SCMH has been a lifesaver for so many people living here in rural Northeast Missouri.  Thank you to the people along the way; nursing staff, doctors, all the ancillary staff (who haven’t been outsourced) for caring for us.  Now, it appears the CEO and elected board members have put our hospital on “life support”.  Their actions, to say the least, have cost the hospital potentially as much as $2,500,000 to $3,000,000 in the last three years.  That is a lot of money!

 How did it happen?  It started when our Hospital brought in an outside pharmacy and refused to work with our local ones, Scotland and Clark County Pharmacies.  The following events have happened.  The elected board and CEO have chosen to outsource local pharmacy, deny the local pharmacies to present projected figures from S.C. Pharmacy and Clark Co. Pharmacy to show boosting revenues for the hospital, and the purchase and transfer of a retail pharmacy within the hospital building using hospital monies.

Two and a half years ago my wife Tina, my father Neill and I met with Dr. Tobler about participating and contracting with the hospital on the 340B plan.  The previous year we had been contracted with the Hospital 340B program as well as the Clark County Pharmacy was too.  At the end of the initial contract in June 2016, negotiations to continued had stalled, but in December 2016 Dr. Tobler approached us and offered us an acceptable contract and we agreed and shook hands that night.  But as it came to be, the offer was never actually enacted.  The reason was, as we learned later, even though we were offered a contract the hospital had already been in talks with a pharmacy from California to come into the hospital.  A month later the board met and finalized the deal.  My wife Tina and I met with Hospital board chairman Curtis Ebeling prior to their January 2017 meeting.  Curtis informed me the board had been negotiating since the previous summer with a pharmacy from California.  The hospital board brought in Memphis Community Pharmacy and offered them the 340B program. 

I know the program may be confusing but to simplify it, it works like this.  When a hospital contracts with a pharmacy, and a patient that sees a practitioner from the hospital fill their prescription at a contracted pharmacy, that fill qualifies for the 340B program.  This allows the hospital to purchase the medication for the pharmacy at an extremely low cost and be reimbursed at the pharmacies retail cost of the medication.  The patient will see no difference in their cost of the prescription if filled at a 340B pharmacy and a non-340B contracted pharmacy if commercial insurance is used.  Their co-pay will be the same.  This is a very beneficial program for the hospital and pharmacy.  I have always expressed an interest in participating with the hospital in the 340B program, before and after Memphis Community Pharmacy was brought in here.  But after MCP was brought here, we were never allowed to be a part of this program again. 

Jump forward to November 6, 2018.  I was approached by the owner of the Memphis Community Pharmacy.  He stated that his pharmacy was for sale and asked if I wanted to purchase it.  He stated the price was $165,001 and if we wanted it, we could buy it.  I met with my father and we agreed to purchase the pharmacy. The reason we agreed to this deal is because we had been trying put a deal together on the 340B program, together for ours and Clark County Pharmacy for years.  This way we had hoped that a comparable or equal program could be extended to the two other pharmacies.  

Part of the proposal to purchase, we agreed to honor the contract their pharmacy had with the hospital, and that we would stay out at their current location. The owner of Memphis Community Pharmacy flew in from California and we met and agreed to finalize the deal.  After the meeting he stated he was going to meet with the CEO the next day and let him know we were purchasing the pharmacy.  After that meeting the owner never met with us again. 

Later I learned he met with Dr. Tobler.  They came up with an agreement for the pharmacy to be purchased through a deal with Dr. Tobler and the hospital.  After the deal fell through, I did not give up hope.  The reason is because when we had tried to get a deal with the owner of the Memphis Community Pharmacy, we were provided a copy of the 340B contract the hospital had with this pharmacy.  When looking at the details I was completely shocked.  The deal the hospital had with Memphis Community Pharmacy was a worse deal for the hospital than the deal we had been trying to get the hospital to agree with us.  That is, if the hospital agreed to the deal S.C. Pharmacy offered, they would make more money and spend less than with the deal they had with Memphis Community Pharmacy.  When I saw this, I got very excited.  I was optimistic the hospital would surely take a deal that was even better than the deal they gave Memphis Community Pharmacy.  This 340B program is a great opportunity for this whole community to benefit.  It would provide more options for patients to receive reduced cost medications and would extend it into Clark County for their patients too.  With this information and newfound optimism, I thought how I could approach this and make something happen.  I hired a company specializing in 340B negotiations and met with them. 

They looked at the contract the hospital had with Memphis Community Pharmacy, then looked at the contract I wanted to do.  This company pulled all my data and determined exactly what I had thought. My proposal would make the hospital more money than the deal the hospital currently had with Memphis Community Pharmacy.  The hospital would also spend significantly less money using my deal over the deal they had with Memphis Community Pharmacy.  After getting our information together, the company I hired contacted Board Chairman Curtis Ebeling and told him he represented my pharmacy and Clark County Pharmacy and asked if we could meet with the board to present our data to them.  He then went on to inform him that if the hospital would sign a 340B deal with us they could make almost a million dollars a year for the hospital.  You read that right, almost $1,000,000 per year just by contracting with us.  Under the contract the hospital had with MCP, if used with our pharmacies (SCP and CCP) the hospital would spend about $500,000 more and make about $50,000 less a year then if they used the contract we have offered.  Now if you are following this, the hospital has not used SC Pharmacy or Clark County Pharmacy for 3 years on the 340B program.  What this means is the hospital has missed out on possibly anywhere from $2,500,000 to $3,000,000 over those three years.  After contacting Curtis, he told us to contact the CEO.  The company I hired contacted the CEO and explained to him we wanted to contract with the hospital.  The CEO asked him to send him the data, which we did.  The data was sent to the CEO, but nothing ever came of it and they never answered or responded to our request to address the whole board. 

I want people to know the hospital can contract with Scotland County Pharmacy and Memphis Community Pharmacy at the same time.  In fact, as of right now the Hospital is contracted with Memphis Community Pharmacy, Knox County Pharmacy and Riders in Kirksville. But they continue to refuse to work with SC Pharmacy or Clark County Pharmacy for some unknown reason. 

Clark and Scotland County Pharmacies have been here in the community for many years, we have built up the number of prescriptions we do by providing excellent prescription service and patient care.  This is how we can benefit the hospital so much.  Revenue generated by our pharmacies could be as much as $1,000,000 a year for the hospital.

The CEO and board continue to shut out local pharmacies, why?  I’ve racked my brain over this for years because there is zero negative to the hospital.  The community in a whole, would benefit from this.  This would add a negligible expense to the hospital with a huge return.  Bringing this much money to our hospital would be an immediate and extremely beneficial boost to our hospital.  It literally is as simple as cashing the check. 

I started looking at the deal with the purchase of Memphis Community Pharmacy in late 2018 and early 2019.  What I found shocked me and started making sense of things.  In previous articles in the Memphis Democrat (1/24/19) Dr. Tobler stated the hospital purchased the pharmacy.  Then in another article (3/20) he stated that the Scotland County Hospital Foundation purchased the pharmacy.  This is very confusing because Dr. Tobler has also stated that because our Hospital is a district hospital, political subdivision, the hospital cannot own a retail business.  Now this last part does make sense to me.  A non-profit, tax supported District hospital shouldn’t be able to use its money, part of it paid for by our taxes, to purchase a business to compete against the very retail business being taxed to support the hospital to begin with.  I would like to know how our hospital can form a foundation and a separate pharmacy company (Memphis Democrat 1/24/19) and do this while being a District, non-profit, and tax supported Hospital.  How can a hospital own its own foundation and how can a hospital own a retail business?  Well when I checked the Missouri Secretary of State Corporation website (https://www.sos.mo.gov/business/corporations) it shows that Memphis Community Pharmacy is owned by Scotland County Community Health Development Services Inc.  When you look that up you find that this corporation is a General For-Profit Corporation, just like any other retail business.  So, who owns this corporation?   Does our Hospital own this “For-profit” corporation?  If so, how?  How can our hospital own a retail business?  Well my guess is the hospital doesn’t own it, they just paid to have this corporation created.  When you look into this corporation you see that the President is Dr. Tobler (Hospital CEO), Vice-President/Secretary is Joe Doubet (Hospital Board), Treasurer is Michael Brandon (Hospital CFO) and the Board of Directors of this Pharmacy is Dr. Tobler, Joe Doubet, and Curtis Ebeling (Hospital Board Chair). 

Look up Scotland County Hospital Foundation on the Secretary of State website, it shows that this Foundation is a non-profit corporation.  Now when Dr. Tobler states the Hospital Foundation owns Memphis Community Pharmacy, I still have the same question.  How can a non-profit corporation own a for-profit business?  I really would love some clarification from the hospital, who are the owners of this pharmacy?  And if the answer is the Scotland County Community Health Development Services Inc, then who owns them? 

It has been reported that the Hospital provided the funds to purchase this pharmacy paying an attorney to create these two corporations.  How much did this cost?  I know the sale price given to me to purchase was $165,001 plus cost of inventory and equipment.  Did the hospital pay that?  If the hospital can’t own this pharmacy or a “For-profit” corporation because it is a District Hospital, how can the Board use our tax supported hospital’s funds to pay for this?  It was also reported that the hospital has now hired the employees from the Memphis Community Pharmacy, and they are now hospital employees.  So, the pharmacy has no employees?  Is it true the hospital will be using hospital employees to cross train with the pharmacy?  Can we just send hospital employees out to work at any retail business? 

I have remained pretty much silent for the past three years, hoping the hospital would look at the revenue generating potential from the locally owned pharmacies.  I want people to know if the hospital would contract with Scotland County Pharmacy, it would be able to generate a large positive NET Profit for the Hospital.  That dollar figure could be a real transfusion for our hospital.   Scotland County Pharmacy has not been asked to present facts and figures to the board and public about potential revenue for our hospital. 

The hospitals own revenue figures continue to show red ink.  Ask yourself, “Is the CEO and Board outspending money and then limiting money coming in by not using locally owned pharmacies as a source of a better cash flow?  Is this their part of the plan so the community will better accept a hospital takeover/management?” 

It is hard to ignore all the outsourcing of jobs, firing or laying off staff and ignoring potential revenue from pharmacies that provide jobs for approximately 45 to 50 people. 

SCMH is the center point of our community, second only to our school system.  It is up to us, we the people, to be the Lifesaver for our hospital.  Make the CEO and board members accountable to us.  Time is short.

Sincerely,

Matt McKee

Scotland County Pharmacy

P.S.

On June 17, 2019, I took a call from SCMH CEO Dr. Randy Tobler.  During the call I inquired about our request to be added to the agenda so we could present to the board.  Dr. Tobler stated we are always welcome to participate in the public comments section of the board meeting.  The public comment section is limited to 5 minutes with no interaction from the board.  I asked about our earlier request to be added to the agenda and he said that it was the board president Curtis Ebeling’s decision on what is added to the agenda and the reason why we were not allowed to present to the board.  I asked about our offer that we sent to him and the board and he said the offer has been refused.  I said our offer will make more money for the hospital then the offer they accepted for MCP.  Dr. Tobler stated the decision has been made to continue the path they have chosen now and that by their failing to respond should let me know their decision was rejecting my offer.  Before getting off the phone, I asked Dr. Tobler “Who actually owned MCP?”  He stated he had no ownership in the pharmacy and that it was a Hospital Board controlled pharmacy.  So, by that statement what is happening is the Board of a non-profit hospital, is operating a for-profit pharmacy and is competing against our pharmacy, which is being taxed to support the hospital.

How is that right?