North Adams hospital suffers in safety survey

By SHANNON CHIU

EXECUTIVE EDITOR

Statistics suggest that North Adams Regional Hospital (NARH) does not have the best track record in preventing medical errors. According to a national hospital-quality organization, The Leapfrog Group, NARH’s overall rating of safe practices score was markedly below the median, but not in the lowest quartile among hospitals surveyed in 33 regions across the nation in June 2007. Despite rumored horror stories of students’ experiences at NARH, most students’ personal anecdotes do not reflect dramatic lapses in care.

Over a month after he had his appendix removed, Eric Mohamed ’08 is still recovering from his surgery. Despite experiencing a post-operational complication, Mohamed said that his slow recuperation may have been more his own fault than that of his doctors at NARH.

NARH surgeons performed a laparoscopic appendectomy on Mohamed, a minimally invasive surgical procedure whose main advantages include faster recovery and less post-operative complications. A complication, however, arose soon after Mohamed left the hospital, the nature of which he did not specify due to medical confidentiality.

The complication required Mohamed to have a second surgery, and since then, his road to recovery has been longer than expected. “This could have been partly my fault in getting back on my feet too quickly,” Mohamed said, adding that the complication is a relatively common occurrence and was not necessarily due to the quality of the surgery.

“I don’t have any complaints in relation to my doctors at NARH, but this is a small-town hospital,” Mohamed said. “I would not go to NARH had I had something more serious than appendicitis.”

Other students’ experiences with local healthcare providers have been similarly mixed. After Tom Derbish ’08 underwent an appendectomy during his sophomore year, his intestinal system shut down, and he had to undergo a second surgery five days after his appendectomy. During the second operation, surgeons found a “kink,” which they explained was the cause of the intestinal obstruction.

“They didn’t really tell me how this happened, and I’m not sure they knew why,” Derbish said.

Derbish’s total hospital stay was extended to nearly two weeks, but he has not experienced any problems since and does not hold the hospital accountable for his post-operational complication. “They did a decent job with my surgeries, and I would say that the hospital was above-average just for the fact that, unlike an informal corporate hospital, [NARH] did not rush me out of there after the procedures,” Derbish said.

David Rogawski ’08 recently had knee surgery at NARH, and his rehabilitation did not proceed as planned. Surgery was performed to repair a torn medial meniscus in his right knee. “The surgery went smoothly, but the rehab did not, [as] the cartilage simply did not anneal together,” Rogawski said. “We don’t know the exact reason why.”

Like Derbish, Rogawski did not complain about his post-operative setback and explained that meniscus repairs are difficult to heal because of low blood supply to the knee cartilage. “Nothing went wrong per se during the surgery or rehab,” he said, adding that his surgeon was one of the most personable doctors he has encountered. “Dr. Cluett took his time explaining my injury to me and exactly what he would be doing during surgery,” Rogawski said. “I don’t think the unsuccessful repair was his fault.”

Rogawski is scheduled to have a second surgery, a menisectomy, to remove part of the meniscus in his home state of Maryland.

Jennifer Rush, vice president of quality and risk management at Northern Berkshire Healthcare (NBH), could not be reached for comment regarding the hospital’s policies on medical errors and financial compensation. NBH is the parent company of NARH.

Local providers beyond NARH

NARH is not the only outside medical resource students seek, as several private practices have Williamstown offices. One student, who requested anonymity to prevent jeopardizing future relations with doctors, sought help from Williamstown Physical Therapy (WPT) last year for a partial Achilles tendon tear. A costly pair of orthotics that they encouraged the student to purchase from them led to further injuries.

According to the student, she developed a stress fracture in an unusual bone in the foot after four weeks of walking around in the orthotics, and had to spend six more weeks on crutches. The student, who is an athlete, was not able to play for another season. The student was later told by an orthopedic surgeon in Williamstown and a podiatrist at home in Pennsylvania that the orthotics were not made correctly for the student’s feet and thus were the most likely cause of the stress fracture.

Although the anonymous student did not pursue any financial compensation or follow-ups with WPT, she visited other healthcare providers, including NARH, to remedy the situation. “I think people should definitely get second opinions if they do make investments in orthotics from WPT,” the student said.

When asked about her impression of healthcare services near the College, Ruth Harrison, director of health services, said that both access and quality are excellent. She said that to her knowledge, the vast majority of students relate positive experiences with outside healthcare services.

“If tertiary care is needed, students need to go outside the area, but that is not a failure of Williams,” Harrison said, noting that the College’s location in a rural community is another unchangeable factor. “It is just not possible to have all healthcare services available either on campus or in the local community,” she said.

Challenges facing healthcare in the Berkshires

Medical expenses have become increasingly taxing for residents of Williamstown and the Berkshire County. “The pressures on small, regional, rural systems exacerbate the most difficult challenges,” said Steve Klass, vice president for operations and chairman of finance committee on NBH’s Board of Trustees.

Comparatively speaking, Berkshire County is not a wealthy community, with median household income of just over $41,000, based on the 2000 U.S. Census Bureau. This figure is more than $10,000 below that of the state average. Moreover, the County supports a higher number of elderly persons, with the percentage of individuals aged 65 and over for Berkshire County (17.8 percent) ranking the second highest out of 14 counties in Massachusetts.

Accordingly, the rate of insurance premium increases creates a rippling effect on households. “[This] hobbles a large number of businesses and organizations, including school districts,” said Jim Kolesar, director of public affairs.

Just as local households face increasing financial burdens, NARH has also been under tremendous financial strain, which manifested itself in a $2.8 million operating loss in 2005.

While the amount of fiscal loss has decreased slowly since 2005, NARH spokesman Paul Hopkins also pointed to the region’s demographics as main causes of the hospital’s problems. These included low volume of services, high proportion of people covered under MassHealth (i.e. Medicaid) and high percentage of elderly citizens under Medicare – all of which lead to greater costs of treating patients on average.

“None of these factors are changing,” Hopkins said. “Right now, we hope to break even [in our budget] by 2008.”

On the revenue aspect, NARH cannot count on consistent government-subsidized income, such as reimbursement plans, due to the regional age and median income demographic in the Berkshire County. “Medicare and Medicaid are historically low reimbursement plans whose scales don’t keep up with the extremely high annual inflation inherent in healthcare,” Klass said.

Hopkins noted that the hospital did seek outside expertise a few years ago from FTI-Cambio, a national hospital turn-around specialist, to refine ways in which the hospital obtains reimbursements.

Nevertheless, NARH will receive a $2 million boost from the state this November, as part of over $37 million awarded through the Essential Community Provider Trust Fund. The amount allotted to NARH is among the largest of the sums provided to the 69 recipients across the state’s health care providers. “This grant has a very real and positive impact on the system’s operating budget,” Klass said.

Some additional revenue streams helped to decrease NARH’s operating gap to $310,000 at the end of 2006. One source is the $12 million from a recent fundraising campaign. “This might not seem like a lot compared to what the College has in endowment,” said Steven Fix, professor of English and NBH Trustee. “But [the amount] is tremendous for something that is community-raised.”

The money raised has been used predominantly for capital investments, part of which contributed to NARH’s $23 million renovation project. A new Birthing Center, Critical Care Unit and Emergency Department were completed last year. As an ongoing effort to increase profit margins, NBH is also looking to form strategic alliances with other hospitals and/or practices to build specialty practice centers, Klass said.

A number of factors have made it difficult for NARH to reduce costs beyond certain thresholds. Klass cites human resources as the primary operating cost in healthcare, including the importance of maintaining good staff-to-patient ratios. Regulatory changes create additional expenses as well, which include the present issue of Massachusetts Nurses Association (MNA) negotiations on nurses’ pension plans. “As it is currently structured, NBH will be required to fund an additional $1.2 million in the plan annually to address changes in pension plan funding,” Klass said.

In contrast with NARH’s fiscal outlook, Massachusetts’ hospitals, on average, have shown an ongoing trend of profitability. Massachusetts Department of Health Care Finance and Policy recently reported that the state’s hospitals hold nearly a half-billion dollars of surplus for the first six months of 2007. Their data also showed that NARH is one of only a handful of hospitals (66 total Mass. hospitals surveyed) that has posted consistent operating losses for at least five to six years.

Klass, however, warns against making broad judgments of the hospital’s “success” based on financial indices. Interdependent variables like location, population demographics, hospital structure and related attributes need to be taken into account, he said. “As you can imagine, it is very difficult to make simple comparisons of the economic health of various hospitals.”

College addresses local healthcare concerns

The College formed an ad hoc north Berkshire healthcare taskforce last year to examine the local system in the context of national challenges, according to Kolesar, who served as the taskforce’s secretary. Headed by Trustee Paul Neely, the committee comprised of representatives from local doctor groups, NBH, insurance companies and state representative Dan Bosley.

Members noted that one of the greatest challenges in this region is recruiting and retaining primary care physicians – a national challenge that is especially prominent in rural areas, Kolesar said. The taskforce prompted the College’s decision last year to fund a loan repayment program for recruiting primary care physicians. Specifically, the College has agreed to contribute toward medical school loan repayment for two physicians that the Williamstown Medical Associates were able to recruit, Kolesar said. The College will pay each of these physicians $10,000 per year, for up to three years.

“It’s impossible to know how large a role this repayment program played in the decision by these two physicians to come to Williamstown,” Kolesar said. “But the Williamstown Medical Associates were certainly pleased to be able to offer it in the extraordinarily competitive market for primary care physicians.”

This newly implemented loan repayment program is not unique to Williamstown. Other rural areas in the nation have started similar projects, including Vermont, Pennsylvania and Utah. Umbrella institutions, such as National Institute of Health (NIH) and National Health Services Corps (NHSC), also currently provide grants directly to participating states to operate their own loan repayment programs.

Despite the tangible outcome of establishing a recruitment strategy for primary care physicians in the area, the College’s ad hoc healthcare taskforce has disbanded as an ongoing entity. “It wasn’t at all clear what the group could do to address healthcare challenges until there’s change at the national level,” Kolesar said. The committee, however, may still meet on occasion as warranted, according to Kolesar.