An old rift between physicians and the board of Haywood Regional Medical Center resurfaced last week at a time when cooperation is essential.

The rift flared up when hospital board member Jim Stevens objected to doctors offering opinions or asking questions during hospital board meetings.

“None of you should be able to speak up,” Stevens told the crowd, cutting off Dr. Al Mina who was in the middle of sharing concerns over the viability of the hospital on behalf of the medical community. “We can have an open session and let you speak at the beginning of the meeting and then once the meeting starts, you can sit there and listen — or not.”

Mina looked down at his copy of the meeting agenda.

“So where is open session on here?” Mina asked. Stevens replied that it wasn’t on there this time, but that it should be in the future.

Board member Pam Kearney objected.

“I think at this point in time these meetings need to be participative,” Kearney said. The interchange between the doctors and hospital employees in the audience have resulted in better decisions by the board, Kearney said.

“I think it is very important the board and the community engage in these discussions at these open meetings. I think it is healthy,” said Kearney, a new board member who is retired from the financial industry. “There is more than one group of stakeholders, and as a board we have to represent all of these stakeholders.”

Despite Kearney’s comments, Stevens had already offended doctors in the audience. Dr. Richard Lang, a radiologist, was prepared to make a report on a recent committee meeting of 22 doctors who have been discussing the direction of the hospital in terms of a merger. Lang said the board obviously wasn’t interested in what he had to say, and left. He was quickly followed by Dr. Luis Munoz, a pathologist, and later by Mina.

Munoz conveyed his disappointment in some members of the hospital board in a later interview.

“I have deep-rooted concerns about the board not properly interacting with the medical staff. I am very concerned about the indifference and arrogance of some board members,” Munoz said.

“The only way we are going to get out of this mess is if you have complete trust and interaction between the board and medical staff.”

But that clearly is not happening. Physicians have had “minimal input” in hospital affairs in recent years, Munoz said. It should be different this time, given the gravity of the decision ever facing the hospital — namely whether to merge with another hospital.

“This is a decision we all have to collectively play a role in, for the best of this community and institution,” Munoz said.

‘Hold it together’

The fiasco at last week’s meeting underscored a pre-existing divide between the medical community and the hospital board. It’s been a recurring concern of doctors in recent years, who have accused the hospital board and hospital administration of ignoring their concerns and ideas and making them feel undervalued.

That disconnect was cited as one of the HRMC’s downfalls by a consulting firm hired to help overhaul the hospital after its certification for Medicaid and Medicare was yanked by federal inspectors, leading to the resignation of CEO David Rice.

“Physician-hospital integration was actively discouraged. Medical staff had been kept at arms length,” Compass President Kate Fenner said in a report in March. Even in the lead-up to the Medicaid-Medicare crisis, the medical community was kept in the dark.

“People that should have been consulted were not involved in the process of solving this problem,” Fenner said.

Since the crisis, the board pledged to turn over a new leaf of openness and inclusiveness and to improve the broken relationship with the medical community. But the events at the meeting last week suggested there are still problems.

“We are still dealing with the old administration,” Munoz said.

Dr. Richard Steele, a hospital board member, has publicly noted the disconnect in the past, and noted it again last week.

“There is disconnect between the medical staff and this board, and because they walked out there is still a disconnect. We need to bring that bond back together again,” Steele said.

Dr. Henry Nathan, a newly appointed board member, said the hospital board should do everything it can to hang on to doctors. They are understandably nervous about whether they will have a hospital to practice at if things don’t get better, Nathan said.

“There are many more who are just as worried but aren’t as vocal. We have to bend over backwards to try to reassure and satisfy these stakeholders so they hang in there with us,” Nathan said. “We’ve got to hold everybody together. We don’t want them to desert us now. We need to not just make an appearance of doing everything we can, but actually do it to make sure the doctors and nurses stay.”

Nathan said the physicians are the hospital’s strongest asset right now — at least that’s what he’s heard in merger talks with other hospitals.

“They said frankly your medical staff is one of the reasons we might be willing to partner with you,” Nathan said.

When to talk

By the end of the board meeting last week, Stevens apologized for interrupting the doctors.

“Let me say this since I am the bad guy tonight: I realize and I know the doctors and the nurses are the reason we came out of this. The doctors said ‘we are going to stick with you,’” Stevens said. “I certainly want the doctors to be heard and the nurses. But I want it done in an orderly manner.”

The board discussed whether audience members should be allowed to speak up during meetings, but no consensus was reached.

Roy Patton, an attorney and newly appointed board member, said he could see the potential for unruliness or disruption, but that hasn’t seemed to be a problem.

“From the meetings I’ve seen, what comments we’ve had from the floor seem to be somewhat pertinent and somewhat helpful,” Patton said.

Meanwhile, Glenn White, the board chairman and long-time board member, sided with Stevens. The board used to have a public comment period at the outset of the meeting, allowing people two minutes to speak.

“I think we need to go back to that,” White said.

But Patton said it was problematic to make everyone speak at the beginning of the meeting. People don’t know ahead of time what issues will come out and therefore don’t know what issues to speak to at the outset of the meeting. Patton suggested allowing people to speak up, with the caveat they raise their hand and be recognized first.

“It is important for the public to feel like they have participated in the renewal of the hospital. If that is not offensive I would make that suggestion,” Patton said.

Stevens said he would rather confine public comments to a single item on the agenda.

“I just don’t want everybody jumping up,” Stevens said.

Cliff Stovall, one of the newly appointed board members, said he was disappointed Stevens had interrupted the doctors.

“I personally wanted to hear from them,” Stovall said. “I thought it was worthwhile. I am sorry Jim interrupted.”

“I am sorry it happened myself,” Stevens said. “I take some responsibility. I was wrong on some of that.”

Old versus new

The dispute over whether the public should be allowed to speak during meetings revealed a rift between old and new board members. There are 10 members on the board —five appointed since the crisis.

Dr. Luis Munoz said there are several hard-working, dedicated, valuable members on the board, namely the two doctors and the new appointees. But the old guard seems to be still in control and has persisted with its same old dogmatic approach, Munoz said.

“There have been some positive additions, but unfortunately there have not been enough subtractions,” Munoz said of the board. “We are still dealing with the old administration.”

Kearny, a newly appointed board member, expressed concern that the business of the hospital board was being conducted by a small group, not the full board. Kearney suggested that information was being shared with some board members and not others.

A dispute between Kearney and Stevens last week epitomized the division on the hospital board between its old and new members. Specifically, Stevens objected when Kearney passed out notes from a committee meeting to the rest of the board members.

Committees comprised of three or four other board members are where the majority of hospital affairs are hashed out. Kearney, along with Roy Patton, another new board member, had been assigned to the by-laws and governance committee.

Patton and Kearney set about writing a policy spelling out what events were serious enough that the hospital CEO should notify the board. Former CEO David Rice was blasted for keeping board members in the dark for weeks while the Medicare crisis was brewing back in February. They didn’t learn the hospital was about to lose its Medicare status until the last minute.

Interim CEO Al Byers similarly failed to inform board members when the hospital nearly failed its reinspection in May thanks to a minor sprinkler technicality. Initially, the hospital was told it passed the inspection on May 22. It immediately began accepting patients, with the understanding it could begin billing for Medicare immediately.

But when Medicare staff in Atlanta reviewed the inspection report, they decided to fail the hospital because of a sprinkler head. It would mean a months-long delay in getting Medicare back — a blow that could have ultimately sunk the hospital. State and federal politicians intervened, convincing Medicare staff to simply let the hospital replace the sprinkler head without failing them. The Medicare staff relented.

But as a result, the hospital couldn’t start billing Medicare until the sprinkler was fixed on June 6, not the May 22 date the hospital had begun accepting patients. The hospital had to eat the cost of treating patients for the intervening two weeks.

Initially, Byers didn’t tell the entire board or the public about the averted catastrophe, nor did he elaborate on why the hospital couldn’t bill retroactively to May 22. It became public knowledge only after N.C. Rep. Ray Rapp, D-Mars Hill, inadvertently mentioned the saga in an email newsletter where he chronicles his activities from the week.

Patton and Kearney said Byers should have told the board; but to be fair, they said, there is no written policy that outlines when Byers needs to do so. So Patton and Kearney began developing one through the bylaws and governance committee.

“Rather than be upset that we didn’t get informed, I think the main thing is that we have never told the CEO what he should inform the board about,” Patton said.

The protocol identifies “critical events” that should trigger the CEO to notify the board. Kearney passed out a copy of the list to fellow board members at the start of the meeting, much to Stevens’ disappointment.

“Who did this that we got here now?” Stevens asked, waving the piece of paper in the air. “I don’t think all of us ought to be handing out stuff here. I just don’t want all of us around writing memos and handing them out at the meeting.”

Stevens said everything should go through the board chairman, Glenn White.

“Did you sanction this?” Stevens asked, turning to White.

White said “no,” that it came from Kearny and Patton’s committee.

“We’ve got to have some order here,” Stevens said.

“This was done in an attempt to inform the board of what we are talking about,” Patton said, defending the distribution of the notes from his committee. “I think the board is going to have some comments on this.”

White said that if that is the case, it needed to come from the committee as a whole.

“I don’t want it coming from any one person in here,” White said.

“It did come from the committee,” Patton said.

“Well, who’s chair?” Stevens asked.

“Me,” Patton said.

“Well, I didn’t get it from you,” Stevens said. It then became apparent Stevens’ issue was with Kearney, who had actually passed it out. Kearney has quickly become known for asking probing questions of hospital administration and demanding elaboration when issues discussed during the meetings aren’t clear. Her questions have irked some of the old board members and now Stevens was challenging her right to distribute materials to fellow board members. Kearny questioned why Stevens was so upset over the document.

“This is a discussion document, no differently than the notes that we have all gotten and are handed out at this meeting,” Kearney said. “Our intention was to bring it to the board members, let you look at this, and see if are there any other critical events you would like the committee to add, so Al (Byers) won’t be put in the position of deciding what is a critical event.”

Kearney said the board members have a mandate to provide oversight of the hospital, and they can’t do that unless they know when important things happen.

“We are telling the community that as a board, we share in the failure and success of the hospital,” Kearney said.