As if dealing with the trauma of breast cancer wasn’t enough, Martha Yonce, 62, was also hit with a devastating $80,000 in out-of-pocket expenses for her surgery, chemotherapy and radiation.

Yonce, a Franklin resident, thought she had her bases covered with the equivalent of a state employee’s health insurance policy. She received the insurance through her husband, who was a science teacher at Macon Middle School at the time.

Yonce’s insurance company had agreed to pay 80 percent of the cost but left her to deal with the remaining 20 percent in whatever way she could.

Coming up with such a large sum of money proved to be a major struggle, as Yonce and her family neared the brink of bankruptcy and almost lost their home.

“We wiped out what savings we had,” Yonce said. “It just took everything we had. That was nine years ago, and we’ve never really recovered financially.”

To make matters even worse, Yonce and her husband were recently denied insurance coverage that would supplement Medicare due to pre-existing conditions, including her breast cancer, and his diabetes and heart problems.

Even though Yonce has been cancer-free for years, she said the worry about recurrence never goes away.

“Good days are days you don’t think about cancer,” said Yonce. “You know that if it recurs, you are going to have a tremendous financial burden. You’re going to do all you can to save your life and treatment costs money — even with insurance.”

Yonce said she recalled taking medication for nausea that cost $100 a pill, while other women went without because they simply could not afford it.

“The thought of somebody that’s kneeling at the toilet vomiting and there’s a medication out there that can help them and they can’t afford it, that’s sad, that really is,” said Yonce, who has actively been calling for health care reform in the past year.

Yonce has attended rallies and made frequent calls to representatives and fellow citizens in the past few months. She hopes that Congress will pass a health care bill that places a cap on out of pocket expenses.

Yonce said she was surprised by how many sad stories she came across while working at a phone bank. She once talked to a man who was asked to pay $900 cash for anti-rejection medication after receiving a kidney transplant and a woman who broke her hip but could not afford to go to the hospital.

Despite all the gloomy stories she’s heard, Yonce has managed to retain a sense of humor.

On a recent afternoon, Yonce prepared to go door-to-door to distribute flyers that featured a man named Vernon whose inadequate health insurance left him $28,000 in debt.

“This guy is not in as bad shape as me,” joked Yonce. “Vernon, you don’t know how good you’ve got it.”

Nothing could have prepared Franklin sisters Suzanne Thomas and Karen Rice for the total financial ruin that followed their injuries.

Thomas, 63, and Rice, 70, are still coping with the impact of astronomical medical costs from nearly a decade ago, while another sister Shirley Ches, 74, is dealing with a health insurance bill that already scoops up about 33 percent of her household income and continues to climb significantly each year.

Thomas had to file for bankruptcy, while Rice had to move into a mobile home, giving up electricity and washing machines in the meantime. What astonished the sisters most about their plight was that they both had what they considered good health insurance when their injuries occurred.

Ches, Rice and Thomas have channeled the anger and frustration of their experience into an active fight for healthcare reform across the country, helping to organize vigils, sending petitions to Washington and sharing their story with crowds of strangers.

“We have all made a career out of writing letters to the editor,” said Ches.

Through their activism, the sisters have realized they are far from alone in their hardships.

“When you go to these things, you find people with phenomenal stories,” said Ches. “We’re shoulder to shoulder with so many people.”

Losing it all

Thomas had been perfectly happy with her health insurance before she suffered a major shoulder injury due to a fall in 2000.

“I had wonderful insurance. I didn’t worry about a thing,” said Thomas, who never hesitated to visit the doctor, the dentist or optometrist.

Two years later, Thomas had not only lost that health insurance, but also her job, her home and her good credit. Thomas had to file for bankruptcy and move from her two-bedroom apartment in rural Michigan to Ches’s home in Franklin about seven years ago.

It was all the result of a ruptured spleen that doctors didn’t even discover until two days after her accident. Thomas had complained about stomach pain, but her doctors wrote it off as a side effect of her pain medication and sent her home to await shoulder surgery.

Thomas began throwing up frequently and continued to suffer excruciating pain. Her friends decided to rush her back to the hospital as she floated in and out of consciousness.

After making the 32-mile ambulance trip to the hospital, Thomas summoned up enough strength to sign off for the splenectomy surgeons said she needed to stop her internal bleeding.

Along with the splenectomy, Thomas had five surgeries on her arm, and physical and occupational therapy over the next year and a half. Her hospital stay alone rang up $35,000.

When the time to pay the medical bills rolled around, the insurance company refused to pay for the splenectomy — Thomas had never gotten pre-approval for it.

Thomas was appalled that the insurance company expected her to give them a ring during the emergency ambulance transport.

“I was half-dead,” said Thomas.

Thomas couldn’t work her full-time job as she recovered, so she ended up losing her health insurance along with her job.

“You can only do Cobra for so long and afford it,” said Thomas.

Though Thomas tried to take on spot jobs, including a stint harvesting grapes with her non-dominant hand during Michigan’s chilly fall, she could not make enough to keep up with her monthly bills.

At one point, Thomas had to run outside as a tow truck began to pull away with her repossessed car to salvage all her belongings from the vehicle.

At a time when just getting dressed proved to be a struggle, Thomas had to deal with a steady stream of hospital bills and an unsuccessful legal battle to appeal the charges. Thomas had no recourse but to file for bankruptcy and move into Ches’s basement apartment.

According to Thomas, most people in the U.S. are not immune from suffering the same ordeal.

“I paid my bills. I had good credit,“ sad Thomas. “Yes, you have a job right now. Yes, you have health insurance right now, but ... maybe you’re going to end up having to pay.”

Thomas currently works as a cashier at Harrah’s Casino in Cherokee, mostly because the job provides health insurance.

“I never thought I would be working at this age,” Thomas said.

Extreme sacrifices

Because of her own shoulder injury, Rice now finds herself living in a single-wide mobile home in Franklin.

After several months of physical therapy and doctor’s visits, Rice had to pay between $25,000 and $30,000 in out-of-pocket expenses.

Rice said she checked in with the insurance company each time she went to the doctor’s office to make sure she had enough coverage. It turned out her insurance company had not yet processed her bills, so they were not aware her coverage had already run out.

“I would have said ‘Look, I’m running out of money. I will settle for a certain level of disability, find an alternative source of treatment I can afford, or save up until I can afford to continue,’” said Rice.

Instead, Rice had to sell her 200,000-square-foot home and move to a single-wide trailer in Franklin to be closer to her two sisters and save up for the “next healthcare disaster,” Rice said.

Rice, who said she always paid her bills on time and never carried credit card balances, saw her credit ruined since she couldn’t keep up with medical payments.

But Rice decided to take a proactive approach after that financial catastrophe.

Rice slashed every expense that she could, using candles instead of electricity and washing all her clothes by hand. She stopped traveling to see her children and no longer sent them any gifts. Rice consolidated trips to the grocery store, going only every two or three weeks, to save on gas.

“If it wasn’t something I absolutely needed to survive, I didn’t spend the money,” said Rice, who didn’t meet her youngest grandson until he was three years old and came to the area to attend Rice’s husband’s funeral.

Now that Rice believes she’s saved up enough of a cushion, she has started using electricity again, though she continues to wash her clothes by hand.

Rice hopes the money she has saved will be sufficient to cover her future medical costs without relying on others.

“All seniors are afraid that we’re one disaster away from ruin,” said Rice. “I do not want to be a burden on my neighbors, friends, church and society.”

Rice said she had previously been ashamed about her financial turmoil, wondering what she could have possibly done wrong. But she decided to share her story because many others were experiencing similar predicaments.

“I’m not alone. I’m not unique,” said Rice. “That’s the sad part about it.”

Rice said she does not want health care reform for just her or her sisters.

“We want this for others, our children and grandchildren, for everyone,” said Rice.

A broken system

Ches said she and her husband are being punished unfairly for simply growing one year older. Her insurance costs have gone up by 15 percent this year.

“It has gone up for no reason,” said Ches. “We have not been sick. We haven’t even used the amount of money that we’ve paid into it.”

Ches wonders what will happen if she has a medical emergency like those her sisters experienced.

“We’ll join the mob in the emergency room,” said Ches. “Then, all the people currently have health insurance will be impacted negatively.”

After having such a terrible experience with the American health care system, the three sisters feel very strongly about passing health care reform.

“The people who have insurance don’t realize that they can lose it,” said Rice. “The people who have insurance are very happy with the status quo.”

The sisters say those who are sick should not be spending their time wondering about how they would pay for treatment.

“I think something is really broken here,” said Rice. “I have to be afraid to spend a penny because I’m afraid of a medical emergency.”

Ches said those who receive health insurance through their employer and believe they are safe from similar scenarios are living in a “fool’s paradise.”

“You have employer subsidized insurance until you are out of work,” said Ches.

According to Rice, the U.S. must ultimately come up with its own solution rather than following how other countries run their health care system.

Though all three sisters say they would like to see a single-payer system, Rice said she has had “wonderful conversations” and found common ground with those who oppose exactly what she supports.

“Fox, CNN, MSNBC – I watch all of them. I will listen to all sides, the truth is somewhere in between,” said Rice, who is disappointed that the health care debate has taken such an ugly turn.

“This should not have become a partisan issue, the people need to realize that,” Rice said.

It was late September, and Travis George, a 27-year-old Waynesville resident, was almost done mowing his grandmother’s yard. With just five minutes left, his foot accidentally slipped right under the mower, chopping off three of his toes and part of his foot.

George was rushed to Mission Hospital in Asheville, where doctors performed surgery and cleaned up the gaping wound. A month later, George had to undergo skin graft surgery.

George was able to get Medicaid to pay much of the $30,000 bill, and he received about $1,000 from his grandmother’s homeowner’s insurance, but $7,000 must come out of his own pockets.

Unfortunately, George has not been able to find a new job after being laid off from his job as land surveyor last Christmas.

Now he’s caught in the middle. George no longer qualifies for unemployment, since he is no longer able to work. Yet he cannot receive disability benefits because he will be able to return to work in less than a year.

“Ever since I got hurt, I have no income,” said George.

George said he almost didn’t qualify for Medicaid because of his wife’s income as a bank employee. While her health insurance covers their two children, George said adding him to the policy would result in outrageous costs.

“She would end up paying more for our family’s insurance than she would take home,” said George “It’s unreal.”

For George, the problem with the health care industry is tied to the greed of insurance companies. Despite taxpayers picking up the tab for part of his medical bill, George said the government should not be responsible for everyone’s health care.

George supports opening up competition among insurance companies across state lines to lower prices instead.

“I don’t think the government should make everybody pay,” said George. “I had a terrible accident, trying to get help as I can, but the rest of it I’m responsible for. That’s the way it should be.”

Two Waynesville companies recently decided to assist George by holding a chilly cook-off fundraiser to raise donations for his $7,000 payment.

“That’s helped out a little bit,” said George. “Other than that, I don’t know how I’m going to pay that balance.”

Bridget Nelson, 40, graduate student at Western North Carolina

Nelson was required to get health insurance after enrolling at WCU though she said not having insurance previously didn’t bother her.

“I view insurance companies as legalized organized crime.”

Nelson considers herself a healthy individual who would probably only use health insurance for medical emergencies.

While working for a nonprofit, she once faced the awkward situation of receiving good insurance coverage through her employer but being unable to extend that coverage to her two children. Nelson eventually acquired Medicaid benefits for her kids, which helped cover costs when her daughter broke her arm.

In Nelson’s view, health care reform should be a national priority. She said a single payer system would make more economic sense than the current wars in Iraq and Afghanistan.

“We’ve spent trillions on apparently useless wars, so if you’re willing to spend on that but not health care, there’s a priority problem.”

Amy Tucker, 24, server at Ryan’s Family Steak House in Sylva

Tucker is on her father’s company health insurance policy but has a $5,000 deductible, which means she usually pays for “pretty much everything.”

Tucker says she is against the health care bill. “I don’t think that it should be free for everyone,” said Tucker, “[But] everyone should have some kind of coverage.”

Tucker said she’s more in favor of an assistance program than universal health care.

Sunshine Cochran, 33, server at Ryan’s Family Steak House in Sylva

Cochran is considering buying health insurance through her job, but as of now, she has none. She said the health insurance rates through Ryan’s are pretty reasonable. “I just gotta make sure it fits my budget.”

Cochran has received Medicaid benefits when she was pregnant with her five kids, who are all on Medicaid now. But she is still paying off a $15,000 debt she incurred after breaking her arm in a car racing accident.

Cochran was able to pay the $900 upfront cost, but she hopes to avoid landing in the same situation in the future.

“I try to stay away from getting hurt.”

Kirk Childress, 22, manager of Black Rock Outdoor Company in Sylva

Childress will soon get a monthly allowance for health insurance after being promoted to manager at the store. Before that, however, Childress did not have health insurance of any kind. For Childress, the choice was between paying for health insurance or paying for a car. He chose the car.

“I’ve always been healthy. I’ve never had a problem.”

Childress says his approach to health care has been more reactive than pro-active. He once had a serious spider bite that needed to be treated. A friend’s father, who happened to be a doctor, was able to call in a prescription for antibiotics to take care of it.

Childress said those who cannot afford health care should be given the minimum for family doctor visits and emergencies, but he said most people should purchase health care for themselves.

Sheryl Rudd, 49, and Dieter Kuhn, 54, co-owners of Heinzelmannchen Brewery in Sylva

Rudd and Kuhn choose not to pay for health insurance, relying on natural medicine and wellness instead. They had been paying monthly premiums for a policy with a $5,000 deductible but decided to drop the insurance.

“Nothing was being covered,” said Rudd, adding that the insurance company would not help pay for her to see her preferred doctor.

Kuhn admits that not having health insurance places more responsibility on the individual to stay well and handle any resulting financial responsibilities.

When it comes to health care reform, Rudd said she is not in favor of placing more burdens on businesses through regulations.

“That’s not fair,” said Rudd. “That takes my choice away.”

Instead, Rudd would like to see everyone in the country get the same health insurance that Congress receives.

“But what they’re proposing, I’m against,” said Rudd.

In an effort to boost recruitment of doctors to the region, hospitals across Western North Carolina are following in the footsteps of a national trend to employ physicians in-house.

Historically, doctors set up independent, private practices.

But doctors are increasingly being squeezed by rising overhead and lower reimbursements for Medicare and Medicaid patients. As a result, doctors are gravitating toward a new model of being employed directly by hospitals. The hospitals keep the revenue generated from the patients, while providing a steady salary to the doctors.

“It allows them to do what they were trained for, the clinical work, and let someone else handle the administrative side,” said Tim Hubbs, CEO of Angel Medical Center in Franklin.

Whether it’s disciplining chronically late employees, shopping malpractice rates or billing insurance companies, “It is nice to say ‘Hey, can you all just handle that?’” Hubbs said.

Sylva-based WestCare is leading the hospitals west of Asheville in the number of physicians employed in-house. WestCare employs 19 physicians across six practices. Angel Medical Center employs 13, while Haywood Regional Medical Center employs five.

WestCare CEO Mark Leonard said the trend reflects a generational preference among younger doctors. He cited a recent survey of medical school grads at Duke University where 74 percent said they would rather be employed upon graduating than go into their own private practice.

“This really reflects a generational shift on the part of new physicians entering into medicine,” Leonard said. “It was incumbent on us to shift and embrace this new way of doing business.”

Leonard said he understands why the new model is attractive to today’s younger doctors, citing the long shifts doctors pull simply to care for their patients.

“When you put on top of that being a business owner and doing the taxes and the personnel issues, that causes the hours to stack up,” Leonard said. “These new physicians coming out say, ‘I just went to medical school and I want to emphasize the clinical side of medicine.”

Haywood CEO Mike Poore added that young doctors aren’t eager to follow the rigorous on-call schedule that had their older peers chained to beepers most of their lives. They want a steady salary and more free time.

Balancing autonomy

The only downfall of the model is a potential loss of autonomy. Doctors can suddenly find themselves answering to a hospital CEO, unlike a private practice model where they answer to no one but their patients.

All three hospital CEOs interviewed for this story said they recognize the concern.

“When I go to my personal physician, I don’t want to be thinking that there is a suit in another room influencing how he is going to care for me, my wife or my children,” Leonard said. “I want his decision to be based on what’s in my best interest as a patient.”

At WestCare, Leonard said he has laid the foundation of trust between physicians and administration and a collaborative decision-making model, which should in turn allay such fears.

“I am not a physician. I did not go to medical school. I am going to rely on and trust the physician’s judgment when it comes to clinical decision-making,” Leonard said.

Hubbs also pledged a hands-off management style when it comes to medical care.

“If a physician says I think we need a CAT scan on this, we are not going to second guess that,” Leonard said.

For Dr. Bruce Lobitz, an ER doctor who joined a team of hospital-employed doctors in the Angel emergency room this year, the possibility of hospital administration intruding on his care of patients was a top concern.

“That was one of my hesitations,” Lobitz said, who has found it not to be the case, however. “Here, there is very little of that.”

While it might give some physicians pause, the positves seem to outweigh the negatives.

“There is some trepidation in the loss of autonomy,” said Dr. Charles Trenthem. “But if you look at the trends nationally, this is what’s happening.”

While the nonprofit hospitals in the mountains have a community minded philosophy, larger for-profit hospitals could take advantage of the employment model.

“They do have a profit model, and they do push the providers at all levels to see that one extra patient, to generate that one extra charge,” said Dr. David Farley, an internist at Angel Medical. “I have not seen that be an issue here.”

Hubbs said there are external controls to ensure hospitals don’t prod physicians to order more costly tests than a patient really needs just to boost revenue. The insurance companies or Medicare who get stuck with the bill would notice an outlier ordering gobs of tests, Hubbs said.

There is one upside for patients: fewer bills. Anyone faced with a hospital stay braces for a litany of separate bills trickling in for lab tests, X-rays, various specialists and the hospital itself. Poore said bundled payments — where the bill for doctors is included with the bill from the hospital — is a model that shows promise.

Hospitals employing a critical mass of in-house doctors will often house them in a joint practice, even if they aren’t in the same specialty. It allows for integrated patient care, providing quick access to charts and reducing the chances of two doctors ordering the same test.

“Really it is kind of a data flow issue that is so clumsy in medicine right now,” Farley said. “If you’re housed in the same unit, you can walk down the hall and say ‘What did you think of Mrs. So-and-so this morning? Should I be concerned about this?’ You don’t have that when you are all scattered around in separate pods around town.”

Making the transition

While urban hospitals have launched a large-scale transition toward employing doctors, rural hospitals are using the model primarily to lure new recruits or to stabilize a faltering practice in a specialty the hospital can’t afford to lose within its medical community, said Dr. David Farley, an internist at Angel Medical.

“In this town, most of the employed physicians are the new recruits,” Farley said. “The existing doctors have remained solo, but I don’t think you can predict that will continue.”

Farley said the new model could be enticing to physicians at different points in their career, like a physician nearing retirement who wants to go part-time and no longer wants to deal with the hassle of managing a private practice.

As the new model develops, the result is a hybrid of traditional private practices and hospital-employed physicians within the community, Leonard said. Leonard largely follows the preferences of the doctor being recruited. If there is an existing private practice in the community the doctor wants to join, the hospital simply plays matchmaker.

When a doctor joins an existing practice, they are often expected to make an upfront investment.

“They buy in to do their fair share,” Poore said.

In Haywood County, both models exist within the same orthopedics office. Western Carolina Orthopedic Specialists has three doctors, two of whom own the private practice, while a third, Dr. Gerald King, is an employee of the hospital.

The hospital pays Western Carolina Orthopedic Specialists a management fee to covers King’s share of overhead, from office space to secretarial staff. The hospital also pays Kings salary.

In exchange, the hospital gets 100 percent of the revenue generated from King’s patients. It also benefits from having an orthopedist in the county who will bring business through the doors of the hospital. The hospital was suffering from a chronic orthopedist shortage that led patients unable to get appointments locally to take their business outside the county.

Haywood Regional Medical Center recently bought out Haywood Women’s Medical Center, the only Ob-Gyn practice in the county. The hospital now owns the practice and the doctors are employees of the hospital.

It was one of the first moves toward hospital-employed physicians in Haywood. The Ob-Gyn practice was a good starting place for several reasons, Poore said.

For one, doctors who deliver babies have some of the highest overhead.

“The malpractice is unbelievably high,” Poore said.

But the service is so crucial, no well-rounded hospital could afford to be without it.

“Our goals was to keep a viable Ob-Gyn practice in Haywood County,” Poore said.

Buying out an existing practice is more complicated than setting up the arrangement from the get-go with new hires. The process took six months and required outside consultants to help arrive at a fair purchase price.

Getting squeezed

The new model is particularly attractive to doctors in a climate of decreasing reimbursement rates for Medicare and Medicaid patients. Doctors take a bigger hit in rural areas, where a higher percentage of patients are likely to be on Medicare or Medicaid. It makes the offer of employment — and the steady salary that goes with it despite the poverty level of patients — an even more important recruiting tool in rural areas, according to Dr. Charles Trenthem, an anesthesiologist and chief of staff at Angel Medical Center.

“If we weren’t employing physicians and subsidizing their practices, the health care in Western North Carolina would suffer,” Trenthem said.

Angel Medical recently got a special “critical access” designation for its hospital that gets it a higher reimbursement rate from Medicare and Medicaid. Physicians employed by the hospital also enjoy the higher reimbursement rate, since billing is done by the hospital itself.

The issue is particularly acute in emergency room settings, where doctors are likely to see a higher number of patients without insurance who have no means to pay their bills.

While ER doctors theoretically treat patients without regard for whether they can pay, it can influence doctors on a subconscious level, said Dr. Bruce Lobitz, an ER doctor at Angel. But as a hospital-employed physician with a steady salary regardless, it makes it easier for doctors to ignore a patient’s ability to pay when providing care.

“I don’t care about the patient’s payer status. The hospital takes care of all that,” Lobitz said.

The hospital is left to absorb the hit, which can be a problem for rural hospitals already operating on a paper-thin margin, Trenthem said. The model also saddles hospitals with the upfront investment of setting up a new doctor and shouldering the risk if patient revenue falls short.

“Costs are being shifted to these smaller hospitals,” Trenthem said.

But given the trend, they had no choice but step up to the plate and adopt the model.

“The days of a physician going out and hanging a shingle are kind of over now,” Trenthem said.

Today at HRMC, 10 sets of eyes peer over the shoulders of the hospital administration, ready and willing to question every move.

Though the hospital had a board of directors in place when the hospital lost its Medicare and Medicaid certification a year ago, oversight arguably wasn’t the board’s strong suit. But today, the buck stops with the hospital board when it comes to avoiding another crisis.

In the months following the hospital crisis, it was out with the old, in with the new on the hospital board. The original board members either resigned or didn’t reapply for their terms. A host of Haywood residents, appalled by the hospital’s downfall, were more than happy to step up and play watchdog. When two seats became open in April, county commissioners were flooded with a staggering 37 applications (in contrast, many boards are happy when one person applies). Seven out of 10 sitting board members today are new since the crisis.

The clean sweep will continue in April, when long-time board member and chairman Glenn White will step down and the board is expanded by two. When that occurs, only two out of 12 board members will have been in place under Rice.

“It’s good to have those without experience, because they keep it fresh,” said Cliff Stovall, who was appointed to the board in June. “You don’t want to just do it the way that it’s always been done.”

Board members come from a wide range of backgrounds: a banker, a retired Army colonel, a former district attorney, a nursing instructor, to name a few.

“I think it’s important to have people that aren’t entirely immersed in medicine, because it brings a different point of view,” said Pam Kearney, who also came on board in June.

Back to basics

Defining just how the board is supposed to function has been a top priority. Since the crisis, the board has had to do some serious reinforcing of its core mission — overseeing the hospital administration.

“We didn’t have any concept of what the board’s duties were,” said Roy Patton, who became a board member in June. “There had been more or less a structure for the board, but I don’t think that the board had ever learned to use it. The former CEO kept the board pretty much in the dark.”

That’s not the case anymore.

“The board’s role is oversight, and I think we’ve come to realize how much more important that is than we may have realized at one point,” said Patton.

In the drivers seat

The revamped hospital administration has made it much easier for the board to perform its duty as watchdog. Former CEO David Rice held a tight grip on the flow of information, so what the board knew about day-to-day hospital activities was limited.

“We asked questions in the past, too, but it’s the answers and responses that you get that are key,” said Mark Clasby, a board member who had served for a year and a half when the crisis hit.

“I think that the board was just somehow lulled into pretty much an acceptance of what Rice said was going on,” Patton said.

Consequently, HRMC’s loss of Medicare and Medicaid certification caught board members completely off guard.

But as the hospital’s culture began to change in the wake of the crisis, so did the relationship between the board and the administration.

“I think the thing that I see changing is that the board members and the administration are actually having dialogue and discussions,” said Kearney. “It’s not a one way street. The communication lines are now open, and board members are not denied access to information.”

Kearney said the board has demanded the larger role.

“I think the board really is driving it,” Kearney said.

Since the crisis, the board has put measures in place to make sure it’s not kept in the dark.

For example, an immediate notification process requires the hospital administration to notify board members of any incident affecting HRMC.

“It allows the board to be in the loop of information from day one,” said Kearney, “so we don’t read about it in the media or find out about it secondhand.”

In contrast, Rice kept such incidents a secret from the board. Board members were unaware of the brewing crisis a year ago that the hospital’s Medicare status was in jeopardy.

Board members also now attend exit interviews when any hospital inspection is completed, which “enables the board to learn firsthand if there are serious patient concerns,” said Kearney. “This was discouraged in the past.”

At a recent exit interview, surveyors even opened up the floor so board members could ask questions — something Kearney recognized as a real turning point for HRMC.

“There was not one person in the hospital who was going to make or break that survey, as was the case in the past,” she said.

Haywood County Commissioner Kevin Ensley, who along with other commissioners appoint the hospital board members, said the crisis should serve as a wake-up call to anyone serving on a board to be more diligent in their oversight. Too often, those at the helm of an organization can lull their board into complacency or charm them into compliance.

“If you tried to remove David Rice two weeks before that happened there would be a firestorm,” Ensley said. “The one good thing that has come out of this is all the boards in the county see you really have to watch what management is doing. We could all point our fingers at ourselves because people weren’t paying attention.”

Not afraid to ask

The idea of the board taking the wheel marks a sharp change from before the crisis, when decisions were often made in a unilateral manner by the administration.

“I don’t think that we would now be able to have that same reliance (one the administration),” said Patton. “I think we’re always going to be saying, is this right?”

Today, there is no shortage of questions for hospital administrators at board meetings.

“I can assure you that nobody leaves without getting questioned to the hill,” said board member Cliff Stovall, who was appointed in June. “There’s no timidity on the board. There are no wimps in the meetings I’ve been in.”

Board members hope a renewed emphasis on oversight and open communication will ensure they’ll never again be blindsided, as was the case a year ago.

Turnaround?

Though the hospital is still on a road to recovery, board members say there have been some key turning points since the crisis.

Patton says positive change began to take hold right away.

“I think that immediately, when things fell apart, some things started turning around,” he said. “All of a sudden, we had training going on, and more attention to the things that we hadn’t been paying attention to earlier.”

Stovall said one of the board’s biggest accomplishments since the crisis has been getting the hospital’s finances back in the black. The hospital’s lack of debt made this easier, he said.

“We did spend a lot of money just to keep going, but our money did not evaporate,” Stovall said.

Clasby said as of December, the hospital was ahead of its budget for the year — a positive but preliminary sign, since the fiscal year only started in October.

Board members also named the hiring of CEO Mike Poore as a key accomplishment.

“It’s just been a breath of fresh air for us,” Patton said.

Board members expressed mixed sentiments on whether the hospital has overcome one of its greatest challenges: regaining the community’s trust.

Stovall said he views the frequently full parking lot at the hospital as a sign that people are coming back.

“I think that’s an indication that people are using it, so it’s restored confidence,” he said.

Patton was a bit more hesitant.

“I would say yes, there has been some trust regained, but I don’t think that we’re to the point where we can say, we’ve done it now and we can relax,” he said.

Kearney also says there’s work to be done.

“The community sentiment is more positive toward the hospital than a year ago, but we haven’t yet seen a sufficient increase in the daily census,” she said. “I think that’s the only tangible way you can measure that. I would say there are people that are going past Haywood and going to Asheville.”

Phoenix rising

The crisis that hit Haywood Regional helped to erase a culture of fear and overhaul the hospital’s administration and practices. So is HRMC better off for it?

“That’s a real difficult question, because you just blew $10 million,” said Kearney. “We spent some of our future, which is unfortunate.”

Clasby says that in the end, HRMC did emerge as a better hospital — though the road to get there was tough.

“It’s a shame and it’s sad that we went through what we did, and it was very painful for the community,” he said. “But we had an opportunity unfortunately to correct the things that were wrong and to rebuild this into an excellent, quality institution. It’s kind of the rising of the phoenix.”

Doctors and officials at Haywood Regional Medical Center are accusing state inspectors of being heavy-handed, draconian, unprecedented, dangerous and unfair by pulling the hospital’s Medicare and Medicaid status.

By Sarah Kucharski • Staff Writer

Arthur Pitts sat in a plastic lawn chair waiting to pick up prescriptions from The Village Pharmacy in Waynesville Monday afternoon (March 13).

At 73, he is one of the nation’s many Medicare subscribers. His coverage comes through a Blue Cross Blue Shield plan, which he says has been fairly reliable so far.