Val Verde Regional Medical Center: What employees are saying

December 31, 2007
By Bill Sontag
Feature Writer

Employees and physicians at Val Verde Regional Medical Center shouted in writing a growing disenchantment with administrators and the working and patient environment at the hospital in a report released by the Val Verde County Hospital District Board, Dec. 12.

Dr. Susan Korbel, contracted by the board to secure public, staff and physician opinions, discussed her 223-page report in brief executive summary to the board at a small gathering of members, hospital employees, physicians and interested citizens. Despite a board decision to release the full report, Korbel’s work was not immediately available to the media or the public.

Board member Frank Larson, whose motion to release the report was approved, told LIVE! Monday (Dec. 31), “Our attorney, Quinton Etzel, advised the District Board that the proper procedure in the past was that requests for information should be routed through the hospital administrator [CEO Jack Houghton] who has acted on the District Board’s behalf because of his central location,” said Larson.

Larson said he’s never seen this procedure described in writing. “We may alter this policy after review by the district board at an upcoming meeting.” On Friday (Dec. 21), LIVE! submitted a Texas Open Records Act request, obtaining an unbound copy later that day.

Employees who responded to Korbel’s invitation – at interviews, with online questionnaires, in hand-written responses, and at two public forums – were not shy about sharing their frustrations. Most expressed the sentiments of Bob Boland, board president, almost exactly a year ago, Jan. 4, 2006: “All I want is a good community hospital. And it has to be run like a business, but, damn it, it’s the people that make it a good hospital.”

Respondents to Korbel’s research indicate widespread belief that hospital administrators have lost sight of that ethos and the gratification it provides to dedicated employees. Staff members responding to the survey’s evaluation of management, public relations, human resources, and laboratory functions gave failing grades to the managers and the human resources (personnel, employee development) office.

The latter received “D” or “F” ratings from 62.5 percent of staff respondents, and many urged the removal of Human Resources Director Esmeralda Graham. “Get rid of Esmeralda Graham,” wrote one commenter. “She has done nothing but promote discord and discontent with her meddling, but not being available to staff to actually do her job.” “HR Director needs to be terminated,” said another, and so on.

The category of “managers” fared worse, receiving “D” or “F” ratings from 66.7 percent of respondents. Chief Executive Officer Jack Houghton was targeted for comment by many respondents. “Need a new CEO, caring, doesn’t lie to employees, respect medical staff and board. CHC [Community Hospital Corporation, contracted to manage VVRMC] is here for one purpose, to make money. They don’t care about the community, patients, employees, or doctors,” asserted one commenter, characteristic of many comments about hospital management.

Laboratory services at VVRMC were applauded by many respondents. Nearly half (44.4 percent) gave the lab an “A” or “B” rating.

Staff member respondents rated 11 departments on the same “A” through “F” scale, and one – the Emergency Department – was graded the most severely by employees, mirroring concerns expressed both in this survey effort and, anecdotally for years, in news reports, comments to board members, and reports to physicians. Exactly half the staff respondents – 50 percent – gave the ER a “D” or “F” evaluation. An additional 28.4 percent rated the department with a “C,” 14.8 percent, “B,” and only 5.5 percent rated ER “A.”

Top “A” ratings from employees went to Hospice, 46.2 percent, Respiratory Care, 33.7 percent, and Volunteer Services, 31.8 percent. But current staff members, in collected comments among the “Hospital’s Best Features,” showered their appreciation on two characteristics: Devotion of staff to patient care, and quality of equipment and diagnostic technologies. “I think we have employees that are very caring if given the opportunity. We have a lot to offer Del Rio if we can get the hospital back in good graces with the community,” wrote one respondent.

“Our patients are the only reason I keep going back,” summarized another. “Lots of good things, number of dedicated staff, camaraderie, sense of family, home grown, close, defend and take care of us until we die, employees like that,” was offered, too. Many lauded hospital equipment purchases that received a surge of attention under the previous CEO, Rick Jacobus, with comments such as, “Awesome equipment,” “Good equipment, we do give good care,” and “Digitalized CT scans good, board voted yes.”

Korbel also examined VVRMC Employee Satisfaction Surveys, scrutinizing differences between 2006 and 2007, reporting that the comparison “…shows that this year’s scores are lower for 13 of 17 attributes tested.” Korbel also pointed out, “The four attributes with the lowest scores [of employee satisfaction] are usually seen as the most important to employees: Compensation (pay and benefits), and recognition…”

The top three sources of satisfaction for VVRMC employees are those in which gratification comes from the respondent’s attitude and perception of immediate work surroundings: “I like the work I do at VVRMC,” “I get to do what I do best in my current job,” and “I have a good friend at work.” As noted by Korbel, most gauges of levels of satisfaction slipped from one to 12 percent in employee confidence on the five-point scale, the greatest loss seen in the attribute, “People listen to my opinions.” (See Employee Satisfaction graph, single click on it to enlarge for better readability.)

The report also includes court-recording-style transcripts of all comments at two public forums held at Ramada Del Rio Ballroom, Nov. 1. Korbel sub-contracted with Ximenes Associates, San Antonio, a public relations firm with experience in public involvement on controversial projects, to organize and analyze results from the forums.

Linda Ximenez prepared a summary of the public comments for inclusion in Korbel’s final, full report. “Personal accounts of undesirable working conditions, substandard patient care, and the perceived disinterest in improving the situation were common themes,” Ximenes reported. “It appears the situation has become progressively worse, particularly in the past eight (8) months.

“Testimony revealed, whether true or perceived, the Community Hospital Corporation (CHC) as the hospital administrator, their corporate board [Val Verde Hospital Corporation], and the voter-elected hospital district board have allowed internal issues to seriously hamper their ability to manage the hospital in a manner that promotes collaboration in the work place and trust in the community,” Ximenes stated.

“Time and again, members of the community spoke about CHC’s disrespect toward staff, nurses, and physicians as well as the decline in working conditions. Nurses have been forced to take on twice the number of patients as a result of massive lay-offs or forced resignations. It seems in the past the hospital provided full-time security, employee meals, and regular work schedules requiring very little overtime. According to testimony, currently there is no daytime security on duty, employees are responsible for their own meals and the cafeteria is not open on the weekends, and many employees are working overtime on a regular basis. There is a lot of resentment that locals are losing their jobs to contract nurses, and that the entire organization is losing its local stake in its only hospital.

“Most speakers expressed the belief that CHC does not promote open lines of communication between the management and the employees, nurses, or physicians. Employees are fearful of speaking out against management. They have seen former employees try to improve working conditions only to be terminated without explanation. The administration seems to be taking a ‘hands-off’ approach to employee relations and placing emphasis on acquiring more equipment and building more parking. This approach has resulted in decreased morale and a loss of qualified and respected local physicians, nurses, and staff. Which in turn has resulted in a decrease in the standard of care and a lack of consumer confidence,” Ximenes reported.

At the Nov. 1 forums, Jacki Dalton, speaking on behalf of an employee who feared retribution if named publicly, described past working conditions which her source says are now absent. Examples include, “…the care in large part was good quality,” “We had a full time security service that responded not only when there was a …problem, but were there for nurses as escorts when needed,” “Overtime was a rare event. And only when there was a true emergency. The morale of the people was very high. They knew what was expected of them and they did it,” said Dalton.

Dr. Emile Glines Abbott also addressed hospital employee morale at the forums. “The work environment is completely hostile. None of the nurses are happy, and we have a nursing shortage here at this hospital. These nurses are overworked and underpaid and unappreciated by the administration,” Abbott said. Later, he addressed comments he believes are being circulated about him by hospital administrators: “Now, I have been considered to be an incompetent physician recently, and that’s because of the low utilization rate in this hospital. That’s amazing. I have never had a malpractice lawsuit since 1966, which is when I graduated from medical school. I guess competency is more gauged by the administrator [Houghton] as to the amount of people that you put in the hospital, rather than your ability to take care of your patients.”

Structurally, the Hospital District Board’s report includes seven pages of “Hospital’s Best Features” comments, followed by 13 pages of “Suggestions for Improving Val Verde Regional Medical Center,” and 21 pages of “Other comments that would be helpful for the District Board and Management Team.”

In addition, Korbel included copies of all media reports leading up to and through the survey process, as well as complete transcripts of comments from all presenters, Nov. 1, plus sign-in sheets at the forums.

The full report has not been put on public view, but Hospital District Board Vice President Rachel Beavan told LIVE! that the subject – possible placement at the Val Verde County Library – will be on the board’s agenda for discussion at the next regularly scheduled meeting, Tuesday (Jan. 29).