Following two hours of final deliberations and wordsmithing, the Southeast Health Planning Task Force issued their report on the fate of Inova Mount Vernon Hospital. Even then it wasn't unanimous.
The meeting remained closed to the press and public until the final report was issued. And their closed door vote was again by secret ballot. The final tally was 14 -3 with one abstention in favor of adoption.
Wrapping up more than 13 months of deliberations, including input from Inova Health System and an outside consultant retained by IHS, Task Force recommendations were confined to four paragraphs. In summary, IHS should continue to enhance services and eliminate financial losses at IMVH. IHS should develop and implement a long-term plan to improve and expand existing services to elevate IMVH to a state-of-the-art facility serving Southeast Fairfax County. Sufficient capital necessary to achieve these objectives should be committed immediately.
Also, IHS should maintain the existing Inova Franconia Springfield Healthplex at its current location with a 24/7 Emergency Department and developed a like facility in Lorton to operate on a 24/7 basis. The latter to be licensed by IMVH.
IHS should undertake no other commitments to major projects in Southeast Fairfax County and should defer projects elsewhere in the IHS that could deter services which might otherwise be delivered by IHS in Southeast Fairfax County.
And finally, IHS must seek broad public support in order to build greater community trust concerning its planning process by a more open dialogue among IHS planners and management, the medical professionals, and the community. To facilitate this, the Task Force should be continued.
Part II of the report gave an abbreviated history of the Task Force. Part III concentrated on how they reached their consensus and urged IHS to implement the report as well as "change the environment in which health care planning decisions are made."
LEE DISTRICT Supervisor Dana Kauffman, although not officially part of the 18 member Task Force, praised the final product saying, "I think we have a very strong statement for the hospital, the community, and the medical staff at the hospital.
"However, there is no language in the report requiring IHS to respond within a certain time frame," Kauffman pointed out. When questioned about this fact, H. Patrick Walters, IHS senior vice president and working, though not voting, member of the Task Force, said, "Probably by the end of the year."
He explained, "We will bring this up as part of our assessments across the system. It will be considered when the Board (IHS) takes some action on our capital plans."
Mount Vernon District Supervisor Gerald Hyland, now a member of the Inova Health Care Services Board of Trustees said, in a press release, "I am confident that Inova will heed the recommendations of the Task Force and make the right decisions for the citizens of the Mount Vernon and Lee Districts."
When pressed to define the reference to "sufficient capital" in the first recommendation, Task Force member Herbert E. Harris II, volunteered, "$100 million over the next five years." He also noted, "This report not only makes recommendations for expanding the hospital, it also says we ain't going to go away."
Harris added, "This report is a victory for the community. We urge the IHS Board to listen to the report."
Jeffrey C. McKay, chief of staff to Kauffman, a voting Task Force member, and author of an alternative report to an IHS version several week ago, emphasized, "The quality of care has been our prime concern. The report is a prescription to provide the best health care for the area."
This was buttressed by Cleveland Francis, MD, another Task Force member and present head of IMVH medical staff. "I want to make perfectly clear that the quality of medicine practiced here is second to none."
ONE OF THE prime concerns of the Task Force from the outset was the report that IMVH lost approximately $8.5 million in 2002 and was on its way to another $7.8 million deficit in 2003. Both were attributed by IHS to a series factors ranging from changes in Medicare reimbursements to providing an inordinate amount of health care to "uninsured/under-insured" patients to the closing of Woodlawn Road.
Task Force member, Khosrow Matini, MD, an outspoken critic of IHS and practicing physician at IMVH insisted, "IHS's investment should be whatever amount of capital it takes to stop IMVH from losing money."
Walters responded, "We are looking at the overall needs of the system. This report will fit into that analysis. We can't do everything, everywhere. We have to make the best use of capital. We could invest more capital in a given program and the loss could get worse."
He also pointed out, "The IHS Board is a citizen board. It is comprised of community people from across Northern Virginia."
Referring to the third recommendation calling for IHS to "defer projects elsewhere within IHS, such as the expansion of obstetrics at Inova Fairfax Hospital," which might be developed at IMVH to improve its bottom line, former State Senator Joseph V. Gartlan, Jr., noted the word "elsewhere" does "impact the entire system when assessing capital expenditures."
Noting the Task Force was to continue, they were asked if future meetings would be open or continue to be closed to the press and public. Co-chair Anne Andrews justified closing the meeting by indicating that it was a safety precaution to protect Task Force members from what she perceived as possible adverse public reaction toward individual members.
"I, for one, was very frightened how my votes and opinions might impact me in my other roles in the community," she confessed. "It also could hurt those trying to do business with others in the community."
Both McKay and Harris took strong exception to her explanation. "Not everyone felt that way," McKay insisted. "But we went with the majority [for closed sessions[ to achieve a consensus. I would hope future meetings [of the Task Force] would be open to the press and community at large."
Harris said, "With a decision of this extent it is important we go on the public record. If we are going to establish confidence, it is essential every person stand up and explain their views."
AS FOR THE creation of an additional Healthplex in the Lorton area, possibly at the new Laurel Hill community on the site of the former Lorton Prison, the report stated, "Working with Fairfax County, IHS should explore the possible use of County Land and County Bond financing."
The present hospital came into existence through the same arrangement in the 1960's when county voters approved a hospital bond referendum. "Part of the bond proceeds, which were repaid with county tax dollars, was used to acquire the land and build Mount Vernon Hospital," the report noted. Opened in 1976, IMVH operates under a lease agreement with the County which calls for a payment of $10 annually.
Hyland verified at the meeting he envisioned a similar arrangement if a new Healthplex were established in the Lorton area. However, he pointed out, "This has not been brought before the County Board of Supervisors."
The primary stumbling block to initiating obstetric services at IMVH is the low number of potential patients, according to the report. "Virginia data show higher infant death rates and much higher costs per patient in a smaller obstetric program," it stated.
Better results, both for patients and hospital economics, are achieved when 3,000 births per year or higher are performed, statistic show. "Several Virginia hospitals with fewer than 2,000 birth per year are closing or considering closing their obstetrics programs," the report pointed out.
Lewin Associates, the consultant retained by IHS to work with the Task Force, estimated IMVH would "have only about half the 3,000 births annually" due to service area demographics. IHS's position that establishing an obstetrics unit with this volume "would add to financial losses at IMVH."
A PROPOSED joint obstetrics program with DeWitt Army Hospital at Fort Belvoir has been proposed. But according to IHS, "the Army is interested in such an arrangement only if IMVH were relocated to a site near Fort Belvoir." Presently, the hospital is only about five miles from Belvoir's main gate on Route 1.