Will NIH get the last LAFCO?

Mammoth and Northern Inyo hospitals are still in a tug of war over broken bones and pulled muscles.

The issue of a new Mammoth Hospital owned and operated orthopedic and physical therapy clinic (to be housed next to Mountain View Animal Hospital) in Bishop was brought before the Inyo Local Agency Formation Commission on Monday for further review.

Currently, Mammoth operates its physical therapy clinic out of an off-site building near the NIH campus and its orthopedic clinic on the NIH campus.

However, and this is a curveball, Mammoth recently learned it will have to fill out an application with LAFCO to get permission to operate outside of its district.

Mammoth has been operating in Inyo County outside of its district for several years now with tacit verbal permission and even encouragement.

Turns out that written permission is required.

The matter has been placed on LAFCO’s June agenda for probable action. Whether or not the new facility will be welcomed, or even open, has yet to be determined.

LAFCO commissioners said they hoped the issue could be resolved before then by the two parties without going through a formal application process.

A new clinic would represent an expansion of Mammoth’s existing physical therapy and orthopedic services in Bishop. NIH and the Northern Inyo Healthcare District are worried that the 6,400-square foot clinic on Main Street, anticipated to open by June, is too big and will draw customers away from the local hospital.

NIH asked the Inyo County Board of Supervisors to intervene in February, but it wasn’t within the board’s jurisidiction and it passed the matter to LAFCO, an agency which typically handles inter-county issues. The Inyo LAFCO heard the matter and read letters from NIH and its Board of Directors.

LAFCO Commissioner and Inyo County Supervisor Jeff Griffiths explained that Inyo LAFCO will receive the application from Mammoth and determine whether or not to allow the new clinic to operate outside of its district. He said that according to County Counsel, Mammoth and the Southern Mono District have been operating without legal authority in Inyo.

Griffiths and representatives from the Inyo County Planning Department said they were not sure what recourse Mammoth would have if the application is denied.

No one in Inyo County said the Southern Mono Healthcare District could build a new facility, according to NIH. According to Southern Mono, it didn’t think it had to ask. After all, the only reason Southern Mono is in Northern Inyo at all right now is because it was invited.

NIH asked Mammoth to lend a hand with orthopedic surgeries due to a lack of staff in 2003. NIH was also agreeable to Mammoth opening a physical therapy clinic on West Line Street in 2011 following the closure of a physical therapy private practice in Bishop and NIH’s lack of interest in opening its own P.T. facility. Then-NIH CEO John Halfen said in an interview in 2011 he was fine with the idea and wished the new clinic luck with finding customers.

Mammoth Hospital CEO Gary Myers stated in an email Wednesday that following the clinic opening in 2011, business increased. He said there was room for expansion on the second floor of the West Line Street physical therapy clinic, but walking up stairs is not conducive for physical therapy – its hard to walk up a flight of stairs for P.T. with a cast on a leg.

“Both our services have gotten busier in Bishop over the past few years so we are renting ground floor space on South Main St. with much better access and parking to co-locate both clinics under one roof,” Myers stated.

While California Health and Safety Code 32121 states a district can serve outside its boundaries for the benefit of those in the affected district, Government Code 56133 states that a district must receive permission to operate outside of its own district. There are no written or formal agreements made between Mammoth and NIH about the shared services, it was just a neighborly thing to do, especially in a small, isolated area.

“As you might imagine, we are a bit taken aback by all this given that we’ve been in Bishop all this time and no one has protested our presence previously,” Myers stated in the email. “But we will take whatever action is right and proper and try to work through whatever reasonable process that may exist to satisfy whatever legitimate requirements there may be to continue to offer our services to the people of Inyo County. We just don’t know what that looks like yet.”

NIH Board member, Dr. John Ungersman said in an interview this weekthat there are obvious financial concerns for Bishop and NIH. There may not be enough patients to support an expanded specialized facility, Ungersma said. The patient pool could become too shallow for anyone to make a living in. He pointed to probable financial concerns Mammoth could be having because of years of drought and weak ski revenue. He saw the expansion as an attempt to make up for that loss.

Orthopedic Surgeon, Dr. Mark Robinson who worked for both hospitals and is now chief of staff at NIH, said at the February LAFCO meeting that there may not be enough patients or practice in Bishop to keep so many orthopedic specialists busy.

Bishop City Councilwoman and LAFCO Commissioner, Laura Smith said she has been asked why Mammoth is being allowed to come into Bishop and steal business away from the new and expensive NIH and from others who have raved about Mammoth Orthopedic services. Smith, a nurse and teacher, added that Bishop had been in need of sport’s medicine specialists for years. Now, there may be too many.

Griffiths said he hoped the two hospitals could work out this matter between themselves. “They are both community hospitals,” with residents from both counties visiting either hospital, Griffiths said. He said he considers both Inyo and Mono one big community, “They (the hospitals) should work together.”

There are currently eight orthopedic surgeons serving the Mammoth Hospital Orthopedic and Sports Medicine clinic, three of which also serve the Bishop clinic. There are two orthopedic surgeons at NIH, with two more newly added to staff. One of NIH’s surgeons is Robinson.

According to the American Academy of Orthopedic Surgeons, there are an average of 7 to 11 orthopedic specialists per 100,000 population. There are currently at least 10 specialists serving both Inyo and Mono counties, with a population, according to current US Census data, of 18,410 in Inyo 13,997 in Mono, or approximately one orthopedic surgeon per 3,200 people. The ratio is large, but the Eastside is also a mecca for atheletes coming for high-altitude training or a taste of the world-class climbing, skiing and biking. These sports are all inherently dangerous and can lead to a visit to emergency room or an orthopedic clinic.

There were no numbers available for how many orthopedic patients either local institution handles or a price list for procedures. New websites that let consumers compare hospital prices, like newchoicehealth.com, does not include tiny Inyo or Mono counties in its data base.However, health.costhelper.com estimates the average price of an knee surgery, or anterior cruciate ligament (ACL) repair, for example can run between $800 with insurance to $50,000 without. An ACL repair cost includes the surgeons fee, the anthestheologist fee, the hospital fee, physical therapy and admisitrative costs and performed by the army of workers from the CEO to the janitors.