Consultants hired to fix the crisis at Haywood Regional Medical Center blasted hospital administration in a 150-page report released Friday, accusing top leaders of a “bunker mentality” and “Lone Ranger approach,” controlling the flow of information “like it was gold.”

Compass Group president Kate Fenner read the report before a packed room of doctors, nurses and hospital workers at a hospital board meeting, then again before county commissioners. While the hospital technically lost its Medicare status due to nursing errors, Fenner said a “significant leadership failing” was the root cause of the crisis.

“Information going to the board and going to staff and managers has been tightly controlled in the past. Information that should have been freely shared was not. From this comes what appears to be an atmosphere where employees, managers, and vice presidents felt intimidated about job security. People were told, ‘You want a job, keep it to yourself,’” Fenner said.

The culture of fear was prevalent at HRMC, she said.

“Fear trickles down through an organization and it gets intensified as it trickles down and turns into an imminent hanging at the front line,” said Fenner. “How real that threat was versus how implied it was I cannot say, but you have frightened people.”

It took Fenner less than a week to assess HRMC. Her findings mirror allegations raised repeatedly by nurses and doctors in recent years — but they were repeatedly ignored by the hospital board, as well as county commissioners who appoint the hospital board. Former CEO David Rice, who resigned in the wake of the crisis, was rarely if ever questioned by the hospital board. Doctors or nurses who attempted to circumvent Rice and bring concerns directly to the board were painted as troublemakers and punished.

“Access to the board was strictly controlled so people were not permitted to talk to board members without going through the CEO without threat of termination,” Fenner said.

The atmosphere of intimidation kept serious problems from being addressed, Fenner said. She said doctors were asked not to be involved in oversight of clinical care.

“Physician-hospital integration was actively discouraged. Medical staff had been kept at arms length,” Fenner said.

That same attitude kept administration from acting swiftly to seek outside help to fix the problems when first cited by inspectors. Instead, administration tried to fix it themselves quietly, only to fail their follow-up inspections.

“People that should have been consulted were not involved in the process of solving this problem,” she said. “Instead, outsiders spotted these areas, and that’s not where we want to go in this world.”

Board shares the blame

Even the hospital’s board wasn’t aware of the crisis brewing at HRMC, said Fenner. Information shared with the board by the hospital administration was minimal at best, manipulated at worst. Board members were complicit by failing to ask questions. Fenner said the hospital board had some “very nice, very good community members,” but that didn’t mean they were knowledgeable of what it took to run a hospital.

“The board indeed had not been developed or given an orientation and information about what to ask for and when,” said Fenner.

Two hospital board members at the meeting when the report was unveiled did not attempt to counter Fenner’s claims.

“She told it like it is,” said Jim Stevens, a political appointment to the board. Stevens refused to comment further, marking the fourth time he has refused to speak to the media since the crisis unfolded.

Glenn White, a hospital board member with a background in finance, said in hindsight he realizes the board had been led astray.

“Her report was right on,” White said. White said he knows now to “keep asking why.”

Moving forward

Fenner had positive remarks about the county’s doctors and nurses, however.

“You have a fine, fine medical staff. I’m terribly impressed by how you’ve been able to recruit some of the sharpest, best-prepared physicians,” Fenner said. “I would do whatever I could to retain the physicians in this community.”

Dr. Henry Nathan, a gastroenterologist, said he doesn’t know of any doctors who plan to leave.

“It is quite amazing that the physicians want to stay here and want to help be part of the solution because many of us could just say ‘I’ve had it with this place. I am going to live or work elsewhere,’” Nathan said. “That is one of the very positive signs that I see that we are going to be OK.”

Nathan said he has faith the nursing staff will stick in there as well.

“I think the nurses and other staff, they don’t want the place to close. They want to stay here and keep working — they just want it to work well,” Nathan said.

Fenner said the hospital has good nurses, but they need to be empowered.

“Your staff had been told what to do for so long they need to learn how to do it themselves,” Fenner said.

Fenner concluded Compass’ report with perhaps the most stinging statement.

“The organization as a whole, because of dysfunction, has lost sight of its primary mission, which is patient care and not indeed to secure our own little kingdom,” Fenner said. Again, it’s nothing new to critics, who have long accused Rice of empire building while ignoring the front lines of medical care. Penny-pinching on nursing was one critical mistake. When combined with the negative work environment, it led to an exodus of nurses over the past two years.

“Any hospital that loses 60 to 70 nurses in two years will have quality of care issues,” said Dr. Daniel Fox, an internist. “I really think it was mistreatment by the administration. I think they were overworked, underappreciated, under-trained. The next administration needs to focus on the backbone of the hospital, the nursing staff.”

Fenner said from now on, the hospital must adopt a whole new way of operating, communicating and going forward.

“The task now is to rebuild the house because there has been major damage done to the foundation,” Fenner said.

The blunt nature of the report came as sharp contrast to the tight control of information practiced at HRMC until recently and denial of any problems. Interim CEO Al Byers said the focus now is on transparency.

“We had told you before that we would bare our soul to you and we would tell you the good and the bad and be transparent, and that’s what we’re trying to do today. Whether we like it or not, we’ve heard the message and we’re going to fix it,” he told the audience at the hospital board meeting.

HRMC is working to address the problem areas highlighted by the Compass Group, including restraint, patient grievance process, medication administration and data analysis. Fenner also cited areas of equipment supply and maintenance, pharmaceutical and respiratory care, and infection control as needing improvement.

Fenner said the staff can be retrained on new protocols and operations rapidly. Commissioner Kirk Kirkpatrick questioned whether having so few patients left will hurt the hospital’s reinspection.

“Will they say ‘Gee whiz, no wonder you can get this right, you only have 20 patients?’” Kirkpatrick asked.

Fenner said as long as the hospital has two or three patients, it will be enough to demonstrate the new protocols. Fenner said the hospital could have its Medicare status restored in less than 60 days, limited only by the inspectors’ timeline to complete the process. She told the medical staff Monday night (March 10) that the hospital will be ready for an inspection earlier than expected, probably by March 31.

“We are going to turn this around so fast your patient load will be back,” Fenner said. “It will be well before you are in danger of having to close.”