►    Seven-member group to study hospital's ambulance service, areas of concern listed by White

Mayor Matt White has appointed five El Reno residents, himself and the city finance director to his Parkview Hospital Ambulance Service Panel.  White has also listed specific areas he wants the panel to scrutinize.

White has been highly critical of the administration at Parkview and recently called for the resignation of Lex Smith, long-time administrator at the city-owned hospital.

In announcing the members of his panel, White said the group will "dig into the issues surrounding the hospital and ambulance service."  In a written statement he outlined the objectives of the panel, saying the panel will "review the findings; report them to the citizens, the Parkview Hospital board of trustees and the City Council.  The panel will then make recommendations as necessary to ensure both the hospital and ambulance service remains a strong and viable partner in the El Reno community for years to come."

Community members serving on the board will include Richard Thompson, a former banker'; Naomi Davis, a retired government employee; Susan Schwarz, a former City Council member and Redlands Community College employee; David Ratliff, certified public accountant and a former city councilman; Jerry Robertson, former vice mayor and former member of the Parkview Hospital Authority; and Ruth Beal, city finance director.

"Julie Rozsypal (who was initially a member of the panel) decided she would not have enough time to devote to this panel," White said.

The panel was formed as an ad hoc committee under the direction of the mayor, White said.

"I hope to get clarity and focus on the main goals and operation of the ambulance service," he said.  "We hope to establish the main, immediate and long-term goals of the hospital itself."

Hospital authority board chairman David DeLana said although he is not sure he agrees with White as to the necessity or credibility of such a committee, he is for anything that might produce positive results.

"That is kind of why we have auditors," DeLana said.  Local people are on the board and they are here in town.  I feel a consulting group can serve as a disinterested third party that deals with hospitals across the United States to give a direction someone from our community may not see."

White said he hand-picked the panel for specific reasons and believes they will make a difference.

"First, I know each one of these people care for people," he said.  "Also, I think you have a lot of caring, concerned, intelligent people from El Reno on this panel.  The bottom line is all we see are the numbers.  We will recommend our findings to the Parkview Hospital board, the City Council and to the citizens.  These will be open meetings and will be posted at City Hall."

In a written statement of functions and responsibilities, White listed nine areas the panel will research and review;

White said the panel was formed with the explicit goal to "find out how we stand in the grand scheme of hospitals in our county.  At one time we were it.  Now as one of the fastest-growing counties in the state, we need to find out what direction we need to go."

DeLana said he understands Canadian County is growing and there are other medical facilities in the county now, but he does not see a negative impact to Parkview.

"Yes, there is a hospital on the eastern side of the county and that area has grown at a rate of 18 percent for several years," DeLana said.

"Our patient group is primarily from El Reno and to the west.  I don't see that we are experiencing much competition from our neighbor to the east."

DeLana said without doing some digging, he is not sure of the specific statistics, but he is "relatively certain from speaking with a doctor that services both sides of the county and uses both hospitals, that the patient load at Parkview has stayed pretty much level.  To use that doctor as a benchmark, one could establish that Parkview Hospital's patient load has not decreased."

►    Administrator cites attorneys' counsel

Parkview's administrator said public notices of the hospital authority's budget and finance committee are not posted because, according to hospital attorneys, the meetings are "not an open meeting because there is no action and there is no quorum."

Lex Smith made the comment last week following a request by The tribune to be notified and provided an agenda of future meetings of the committee.

Parkview's Chief Finance Officer Rod Shook said the budget and finance committee is comprised of David DeLana, Dr. Mike Compton and Dr. Margaret Mehle.  Shook said he and Smith also attend the meetings.

"There are minutes kept and they are reported to the board of trustees," said Shook.  "Mr. Smith told me it was not a public meeting because there are only three board members present."  He referred further questions to Smith.

Smith said he was advised by the hospital's attorneys that the budget and finance committee meetings did not have to be considered an open meeting.  "What you can do is give me your interpretation of the open meetings law and I can refer that to our attorneys," he said  "We will get that over to Joe Weaver and Jim Bass at Bass Law Firm."

DeLana, committee chairman, said he is not sure what the law is regarding the budget and finance meetings.  DeLana said he does not believe the meetings are closed, but that they have not been published for as long as he can remember.  He agreed with Smith on the reason the agendas are not published is because there is no action taken at the meetings.

"It has never been questioned that I know of," DeLana said.  "Frankly, there are times that you need to discuss things in order to sort through things to bring to the main meeting."

It has just "been the protocol since I have been on the board."  He requested further questions be directed to attorneys for the hospital.

According to the Oklahoma Open Meeting Act, "All meetings of public bodies, as defined hereinafter, shall be held at specified times and places which are convenient to the public and shall be open to the public.."

A public meeting is defined by the Open Meeting Act as "the conduct of business of a public body by a majority of its members being personally together..

Smith and Shook both said the budget and finance committee does not constitute a "public body" because a majority of the hospital's trustees are not present.

The Oklahoma Open Meeting Act defines a public body in part as "all boards, bureaus, commissions, agencies, trusteeships, authorities, councils, committees, public trusts, task forces or study groups in the State of Oklahoma supported in whole or in part by public funds or entrusted with the expending of public funds, or administering public property, and shall include all committees or subcommittees of any public body."

Paul Hesse, assistant district attorney for Canadian County, said he could not comment until he had reviewed the Open Meeting Act and familiarized himself with the situation.

"I do not know without looking at that case, if I could give you an answer," he said.  "A quorum is not a defining measure of whether a meeting is open or not."

►    Both administrator, mayor question each other's professionalism

Discussion never materialized at a Parkview Hospital board of trustees meeting about Mayor Matt White's call for Administrator Lex Smith to resign.  White said last week he has "lost faith" in the hospital leadership and called for the longtime administrator to step down.

Following Tuesday night's meeting, Smith said the mayor acted in an unprofessional manner when he made public his statement calling for Smith to resign.  He said the correct venue would have been at the hospital board meeting.

"I did not bring up the issue because I did not feel like ti was my place," Smith said.  "If it were to be be discussed, tonight would have been the perfect opportunity to bring it to the board."

White said he stands by his earlier position.  "I'm not backing off.

"If Lex doesn't feel like he needs to bring it up, that is up to him," White said.

White said he is documenting all of the calls he is receiving and said he will continue to dig into the issues surrounding the hospital's administrative operations.

"I have explained my position.  The calls I have received are overwhelmingly in favor of what I am doing and in figuring out how to keep the hospital and ambulance service and get the hospital employees good benefits," White said.

"As fare as the professionalism issue goes, I questions Lex's professionalism.  He questions mine and I questions his.  We are going to move forward and investigate this thing."

During the meeting the board did take action and discussed the hospital's future.  Trustees voted in favor to approve an agreement that would bring Dr. William Tordzro of Mississippi to the hospital staff.  The agreement would guarantee Tordzro $200,000 annually, give him a $20,000 sign-on bonus and assist with up to $10,000 for moving expenses.

The search for a new physician began in February of 2007 after Dr. Antony D. Anderson announced he was closing his practice in El Reno.  Arthur-Marshall, Inc. of Texas was contracted to help with the search for a new physician.

Tordzro is the second prospect Smith has interviewed and brought to the board.  Rosemary Klepper asked how the guarantee agreement with Tordzro differed from that of Honglan Lu, the previous prospect who backed out.

"We offered $190,000 to Dr. Lu, so the agreement is within $10,000," Smith said.

Trustee Dr. Margaret Mehle said she had the opportunity to meet with Tordzro and is "delighted" that he could join the El Reno community.

"He is very, very personable," she said.  "We are just delighted.  I think he will fit right into our community.

Mayor calls for Parkview head to resign

From The El Reno Tribune - May 11, 2008

By Daniel Lapham - Staff Writer

►   Administrator says he won't step down as long as he has board's support

Following a sharp back and forth between Parkview's Lex Smith and members of the El Reno City Council, Mayor Matt White said it is time for Smith to resign his position as administrator of the municipal hospital.

White said he has lost faith in the hospital's leadership.

"My position is the loss (associated with the ambulance service) always totals $300,000.  The books are made to show that," White said.  "I think the main problem here is with Mr. Smith.  I think it is time for Mr. Smith to resign as the hospital's administrator."

When contacted, Smith said he had no intention of resigning from the position he has held for more than two decades.

"I am the administrator and I serve the hospital and answer to the Parkview Hospital board of trustees as a whole," Smith said.  "I have been very dedicated to the hospital for 24 years.  I was just named outstanding Rural Administrator of the Year for 2007."

Smith said as long as he has the support of the majority of the board, he is not concerned with White's call for him to step down.

Board chairman David DeLana said he is not sure of the specifics, but at this point he does not think Smith should resign.

"As far as the mayor asking Lex to resign, that is definitely his and any other citizen's right to voice his opinion, but it is not one that I share at this stage," DeLana said.

Smith said he has no plans to resigning.

"If he (White) is going to bring that up, I would appreciate the he bring this up to me.  I have never heard this," Smith said.  "the mayor is only one member of the board.  I feel if he has a problem, he should bring it to the board.  I would be happy to sit down with the mayor and discuss it, but the board is ultimately the deciding body.  We have had a lot of mayors and vice mayors in my 24 years at the hospital and I am sure there will be more."

White said the board is "moving in the right direction" because they have begun questioning continued financial losses.  White said he is frustrated and the board, in his opinion, is beginning to share in this frustration.

"I'm tires of the answers always changing," White said.

Council member Glen Nichols also expressed frustration with Smith at last week's City Council meeting.

"It just looks fishy," said Nichols.  In particular, he challenged Smith about a $20,000 "dietary" expenditure charged to the ambulance service.

Smith said many of the indirect expenses like dietary needs are charged on a percentage basis to all of the departments in the hospital.

"I really questions that these things are not all a part of the ambulance service," White said.

Council voted 4-1 to delay authorization of a $75,000 quarterly subsidy to the hospital.  The payment is part of an agreement the city made with the Parkview board to help support the ambulance service.  Council member Mark Gilmore was the dissenting  vote.

As part of the agreement Smith is required to present a financial report to the Council.

White said he is in the process of forming a committee to review the expenses associated with the ambulance service to ensure the city is "only paying for the ambulance service.  We are not interested in supporting the hospital," he said.

White said he fully supports the hospital staff, his problem is with Smith as well as Rod Shook, chief financial officer at Parkview.

"I think it is time for new leadership.  I want to see where this money is going."

White said he plans to appoint city finance director Ruth Beale, former Vice Mayor Julie Rozsypal, himself and one other El Reno resident to the committee.

Although she is off the Council, Rozsypal said she agreed to serve on the committee.

"I think the agenda item should have been dealt with according to the agreement," she said.  "I did vote to postpone it because I know how it would go and I knew I would be off the council."

She said she agreed to serve as a citizen on the committee because she is familiar with the issue.

"I feel like the experience I have garnered over the past several years, I feel like I owe this to the community.  It is a little unfair to ask someone to come in and start all over from scratch."

Smith said the Council's decision to postpone the subsidy payment, as well as White's decision to form the committee, will be discussed at Tuesday's Parkview board meeting.

"We also will have a discussion considering a subsidy agreement for next year and a leasing agreement for equipment," Smith said.  "The $75,000 we were asking for is a request we make every quarter and obviously the Council has some questions on they.  They have paid the other two.  So it is a valid contract and it should be followed.  I am sure it is not a matter of them paying it, there is simply some information that needs to be cleared up."

Parkview Hospital Home Health was among 30 agencies to recently receive Quality Awards from Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for Oklahoma

Awards were based on reducing the number of preventable hospitalizations among home care patients and improving the quality of care in such areas as pain and use of oral medications.

As one of the home care agencies that achieved a 50 percent or more reduction in the number of acute care hospitalizations, Parkview Hospital was awarded with the ACH  Quality Improvement Award.

►    Hospital pursues name, marketing plan

Trauma assessment for patients entering the emergency room at Parkview Hospital is set to change as hospital officials prepare to roll out the new "MinorMed: The Minor Care Center at Parkview".

Parkview Hospital board of trustees gave the nod to hospital staff last week to pursue a trademark on the name "MinorMed: The Minor Care Center at Parkview" as the banner for its new minor care center.

A marketing plan is in the process of being put together by Waddell Pointer and Associates, and its cost has not yet been determined, said hospital administrator Lex Smith.

Emergency Room manager Pam Broyles and chief nurse Doug Danker presented updates to trustees.

Danker said the final operation hours for MinorMed have been locked in as 6 p.m. to 11 p.m. Monday through Friday and 11 a.m. to 11 p.m. on Saturday and Sunday with an expected opening date of May1.

Broyles said the foundation is coming together and as of press time, the estimated cost for operations of the new center has "a rough cost estimate to the hospital around $200,000 per year."  At this point, Broyles said in order "to recoup this cost, we are looking at 104 additional patients per month."

Costs for service to patients are still under discussion and no estimates or figures have been decided yet, she said.

The additional cost of the clinic that will operate in the newly remodeled outpatient specialty clinic will cover the addition of "one full-time and one part-time registered nurse and one full-time and one part-time nurse practitioner," Broyles said.

At the board of trustees meeting, Broyles and Danker discussed the "burnout factors" that can be associated with urgent care centers and explained the plan to cross-train staff so they will rotate shifts between the emergency room and the minor care center.

"We will also hire one full-time admission clerk and a part-time admission clerk to serve the clinic," Broyles said.

In preparation for the addition of a minor care clinic that would take non-emergency cases on a pay-before service, insurance or payment plan-only basis, the hospital is restructuring its triage system.  The existing system is a three-level system where a patient's medical status is categorized as emergent, urgent or non-urgent.

"There has been discussion in the emergency room arena on the weaknesses in 'three-level triage,' so we are going to five levels," Broyles said.

Patients who are very unstable and need immediate intervention to save their lives will be categorized as level 1 trauma.  Level 2 trauma patients are still time-sensitive and are diagnosed with things that need to be seen quickly, but do not need to be seen immediately.

"They still have a pulse, a blood pressure and are still breathing," Broyles said.

The next three levels, 3, 4 and 5, are not time sensitive.  Ideally, all of these levels could be seen at a doctor's office.

"the level 3 trauma patients will require more resources so they will still be seen in the ER because we don't want to tie up all of our MinorMed resources," Broyles said. "So, right now we are looking at levels 4 and 5 that will be seen in the MinorMed Center.  These are things like a cut that needs to be stitched, i minor infection that needs prescriptions or the flu or stomach viruses like what have gone through the community would all be appropriate for the MinorMed clinic."

►    Mayor wants city-funded independent study

Opening an after-hours urgent care facility at Parkview Hospital would better patients' needs and help the facility compete with health-care giants, according to a hospital official.

But El Reno Mayor Matt White said he wonders if the move will be enough and supports the idea of a city-funded, independent study of Parkview and the community's needs.

"We are a small, hometown hospital with good values, but we are trying to compete in the corporate world." White said.  "Half of the time we are considered rural and half the time in the Oklahoma City metropolitan area."

Parkview Hospital board of trustees recently approved opening the urgent care center in May after construction is completed on the hospital's new Outpatient Specialty Clinic.

Hospitals are required by federal law to treat anyone seeking help in an emergency room with an emergency, life-threatening condition, regardless of their ability to pay their bill.  Hospital administrator Lex Smith said a physician's assistant or nurse practitioner gives patients medical screenings to determine if the person is experiencing an emergency.

"We have to treat to the full ability of the hospital," he said.  "If it is not an emergency, we can talk about treatment or payment."

Once the urgent care clinic is opened, Smith said patients with non-emergency conditions would still receive care, however, the costs involved could be less.  In both levels of care, he said patients would receive counseling related to a co-pay or down payment and a future payment plan for the bill.

"You have to counsel them about payment and you let them make the decision as to whether to leave," Smith said, adding the patient can refuse treatment.

Patients who could be triaged to an urgent care clinic include those with pink eye, low-grade fevers, localized skin infections, cough or bronchitis, joint and muscle strains or sprains,  minor insect and animal bites, minor allergic reactions, minor burns or cuts.

Patients experiencing chest pain, head injuries, a compound fracture, kidney stones, high heart rates, high fevers and complex conditions involving abdominal pain and shortness of breath would remain in the emergency room.  Smith added most cases involving children are also treated as emergency cases.

During the past heavy flu season, he said the after hours urgent care clinic would have helped free up Parkview's five-bed emergency room for more seriously ill patients.  He said Parkview emergency room workers have seen as many as 45 patients in a day during this flu season, which is expected to continue into April.

However, the hospital's financial feasibility summary shows a peak rate of emergency room use at 1.5 patients in an hour.  The peak hours of use are between 10:00 a.m. and 11:00 p.m., the study shows.

Smith said if patients aren't released and are waiting for an room elsewhere in the hospital or in another facility, with five emergency room beds, it creates a back-log and causes delays in treatment.  If a patient is receiving care for a minor injury or illness, he said, they can be released within an hour, but if they need more tests or a complicated treatment, it takes longer.

"It all depends upon the type of patients you have and what the treatment is," Smith said.

Within  the study, officials at two Oklahoma hospitals reported they considered the threshold for the development of an urgent care clinic to be 2.5 patients per hours and 1,800 patients in a month.  Parkview's emergency room average patient volume for 2007 was 688, or just more than one-third of the outside hospital official's recommendation.

In the beginning, the urgent care facility would be open for five hours a day, from 6:00 p.m. to 11:00 p.m.  To cover increased staffing costs, the report shows the urgent care facility would have to dray 62 patients per month.

Smith said he believes Parkview will draw patients who seek treatment at other clinics because the urgent care facility will be more convenient and charge "reasonable" prices, compared to emergency room care.

"We think it is something that will grow," he said.

However, the health-care industry in Canadian County has boomed in the wake of rapid growth among its eastern cities -- in Piedmont, Mustang and Yukon.  Officials broke ground this week on a $27 million expansion at Integris Canadian Valley Regional Hospital in Yukon, with another phase still in the planning stages.

As more health-care options become available in west Oklahoma City and its suburbs, White said Parkview and El Reno city officials need to take a closer look at the community's needs and how the local hospital can meet them.

"To their (Parkview's) credit, they are trying to think of things to do to keep up with these things," he said.  "I don't know if it is too late, and if we have the resources to do it."

El Reno has a large retiree population White said, adding having Parkview Hospital and the local ambulance service is important for senior citizens to receive immediate care.  In the 2000 U.S. Census, 17 percent of El Reno's population reported at 16,212 residents, where age 60 or older.

El Reno residents also pay a subsidy of no more than $300,000 for t fiscal year, which will expire June 30 for Parkview's ambulance service.  Voters recently approved allowing Parkview ambulance service to receive a share of a sales tax with the portion being decided by El Reno City officials.

Smith said Parkview Hospital is a separate entity from the ambulance service.

"Those individuals, they are going to have to make payments, just like if they are going to the doctors' office like it's a non-emergency condition, but we will try to save them some money by having it at a lower rate than at the emergency room," he said.

While voters supported the ambulance services, White said many residents including his 81-yar-old father, are seeking medical care in surrounding communities, including Kingfisher, which is building a new hospital, west Oklahoma City and Yukon, because those centers are able to offer more services and have connections with larger hospitals.

"We are like a Quick Stop competing with Wal-Mart," he said.

As Parkview competes more for patients, White said he worries its staff will also seek to work at larger facilities that can offer them more benefits and competitive wages, adding Redlands Community College's nursing program provides support for the facility.

"I think the reason a lot of our employees are in El Reno is loyalty to the citizens of El Reno," White said.

Hospital auxiliary OKs TV purchase

From The El Reno Tribune - March 2, 2008

►    Administrator discusses ambulance purchase

Bea Carrol opened the monthly board meeting of Parkview Hospital Auxiliary with Jean Gholston reading minutes and Danella Finnigan giving the treasurer's report.

It was noted that Carroll provided tray favors for Valentine's Day.

The board approved the purchase of six new televisions for patient rooms.

Administrator Lex Smith discussed funding of the new ambulance as well as the outpatient clinic and the after-hours urgent care facility.

Others attending were Lois Horn, Betty Mitchell, Claudina Franklin, Myrtle Chapman, Jean Phillips, Becky Smith and Marge Moss.

Parkview Hospital board gives nod to new ambulance

From The El Reno Tribune - February 17, 2008

By Daniel Lapham - Staff Writer

Paramedics in El Reno are about to get a new ride after the Parkview Hospital board of trustees approved the service to purchase a new ambulance using grant money.

Thanks to a $60,000 grant from the Mary K. Ashbrook Foundation, another $16,000 from the Parkview Hospital Auxiliary and $28,829 from the Parkview Hospital Subscription Fund, the $127,000 4500 GMC McCoy Miller medium duty ambulance is all but paid for.

Parkview Ambulance Service Director Ray Simpson gave a report to the Parkview Hospital board of trustees on Tuesday concerning the possible types of new ambulances and how the purchase of a new "rig" could save the hospital money.  Simpson said he has been requesting a new ambulance to replace one of the five aging units used to service the El Reno area but to no avail until now.

"We are deeply thankful," Simpson said.

Most ambulances function well up to 100,000 to 150,000 miles, Simpson said.  After the 100,000-mile mark, the maintenance and fuel costs for a unit dramatically increase.  Every ambulance in the Parkview fleet has more than 200,000 miles n it and is causing ever-increasing maintenance costs.

"Both Geary and Hinton have purchased new ambulances.  this would be a major step for us," Simpson said.  "I truly believe replacing these vehicles can reduce your costs by a third."

In his presentation Simpson said he would like to see a process implemented that would replace one ambulance every two years.

"Each ambulance would be used in a front line capacity for a three-year period followed by two years of service as a reserve unit," he said.

This plan would allow the unit to accrue 100,000 miles in the first three years and then another 20,000 in its reserve use.

Administrator Lex Smith said the hospital will take one ambulance, with 371,000 miles on its speedometer, "out of service".

He said the new ambulance is expected to arrive from the factory "within the next 90 days".

Smith said the last ambulance the hospital received was in 2004 when the Parkview Ladies Auxiliary purchased a used ambulance from Mercy Hospital in Oklahoma City.

From The El Reno Tribune - February 17, 2008

By Daniel Lapham - Staff Writer

►    Move would be current 'answer to consumerism trend' in health care, administrator says.

El Reno area residents who depend on the emergency room at Parkview Hospital for after-hours and non-life-threatening are could soon have another option.

The Parkview Hospital board of trustees approved a recommendation from hospital staff on Tuesday to continue with plans to open a Minor Care Center in May after construction is completed on the hospital's new new Outpatient Specialty Clinic (OPSC).

Doug Danker, director of nursing, told the board he could be ready to open the new Minor Care Center in May and would staff it with nurse practitioners.

"Our five-bed ER is currently staffed with PAs or nurse practitioners that are backed up by physicians," he said. "The outpatient facility could be staffed with either PAs or nurse practitioners."

Trustee Rosemary Klepper said she thinks the minor care facility would be better suited for nurse practitioners, which would allow for the PAs and physicians to stay in the ER.

The report presented by Danker showed the peak hours of ER use as 10 a.m. to 11 p.m.  The proposed Minor Care Center would operate in the OPSC.  Due to scheduling the Minor Care Center would start out operating from 6 p.m. to 11 p.m.

"The hours could be variable.  We are not sure at this point.  This will function more like a traditional clinic, except it will be opened during hours that a patient would not normally be able to get treatment at a regular clinic," said Parkview Administrator Lex Smith.  "One of the reasons for this is to put patients in the proper setting so they can receive the right kind of care.  We are hopeful this will be faster and better care than what we can provide in our emergency room."

There are several advantages to an after-hours specialty clinic, Smith said.

With the emergence of after-hours clinics that operate inside of Wal-Mart and other pharmacies, Danker's report highlighted the advantages of an after-hours  could bring to the community as well as the strengths Parkview holds over "offsite, non-hospital clinics."

We have name recognition in the existing local healthcare market and access to ancillary services that a retail clinic entering this market will not have," Danker reported.

Smith said the proposed clinic is, in large part, a way to stay ahead of retail after-hours clinics.

"There might be a place for a retail care center in the future, but his is a way to meet the needs of our patients.  This is an answer to the consumerism trend that is happening in health care right now," he said.

No matter what the future holds in terms of retail clinics, Smith said they're trying  to prepare.

"I am going over to a program at the Wal-Mart headquarters in Arkansas to discuss a partnership in the event they were to open a clinic in the Wal-Mart here in El Reno." he said.  "We have no idea of the probability that a clinic would open up here, but we like to be prepared."

The emergence of an after-hours, Minor Care Center also could minimize some of the issues surrounding the increasing challenge of collecting debt from cash-pay patients, Smith said.

"We will take insurance and we will work with patients for co-pays.  If a patient does not have any insurance, we will require payment in full at the time of service or that the patient make payment arrangements with a down payment made at the time of service."

A plus side to the clinic could be a reduction in the cost to patients who might normally go through treatment in the emergency room.

"It will probably be somewhere in between an ER and a non-hospital-affiliated clinic in terms of cost to the patient," Smith said.  "The cost will be tied to the amount and type of services needed."

The effect of the new service on uninsured individuals who have used the emergency room as a clinic up to this point is unknown, but there could be some benefits, Smith said.

"Part of the plan will be that some of those individuals will be able to receive treatment in the minor Care Center and it will provide lower costs," he said.  "The down payment and percentages will be less than what we can offer in the ER."

Danker explained how the system would work.

"In a minor care facility, we could turn people away for non-payment, but only after they were screened by a medical professional to determine what degree of care the patient requires," Danker said.

The system would be arranged with an intake and triage area at the ER as it is now.  After patients were triaged, the non-life-threatening cases could be referred to the Minor Care Center,  They would undergo a screening after which they would be asked to pay for their services before treatment or the insurance would take over.  If an individual was diagnosed with a non-critical injury or illness, was uninsured and could not pay up-front they could be discharged without treatment.

From The Daily Oklahoman - February 20, 2008

By Don Mecoy - Business Writer

►    Address:  4013 Northwest Expressway, Suite 575

►    Web site:  www.waterstoneadministrators.com

►    Employees: 90

►    Products:  LifeCare operates through several subsidiary companies including Waterstone Benefit Administrators, which provides third-party administration for self-funded  health plans and licensed insurance agency for general employee benefit products

Oklahoma Health Network provides a statewide preferred provider organization (PPO). HealthLink Nurse Advice Line offers around-the-clock nurse advice line, general health information, and physician referral for hospitals, the state Medicaid program, insurance carriers and employers.  Managed Care Consulting provides manage care consulting services for VHA-member hospitals.

►    Background:  LifeCare Health Service is a regional operating company owned by the not-for-profit hospitals in Oklahoma, but its employees work for a for-profit entity.  The company provides various services for its member hospitals, but can also generate revenue by offering those services to other businesses.

"We're a for-profit business owned by not-for-profit hospitals," President Tim Reddout said.

One of the unique aspects of the company's structure is that it is not operated to maximize shareholder value.  Instead the company seeks to provide needed services efficiently to its not-for-profit owners.  When those products are well-established, they can be rolled out to commercial customers, Reddout said.

An additional benefit of broadening its offerings is the ability to keep its employees engaged, Reddout said.

"In order for our employees to not become stagnant, we have to have growth opportunities," he said.  "Employees have the opportunities for advancement.."

Reddout's leadership philosophy also includes some extraordinary perks for LifeCare employees.

When gasoline prices soared the company gave everyone in the office a 2 percent pay boost to cover increased transportation costs.

Employees who read books from a list provided by Reddout (generally popular business books) can win movie passes and gasoline vouchers.

Employees also picked out the bold colors of the office, and they opted with purple, green and gold, Reddout said.  A committee of employees schedules events aimed at improving office morale and teamwork, Reddout said.

Reddout said his current goal is to get some of the state's largest corporations to use local companies like his instead of using out-of-state competitors.

►    Quality of service, not money, needs to be focus, report says

According to a national ambulance service consulting firm, El Reno is getting "a good deal" from the Parkview Hospital Ambulance Service.

The service has been at the center of debate for the past two years, mainly over its accountability and transparency in the wake of subsidies from the city.

A part of City Manager Tony Rivera's Capital Improvements Program, which will involve a new tax issue early next year, is earmarked to provide a five- or 10-year interlocal contract between the city and the hospital, said Lex Smith, Parkview Hospital chief executive officer.

At Tuesday's regular Parkview board of trustees meeting, David Shrader, The Polaris Group president, gave a presentation  of his findings during his comprehensive overview of the ambulance service in July and August.

"Overall you are getting a great value," Shrader told the board.  He said the Interlocal agreement between the city and the ambulance service is a good decision and makes sense considering the unique challenges a rural ambulance service faces.

"What I am sayi8ng is the focus needs to be on the value of your service more than the dollars," Shrader said.  "The bottom line is you are getting a good deal.  Almost every time I am called to do one of these, it is the service that is in question.  Here the service was the one thing all of the people we interviewed were happy about.  In most cases, we come out because the ambulance doesn't get there or someone dies from waiting."

Some ambulance services in the country do make money, Shrader said.  With its rural landscape and its demographic, though, Parkview's service is unlikely to turn a profit unless something changes or the population expands.

To ensure stability, Shrader suggested a five-to 10-year contract that would guarantee exclusivity to the ambulance service, helping stabilize it to a point it could expand toward becoming self-sufficient.

The tax issue in the works will have a public safety component encompassing police, fire and ambulance, Smith said.  This is the portion of allotted revenue that would help support the ambulance service.

"Right now the city and the hospital are partners working together to support the ambulance service.  "On top of that, the hospital is the underwriter, which means we try to split the need 50/50.  Right now the need is about $600,000.  We will get $300,000 from the city for this fiscal year, and we pay $300,000.  If the need exceeds $600,000, the hospital will underwrite that amount."

Smith said he has no doubt that with gas prices unstable, raising compensation for EMTs and the need for a new fleet, the service will need a long-term commitment from El Reno residents.

"The idea would be to set out a detailed amount in the contract with a percentage set aside for inflation every year," Smith said.  "The accountability would be written in the contract, and we would continue to report to the city quarterly as we are doing now."*

A breakdown of the CIP will be presented to the Council at the Nov. 6 City Council meeting, Smith said.

Geography works against local EMS,

study indicates

From The El Reno Tribune - October 17, 2007

By Daniel Lapham - Staff Writer

►    Small number of units have to cover large area, service head says

A national consulting firm says geography and demographics have more of an impact on Parkview ambulance service's finances than how the service operates.

"There are some ambulances that make money," said David Shrader, president of the Polaris Group, which studied Parkview's operation earlier this year.  "Most of them, however,  are in urban centers with a large population and a lot of ambulances."

Shrader spoke to the hospital board of trustees last week.

In El Reno, there are only four units covering a 1,250-square-mile area with a population of approximately 20,000, and a good portion of that is relatively spread out," said Ray Simpson, ambulance service director.

"We did have five units, but one unit is not serviceable," Simpson said.

This makes a huge difference in operation costs for two main reasons, Shrader said.  First, how many runs one ambulance unit can make in a specified time frame.

"An example that I am familiar with is the Atlanta metropolitan area," Shrader said.  "At first glance, one might think that the best area to cover as an ambulance service would the the suburban areas surrounding Atlanta where houses range in upwards of a million dollars versus covering the downtown/midtown areas where the income level is much lower."

The opposite is actually the case, Shrader explained, because urban areas have a much higher population density and fewer units take more calls, boosting output.

"The result ended up being a situation where the service covering the upper class suburban areas was losing money and the service covering the urban areas made money," he said.

Also, Parkview's operation isn't large enough to allow it to vary its number of units based on demand, Simpson said.  There is sometimes one unit on call during a 24-hour period.

"A third of our calls involve taking a patient to a specialized care center that is often in the Oklahoma City area.  When that happens, we have to call in another unit that pulls them into overtime," Simpson said.  "We need to have two trucks running at least during the daytime."

Bigger operations with 12 units on call in an urban area makes it easier to cut the hours down on six units when the calls are down, Shrader said.

"You can't sent home half of a unit," he said.

When the situation is put into perspective, it becomes a situation similar to a utility service, Shrader explained.

"What most people do not understand is that an ambulance service is a public utility much like the fire department, electrical, gas and sewer service, he said.  "A utility is something that takes more time and resources to run the network than it does to keep it running.  People are paying for the service to be there when they need it."

When it is presented in this way, the important thing to keep in mind is the value of the utility being given, Shrader said.

"It becomes a matter of the quality of service and the response time provided by the provider," he said.  "Most places I go as a consultant, they are trying to gain service that isn't lethal.  The value of the service here in El Reno is good."

►    Leon Davis cites health, personal reasons in decision to step down

Ward 2 Council member Leon Davis surprised City Council members Tuesday night, telling them he will step down from his post two years early.

Davis talked to City Manager Tony Rivera and Council members just before Tuesday's regular City Council meeting.

"It was a surprise to me and the rest of the Council and staff," Rivera said Wednesday.  "I am really sorry to see him go."

Mr. Davis is in his first year as a Council member, and his Ward 2 seat was not scheduled for election until November 2009.

Mr. Rivera said although he hates to see Davis go, the liming is good.

"If there was a vacancy in the beginning or middle of the year, the Council would be required to name someone," Rivera said.  "But since he is staying until the election in November, we are just adding his ward to the ballot."

Davis cited health and personal reasons for his resignation.  "I don't think at this time I can devote the appropriate time to serve the people in ward 2," Davis said.  "They deserve the best."

In other business, the Council finally approved a $50,000 subsidy for the Parkview Hospital ambulance service and a new contract for $300,000 for 2007-2008.

A tug of war between the hospital and the city over financial accountability and specific contract terms has been going on since February.  The final contract between the city and the hospital requires the hospital to give the City Council a detailed quarterly break down of expenditures and debts.

Council member Julie Rozsypal thanked Parkview Administrator Lex Smith for working with the city in complying with requests to clear up area that were questionable.

"These reports were exactly what we wanted," Rozsypal said of the financial report the hospital presented in order to receive the additional $50,000 for fiscal year 2006-2007.

Also, the Council knocked another nail into the coffin of the apartment building at 412 N. Bickford Avenue, voting 5-0 to name the building a public nuisance and release it for bid to be demolished.

The issue was brought to the Council in June and the building's owner, Elbert Kenneth Dahack, was given 45 days to bring the dilapidated building up to code.  Although Dahack did work on the house during the 45 days, the required improvements had not been completed in the appropriate time said Robert Coleman, community development director, after the public hearing.

During the public hearing on the property, Coleman said the apartment house has been on the city's "watch" list of abandoned houses for five years.  Although Dahack has owned the building for only the past four years, it is a situation that needs to be taken care of Rozsypal said.

"I, in good confidence, move that Mr. Dahack have a certificate of occupancy by September 10 or we will continue with demolition," Rozsypal said.

Dahack spoke at the hearing, pleading to the Council to give him more time.

"I did not anticipate it to rain for 20 days," Dahack said of the 45 days he was given to bring the building.  "I am making an attempt on my part.  I have replaced the windows and have pulled permits for the wiring."

After being asked if he understood what had been decided, Dahack responded by saying he was not going to give up.  He said he would keep working on the building until the end.

Winding down the meeting.  Rivera announced an extension of city hall hours to take effect on September 1.

"City hall hours are changing from 9 a.m. to 5 p.m. Monday through Friday to 8 a.m. to 5 p.m. Monday through Friday," Rivera said.

The only exception is the city's utility pay window which will not change with the rest of city hall.

"The utility window will still open at 9," Riveral said.

►    Changes should be decided after August Council meeting, Parkview head says

The months-long debate on how much and when a subsidy shot would be given to the Parkview Hospital ambulance service could be over next month.

A final draft of a letter and contract was presented to the Parkview Hospital board of trustees at its regular meeting on July 10.  In addition to the request for a subsidy for $300,000 from the City of El Reno, the hospital has asked for an additional $50,000 for fiscal year 2006-2007.

The ambulance service has already received $200,000 from the city, according to records.

The hospital and the city have been in negotiations since February to decide how much and if the ambulance service could justify the need for a subsidy from the city.  After several board meetings, it was decided a subsidy was needed, but there were complications over how much would be haven and how the subsidy would be accounted for.  For its own purposed as well as a means to meet the standards of maintaining financial  accountability, the board of trustees has hired Polaris Consulting Group to review the ambulance service's records and help the hospital adopt a better accountability and accounting system.  The Polaris Group will visit the hospital from July 30 to Aug. 1, stated the board's agenda.

Parkview Administrator Lex Smith said everything seems to be falling into place and, after the August 7 City Council meeting, the changes to the subsidy should be decided.  The major changes to the contract involved some of the verbiage that concerned some of the trustees because it appeared to limit the hospital from accessing more than $75,000 per quarter even if the need was higher than that.  The latest version of the contract has an amendment that states the city will include $300,000 in its 2007-2008 fiscal year budget that will be paid to the ambulance service in quarterly installments of $75,0-00 or the actual amount needed for continued service, "whichever is less."  The only exception is that the fourth quarter payment may exceed $75,000 as long as the full amount of money given to the hospital over the past year does not exceed $300,000, Smith said.

"We had a meeting with the city manager and city attorney and those changes will be going to the City Council in the August meeting."

In other business, Smith boasted of the hospital's  new CT scanner in his administrator's report.  The new 16-slice scanner will round out the hospital's diagnostic equipment upgrade which started last year with a new x-ray machine and continued in January with a new sonogram machine.

"We are installing a new CT scanner this week and it should be completed by the end of the week," Smith said.  "It is a 16-slice projector.  It takes more time to put the patient on the bed than it does to take the picture."

►    Ambulance officials seek final subsidy for 2006-2007 fiscal year

Officials with Parkview Hospital's ambulance service will have to wait until at least August for the final slice of a $250,000 subsidy to be served from the city's 2006-2007 fiscal year budget.

Some Council members said they could not approve the subsidy until they had received the hospital's final financial report.

Last year, the city agreed to a $200,000 subsidy for the ambulance service with the option of allowing hospital officials to seek an additional $50,000 if needed.  In a letter dated June 13, Parkview Administrator Lex Smith asked for the final bite to cover the hospital's "direct costs of providing emergency medical and ambulance service to the city".

Smith said hospital records show that from July 1, 2006, through March 31, 2007, the ambulance services posted a loss of $426,379, and with nine months of city subsidy payments factored in, or about $150,000, that loss was estimated at $267,378.  This number did not include an additional $50,000 that the city would pay as part of the original $200,000 that was approved.

"I believe this totally supports the board's (hospital trustees) request for the $50,000," Smith said.

Council member Julie Rozsypal led the discussion, saying she feels "very strongly about making sure current financial records are available before any money is given.  I just think it is a matter of principle."

She said the Council's obligation lies with the residents of El Reno to "keep track of financial records."

Smith said the financial report should be completed by August's City Council meeting.

The Council voted unanimously to table the issue until that Aug. 7 meeting.

Parkview's EMS subsidy request for fiscal year 2007-2007 grew to $300,000.

In other action the City Council again reviewed a proposed interlocal agreement between Parkview Hospital's ambulance service and the city.  At least three draft letters have been exchanged between City Manager Tony Rivera, City Attorney Roger Rinehart and Parkview officials.  The agreement sets up the subsidy relationship between the city and the hospital.

In the latest draft, Rivera agreed with Smith that a line in the agreement appeared to limit subsidy funding for the current fiscal year to four quarterly payments that could never exceed $75,000 and called for unused funds to be returned.

Smith said he and the Parkview Hospital board of trustees were grateful for any subsidy but were concerned at the way the agreement was written.  Smith said there are times in a year that the hospital might only use $50,000 of the $300,000 subsidy, but the next month it might need $100,000.

Rivera said it was not the city's intention to tie the hospital's hands and hoped that the current draft would clarify the agreement.

After reading the revised agreement, Council member Debbie Harrison said she felt the deal still needed work and the Council voted unanimously to table it until the August meeting.

►    Group discusses tray favors, chamber honor

Bea Carroll opened the monthly board meeting of the Parkview Hospital Auxiliary with Jean Gholston reading minutes and Danella Finnigan giving the treasurer's report.

It was noted that tray favors for Memorial Day were furnished by Myrtle Chapman.  Tray favors for Flag Day were provided by the Agape Sunday school class of the First Baptist Church.

A thank-you letter was received from the hospital for the second pediatric crib that the auxiliary has purchased.

Chapman was recognized as volunteer of the year at the recent El Reno Chamber of Commerce banquet.

Memorials have been sent in honor of Ruth Blessie and Audrey Cornell, who were both lifetime members.

Others attending were Jean Phillips, Carrie Sinyard, Lois Horn, Mary Hill, Claudia Franklin, Betty Mitchell and Marge Moss.

By Daniel Lapham - Staff Writer

►    Developer Ward to step into empty spot on hospital board

Finding a long-term solution to Parkview Hospital's financially struggling ambulance service will be a top priority for a former City Council member who has been tapped to serve as a hospital trustee.

Developer Ron Ward will join the board July 10, replacing local pharmacist Willard Holsted.  A 32-year resident of El Reno and owner of Ward Construction for 35 years, Ward said he sees the chance to serve on the board as an opportunity.

"I think the front-burner issues are the EMS issues.  That is kind of the issue of the day," he said.  "I think the long-term issue is how you make the hospital an economical asset, because things are changing.  You have to be on the leading edge of it or you're going to get behind the 8-ball so to speak."

EMS has been a hot button issue over the last two years as hospital officials have sough public subsidies of the service.  Recently, the city approved a plan that could pump as much as $300,000 into the service during the 2007-2008 fiscal year.

Ward said the city must be prepared for such challenges and additional issues including growth.

"Whether the community accepts this or not, El Reno is going to grow and how we accept that as a community and a hospital is going to define how successful we are," he said.  "The hospital board and the hospital staff are going to have to take the information available from the medical industry and apply it to this hospital.  How you make those things work is going to define your success-- and that is going to be the challenge."

Parkview Administrator Lex Smith said he is confident in Ward's competence and looks forward to working  with an individual who has served on the City Council and has an understanding of the business community.

"We think he can bring a lot from the business community," Smith said.  "He is a business owner and we think he will bring that with him.  We are very excited about him being on the board and we think he will give us great insight."

As a replacement for Holsted, who "had a very long-running business in the community, we are looking for someone who could fill that void to connect with the business community," Smith said.

Ward said a key challenge will be to get a handle on the issues facing the hospital.

"The first thing is to just get up to speed," he said.  "I have served on many boards but the medical field is different so there is a learning curve to see how the board works.  This is a vital service to the community."

Anytime a community the size of El Reno has a hospital that provides the services that Parkview does, it is a vital resource to the community, Ward said.

"I am in other communities that don't have this," he added.  "When you are in a community where the people have to drive hours away to get to the hospital, you quickly realize how important this institution is.  You have to use it a few times to realize how valuable it is."

Over more than three decades, Ward said he has witnessed the hospital grow to a position of respect in the community and hopes to see that continue.

"You are always in a position to figure out what kind of services and personnel do you have to offer?  The hospital has upgraded its physical plant significantly over the years," Ward said.  "I think that the biggest thing is that we have been able to keep up and stay competitive.  If you don't keep up you end up having a facility that is antiquated and not able to stay competitive.  I think the hospital has been able to keep up."

Honoring difference makers

El Reno Chamber of Commerce recognizes community stars at annual banquet

The El Reno Chamber of Commerce banquet took off with a "whoop" this year as historic re-enactors entertained those in attendance and local businesses and individuals were honored for their contributions.

A total of 13 awards were handed out at the banquet last week that marked the 96th year for the event and was highlighted with the recognition of OEMA as Business of the Year and Carolyn Barker as Citizen of the year.  The coveted Roy Stevenson Meritorious Service Award was shared by Delores Sanders and Thomas Alvarado.

According to chamber officials, OEMA was recognized for changes in its service that have saved residents money on the bill and efforts following last month's tornado to aid in the cleanup.  Other factors influencing the decision included recycling events such as "Keep El Reno Beautiful" and its partnership with Boral Bricks, chamber officials said.

Barker was recognized for her work to preserve the history of El Reno and Canadian County as a whole.  An El Reno High School graduate, Barker has compiled 120 books of newspaper clippings, courthouse records and maps of Canadian County.  She has also written eight books dealing with local icons such as the schools and churches.

Chamber officials said Sanders and Alvarado received the Roy Stevenson award because "they have devoted their lives to helping others."

The pair for the past 16 years has ministered to FCI inmates and recently began a similar effort at the Union City prison.  They also founded "God's Helping Hands," a mission aimed at feeding the city's poor and homeless as well as providing "serviceable" clothing.

Other award winners last week included:

►    Community Volunteer of the Year -- Myrtle Chapman who was recognized for her years of service to the Oklahoma Blood Institute and the Parkview Hospital Auxiliary and Parkview Hospital Commemorative Foundation board of directors.

►    Volunteer Charitable Organization of the Year -- Blessing baskets -- a communitywide effort to bring Christmas to those who would otherwise go without.  The effort has served more than 7,000 people over the last eight years.

►    Organization of the Year -- Youth and Family Services -- was recognized for helping more than 2,000 youth up to age 17.  The organization provides protection, guidance, health screenings and a community at-risk program that provides tutoring and mentoring to youth who are facing hard challenges in life.

►    City of El Reno Employee of the Year -- Debbie Elmenhorst -- who serves as El Reno Carnegie Library director, was honored for her dedication to the community over the past 20 years.

►    City Official of the Year -- Julie Rozsypal -- who serves as Ward 2 representative, was honored for her work on behalf of the city including creation of the Character Council of El Reno and service on various boards.

►    State Official of the Year -- Ronnie Funck -- in his second term as county assessor.  Funck was recognized for his service to the community and county.

►    Teacher of the Year -- Rachael Lagueux -- a 10-year veteran of teaching at Hillcrest Elementary School where she has twice been recognized as that school's Teacher of the Year.  She has also been named the Masonic Fraternity of Oklahoma "Teacher of Today" as well as being named a Kiwanis "Terrific Teacher."

►    Police Officer of the Year -- Christopher M. Leal -- was praised for his dedication to the community.

►    Firefighter of the Year -- Greg Graves -- who serves as a driver for the department, was honored for his dedication to El Reno and for career accomplishments including being a nationally registered emergency medical technician, certified as a firefighter I and II and in hazardous materials operation as well as an advanced open water diver.

►    EMS Employee of the Year -- Tony Halsey -- who works as an emergency vehicle operator, was recognized for for consistent dedication to his job and the patients who are treated.  He was also honored for his efforts during last winter's ice storm when he assessed injuries of car accident victims including those of fellow paramedics during hazardous conditions.

The event began with a welcome from Karmon Stanley, El Reno's new chamber of commerce director.  Entertainment  was provided by vocalists Michelle Lloyd and Gene Stroman.  Guests were also treated to  "The History of El Reno" by re-enactors from the Canadian County historical Society and Preservation El Reno.  Matt White served as auctioneer at the event.

Outgoing chamber president Jeff Mills, superintendent of El Reno Public Schools, and incoming president Lex Smith, administrator of Parkview Hospital, also addressed the crowd.

By Lea Terry - Staff Writer

When Parkview Hospital in El Reno opened its outpatient specialty clinic a decade ago, it had already outgrown the space. From one exam room and 80 patient visits a month, to four exam rooms and 800 visits a month, demand for the clinic’s services has continued to grow. And now, the clinic is growing as well.

A planned expansion will allow the clinic to have two physicians on duty instead of one, and should increase efficiency and patient flow, said Parkview director of nursing Doug Danker. Patients now check in at the emergency room, and are escorted to the clinic’s waiting area, but after the expansion, the clinic will have its own admissions area.

It will also have an up-to-date endoscopy room, a room set up for nuclear cardiac scans, an ultrasound room, a pain clinic room, and all new equipment.

Parkview began considering the expansion about three years ago, Danker said. The clinic frequently had to turn away physicians who wanted to practice at the facility since there was only room to staff one doctor at a time.

As the federal government continues to shift reimbursement from inpatient to outpatient settings, it’s more lucrative to enhance outpatient services, Danker said.

"It’s become kind of a cash cow for the hospital as far as bringing in revenue, so that’s where you need to put the money to expand," he said. "And it’s only going to increase in the future; the majority of the revenue is going to be coming from the outpatient side versus the inpatient."

Design for the expansion was overseen by a committee that included Danker, in addition to the hospital’s administrator, the director of plant services and the clinic director.

Demolition on Phase I is underway and the expansion is scheduled for completion in September. Until then, the biggest challenge is maintaining efficient patient flow during construction, Danker said.

"We’ve had to move some offices and take down some patient rooms, as well as move the pain clinic to a different area in the hospital," he said.

"It’s a little further for the patients to walk, but we’re escorting them and making sure no one gets lost in the shuffle."

The new space may also double as an after-hours clinic to help alleviate some of the load on the hospital’s emergency room.

"If the volume in the ER continues to grow as it has, there may be a need for that type of ‘quick care’," Danker said.

Parkview designed the space for both uses but probably won’t decide for several months whether to start the after-hours clinic, which would probably operate between the hours of 7 - 11 p.m.

"Our volume would have to grow," Danker said. "I couldn’t foresee it happening before the next six months or so after the clinic is built."

When the outpatient specialty clinic opened in 1994, it handled only exams, but later added procedures such as stress tests.

The clinic now offers cardiology, nephrology, urology, and has a pain clinic and GI clinic.

Response to the expansion has been positive, Danker said.

"It’s a much-needed service; the employees, patients and physicians all see a need for it," he said.

"We’re thankful we are getting underway with it. I think it will be well-supported by the community.