Despite the loss of two top administrators and concerns that patient care could suffer, executives reassured doctors at St. John's Regional Medical Center on Monday that no layoffs are planned in a push to meet corporate profit goals.
Daniel Herlinger, regional president for Catholic Health Care West, met with about three dozen physicians Monday evening to deny rumors that nursing cuts are planned to push the county's largest hospital into the black.
"We said we know there are rumors out there and concerns about them," said Charles Padilla, the hospital's interim administrator, who joined Herlinger at the meeting. "We reassured them that we have no intention of jeopardizing patient care and asked them for their help in being efficient in what we do."
Padilla said no layoffs are planned.
"That's not to say we wouldn't ever do that," he said. "Things change week to week. But that is not on my list right now."
Dr. Isaac Lowe, chief physician on the St. John's medical staff, said in an interview that he called the meeting so Herlinger could address concerns among the hospital's 200 doctors that severe nursing cuts could come quickly to balance the budget.
Doctors know that the hospital already is operating on a frugal budget, Lowe said.
"That's why the staff is so concerned about this emphasis on greater efficiency and what that really means," he said. "It's not a happy picture here, but we have to deal with it. The only assurance we received was that patient care will not suffer and they're not looking at cutting the nursing staff for now."
Faced with a year of losses at St. John's in Oxnard and its sister hospital, St. John's Pleasant Valley in Camarillo, corporate executives announced Friday the removal of administrator Jim Hoss and the resignation of medical director Ross DiBernardo, a staff doctor for 25 years.
"This has been a very traumatic episode," said Lowe, the chief of staff. "We're going through a period of grief."
Hospital sources said that Hoss--respected by doctors for his handling of difficult personnel issues--balked at cuts in the nursing staff that he thought would jeopardize care, and that DiBernardo saw Hoss' removal as a sign of corporate medicine gone awry. One source said that the proposed nursing cuts were severe, with one department potentially losing 25% of its nurses.
"Hoss was concerned that we're already at bare bones for our nursing staff," the source said. "And DiBernardo resigned because what happened to Hoss is a symptom of the system--they're losing too much money and they're having to make cuts in the wrong places."
Indeed, hospitals throughout Ventura County and the state are struggling to turn a profit in this age of tightfisted managed-care contracts. About half lost money on operations in 1998, according to state reports.
The 48-hospital Catholic Health Care West will report $80 million in operating losses for the fiscal year that ended June 30, officials said.
Padilla confirmed that Catholic Health Care has a 2.5% profit target for its hospitals and that St. John's had not met that goal for some time. But he said he knew nothing of a recent proposal to cut the nursing staff.
"There are these targets, and they weren't met," Padilla said. "I don't know what was proposed [to Hoss]. People proposed all kinds of options. Like in any organization, if you do nothing, someone is going to give you a plan. But I have not been given a directive to cut any specific things. I've simply been told to improve financial performance."
Padilla said he will focus immediately--not on firing nurses--but on hiring more of them full-time, so the hospital is not forced to call in expensive temporary nurses or pay staff nurses so much overtime.
"So one of our strategies is going to be to continue to replace those overtime and registry staff with our own nurses," he said. "Which speaks to hiring more nurses, not cutting them."
Padilla said he will study every aspect of hospital operations--from billing to supplies--to increase revenue.
Lowe said he spoke with Herlinger on Friday and Monday, seeking assurances that the staff would not be cut and patient services eroded.
He got them. And he said he agrees that St. John's cannot continue to lose money and stay in business.
"If there are things the physician can do to improve the way the hospital runs, we will do it," he said. "We hope for the same commitment from the administration."
Lowe said that Herlinger told him that department managers would be given more leeway in suggesting ways to save, but that they must become more efficient.
"It was his hope that we would have an action plan very soon," Lowe said. "And he said that throughout the chain there was no tolerance from the corporate level for not hitting our target levels."
During his short tenure at St. John's, the folksy Hoss, who transferred here from Shasta County, had been forthright in his discussions of the hospital's financial problems. Supporters speculated that may have gotten him into trouble with superiors.
After St. John's closed a hospital wing despite record numbers of patients, Hoss said his hospital was struggling like so many others with the fiscal realities of frugal managed-care insurance contracts.
The March shutdown of a 31-bed wing of the 256-bed hospital meant that some patients would be forced to go to hospitals in other communities, elective surgeries will be postponed and patients will back up in the emergency room waiting for beds to empty, Hoss acknowledged.
That would tarnish an image St. John's has polished since 1992, when it opened a $110-million campus on Rose Avenue, he said.
The hospital wing was taken out of service because the hospital could not pay the double-time wages of temporary nurses and still make money, Hoss said.
Overall labor costs per patient in the wing had risen above $800 a day, compared to typical patient costs of about $500, Hoss said.
Even with the lower costs, St. John's had made only about 1% to 1.5% profit on operations, even before this year's downturn, Hoss said. And during the year that ended in June, the hospital has lost money, Padilla said.