Our family is thankful to have S.C.M.H. We are blessed to have quality doctors. Doctors: Davis, Wilson, Martin, Hoyal, Nissembaum, Rollins, Miller-Parrish, Baily and others have brought David thru numerous critical and acute health issues.

The Nursing Staff, along with Radiology, Lab, OT, PT have provided consistent quality care over the years. This letter is no way a negative commentary on patient care given by staff.

Our hospital has been a plus for rural Northeast Missouri, serving a diverse population. It has served the people well, overcoming numerous challenges. Over the past several years, new issues have become problematic for the hospital.

This letter will review the history of S.C.M.H., address concerns related to changes in policies, outsourcing of resources and administrations attitude impacting the community.

Let’s begin with the history starting in 1970. Land for the hospital and nursing home was purchased from the Charles Harris and Gerald Gray families. Hollis Boyer and other board members used the talents of a young attorney, Dick Webber, who later became a United States Federal Judge, to formalize the beginning of the hospital. Construction began and the community had a 25-bed hospital.

Over the years, Marcia Dial and staff wrote numerous grants not only for the hospital but included community projects. Working with the school system, sports physicals for Scotland, Clark and Schuyler schools were based from the hospital. I believe grants were also written for the ambulance districts here and adjacent counties. Over the years, rural clinics were established.

If memory serves me, I recall grant money for the Women’s Center; Cardiac Rehab Center; Medical Building; Library and funding for the hospital and clinic expansion. She and others recruited and maintained staffing and attracted specialty services. Board Certified Emergency Room Doctors were a part of the hospital. Several young doctors returned to the area.

Yes, there were challenges to a growing hospital, conflicts do occur. Using “Due Diligence”, Marsha and others resolved issues with the best interest of the hospital, employees and community.

Today, our health care environment is being challenged. Federal regulations, decrease in reimbursement are issues that cannot be resolved on a local level. Issues we can deal with are outsourcing of hospital jobs, local businesses and maintaining quality staff. We, the community should be participants, not onlookers.

Outsourcing has had a negative impact on the community over the years. Case in point is the “National Garment Factory”.

Memphis Mayor Harold Davis and Regional Planning were responsible for recruiting the Garment Factory to base part f its production line in Memphis. Approximately forty jobs were a transfusion of money to the community. What a fantastic stimulus for this rural economy!

Sadly, the federal government gave business a green light to outsource clothing manufacturing to China and Mexico. The garment factory closed, jobs lost. Incomes for families became negative. That is a lesson we should remember. It is relevant to our hospital today.

Outsourcing jobs and businesses is becoming the norm at S.C.M.H.. Outsourcing not only affects employment in the community. It also signals to the community we have no people with intelligence to perform the jobs at the hospital. Granted, the hospital does place ads for some positions, but not all.

There are several concepts that apply to the business of managing a hospital. Due Diligence and Request For Proposals are both important concepts in management. I used the phrase “Due Diligence” in addressing the January board meeting.

“Due Diligence” is an investigation or audit of a potential investment or product such as reviewing all financial records plus anything deemed material. (source: Investapedia)

Conducting Due Diligence is 1.) gather documents about business structures and practices 2.) inventory all physical assets prior to buying a business 3.) review all contracts with suppliers and subcontractors.

Request For Proposal (RFP) is just that. Usually it is a minimum of three proposals.

Recently, the current administration and Board has promoted outsourcing the following:

1.) A pharmacy to a business located outside of Missouri, then the hospital or others bought the pharmacy as a foundation. There may be two documents showing ownership by the same agent. The question is; did the board and administration do an RFP (Request For Proposal) from several pharmacies in the area?

How much money did the hospital lose in this transaction?

How was the purchase of the out of state pharmacy paid for?

2.) Outsourced a Senior Health Survey to a company in Arkansas. How do we know our health care history is secure? What amount of the $260.00 comes back to S.C.M.H?

3.) Part of billing was outsourced.

Did they get training on changes in coding and updates? What percentage is the hospital making and how many RFP’s were solicited?

4.) Housekeeping was outsourced. Again how many RFP’s were solicited?

5.) The ambulance district was asked to probably find a different location for the ambulance district. Language is very vague on this issue. How will the hospital use the existing building if it is not used for the ambulance?

6.) QI is being outsourced. Why?

7.) How many employees have left the hospital in the last 3 years?

Over the past several months I have been attending board meetings to assess the interaction of staff, administration, and board. I have been concerned about the lack of staff in a particular department of the hospital. In December, I attended the board meeting to address a situation I personally observed. Dr. Tobler called the afternoon of the meeting to see if I would be attending. My reply was yes. I arrived. Under public comment, a board member informed me I only had five minutes to address the situation. Another board member chimed in that this situation should have been written up and not brought up at a board meeting. “Are you kidding me” was my thought. What an interesting way to tell me to leave.

I have worked in numerous hospitals and different departments, one being ER. This is one area that is primary to patient care. This department has a staffing problem.

Prior to the meeting, I had reviewed organizations that find qualified staff with military backgrounds that are leaving the service. MOAA (Military Officers Association of America) has a transition team that could possibly help this hospital in recruiting doctors, nurses, medics, corpsman to S.C.M.H. I have worked with several doctors who have served overseas in MASH units. They have skills that could benefit this hospital. No interest was indicated. What an attitude! Most of the people at the board meeting have never served in the military.

In January, I was allowed to give some remarks and again brought up the subject of MOAA and their transition team. Human Resources picked up on the idea. Hopefully, HR and I can teamwork to help recruit talented staff to work with current staff.

Upper administration and the board should consider good business practice measures by using care, caution and time when making decisions affecting our community, patient population and employees. S.C.M.H. has worked long and hard to be an outstanding facility.

Members of the community and myself, request Dr. Tobler and the Board, have a meeting allowing for public concerns to be addressed with truthfulness. FYI: If the public wants to ask questions concerning issues with the hospital, ask to be placed on the agenda so the five minute rule will not apply.

Lee Ellen Shultz, RN, BSN