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Dch Property Management – Serious, fundamental change must come to DCH Health System if its hospitals in Tuscaloosa, Northport and Fayette are to survive, district leaders agreed in a spirited debate Thursday.
The difficult but unrestrained discussion about DCH took place during an impromptu session at the Next Level Summit, an ongoing three-day retreat hosted by the West Alabama Chamber of Commerce at the Renaissance Birmingham Ross Bridge Golf Resort in Hoover.
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Initially, the Conference’s nearly 30 breakout sessions focused exclusively on aspects of the seven topics addressed in the Chamber’s Next Level Series — Public Safety, Diversity and Inclusion, Area Infrastructure, Barriers to Workforce Entry, Economic Diversity, Quality of Life and Public Education .
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Chamber President and CEO Jim Page reserved one of the 29 sessions for a “wildcard” topic, however, and by popular demand, the discussion focused on public health.
Tuscaloosa Mayor Walt Maddox, Northport City Administrator Glenda Webb and County Judge Rob Robertson, the leaders of West Alabama’s three largest government agencies, prominently participated in the uncoordinated session.
Each session at the Summit led to healthy discussions, disagreements and debates as more than 100 area leaders strive to design solutions to the biggest challenges facing the Tuscaloosa region. But even in this sometimes controversial environment, everyone who packed the boardroom for the public health session agreed — significant change is urgently needed in the DCH System.
“We have to recognize that the status quo cannot be accepted,” Mayor Maddox said near the end of the meeting.
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Before you start airing the litany of concerns expressed by public and private sector leaders about DCH on Thursday, it’s important to note that not one of the dozens of people who packed the conference room spoke ill of the doctors, nurses, the surgeons and support staff working in the System or its nine-member board of directors.
Instead, the group’s frustration focused on the DCH governance model, which Maddox said has not been substantially updated since the Tuscaloosa hospital was incorporated by state law as a health care authority in 1982.
“I know we’ve talked a lot about models, but 16, 17 years ago, Blockbuster was the number one digital entertainment provider in the world, with 83,000 employees and 9,000 stores worldwide. Today, they’re gone,” Maddox said. “The healthcare model has changed just as quickly as the digital content market.”
As Thread previously reported, the DCH system is bracing for losses of up to $60 million this fiscal year, and with UAB’s state-of-the-art, nine-story Medical West Hospital Authority slated to open in McCalla in 2024, DCH leaders say it must adapt and improve the patient experience or risk going the way of Blockbuster Video.
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As this report will show, the DCH system faces a number of serious challenges, but chief among them is a particularly difficult combination strike.
First, DCH does not turn patients away and no empathetic person in the area should want them to.
No members of DCH System management or its board attended the Summit this week, but Lewis Fitts, who has served on the DCH Foundation board for 12 years, was in the room Thursday and served as the most vocal defender of the system.
“We’re fortunate to have a community hospital because we provide health care regardless of [ability to pay,” Fitts said. “Every year, we give away $30-$40 million in free health care to our community, because that’s what you do when you’re a community hospital.”
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To compound that, Maddox said 18 rural hospitals in Alabama have closed in the past 10 years, many of which were in or near West Alabama.
The result, leaders at the Summit said, is that the DCH System has become a “drainage basin” for health care delivery across the region.
These services are often provided to patients without insurance or the ability to pay for treatment themselves and without significant financial support from the governments whose constituents now come to Tuscaloosa for care.
To make matters worse, local residents who are insured or able to independently finance their treatments are increasingly choosing to go to other hospitals for non-urgent care.
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At the same time, the costs of fighting the COVID-19 pandemic continue to be extreme, but state and federal funding to fund this fight is quickly running out.
These factors and others combine to mean the DCH System, though technically a not-for-profit hospital system, is bleeding money.
Several leaders who attended the health care session shared their own DCH ER horror stories that are probably all too familiar to anyone who has been hospitalized in recent years, stories of hours of waiting in rooms full of suffering people, watching ambulances arrive with more patients but end up stuck waiting for space to free up for their passengers.
Tuscaloosa Councilman Lee Busby said too many people in the community use ambulance services as an Uber ride to the hospital, seeking emergency care for minor issues that could be better treated elsewhere.
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At the same time, Northstar Paramedic Services is struggling with the same kind of staffing shortages that plague countless other businesses in the region, state and nation.
Judge Rob Robertson said it was also a little known fact that by law, when an ambulance picks up a patient, the only place it is legally allowed to take that patient is to a hospital. An EMT is unable to make their own judgment about where an ambulance passenger should be treated, so everyone goes to DCH.
“There are some legislative remedies for some of these that I think are more long-term, but they’re part of what our discussions with the legislative delegation should entail,” Robertson said. “You know where an ambulance can take you once they pick you up? Only to the ER.”
“What if you don’t have to go to the ER? What if you could go to a clinic?” Robertson continued. “Once you’re loaded, they have to take you to the ER to fix your toe, by law. There are things like that that we have to start looking at in this age of health care that will take some legislative remedy to deal with.”
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That’s all well and good, but this year’s legislative session is already over, and Montgomery is hardly known for his ability to quickly resolve a pressing issue.
Stack those problems on top of the global pandemic, hospital staffing shortages and a limited number of ER beds and the hospital overall, and the result is consistently long wait times that local leaders say are no longer acceptable.
The impact is felt across all three governments — when all Northstar ambulances are stacked up waiting to admit patients to the ER, it’s up to those governments to take responsibility for transporting patients to the hospital.
Chief Randy Smith said the Tuscaloosa Fire Department is manning its own ambulances and, in some cases, even using motor trucks to transport patients to the hospital, reducing their ability to respond to fires in the area.
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The county sheriff’s office and the city of Northport also operate a few ambulances of their own whenever an ER wait leaves Northstar unable to meet the day’s needs, which leaders said is happening more and more often.
So what is it about this nine-member board that could affect meaningful change at DCH Health System? The City of Tuscaloosa appoints two of these board members to six-year terms. The county has two other seats and the city of Northport appoints a fifth.
With local governments appointing five of the nine board members and leaders on all three bodies openly unhappy with the status quo at DCH, a solution seems as simple as the five appointees joining together to affect policy change of the hospital, in the administrative leadership or even in the ownership of the DCH system.
“I say this jokingly, but sometimes DCH is like hugging a piglet — it’s not easy,” Maddox said. “For whatever reason, this culture has been created over the last two decades, it seems to me, where there’s this veil of secrecy, where [the board] just doesn’t want to be open about who [they are] and what they’re doing.”
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Maddox said a culture lacking transparency and accountability might be acceptable at a private hospital, but not at DCH.
“When you enjoy tax-free status and taxpayer money, you have every obligation to be as open and transparent as the law allows […] and engage the community you serve,” Maddox said.
Maddox said he still believes the two city-appointed members and the entire DCH board are good people with good intentions, but said there is a disconnect between what they hear in the boardroom and what they share with patients, elected officials and the general public.
“We have an appointee, who is new, and I have regular communication with him — usually through my city attorney,” Webb said. “I will say that there is a veil between the information at the board level and what is being broadcast to the city of Northport.”
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The Next Level Summit is, at its core, about finding solutions to the region’s biggest problems
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