In the words of Yogi Bera, it was "deja vu all over again." Or, from another perspective, it could have been characterized as the day the honeymoon ended.
At the very commencement of the Southeast Health Planning Task Force's initial 2007 meeting, January 3, a conflict arose between Inova Mount Vernon Hospital's still new administrator, Barbara Doyle, and the chair of the Task Force, Anne Andrews, over the lack of attendance by officials of Inova Health System (IHS). This was exacerbated when Doyle revealed she had requested they not attend after they were specifically invited by Andrews.
The two IHS officials Andrews had invited and expected to attend were Rod Huebbers, IHS executive vice president, and Mark Stauder, chief operating officer, IHS. Huebbers presence was desired by the Task Force due to his role in providing strategic planning oversight for both IMVH and Inova Alexandria Hospital. Stauder's invitation was based more on getting to know him as IHS's new COO and having him get to know Task Force members and their concerns on a personal basis.
Prior to launching into the meeting agenda, Andrews stated, "I feel badly we are not considered important enough for them to accept our invitation. Our problems in the past have been with IHS not with this hospital or its administration. That is why I specifically invited Rod here. I didn't even get the courtesy of a response."
The Task Force was originally convened by IHS to defused the ticking time bomb of a rumor that they were planning the demise of IMVH. After that rumor was quelled, the Task Force remained in existence, at their insistence, to serve as a watchdog to stave off any rebirth of a plan, obvious or clandestine, to close IMVH, as well as to serve as an advocate for increased services at the hospital.
"I feel that as CEO of this hospital it's very appropriate for me to sit at this table as IHS's representative, I asked Rod not to come because I want to be the touchstone not Rod. I'm encouraging Rod and Mark not to attend," Doyle said in response.
"It is my job to speak for Mount Vernon hospital. And, it is my job to leverage for Inova Mount Vernon Hospital with Inova Health System. I'm working very hard to get our bottom line in order," Doyle said.
HER INSISTENCE that she, not IHS hierarchy, be the sole Inova presence at Task Force meetings brought forth a near unanimous insistence that Huebbers , particularly, be present at future meetings in addition to Doyle. The Task Force usually meets no more than quarterly.
"I think we should have an IHS representative here in addition to you. Those top staff who have come here gain a good feel for local needs and when they don't come they don't gain that insight," said George Barker, long standing Task Force member representing the Health Systems Agency of Northern Virginia.
"IHS felt compelled to put together this Task Force because of its close ties with this hospital. The decision as to whether this hospital will exist in the future will be made at the top IHS Board level," said Mount Vernon District Supervisor Gerald Hyland who took the initial lead role in derailing any attempt to close or diminish IMVH. He also served on the search committee that selected Doyle.
"I think we need to have them (IHS representatives) at this table to hear us. Their presence is essential. Inova has to hear from us themselves -- not just from you," he told Doyle.
"Their presence is needed to tell us what is happening in the system. We still do not feel that comfortable with their decision making," Hyland said.
That was buttressed by Task Force member and president, Medical Affairs Council, Dr. Cleveland Francis. "We all feel very passionate about this hospital and we have our fears as to the motives of IHS," he said.
"I have not witnessed any conspiracy against Inova Mount Vernon. However, it remains in transition, particularly with the changes coming to this area," Francis said in reference to Fort Belvoir's plans to extensively increase the size and services of DeWitt Army Hospital on post as a result of the Base Realignment and Closure Report (BRAC).
"We need to continue to operate at the top of our ability if we expect to see more investment by IHS. We have the opportunity to be the star in the Inova system. If we are performing quality medicine we can't be shut down," Francis said.
"But, we have to remember this is still a business. You can't go bankrupt if you want to continue providing services. We have to be
the best we can be at what we do. We can't do it all," he said.
With this, Doyle agreed. "We can't do everything for everybody. We have to choose what we can do best. One of the things I've worked hard at for these last seven months is to grasp the history of this hospital. I want to move forward and put the past behind us," she said.
However, she was unrelenting in her believe that she should be the only IHS representative to attend Task Force meetings. In that respect she refused to play a role in reinviting Huebbers to future meetings which only reignited the confrontational past she claimed she wanted to put "behind us."
PRIOR TO BECOMING IMVH's administrator, Doyle had worked for Huebbers in Massachusetts at Winchester Hospital outside Boston where he had been the administrator and she served as vice president of Clinical and Ambulatory Care. She worked at that hospital for 18 years.
It was at Huebbers' suggestion that she put her name into the search process to replace Susan Herbert who resigned in 2005 after eight years as IMVH administrator. There was an interim administrator for 13 months prior to Doyle's arrival last June.
When Huebbers first arrived on the scene as IHS executive vice president from Loudoun County he committed to remaining personally involved with IMVH and the Task Force. He has attended Task Force meetings prior to Doyle's arrival. It was not at the prior meeting September 26,2006.
"I don't see why paid employees of a non-profit organization such as IHS can't see fit to attend four meeting a year of this Task Force," said Task Force member Jeffrey McKay, chief of staff to Lee District Supervisor Dana Kauffman.
"Doyle is supposed to be the advocate for Mount Vernon hospital but she is also a part of IHS. For her to convey the Task Force concerns to them is not appropriate. I think they would naturally get watered down -- even her relating what took place at this meeting," McKay said.
"I also think that the letter that's going to Huebbers requesting he come to future meeting should be stronger. But, I'm going to wait and see if he is present at the next meeting. If not, then I would seriously consider my own letter," he said. That next meeting is scheduled for Wednesday, April 11.
IN MAKING HER REPORT to the Task Force, Doyle said, "We are measuring numerous quality indicators. The Board of Inova has made a commitment that we (IMVH) will focus on quality. We have to make sure we are giving safe care as well as quality care. That determines our medical reimbursements."
However, she also noted that IMVH continues to operate in the red. As of November 30 that deficit was calculated at approximately $900,000 for the month. "We are budgeted to lose approximately $1.9 million in 2006," Doyle told the Task Force. In 2005 the hospital lost just over $2 million, according to Doyle.
The year Herbert left she reported the hospital had achieved a break even financial status following a loss of approximately $7.4 million at the commencement of the rumored closing crisis two years prior. The year previous to her resignation announcement, Herbert had reported a loss of $1.4 million.
"We are not operating close to capacity. Our in-patient count is about the same but our out-patient numbers are down," she said. The ground breaking for the new Inova healthplex at Lorton, which is also planned to supply patients to IMVH, is now scheduled for December of 2007, according to Doyle.
She told the Task Force, "The Quality Core measures at this hospital are among the highest in the nation." Core measures are actions or interventions taken by physicians and/or staff at a given hospital that have been identified to improve patient outcome.
Work at IMVH has been named "best practice" for other Inova hospitals "to model and implement," according to Doyle. "We are focusing our efforts on the highest quality of patient care and those efforts are paying off. Our patient satisfaction scores are climbing which is another indicator of our success," she said.
One of the hoped for developments of the future was for IMVH and Fort Belvoir's DeWitt Army Hospital to work more closely in the future, particularly in the specialty of obstetrics. "I haven't heard anything positive coming out of the Army on this," said Hyland in his report on BRAC developments.
"Until the Army has their act together we can't do anything. I have made myself available for discussions. But, they have not responded," Doyle said.
There have been only six instances nationwide where the military has joined with civilian hospitals in the practice of obstetrics, according to Barker. "It's not their (military) method of operation," he said.