St. John’s Board Responds
The Wave received a copy of a letter the Medical Executive Committee at St. John’s Hospital sent to Reverend Lawrence Provenzano, the president of the board of trustees of Rockaway’s only hospital. The letter expressed “no confidence” in the current CEO Rick Brown and his administrative team. The letter also listed 10 complaints and called for the CEO to be replaced.
Although The Wave attempted to get a response from Provenzano before press time last week, it did not receive one until late Friday night.
What follows is the response Provenzano sent to the Medical Executive Committee at St. John’s.
Dear Sir or Madam:
This is in response to the unsigned letter that was received from the Medical Executive Committee dated February 11, 2014. Though it is my general practice not to respond to unsigned correspondence, the nature of the allegations set forth in your letter requires that a response be given.
I, together with the Board of Trustees, maintain that Mr. Richard Brown has made, and will continue to make, significant operational improvements and structural changes to St. John’s Episcopal Hospital that ensure increased quality of service to the community and strengthen the long-term viability of the institution. In fact, at its most recent meeting held on February 12, 2014, the Board of Trustees adopted a resolution expressing its continued confidence in Mr. Brown.
With respect to the specific allegations in your letter, I will address them one at a time below:
1. Violation of the medical staff bylaws.
The problem with this accusation is that the medical staff bylaws are just that—bylaws intended as guidance for the governance of medical staff. Though you have failed to identify any specific bylaws that were violated, the bylaws themselves do not govern the administration of St. John’s or its Board of Trustees.
2. Mismanagement of the nursing homes’ affairs that led to continuous loss of revenue to the nursing homes and leading to sale of the asset.
The decision to sell the nursing homes so that Episcopal Health Services Inc. might devote all of its energy, talent, and resources to St. John’s Episcopal Hospital was made by the Board of Trustees on October 11, 2011, long before Mr. Brown was affiliated with St. John’s. (Mr. Brown began his affiliation with St. John’s as Chief Operations Officer in February, 2012.)
3. Poor management of the laboratory services that led to closure of the blood bank and near closure of the hospital, which the institution has not recovered from.
Though it is true that mismanagement by the former Laboratory Manager and Chief Pathologist led to the temporary takeover in laboratory and blood bank management by North Shore LIJ, at no time was the hospital in jeopardy of closing. It is Mr. Brown and his management team who are responsible for taking the actions necessary to resume direct control of laboratory and blood bank services; they are confident that this will take place in the near future.
4. Actions leading to the significant loss of business of the wound care program and the hyperbaric treatment center with significant loss of surgical volume at the institution.
The prior physician leadership in Podiatric services, which includes wound care and the hyperbaric treatment center, was responsible for the poor business performance in the Department. The present hospital administration is responsible for removing the underperforming Podiatric leadership pursuant to the discovery of improper activity that was reported to the Office of the Inspector General. Following the change in leadership, the 2013 volume in podiatry has been growing with services expanded to include Plastic Surgery.
5. Outsourcing of the cardiology services with continued decline of the services and exodus of the cardiologists.
The present administration is responsible for solidifying an affiliation with St. Francis Hospital, the premiere cardiac hospital in New York State. The average rate of morbidity and mortality for cardiac patients at St. Francis is more than 10 percent below the national average and has been ranked by U.S. News and World Report among the top 10 hospitals for cardiology and heart surgery for the seventh year in a row. Though it is true that two private practice cardiologists sold their practices to nearby institutions and one cardiologist retired, St. John’s benefited from the addition of two new Cardiologists from St. Francis and looks forward to a Chief of Cardiology from St. Francis that will begin his tenure within the next 30 days.
The partnership with St. Francis has already saved St. John’s $360,000 in professional fees and, with the increased quality of care, will greatly enhance services to patients.
6. Closure of the outpatient primary care services of the institution including pediatrics, divesting the institution of the valuable services that are urgently needed by the community. They now are attempting to recreate outpost clinics after giving away the existing one.
In May 2013, the New York State Department of Health recommended that the hospital form a close working relationship with the Joseph P. Addabbo Family Health Center in order to enhance services to the patients of the Peninsula. The Internal Medicine and Family Practice residency programs have been expanded and have greatly benefited from the relationship with Joseph P. Addabbo Family Health Center. In addition, the hospital has established private primary care practices in Belle Harbor and the Five Towns, making primary care more accessible for many patients in those areas. There are further plans to establish private primary care practices in Arverne and other communities.
7. Recklessly attempted to divest the hospital of the inpatient and outpatient dialysis until it was opposed which forced a re-thinking of their strategy. More dialysis treatment stations were recently approved for the institution.
The current administration conducted a thorough analysis of the dialysis services in December, 2012. At no point was there an attempt “to divest the hospital of the inpatient and outpatient dialysis.” Instead, as a result of the analysis, the administration added another shift in the dialysis unit, which has resulted in the ability to treat 14 additional patients every day. This type of analysis and decisive action for the benefit of the hospital and surrounding community is exactly what the Board of Trustees expects of its CEO and administration.
8. Closure of the badly needed inpatient chemical dependency unit without the approval of the office of department of health, thereby depriving the institution of the revenue and the community of the services.
The chemical dependency unit was closed as a result of a continually low occupancy rate (50 percent in 2011), which is well below what is necessary to keep a chemical dependency unit open. Additionally, the failure of the Department of Psychiatry to better manage these patients given the NYS reimbursement regulations resulted in a $1.2 million loss of reimbursement to the Hospital. The combination of this loss and the low occupancy rate were the main factors requiring closure of the unit.
9. Termination of the Chairman of Psychiatry, which risks loss of one third of the admission and discharge of the facility.
The termination of the Chairman of Psychiatry, which took place on February 5th, 2014, honored the terms of his contract with St. John’s Episcopal Hospital. There is now a new Chairman of Psychiatry and admission rates in the Psychiatric Department have remained the same as they were under the former Chairman. Furthermore, the psychiatric admission rate for the hospital is a mere 7 percent of all admissions and in no way jeopardizes the finances of the hospital.
10. Hiring a recently indicted company to run the psychiatry department after he was fully aware of the indictment and the settlement reached with the office of inspector general by the group. He thinks that since they settled and admit no guilt, it is acceptable to hire them.
The Office of the Inspector General (OIG) does not have the power to indict any party. The company that was engaged to manage the Department of Psychiatry was audited and subsequently cited by the OIG in matters related to billing management. This resulted in the execution of a Corporate Integrity Agreement, which was signed by the company. The hospital administration in conjunction with legal counsel reviewed the billing procedures currently in place and determined that such billing procedures comply with the Corporate Integrity Agreement and all relevant Federal and State regulations.
Based on all of the foregoing facts, the Board of Trustees has every confidence in Mr. Brown and has no intention to replace him. It is our belief that he and his management team have made decisions that have substantially improved care at St. John’s while also maintaining the financial integrity necessary to sustain service into the future.
In closing, may I suggest to the Medical Executive Committee that its members continue to devote their energy and considerable skills to the care of our patients at St. John’s Episcopal Hospital.
Signed, The Rt. Rev. Lawrence C. Provenzano.