"Good evening, everyone," Angela said as she sat down. She again glanced around the room. "First, let me apologize for keeping you waiting. I know it is late and you are eager to get home to your families, so we will make this short. The good news is that we are still in business." Angela glanced at the three presidents, all of whom nodded in a restrained fashion. "The bad news is that our cash-flow problem has gone from concerning to critical. Of course, we felt the situation was critical a month ago, but it has gotten worse."
Angela gestured toward Bob Frampton, who shook his head slightly as if to wake himself. He leaned forward, putting his elbows on the table with his beefy hands together and fingers interlocked.
"We are rapidly approaching, if not violating, our eighty percent margin on our loans with the Manhattan Bank and Trust. We had to sell some bonds to make a payment to our cardiac stent provider. They were threatening to cut off our supply."
"Considering how tight finances are, I want to personally thank you for doing that," Dr. Niesha Patrick said. She was a young African-American woman with light skin and a scattering of freckles in a butterfly pattern across her nose and cheeks. Like Angela, she had an MBA in addition to an M.D. Angela had recruited her from a large West Coast managed-care company to run Angels Heart Hospital. "With our ORs intermittently closed, our only dependable source of income has been from invasive angiography and cardioplasty. Without stents, even that revenue would be severely impacted."
"Invasive angiography and Lasik have probably been responsible for keeping us afloat," Angela said. She nodded in appreciation toward both Niesha and Dr. Stewart Sullivan. Stewart was the president of Angels Cosmetic Surgery and Eye Hospital.
"We are all doing what we can," Stewart said.
"As much of a gold mine specialty hospitals are in the current reimbursement milieu," Angela said, "they are at a particular disadvantage when their operating rooms close."
"But the operating rooms are now all open," Dr. Cynthia Sarpoulus said defensively. Cynthia was a medical-school classmate of Angela's who'd gone on to specialize in infectious disease and epidemiology. Angela had hired her when the current nosocomial infection problem started three and a half months previously. Cynthia was a dark-complected, raven-haired woman with a bit of a temper. Angela had been willing to put up with her thin-skinned and often caustic style because of her training, dedication, intelligence, and reputation. She'd been the reputed savior of several institutions with infection-control problems.
"They might be open, but they aren't being utilized except by a fraction of our medical staff," Dr. Herman Straus said. Angela had recruited Herman from a Boston community hospital, where he'd been a well-respected assistant administrator. A big, athletic man with an outgoing personality, he had a particular affinity for dealing with orthopedic surgeons. That quality combined with his Cornell Hospital administration training made him an ideal president of Angels Orthopedic Hospital, and his record was proof of it.
"And why is that?" Angela asked. "Surely they know we have been on top of this problem right from the beginning. Cynthia, remind everyone what has been done."
"Just about everything possible," Cynthia snapped, as if she was being challenged. "Every OR has been cleaned with sodium hypochlorite and fumigated at least once with a product called NAV-CO2. It's a nonflammable alcohol vapor in carbon dioxide."
"And not without considerable expense," Bob interjected.
"And why that particular agent?" Carl questioned.
"Because methicillin-resistant staphylococcus aureus, or its more common designation, MRSA, is highly sensitive to that particular preparation," Cynthia shot back, as if it were a fact everyone should know.
"Let's not get testy," Angela said. She wanted to keep the meeting friendly and, she hoped, productive. "We are all on the same page here. No one is casting aspersions. What else has been done?"
"Every hospital room that has seen an infection has also been similarly treated," Cynthia said. "More important, perhaps, as you all know, every member of the medical staff and every employee of the hospitals are cultured on a recurrent basis, and those who test positive as a carrier are treated with mupirocin until they test negative."
"Also at great expense," Bob added.
"Please, Bob," Angela said. "We are all aware of the expense side to this disaster. Cynthia, continue! Do you think culturing and treating the staff and employees is critical?"
"Absolutely," Cynthia said. "And we might consider the same for patients as a prelude to admission. Both Holland and Finland had a particularly bad problem with MRSA, and the way that they brought their problem under control was by treating both staff and patients: anyone who tested positive as a carrier. I'm beginning to wonder if we might have to do the same thing. Yet my real concern is that the MRSA is occurring at all three of our hospitals. What does that say? It says that if a carrier is responsible, then that carrier must routinely visit all three hospitals. Consequently, I have as of today ordered the testing and treating of all employees from even here at the home office who regularly visit all three hospitals, whether they have actual patient contact or not."
"Anything else?" Angela asked.
"We have mandated aggressive hand-washing after each patient contact," Cynthia said, "particularly with the medical staff and nursing personnel. We've also instituted strict isolation for all MRSA patients, and more frequent changing of medical staff clothing, such as white coats and scrub outfits. We also require more alcohol cleaning after each use of routine equipment, like blood pressure cuffs. We've even cultured all the condensate pans of all the HVAC air handlers in all three hospitals. All have tested negative for pathogens, especially the strain of staph that has been plaguing us. In short, we are doing everything possible."
"Then why haven't the doctors been admitting patients?" Bob questioned. "As they are all owners, they have to be aware they are taking money from their own pockets by not doing so, especially if we go bankrupt."
"I don't want to hear that word," Angela said, having already been through that demeaning experience.
"It's clear why they are not admitting," Stewart said. "They are terrified of their patients getting a postoperative infection despite all the infection-control strategies. With reimbursement solely based on DRGs, or diagnostically related groups, patients getting a postoperative infection directly cuts down on their productivity, and it is productivity that determines their income. Besides, there's the malpractice worry. Several of our plastic surgeons and even two of our ophthalmologists are being sued over these recent staph infections. So it's pretty simple. Despite being equity owners, it makes economic sense for them to go back to University or the Manhattan General, at least in the short run."
"But all hospitals are having trouble with staph," Carl said, "particularly methicillin-resistant staph. And that includes both the University and the General."
"Yeah, but not over the last three months, nor at the rate we have been seeing it," Herman said. "And despite all these efforts that Dr. Sarpoulus has been spearheading, the problem has not run its course, given that we at Angels Orthopedic had another case late today. It's a patient by the name of David Jeffries."