Review of Presentations and Discussions
Lee Rule, Surgical Nurse Practitioner at BRRH, speaks at the SEARCH meeting about Surgical coverage at Blue Ridge Regional Hospital
Welcome
Karin Rolett welcomed a room full of people to dinner at Trinity Episcopal Church and asked those attending for the first time to introduce themselves.
Local news and announcements
Ambulance Service. Risa Larsen reported that Yancey County has elected to do their own ambulance service. Mitchell County has settled on AMR Lifeguard, a national company that submitted the lowest bid at $1.385 million a year for five years. Note: Contracts with HCA for ambulance service expire on June 30 so the transition will take place then.
Outcomes Committee. Jon Ward said the committee had that day met with new BRRH CEO Tonia Hale and that a report will be forthcoming and posted on the website.
Nonprofit Status, ION Grant. Susan Larson said that SEARCH is already incorporated in the state of N.C. and has filed with the IRS to become a nonprofit organization.
The Dogwood Health Trust (DHT) recently awarded SEARCH a grant to upgrade the website and to study other successful community engagement projects as models for ways to proceed in our local community. The Tipton Hill Community Foundation also received an ION grant, theirs to conduct a feasibility study to make the main floor of their building accessible and useable by the community. They plan to apply to DHT for help through the Leverage Fund to apply for funding to do the project.
Meetings with the Independent Monitor – Victoria Hicks
Victoria Hicks said that between SEARCH and the Health Equity Coalition (HEC) we had someone at each of the seven sessions so we have a comprehensive view of the sessions in the region. The findings were not rosy. People told of unsafe conditions, particularly at Mission Asheville, billing problems, difficulty accessing charity care, etc.
Representatives of SEARCH and HEC met privately with Ron Winters of Gibbins Advisors, the Independent Monitor group, along with John Ball, head of DHT’s compliance committee. Victoria explained that only DHT and the Attorney General (AG) have the authority to sue HCA for non-compliance of the APA (the original agreement). Many of the points of frustration are not strictly within the scope of what Gibbons is monitoring. Even if a service exists on paper, it may be inaccessible to patients. Logging diminishment of mandated services is critical. Legislators in Buncombe County did that and read a letter detailing problems at the Asheville meeting with the Independent Monitor.
Victoria distributed a handout (attached) of places to contact with concerns about the services provided by HCA and suggested that entries be copied and sent to all the places on the list.
Question came up on what’s happening with the unionizing of the nurses in Asheville. Response was we don’t have first-hand knowledge but it doesn’t appear to extend to BRRH.
People spoke highly of Blue Ridge Regional Hospital at the IM meeting. BRRH Advisory Board Chair Alex Glover said Tonia Hale is doing great. He acknowledged, however, that nobody knows who is on the advisory board. He said that names and photos will be posted in the main entry and he will check on whether members can be contacted by email. At this point he suggested writing a letter to the board if there are concerns. He will answer letters.
Mitchell County Transportation and three-county transportation grant – Sheila Blalock
Sheila Blalock, the ED of Mitchell County Transportation, said the service puts in about 350,000 miles a year. They take people to medical appointments all over the state but primarily to Asheville (twice a day, 6-7 people each time, for appointments). They also take people to the airports in Asheville and Charlotte. They accept Medicaid. Grant funds supplement their services. They serve newborns to age 101. Though they strive to be economically efficient, they do have the time to hear people’s stories.
Through a grant which Sheila applied for to the AMY Wellness Foundation, the transportation services of three counties have been able to upgrade their IT with new software where needed as well as well as new iPads, chargers, support from the software company and cell service for two years. It enables each county to see where their drivers are, to keep track of fares through automation, and to save schedulers hours of time. They are now beginning to coordinate rides county-to-county, particularly with Asheville trips.
Local preparation for potential COVID-19 virus outbreak – Diane Creek
Diane Creek, who is head of the Toe River Health District (TRHD) repeated the advice we have been hearing - wash your hands, cough in your arm, stay home, but don’t be stressed or afraid.
She had just returned from a meeting in Asheville with Gov. Cooper who issued a state of emergency so that N.C. can draw down FEMA money and also use the ICS system now. This allows efforts to be organized state-wide. Diane expressed confidence in the way it’s functioning now.
A primary concern is the shortage of kits for testing. TRHD ordered kits for health department. In order to be tested a person must meet these criteria: 1) Fever 2) Cough 3) Have to feel BAD 4) Have to have traveled down the mountain (UPDATE: As of March 15 there is a case in Watauga County – person had traveled outside of US and is self-quarantined and doing well.)
Gov. Cooper issued recommendations for people over 65. You need to try to avoid large groups of people. (Laughter in room as most in the room were over 65!) UPDATE: Gov. Cooper has closed schools until March 30 and has mandated no gatherings over 100 people.
Two tests required. #1. Health Department takes it and sends sit to the state. If it comes back positive that’s a presumptive. #2 . Sample test #2 gets sent to the CDC in Atlanta and if it comes back positive from the CDC, then it’s confirmed.
Diane gave U.S. statistics as of 3/10/2020: 423 cases (presumptive & confirmed), 19 deaths. UPDATE: Five days later 3/15/2020 there were 3,482 cases.
She said that if you have a presumptive positive test result, you may not feel sick, but you should stay home for two weeks. There was one required quarantine in the area, but then the test came back negative. The following numbers are self-quarantined but are not sick: Mitchell – 1, Avery – 3, Yancey – 6 or 7. UPDATE: These tests (by the health departments or private providers) have all come back negative.
Her advice: If you have traveled, if you have a fever and start coughing, call your doctor or health department. Don’t go to the office.
There was a question about supply-chain disruption. Does the Governor’s decision to declare a state of emergency deal with that. Answer was yes. And the Governor has met with insurance companies and Medicaid to make sure the people who need the test can get it.
One test is $300. LabCorp can run tests - $1,500. UPDATE: These amounts are in question. According to MCHP, LabCorp’s cost is $50.
Diane spoke encouragingly about the many partners working to address this crisis – first responders, and other agencies. She was asked how we can get this information out to the community, like to churches. She said that Emergency Services is trying to put out an email that can be forwarded to agencies, churches, individuals, etc. If a person is quarantined, you can still leave food on the porch, but don’t go into the house. Also, don’t get your information from the news; they are just scaring people.
Get your information from the CDC, the NCDHHS.gov website (or their Facebook page) or from the Health Departments’ Facebook pages. Their top priority is taking care of the people in the counties.
A final word of advice: If you haven’t yet, get your flu shot. Get a pneumonia shot. Alleviate the stress on the healthcare system.
UPDATE: Diane Creek says, “ I posted on each health departments Facebook page that if someone has questions they can send those questions to their health department's main email: yanceyhd@toeriverhealth.org, mitchellhd@toeriverhealth.org or averyhd@toeriverhealth.org.
Access to that email address is extremely limited. So I will pull those questions off the email, post them on Facebook and answer them. I will take any identifying information off of the question so no one knows who is asking. “
Updates on our health organizations: Surgery at Blue Ridge Regional – Lee Rule
Lee is an NP who has worked in surgery at BRRH for seven years. BRRH used to have a 24/7 full service surgery center. Dr. Robinson was very busy and there was talk about bringing on a second surgeon. In year two of being Mission owned, they chose to combine surgery with Marion in a 3-surgeon model between two hospitals, but call was hard to manage. They said the volume didn’t justify two surgeons at each. Up until January there were three surgeons and two nurse practitioners. One surgeon was let go. Last month one of the remaining surgeons broke his hand, so we’re down to one surgeon with no surgical coverage at BRRH. They’ve hired some locum tenens surgeons, but if you now show up at BRRH, you will be transferred. That’s a major change for the hospital. Running a hospital without surgical backup is difficult – potentially unsafe. There is a recruitment effort underway, but it is difficult to recruit to a rural, isolated area, especially to recruit young doctors. The APA says that “surgical services” will be provided, but right now, that’s a phone consultation. Does that really fit the provision of services? And working with temporary services (locum tenens) is not ideal as there is no time to develop community trust.
There are major roadblocks. Surgeons just coming out of residency are not equipped to be rural doctors. They need a few years of experience and a backup. There’s a medical legal risk in being responsible for two hospitals 30 minutes apart. Also it’s difficult to sell the amount of call required in working in a rural area.
The volume is low now and BRRH is down from three operating rooms to one, open 4 days a week. On the plus side, we have good nurses and we still have the potential to provide good care.
Susan Larson said that this is a call to action. Let the needs be known to the board, speak to administration. Susan said that it is already a top priority for Tonia Hale.
Dr. Liz Peverall said that sharing with a second hospital model may need to be revised. Surgery isn’t just one service. It underpins so many other services that the lack of it diminishes many other services at our hospital.
A question was asked, at what point did surgery become unprofitable in the hospital’s estimation. Lee Rule’s answer was that it is not unprofitable.
“What should we ask for?” was the question. The answer: 24/7 coverage at BRRH, not shared with Marion. Susan reported that she had just asked Tonia Hale when that might happen, and the response was maybe next year.
Who has the power to make that decision? HCA
Dentistry at MCHP – Dr. Alex Green
Dr. Green, a Spruce Pine native, will be the new dentist practicing under MCHP’s auspices across from the Bakersville Medical Clinic in what was the Toe River Dental facility. The clinic, about 8 weeks from opening, will take all ages. They will offer comprehensive dental services including crowns, bridges, cleaning, partials, root canals. They will use nitrous oxide, not IV sedation. They will not do implants or implant services. They plan to grow, but it will just be Dr. Green to start. He intends to start slowly, going with recommendations from MCHP. He said they are funded mostly through grants: BC/BS Foundation, NC department of Commerce, Sisters of Mercy, NC Department of Rural Health. They hope to have a May or June block party to celebrate the opening.
Dr. Alex Green, new Dental Director at Mountain Community Health Partnership
in Bakersville, speaks about the new dental office there.
Philanthropy – Susan Larson
Susan reminded people that SEARCH is an organization run by volunteers and that it welcomes contributions of money and time. She circulated a sheet (attached) which asks that people self-identify the ways in which they can become involved.
Dr. Randy Ellis, the chair of the AMY Wellness Foundation, told about the three workshops for nonprofits that are being offered free and suggested that organizations go to their website and sign up: amywellnessfoundation.org.
Next meeting: Tuesday, April 28, First Baptist Church, Burnsville. (Of course, this depends on health status in the area.)