Niran Al-Agba St. Michael Medical Center Struggles in Public Hospital District


Over the past few columns, I’ve written about the impasse in the emergency department at St. Michael Medical Center (SMMC). Hospital staff are working extremely hard and doing their best, but there are not enough of them to meet the overwhelming demand from patients. Believe it or not, things could get worse.

Yet at the same time, there may be a path to a better long-term future in Kitsap County. I will come back to that later. First, recent struggles and a little background on the system.

SMMC President Chad Melton sent a memo on September 14 titled ‘staff cuts’ which explained that employees in ‘non-patient roles’ had been made redundant due to the hospital’s financial situation. . This was less than two weeks after the Joint Commission issued the hospital a preliminary denial of accreditation, as the Kitsap Sun reported on Thursday, due to “the existence at the time of the investigation of a condition which, in the opinion of the Joint Commission, poses a threat to patients or others served.”

Catch up: Standards of Care Group Issues Preliminary Accreditation Denial to St. Michael Medical Center

At a time when ambulances are piling up outside, local fire chiefs are sounding the alarm about an impending emergency crisis and a patient safety organization is raising red flags, does it make sense to reduce the number of employees in Kitsap County’s only hospital?

This might make sense if one cares more about profits than patient care. Before discussing the non-existent profits and significant losses Virginia Mason Franciscan Health (VMFH) suffered in the first half of 2022, I want to review the most recent hospital merger.

In early 2019, Dignity Health and Catholic Health Initiatives merged to form CommonSpirit, the nation’s second-largest health system, with more than 700 care sites and 142 hospitals in 21 states. Statements from both systems emphasized that “the potential of the combined ministry to achieve scale and impact for Catholic health care is compelling.”

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In reality, the financial outcome of this mega-merger has been anything but convincing: In the first half of 2022, St. Michael lost $18.5 million, according to Department of Health financial reports. And the SMMC is just one of many hospitals in the VMFH park in the red. In total, those in Washington State – including Virginia Mason Medical Center, St. Anne, St. Anthony, St. Clare, St. Elizabeth, St. Francis, St. Joseph Medical Center, St. Michael Medical Center and Wellfound Behavioral Health – reported nearly $250 million in operating losses so far this year.

Some of these losses are obvious. At the time of the merger, the healthcare system had a two-CEO model. After working six months in 2020, outgoing CHI CEO Kevin E. Lofton has earned $17.3 million. One wonders how much he would have been paid to work all year. Co-CEO Lloyd H. Dean earned a whopping $16.7 million while working in the C-suite. I don’t see current compensation for VMFH CEO Ketul Patel or SMMC President Melton , but I suspect they are well paid and considered a necessary expense.

What choice does the CEO of a seven-figure hospital have other than to lay off his most expensive employees? I guess a pay cut for the CEO is definitely out of the question. Of course, Melton consoled himself in the memorandum, saying the decision to lay off employees “affects less than twenty people — or less than one percent of our total staff — and is limited to non-patient roles.”

However, I am skeptical that the number quoted on September 14 is still valid, and I am sure the employability at the start is important. I have heard of several employees who were terminated before or after this date. While the majority were indeed “not in contact with patients”, none of them had worked for the organization for less than ten years. And none of those who have spoken to me have ever had a negative performance review. In addition, some terminated employees were close to retirement. Some held leadership positions. Make no mistake about it, VMFH is above all a company. And he seems to be in trouble.

Today, our community is paying more for less health care than ever before. Due to the stagnation in hospital reimbursement by Medicaid and Medicare, coupled with the expansion of government programs through the Affordable Care Act, hospital consolidation has exploded. Hospital mergers result in fewer hospitals, higher prices, and no improvement in the quality of care. And here’s why you should care about paying more out of pocket for health care: A hospital bed and the health services you want may not be available when you need them.

Niran Al Agba

First, hospital bed capacity has dropped significantly across the country. In 2000, there were 3 hospital beds per 1,000 people in America. Today, that number is down to 2.4 per 1,000. Unfortunately, Washington’s hospital bed ratio ranks lowest of all 50 states, with just 1.6 hospital beds per 1,000 people. And Kitsap County is even worse, with just 1 in 1,000.

Second, one in six acute care hospital beds in America today is Catholic, which means “God’s will” trumps medical decision-making for a large number of patients. In fact, four of the top 10 hospital organizations are Catholic, according to Community Catalyst. Again, Washington State fares far worse than the rest of the nation. In terms of the percentage of non-Catholic acute hospital beds, Washington ranks 49th out of 50 states, just behind Alaska. And the more Catholic hospitals become the sole community provider of acute hospital care in small communities, the less choice we will have about our health care.

Virginia Mason and CHI Franciscan both stressed that this merger agreement would “strengthen Catholic health care”. But what if you don’t want to receive Catholic care? Here is where there is an idea for this community to pursue.

It may be time for Kitsap County to consider forming a public hospital district, a community-created entity authorized by state law to provide health care, including but not limited to health care. limit, acute hospital care. Public hospital districts are formed by a vote of residents and are governed by an elected board of commissioners. It’s one of the only ways to add hospital beds outside of the draconian Certificate of Need system the state uses to allocate the number of hospital beds in a county.

In Washington State, 58 communities have already established public hospital districts, including Mason and Jefferson counties. Forty-four of these entities have hospitals. Fourteen provide other health services such as ambulance, emergency care and nursing home care. Nearly half of all hospitals in Washington State are part of public hospital districts.

Since VMFH has put its faith in God, perhaps our community should consider putting ours in creating a public hospital district. At the rate that VMFH is laying off staff, there will certainly be plenty of qualified, first-rate people who will want and can support an organization that is less dependent on religion and more concerned with supporting our community.

Dr Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at [email protected]


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