Turf war
Local hospital districts fight over Bishop.
As Mammoth Hospital prepares to open an expanded orthopedic and physical therapy clinic on Main Street in Bishop, Northern Inyo Hospital (NIH) is soliciting support from local government agencies to prevent the expansion.
“They seem to be opening a much larger facility than what the need is,” said M.C. Hubbard, NIH Board of Directors President. After meeting with Mammoth Hospital CEO Gary Myers and Board members to no avail, NIH CEO Victoria Alexander-Lane wrote a letter, dated Feb. 25, to the Inyo County Board of Supervisors asking for its support.
Hubbard said the letter was a request “to support their district hospital in saying that we think it could be impactful to the financial status of NIH for Mammoth to offer these services,” she said. “We are a public district hospital that relies on public funds that we are accountable for. As does Mammoth Hospital. It is appropriate to ask our Supervisors for support.”
In the letter, Alexander-Lane questioned the “tax burden” NIH will incur due to Mammoth Hospital’s services—services already provided “as well or better” by NIH. She took issue with Mammoth Hospital’s purchase of a digital x-ray machine for the Bishop Clinic, stating that NIH already provides these services and the capital expenditure “could possibly” increase the overall cost of healthcare in Bishop, Hubbard said.
NIH also expressed concerns about bearing the burden of residents who need emergency care after surgery due to infections and complications. “If their doctors are not available they will be coming into our emergency room,” Hubbard said.
Myers sent a response letter to the Inyo County Board of Supervisors on Friday detailing Mammoth Hospital’s history in Bishop. “Ms. Alexander-Lane’s letter infers to the reader that Mammoth Hospital is establishing a new clinic to begin a new orthopedic service in Bishop. This is not true,” he wrote.
Myers explained that Mammoth Hospital opened orthopedic services in Bishop in 2003 at the request of NIH, following the departure of their only orthopedic surgeon. After consulting with legal counsel as to the legality of opening operations outside of their district, Mammoth Hospital opened a clinic on the NIH campus. “Until initiated and requested by NIH in 2003, [Mammoth Hospital] had not previously operated or ‘relocated’ a facility outside of the district territory,” Myers said.
Mammoth Hospital “incurred significant expense to lease the office space, provide all staff, manage and operate the service, ensure compliance, and provide billing and collection services, in order to fulfill its commitment to NIH and the patients of Inyo and southern Mono Counties,” he continued.
In 2011, Mammoth Hospital also opened an outpatient physical therapy clinic. “NIH was aware of the shortage of physical therapy services in the community following the closure of a busy private practice the year before but chose not to address the shortage at that time,” Myers said.
Last summer, the Mammoth Hospital Board decided to lease a space on Main Street in Bishop to consolidate its physical therapy and orthopedic clinics “under one roof for improved patient convenience and service,” Myers told The Sheet, with plans to open the clinic around June 1, after the owner finishes renovations.
The decision addresses the “need to provide larger clinic space with on-site x-ray services to provide quality care, adequate parking, improved patient privacy, and convenient patient access and service,” his letter stated. Myers said Mammoth Hospital hasn’t tried to hide the expansion plans and has discussed everything in public meetings.
“Finally, as to accusations of lack of accountability to provide follow up care, the profession of medicine has well-established procedures to ensure that ethical, moral, and legal standards of practice are followed,” Myers concluded. “As an experienced hospital administrator, Ms. Alexander-Lane should be very familiar with how to assert concerns of this nature regarding the practices of any licensed physician rather than resort to public comments bordering on slander which certainly do not serve her expressed intent of ‘working toward better alignment of healthcare services.’”
Hubbard agreed that NIH asked for Mammoth Hospital’s help in 2003, after the only orthopedic surgeon in the area moved away. However, “there was no written formal agreement,” she said. “It was just helping us out with the surgeries being done in Bishop.”
Since then, NIH has hired two orthopedic surgeons of its own and Mammoth doctors no longer perform surgeries in Bishop. They have however maintained a clinic, where doctors see patients, bringing them to Mammoth Hospital if surgery is necessary.
Although NIH has no issue with Mammoth Hospital’s physical therapy services in Bishop, Hubbard said “we don’t really need orthopedic surgeons in our community taking Bishop residents up to Mammoth to do the surgeries. We asked that our surgeons are the ones taking care of our community.”
Hubbard affirmed the rights of patients to choose their own physicians—“We’re not trying to tell patients where to go,” she said. Mammoth Hospital’s clinic in Bishop is “depriving Bishop of funds,” she argued. “When you’re a district hospital it’s not the best neighborly thing to do to encroach into another district’s area of patients.”
Before writing to the Board of Supervisors, NIH solicited the support of the Mono County Local Area Formation Committee (LAFCO) as another possible avenue to prevent the Mammoth Hospital’s expansion of services in Bishop, but was told LAFCO couldn’t be involved.
LAFCO deals with special districts, mostly utility districts, as communities sprawl and overlap particular jurisdictions. According to Scott Burns, Director of Community Development and County staff assigned to LAFCO, “Hospitals aren’t a clean district in the LAFCO world.” He cited examples of both NIH and Mammoth Hospital frequently sending patients to Reno.
Burns met with NIH and Mammoth Hospital administrators and Board members several weeks ago, given NIH’s concerns. After listening to the issue, Burns raised the question of healthcare district law. “A hospital district can operate within or without their district to the benefit of the district and its people,” Burns said. “As far as we are concerned, [Mammoth Hospital] can operate outside their district as specified by the government code.”
In his estimation, Inyo and Mono Counties “generally work well together. Our region is very collaborative.” He encouraged NIH and Mammoth Hospital to do the same.
The Inyo County Board of Supervisors is drafting a response to NIH’s letter, also asking the hospitals to work together to offer more services to the citizens of both counties, while considering the financial impacts. “As supervisors and as citizens, we support the two districts to provide health care offerings for both communities,” said Matt Kingsley, Inyo County Board of Supervisors Chair.
“It’s a jurisdictional issue. We don’t really have any jurisdiction with any of the hospitals, period. It’s disappointing they aren’t able to work to compliment each other instead of work in competition.”
Hubbard wasn’t aware that the Board of Supervisors discussed the letter last week, and said she wished NIH had been notified in order to argue their case in person. “We took the steps that we thought were appropriate to start the dialogue,” she said. The NIH Board will continue to discuss their options of recourse.
Beck Investigation
There is an ongoing investigation of Mono County Assessor Barry Beck. The investigation reportedly relates to workplace harassment. Allegedly, Beck has sought to punish those within the office who did not support his bid for election last year. Beck, Mono County CAO Jim Leddy and various County Supervisors refused to comment.
Fatalities on the hill
Two skiers died on March 6 & 8 respectively. Both were males in their mid-to-late fifties. One was found unconscious in the Chair 20 area; the other on Dry Creek in the Chair 5 area. Determination of cause of death is pending in both cases.
