last seen swimming across the Potomac. “We’re confident it will return soon,” stated one aide. “It has nowhere else to go.” There were unconfirmed reports that Social Security reform had been spotted frolicking on a Mexican beach with the Defense of Marriage Amendment. Not that there’s anything wrong with that.

Pope John Paul II dies. To the horror of many, his successor turns out to be Catholic.

Gitmo torture tales surface again in May, as Newsweek claims that a Koran was flushed down a toilet. The story is later retracted. Did no one at Newsweek consider the difficulty of flushing a book down a commode? Probably its elitist reporters and editors have Mexican housekeepers who do all their flushing for them.

John Bolton is nominated to be U.S. ambassador to the U.N., despite his moustache. The U.N. tower has 38 stories, Bolton once noted, and “if you lost ten stories today it wouldn’t make a bit of difference.” To the contrary, insisted Bolton’s critics, the uppermost floors are devoted to tsunami advance-warning detection, non-polluting hydrogen power, and a cheap AIDS vaccine that also doubles as a dessert topping—all almost ready for release. Bolton is later given a “recess appointment,” which is something Presidents can do whenever grade schools are not in session. When our new ambassador arrives at his U.N. office he finds that, yup, just like at State, the keyhole has been filled with Superglue.

Rumors persist in the media that there is a new left-wing radio network called “Air America.”

Darfur victims petition Janet Jackson to show up and partially disrobe, if only to get the world’s attention. Alas, this works no better than their previous request to have Terry Schiavo moved to the Sudan, in the hopes of catching a reporter’s ear after he’s finished his hourly update on the saline levels in her intravenous bag.

An oppressive colonizer is forced to withdraw from occupied Arab land. This is initially met with dancing in the streets of Cairo, Paris, and Turtle Bay. Then everyone realizes it is Syria pulling out of Lebanon. You must understand that the Cedar Revolution, after years of Syrian domination, has nothing to do with the American presence in Iraq, you jingoist. It’s just one of those international coincidences like the moon being where it was when Apollo 11 flew past. A few months later, Israel voluntarily withdraws from Gaza, earning approximately 17 seconds of good will from the international community. Personal best!

Iran announces it will no longer allow inspectors into the Khomeini Memorial Peaceful Nuclear Research Facility for Hastening the Destruction of Israel. European diplomats threaten to take the matter to the U.N. Subcommittee of the Task Force for Occasionally Threatening to Issue a Strongly-Worded Report. But the group’s next meeting isn’t until 2007, and it must first take up the horror of Israel’s security fence. Iran promises to allow inspections in exchange for 500 million Euros, payable in coins of enriched uranium. The E.U. agrees, with the condition that the interest rate on the loan will be adjusted upward if Iran makes nuclear bombs. If they actually detonate a bomb there would be an immediate balloon payment, make no mistake about it.

North Korea’s envoy approaches a negotiation table in Beijing at an oblique angle. He traces a tic-tac-toe grid in the dust on its surface. He wanders off again. Whistling.

Summer movie season. Ticket sales are way down, and Hollywood wallows in self-pity, wondering what America really wants. The studios collect a stack of comment cards nine miles high that show Americans are craving movies about NASCAR racers who join the Marines, go to Iraq, and kill terrorists with martial arts kicks. The comment cards also indicate that most Americans have no idea where the accent falls on “Affleck.” With all of this in mind, astute producers greenlight a picture about how Edward R. Murrow valiantly kept Joe McCarthy from introducing the Patriot Act. Quentin Tarantino starts another film where some guys, okay?, hip guys in black suits, dig? (who turn out to be neo-Nazi, Christian, Canadian separatists) fly planes into public schools. The cockpit-encounter dialogue is killer. Why do they call it a cockpit, man? You don’t think that’s gay? You think the whole shape of the plane is an accident? It’s all just suppressed homoeroticism, man. In the climax, the bad guys will ram their Boeing into a school that refuses to teach Intelligent Design.

Bombs explode in London, as perfectly ordinary apolitical young men driven to extremes by America’s imposition of elections in Iraq react the only possible way: by driving metal through the flesh of British commuters.

The 1,587th death in Iraq provokes no major display of eye-catching graphics in the Western media, as it is not a round number.

John Roberts is nominated to the Supreme Court. The snarkblogs point out that he wore plaid pants in the ’70s, and that his children may yet. He is confirmed nevertheless. There are tense moments, however, when Senator Feinstein attempts to plumb his feelings as a man and father. This seems to be a new standard for top jurists. Roberts refuses to profess that he would powder the bottom of the Bill of Rights, tuck it in, leave a light on, and play new-agey music softly while he read a book in the next room, one ear cocked should the Constitution wake up crying because it had a nightmare about an emanation chasing a penumbra. He is confirmed nevertheless.

A small piece of yellowcake is indicted for leaking the real first name of Scooter Libby.

Cindy Sheehan’s application for a mortgage on a small piece of a Texas driveway is approved. Most of the major networks are listed as co-signers.

Hurricane Katrina strikes precisely at the moment when the dynamite charges, personally installed by Karl Rove, blow up New Orleans’s levees. Teams of the same ninjas the Bushies used to rig the Diebold voting machines have already disabled the buses that could be used in evacuation. Initial media reports indicate that refugees in the Superdome have resorted to murder, cannibalism, voodoo, keno, and possibly jai alai. FOX anchor Shep Smith is consumed on camera by zombies. His last words indicate that he shares their outrage, if not their desire for sweet, sweet brains. In the weeks that follow it becomes obvious that the hurricane was caused by global warming—specifically, a 0.07 percent rise in median ocean temperature that caused New Orleans police officers to snatch DVDs from Wal-Mart shelves. The destruction of New Orleans, and the attendant effect on refinery capacity, is exposed by media crusaders as part of a GOP plot to raise gas prices and cripple the economy in time for the midterm elections, so they can run on a platform of “You like that? You want some more? Well do you?”

October. After years of haranguing the U.S. for refusing to ratify the Kyoto Protocol, E.U. leaders admit they will miss their own Kyoto guidelines, and have actually increased greenhouse emissions by 1.1 percent. Hurricanes level Paris and Stockholm.

Harriet Miers is nominated for the Fairfax school board. No, wait—the Supreme Court. Half of the conservative base decides this is the opportune time to freak out and toss pitchforks of smoldering tinder to the opposition. Hey, not all the wheels are coming off the Administration—let us help you with that balky bolt! More innovative conservatives drop their opposition to human cloning and urge the President to start an NIH program for growing fresh new Scalias in petri dishes. Miers’s nomination is withdrawn after it is revealed she was actually a cyborg, sent from the future by Karl Rove’s son to revitalize the conservative base. She is disassembled and put in storage. Her replacement, Sam Alito, makes everyone happy, except some on the Left who insist he will take a backhoe to Martin Luther King, Jr.’s grave while humming the theme from The Godfather. But they are a slight minority of senators.

Washington is ablaze with buzz: It appears that Karl Rove, acting on telekinetically transmitted orders from Dick Cheney’s throbbing brain, told “Scooter” Libby something, and he then hinted to “Biff” Novak and “Muffy” Miller that Valerie “Hidden in Plain Sight” Plame is actually Super Secret Agent Double-Y Seven. This completely blew her deep cover—she had been known publicly as an Iranian nuclear weapons program expert. Imagine the mullahs’ surprise when her beard came right off with one tug! Right away, the Marines had to extract Plame from The Palm during a crowded lunch hour, at great risk.

The purpose of the telekinetic plot was to discredit Joe Wilson for reporting he had been to Niger, visited the docks one morning, and never once heard anyone shout “Hoist the yellowcake into the hold of this Iraqi cargoship, lads!” After Wilson concluded the Iraqis merely wanted to buy Niger’s primary export—novelty figurines that glowed in the dark and made your hair fall out if you stood too close—traitorous leakers went to work. That was too much for the crusading media, who are well known for hating leaks and zealously guarding national security secrets.

Saddam’s trial begins. His lawyer first asks for a California jury. He then considers calling April Glaspie to the stand for the “b*tch set me up” defense. He begins working on rhyming cadences for his jury summation. Saddam and counsel ultimately admit to several hundred thousand murders, but invoke a novel defense: Executive Privilege. Ultimately, Hussein refuses to recognize the court’s legitimacy, and demands a change of venue to a Judge Judy show, tentatively scheduled for February. This brings up the possibility that Saddam will not only be the first Arab dictator to answer for his crimes in court, but also the first one to be executed by yelling.

The Iraqi constitution, a Middle East milestone, is approved. But hey! Over there! It’s Britney and her new baby! Everybody grab your cameras and run after her! Dang: false alarm. Anyway, what was that about Iraq? Right: They chose their own rules of governance. Yet statistics show voter participation is down significantly—from 99.99 percent in Saddam’s day, to 60 percent.

Hard as it seems for some to believe, this is good news.

James Lileks is a TAE contributing writer.

Published in Whatever Happened to Small Government? January/February 2006
By Joel Kotkin

2006 Hospital Appointments

As we begin 2006, our county commissioners once again have the task of appointing or re-appointing board members to Floyd Memorial Hospital and Health Services. They meet tonight to make these decisions at their regular meeting.

This year, Kay Garry and Dr. Daniel Eichenber are up for re-appointment. They have each served one term and the majority of board members usually serve two consecutive terms. The commissioners could choose to re-appoint one or both of them or replace them both.

The hospital is embarking on the opening of the new Heart Center in January as well as considering options for combatting the ongoing threat of competition. The hospital has its senior management approaching retirement and needs to seriously consider how such a transition will take place. All of these are difficult issues that require a knowledge of the current situation. This cannot be obtained except by experience.

It takes months for board members to feel comfortable with the tremendous amount of information given to them and for them to make informed decisions that are in the best interest of the hospital and community.

This is the time when the commissioners can choose who is best for these positions and not making choices because of politics.

Any decision other than re-appointment of these two individuals would have to seriously be questioned as to motive.