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Yellville, Bull Shoals

Thursday, December 13, 2007

Hospital closings not connected to BRMC

In January of 1989, a small 21-bed hospital in Yellville, Ark., closed its doors. The hospital, known as the Marion County Hospital or the Central Ozarks Medical Center (COMC), was losing $25,000 to $30,000 each month according to reports. Even though a bailout by then Baxter County Regional Hospital (BCRH) was attempted, it was too little, too late.

Three years later, another hospital in Marion County, the Bull Shoals Community Hospital and Clinic, shut its doors on Feb. 29, 1992.

On Nov. 29, 2004, Eastern Ozarks Regional Hospital in Cherokee Village closed, deeply in debt and with an aging facility needing millions of dollars to bring it back-up to standards.

Today, the Fulton County Hospital in Salem is struggling to keep its bottom line in the black. Whether it will join the thousands of small rural hospitals that have already closed their doors remains to be seen, but a determined FCH board is looking at all possible options to keep the much needed critical access hospital open and serving the residents of the tri-county area.

In late October, after a letter of intent between FCH and Baxter Regional Medical Center was signed, rumors surfaced in the community blaming BRMC for the closing of the Yellville and Bull Shoals hospitals. But, according to published news reports from that time period, BRMC had no connection with either closing.

Central Ozarks Medical Center Yellville

In a January 1989 issue of the Baxter Bulletin Carol Ann Coward reported that COMC would likely close. According to the article the Marion County Board of Governors learned at an emergency session that COMC would close its doors on Jan. 15, 1989. The county-based hospital had suffered a rapidly declining patient count and watched as three private management corporations abandoned their leases or management agreements prior to each firm's termination dates. In 1986 Westworld Community Healthcare Inc., which was leasing the facility, filed bankruptcy and abandoned its lease.

In 1989, COMC was a nonprofit corporation governed by a board of directors with a lease between the COMC nonprofit corporation and Marion County. A statement released by the hospital board of directors on Jan. 4, 1989, said, "COMC will begin the phase-down of all hospital operations immediately with a closure date of Jan. 15, 1989."

Several factors were enumerated in the statement:

* Inadequate reimbursement for Medicare and Medicaid patients who accounted for 87 percent of COMC's admissions;

* Rural hospitals which "serve a significantly low income, uninsured population" receive less payment than urban hospitals;

* Accounts receivables (which total $444,000) are not being adequately reduced because of combined Medicare, Medicaid, and/or self-pay constraints to allow viable operation (because accounts and notes payable total approximately $200,000);

* Failure of a hospital millage issue on the Nov. 8, 1998, ballot damaged the facility's borrowing power; and

* "Lack of community support" signaled by the hospital millage failure.

In the article board chairman Richard Wendel said that COMC's directors "have pursued options available to them" and "no proposals came forward; they were turned down by everyone." The frequent comment by those who answered directors' inquiries and investigated COMC was surprised the facility had stayed open as long as it did, he said.

A week later a front page headline in the Baxter Bulletin read, "BCRH offers to sublease troubled COMC -- Mountain Home hospital plans to use Yellville facility as an emergency center." The article stated that a letter of intent from BCRH for a one-year sublease was submitted to the hospital board "for consideration in resolving the dilemma of the financially-troubled COMC."

Some of the provisions listed in the letter of intent said that COMC would be operated as an outpatient emergency center with paramedic ambulance service manned at COMC. BCRH would also assist in other ways including help with the collection of accounts receivables, and assuming accounts payables and indebtedness.

According to the Baxter Bulletin both COMC's board of directors and the Marion County Quorum Court voted to accept BCRH's proposal to sublease the failing hospital. Although the community hoped this would be the means needed to save the small hospital, officials say the sublease did not go through.

Board chairman at that time, Richard Wendel, told Areawide Media that part of the reason the plan did not go through was because COMC had "too many liabilities." Marion County Quorum Court member during this time, Kenneth Johnson, also said the proposal was never finalized and BCRH never took over the management and operation of the facility.

Although a portion of the facility was leased to different operations, Sue Trammell, director of the Marion County Nursing Home, said the hospital never reopened. It was eventually utilized and made a part of the current nursing home facility.

Baxter Regional Medical Center's Web site says that in 1990 the Yellville Ambulance Service was established by BRMC.

Bull Shoals Hospital

The only hospital left in Marion County closed its doors Feb. 29, 1992. A series of problems, including 274 violations found by the state Health Department, led to the suspension of the hospital's certification to receive Medicare and Medicaid payments on May 7, 1991. A subcommittee of the state Board of Health also recommended in May that the hospital's license be revoked. The hospital's certification was reinstated in November 1991. (Between 1988 and December of 1991, the hospital lost its Medicare/Medicaid certification three times, according to reports.) That loss plus a lawsuit ending with the hospital being ordered to pay $300,000, as well as publicity concerning problems between a doctor, Dr. Loyde Hudson, and the administration, were all contributing factors that forced the closing of the hospital.

According to an article in the Baxter Bulletin in 1992, Abija Hughes, co-owner of the hospital, blamed interference by the state Health Department on the decision to close the doors. Hughes and Dr. L.A. Kelley founded the hospital in 1977.

According to the Baxter Bulletin, Hughes told reporter Joseph Huddleston that the problem with the Health Department started in April 1991 when a state inspection found a leaky roof at the hospital. He said he was trying to get the roof repaired, but incessant rain had delayed workers.

"They reported me to Medicare. I got the roof fixed but every time they came up they would find something else," Hughes said in the article. Without Medicare and Medicaid, the hospital sometimes had only one or two patients.

In May of 1991, bus loads of Bull Shoals residents traveled to Little Rock to ask the board to keep the hospital open. The board in July agreed to give the hospital a reprieve -- under conditions. One of those conditions was that co-owners Hughes and Kelley resign from the hospital's board and agree to sell their interest in the hospital by Aug. 1, 1992, and a new board would be appointed Aug. 1. The new board would set policy and become the hospital's governing body and the new board would find a management firm to run the hospital. Earlier, the report said, staff physicians had asked Hughes and Kelley to step down. An October 1991 inspection noted deficiencies in the laboratory, unsatisfactory proficiency scores, safety code violations, including no fire wall between the hospital and the clinic.

During this time the hospital lost a malpractice lawsuit and was ordered to pay $300,000. After this judgement Hughes and Kelley filed for Chapter 11 bankruptcy.

In November 1991, the hospital and Dr. Loyde Hudson parted ways. Hudson had been a vocal critic of the quality of care provided at the hospital, the article said, and was among the doctors who had called for Hughes and Kelley to step down from running the hospital. Hospital officials said that Hudson had resigned from the staff; Hudson denied that saying he had resigned from some hospital committees, and the hospital administration was denying him staff privileges.

This very public argument played out in the chancery and bankruptcy courts and resulted in the reinstatement of Hudson, reports say.

Claude Jones, a Harrison, Ark., lawyer who was appointed bankruptcy trustee for the hospital, said in the Bulletin's article that the hospital was closed the end of January, "because there were no patients."

After the hospital closed, Baxter County Regional Hospital announced it would temporarily station a paramedic ambulance in Bull Shoals. Later that year that arrangement was made permanent.

From the editor: This information was researched and published because of rumors that BRMC had taken over the Yellville and Bull Shoals hospitals and then closed them down. We did extensive research and talked with a number of people involved with the hospitals during this time but did not find any basis for this rumor. ~EH

Jody Shackelford contributed to the research for this article.

The next hospital board meeting will be held Monday, Dec. 17 at 7 p.m. at the Higginbotham Building in Salem. The public is invited to attend.



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