By Deb Murphy
The 6,000-square foot orthopedic/physical therapy clinic slated to open in late spring on South Main Street in Bishop is a bone of contention between area hospitals.
The clinic is an expansion and relocation of Mammoth Hospital’s existing PT facility and, according to Northern Inyo Hospital Chief Administrative Officer Victoria Alexander-Lane, represents a duplication of services already available in Bishop and “an unnecessary tax burden on” the local hospital district. In late February, Lane sent a letter to the Inyo County Board of Supervisors requesting “support regarding NIH’s efforts to work towards better alignment of healthcare services.” The Board has yet to respond formally.
The next round went to Mammoth Hospital’s Chief Executive Officer Gary Myers responding to Lane’s allegations of lack of accountability on the part of Mammoth for follow-up care. Myers’ letter states Lane’s comments border on slander.
At its March 17 meeting, Inyo Supervisors suggested the Local Agency Formation Commission could deal with the issue. While Josh Hart, county planning director and Inyo’s LAFCO staffer, said the commission would “look into it,” the Mono County LAFCO seemed less inclined. LAFCOs generally deal with changes in boundaries and services of utility districts.
For NIH board member Pete Watercott, it’s an issue of trust. “Personally, I feel like we were led down a path. It sucks the trust out of the relationship,” he said in a recent interview.
The issue of the Mammoth-sponsored clinic creating an increase on area taxpayers was explained by Lane. “If people come here (for orthopedic care), we will be less dependent on taxpayers. Everything they need is here. Our surgical cases are covered; we (also) have digital x-ray equipment.”
As work proceeds on the Bishop clinic, the dispute appears to be at a standstill.
According to both Watercott and Myers, the orthopedic relationship between the two hospitals goes back to the early 2000s. NIH, between orthopedic physicians, initiated an agreement with Mammoth. According to Myers’ letter, the Southern Mono Hospital District leased office space and staffed ortho services in the Pioneer Medical Building in 2003. Dr. Mark Robinson, newly-named chief of staff at NIH, was the physician and credentialed at both Mammoth and Inyo hospitals. In 2011, Mammoth opened an outpatient physical therapy facility in Bishop to service Inyo County patients. According to Myers, NIH “chose not to address the shortage” following the closure of a private physical therapy practice in Bishop.
According to Lane, Robinson “felt he was being pressured to do surgeries in Mammoth. He felt that was undermining the agreement.” By January 2013, the orthopedic practice sponsorship shifted to and Robinson was hired by NIH.
By May 2014, Lane, Watercott and Myers were attending an Association of California Hospital Districts conference in Pasadena. According to Watercott, Myers told him Mammoth Hospital had made the decision to close their clinics in Bishop, but that the orthopedic group may want to continue on their own. Myers recollection of the exchange differs. In an e-mail, Myers states Watercott asked him if the hospital intended to open a surgery center in Bishop. The clinic on Main Street will not be doing out-patient surgeries.
“The two doctors involved in the Bishop clinic don’t want to be on staff (at NIH),” Alexander-Lane said. “They could be credentialed at both hospitals and do surgeries at both. If they did, there wouldn’t be an issue.
“We (NIH) have no clinics in Mammoth. They are the predators.”
In addition to where Bishop clinic patients undergo surgery, Alexander-Lane has issue with practices that could “result in our physicians having to provide emergent follow-up care for the infections and other negative outcomes which present in our emergency room.” The practices she described in a recent interview include knee replacements on an out-patient basis and the use of steroids to fight infection but “mask issues” that show up later.
Myers response by e-mail states that knee replacement patients at MH have “an average length of stay of one day.” He went on to add that he was unqualified to comment on the post-operative management “as it is outside my scope of practice (board certified physical therapist)…. Dr. (William) Karch stays fully up-to-date with the orthopedic literature and follows evidence-based protocols in the management of his patients.”
A review of studies of steroid use for knee replacement surgery published in SciMed Central, Annals of Orthopedics and Rheumatology shows four cases of infections in 791 patients. According to the article, steroids are used to reduce pain and inflammation, getting the patient into rehabilitation more quickly.
Despite the not-too-subtle war of words between the two CAOs, both maintain they are both open to future collaboration.