Dear Editor:

Missouri’s Sunshine Law is the embodiment of Missouri’s commitment to openness in government. Scotland County Hospital & Clinics is designated as a District Hospital and a Political Subdivision, with elected Board of Directors as such. Our board meetings are open to the public. Every answer to all questions posed in Mrs. Shultz’s Letter to the Editor have been discussed and disclosed in the monthly board meetings. I urge citizens to not only attend the board meetings for the public comment portion of our agenda, but don’t leave after that, rather stick around for the full meeting to hear the discussions and decisions that the board makes. Come to the board meetings. It’s part of our strategic plan to involve the community in the business of your hospital. Board meetings have always been open to the public as a public forum for community engagement. Our hats are tipped to Mrs. Shultz for attending the Public Comment portion of several monthly board meetings. Mrs. Shultz is to be commended for attending the board meetings exercising her citizenship privilege to speak during the public comment agenda.

We maintain that a public meeting, as requested by Mrs. Shultz, is not needed as that occurs every month at our board meetings. Your Hospital’s “meeting allowing for public concerns” occurs every month for 4 – 5 hours. Board agendas are publicly posted each month, at least 24 hours prior to the start of the meeting. Additionally, there are other committee meetings posted  that the public is encouraged to attend to understand even further the complicated and expansive issues that we face in healthcare and the pressures of keeping our small, rural and remote hospital on the map and providing a broad list of services to the communities.

There is a five person executive leadership team of employees that shares recommendations and their rationale to the board that then either modifies or accepts recommendations. It is a team effort between paid staff and volunteer board members. These volunteer board members are your neighbors and represent six geographic districts in this county. I ask the readers, who do you think falls short in “considering good business practice measures when making decisions affecting our community, patient population and employees”? We would respectfully ask people to consider why it would be in anyone’s interest that is leading this organization and are regular patients of  the services, as well as their families and their neighbors, to do anything other than that which is in the best interest of this hospital and maintaining these healthcare services in this community? We are the only community in the area that holds a hospital as a community asset. I believe I can speak with certainty that everyone understands how fortunate we are to hold this community asset and our investment in protecting this asset. Again, with certainty I speak, none of us hold that authority lightly. One would have to suspend reasonable judgment to assume otherwise.

We have regularly scheduled quarterly outreach to our patients through our Quarterly Community Discussion Forums where 30-50 invitations are sent to random former patients inviting them to have lunch and discuss their experiences with administration, voice concerns, have questions answered and offer suggestions. I give each attendee my personal (and only) cell phone number.  If you are a citizen that has attended one of the Quarterly Community Discussion Forums, please be our advocates in the community to share your experiences of the forum with your circle of friends & family about my transparency in answering your questions and responding to your suggestions.

As Mrs. Shultz pointed out with empathy, the business of healthcare is “challenging and conflicts do occur.” As the leaders of your hospital, we have to make difficult and admittedly controversial decisions, after having done our due diligence. But, those decisions are openly discussed in our monthly board meetings.   

Today’s hospitals, whether rural or urban, are challenged to improve quality while reducing costs. More than ever, physicians, advanced providers, nurses, staff and their communities need to work together to find innovative solutions to provide and maintain effective, high-quality care. We understand times are difficult and healthcare is arguably the most complex & volatile industry in our nation right now. We appreciate your patience. We are honored and humbled when you walk in our doors and trust us to take care of you. We invite your questions and your suggestions. If anyone would like to schedule a private meeting with me to answer your questions, I am happy to have those conversations. If anyone wants to hear the discussions about your hospital, please attend a board meeting. The next meeting is March 28th in the hospital conference room at 5:30 pm.


Randy Tobler, MD, FACOG, CEO

Scotland County Hospital