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Doctors Challenge Inova

Medical staff at IMVH suggests ultimatum.

A committee for Inova Mount Vernon Hospital (IMVH) medical staff has thrown down the gauntlet to Inova Health System (IHS). Following a July 19 letter from the medical staff to the leadership of IHS, with suggestions on how to save the hospital from closure, the Planning and Programming Committee told IHS to either respond to that letter by Sept. 1 or staff would propose talking to other organizations to assume management of the hospital.

That was the word from Dr. Khosrow Matini, immediate past president of the hospital's medical staff and now chairman of the Planning and Programming Committee. This ultimatum must be approved by the Medical Staff Executive Committee, which does not meet until Aug. 19, according to Dr. Cleveland Francis, president of IMVH medical staff.

Both Matini and Francis also serve on the Southeastern Healthcare Task Force, formed to evaluate the viability of IMVH and recommend a future course of action for that institution.

"The task force has been meeting for over six months, and not one thing has been accomplished," Matini said.

"The task force doesn't know how to make the hospital profitable. They are not medical people. Supposedly, Knox Singleton [IHS CEO] formed the task force to tell him what should be done with Mount Vernon Hospital. Now, he has made up his mind — so naturally, they don't count," Matini insisted. "They [IHS] need to admit they have made a mistake."

THE LETTER WAS sent not only to Singleton, but also to Gerald Hyland, Mount Vernon District supervisor; Richard Knapp, chairman, IHS Board of Trustees; Warren Cikens, task force chairman; and Susan Herbert, administrator, IMVH.

"This letter is a culmination of all the opinions of the doctors in the hospital. We wanted to come out with a united position," Francis explained. "The general consensus of the staff is that the hospital should remain where it is and new programs should be started at the hospital to help it financially."

Matini noted, "This letter clearly tells the public that Mount Vernon Hospital didn't go down a financial tube by itself. Every time the medical staff suggested something to make the hospital better, they [IHS] said this would hurt our sister institutions."

Matini added, "Knox Singleton had a meeting on June 4 in which he outlined three choices for Mount Vernon hospital. They were closure, expansion of services, and building a new facility eight miles away. He maintained the board would not approve expansion, and he practically said to them he wanted a new facility."

Matini's frustration was buttressed by Dr. Paul Luisada, head of psychiatry at IMVH and a member of the Medical Staff Executive Committee for 18 years.

"In the late 1990s, Inova made a plea for the doctors' help. They said HCA wants to build a hospital in Springfield and we need your help," he said.

"They told us we are going to build a full-service medical facility and call it the Mount Vernon Healthplex. Well, they did build it. It opened in April 2001. That's when the decline of Mount Vernon Hospital started. The decline in admissions here [IMVH] is at the core of Mount Vernon's financial problems," Luisada said.

"They [IHS] didn't even live up to their promise to call it the Mount Vernon Healthplex. The sign reads ‘Inova Healthplex.’ We were also told our physicians would staff that healthplex. Not so. It is staffed by Fairfax doctors who send patients there if they need a hospital," he said.

"Our admissions were holding up until the healthplex. They started to decline well before 9/11 and the closing of Woodlawn Road. I have analyzed the data presented by IHS and it shows the healthplex is what damaged Mount Vernon's financial status," Luisada said.

"The feeling among the doctors is that IHS is isolating us from any input on this situation. It appears Singleton wants to control all access to the board," Luisada said.

THAT IMPRESSION goes back to at least Nov. 21, 2001, when Matini, as outgoing president of the IMVH medical staff, sent a previous letter to the IHS Board of Trustees expressing his thoughts on some of the problems that IMVH has been facing since the time it was started 25 years ago.

He maintained, in that letter, IMVH has been frustrated in establishing services in the departments of obstetrics and radiation oncology. Those services were sent to Potomac and Alexandria hospitals, according to Matini.

"As a result, the type of patients who come to IMVH are mostly Medicare and Medicaid patients, with the lowest reimbursement levels for hospital care among the four Inova hospitals. Although IHS claims that the four institutions are one family, there is an expectation that every individual hospital be self-sufficient with regards to budgetary matters," Matini wrote.

"Last year ... the budget plans for expansion over the next four years of IHS were presented. A total of $750 million dollars was allocated to be spent. ... Of this, not one dime was allocated to IMVH," he pointed out to the board members. Matini outlined five areas where IMVH could be improved in both services and facilities that actually make money for any hospital facility.

"The leadership of our hospital medical staff presented this issue in a multi-executive committee meeting that was held in 2000. More than six months ago, when I spoke with Mr. Singleton about this matter, he agreed with me that if an investment is not made then, money will not be made," Matini revealed.

AS AN EXAMPLE of critical cutbacks, Matini cited the elimination of "a nurse-anesthetist in the hospital on a 24-hour basis for emergency intubations on patients who have respiratory or cardiac arrests. This service was eliminated on Oct. 1, 2001, due to lack of funding."

As a direct result of that action, Matini informed the board, "we lost a patient when intubation was attempted by a house physician and emergency room physician but was not successful." He then stated, "I have sat with all of you in many quality meetings, and we have discussed patient safety. ... I cannot understand what has happened to the concept of quality when it comes to IMVH."

He then inquired, "Are the people of the Mount Vernon community to be treated differently from the people of the communities around the Fairfax Hospital, Fair Oaks Hospital or Alexandria Hospital?

“Our patients are no different than the patients at Inova Alexandria, Fairfax, Fair Oaks and Children's Hospitals."

Matini wrapped up his pleas by reminding the board, "Ultimately you are the people responsible for overseeing the functions of all the various Inova hospitals." He also cited a letter sent out by Singleton "bragging" about the plans of IHS for the next decade. "Amazingly, IMVH was not even mentioned one time in the plans," Matini pointed out.

TO THIS DAY, no member of the IHS Board of Trustees has answered Matini's letter of November 2001. "The chairman called and asked that I come to the board meeting to further explain some of the points. Then he called back and said Singleton said 'no' to my visit," Matini charged.

Matini has emphasized that his advocacy for the hospital is as a concerned citizen "not out of any selfish motives." He pointed out, "Most of my practice is outpatient. I will work regardless of where the hospital is."

In the July 19, 2003, letter — signed by doctors Howard M. Lando and Ali Ganjei, vice president and secretary-treasurer of the IMVH medical staff, respectively, in addition to Francis and Matini — they emphasized, "Inova feels the best solution to this problem [IMVH's financial troubles] is to build a 150- to 225-bed full-service facility in the Lorton area.

"This would place the new hospital beyond the normal commuting patterns of the Mount Vernon community in a less accessible location.

“This is especially true of the low-income residents of the Route 1 corridor. This group is especially mentioned in the lease agreement between Inova and Fairfax County, which allowed Inova to use a hospital built on county land, and caring for them is part of our mission."

They further stressed, "We, the members of the Executive Committee, the elected officials of the medical staff of MountVernon Hospital, feel that the hospital does not need relocation to serve its community. Profitability can be achieved with the addition of new and financially positive services that would supplement the existing service lines within the present hospital."

The Executive Committee presented five policy changes and 14 service improvements, which they maintain "will reverse the financial trends and make MountVernon again a valued member of the Inova 'family' without any change in location even being contemplated."

Francis verified that neither the Inova Board of Trustees nor the Inova hierarchy has responded to their letter. "One of the reasons the medical staff wants a timetable is that no action by IHS is undermining morale," he explained.