Voters Asked To OK New Board for Proposed Hospital
By Ryan Schlehuber

For the next six months, the Mackinac Straits Hospital Board will be focused on establishing a new nonprofit board and committees that will oversee the proposed new hospital facility and functions, while the current board will maintain the current building, much of the staffing, and the ability to collect a county-wide millage. The hospital board will ask voters to transfer hospital operations from the current Mackinac Straits Hospital Authority to the new corporation in the May 6, 2008, election. If approved, the move will finalize requirements to acquire federal funding for the construction of the new hospital at St. Ignace.

Federal Public Act 47 requires that such a transfer must have approval by authority members before it is official, said Rod Nelson, hospital CEO. Members of the Authority include voters in the City of St. Ignace and in the townships of Moran, St. Ignace, and Brevort, explained Mr. Nelson at a hospital board meeting Monday, December 10.

Hospital board members want to be sure the ballot language stresses to voters that funding for the construction, maintenance, and operation of the new facility will not use local tax dollars.

Because a new hospital structure, called Health Care Systems, Incorporated, is nonprofit and is eligible to receive more federal and state funding than the structure currently in place, taxpayers will not have to contribute to the new facility's debts, said Authority Chairman Ron Mitchell.

"If [the voters] recognize what's happening here, they will jump on it because it will get the taxpayers off completely," Mr. Mitchell said. "We are going to really have to make an effort to go out there and make sure everyone understands it."

The new corporate structure being formed to operate the new hospital will be able to receive federal financing benefits not available to the old Hospital Authority.

The Mackinac Straits Hospital Authority will continue to exist, said board Chairman Ron Mitchell. It's main purpose will be to continue to oversee operations of the Long Term Care facility.

"The Authority will continue to collect the millage for Long Term Care and it will keep employees under its retirement system and lease them to the new corporation," said Mr. Mitchell. "This will allow them to keep whatever retirement benefits they have earned so far and not lose them by having to go under another retirement system."

The annual 1.2 mills paid by county taxpayers, which generates $900,000 for the hospital, will still be needed to subsidize the Long Term Care Facility, said Jason Anderson, the hospital's chief financing officer.

While Mr. Nelson was hoping to get the issue placed on the January 15, 2008, presidential primary ballot, the U.S. Senate did not address it in time, thus, the hospital is focusing its efforts to make the May 6 regular election.

After the meeting, Mr. Nelson said hospital representatives will attend many local governmental meetings to explain the process of transferring authority from the existing board to the new board.

The rural, critical access hospital covers all of Mackinac County and has satellite clinics in Naubinway and on Mackinac Island.

The new hospital, to be renamed Straits Area Healthcare Village and to be constructed on North State Street near the Mackinac County Airport, will replace Mackinac Straits Hospital and Healthcare on the corner of Hombach and Burdette streets, which was opened in 1954.

The new hospital will include space for a tribal health center for members of the Sault Ste. Marie Tribe of Chippewa Indians, an emergency department, inpatient and retail pharmacy, radiology, aqua therapy, and outpatient surgery. It will also offer expanded areas for chemotherapy and infusion, a six-chair renal dialysis unit, and space for radiation therapy in the future.

The hospital received $37.2 million in loans from the United States Department of Agriculture for the construction of a new facility. It comes as $10.4 million in direct low-interest loans and $26.8 million in loan guarantees from Rural Development, and will now allow the long term care facility to be moved to the new building.

Construction will cost $26 million and the rest will refinance the debt at the Mackinac Island Medical Center and the hospital's $1.2 million short-term debt.

A building committee and a strategic planning committee are being formed now, as the new facility's construction plan is underway. Construction is expected to begin in April.

The strategic planning committee will be important in communicating with other hospitals and health agencies, especially as the hospital seeks to add more services, such as surgery and an oncology department.

Had a strategic planning committee been in place already, it may have influenced Karmanos Cancer Institute of Detroit to implement a radiation oncology department at the new facility. Instead, Mr. Nelson reported, Karmanos has declined the request.

"Part of the reasoning Karmanos gave us was because of the lack of volume (of people) in the area, but also, I think, there was some regional pressure on them not to allow a unit up here because their partners did not want it," said Mr. Nelson to the board. "So I think this board, the new board, and my hope is that everyone here will be a part of committees, and be a part of a process to determine who our friends are, and who we are going to align with."

The new committee will be a key component, Mr. Nelson said, in working with War Memorial Hospital in Sault Ste. Marie, Marquette General Hospital, and Northern Michigan Regional Hospital in Petoskey to provide as many local services to area residents as possible. Mackinac Straits Hospital has existing agreements with all three hospitals for critical access care services.

"We're looking at bringing in new services to our area, and that may open a can of worms with other health care entities," said Mr. Nelson after the meeting.

The board received a copy of a construction timeline for the new hospital from its architect, Skanska USA, although the board did not discuss it directly and no action was taken on it.

Construction could begin as early as March and occupancy could begin as early as October 2009.

Board Approves $1.3M in Loans

The board approved the acquisition of two loans, one for $1 million from Central Savings Bank and another for $300,000 from First National Bank of St. Ignace, both to provide funding for the general operation of the hospital.

The hospital is still not at a point where it can rely on incoming revenue alone, said Jason Anderson, the hospital's chief financing officer.

The hospital has received the $300,000 cash flow loan annually for years, said Mr. Anderson, and the $1 million loan is to insure that the hospital will make budget through the winter. November and December usually are the hospital's lowest revenue months.

The hospital will also receive about $900,000 from its countywide millage between February and May. The 1.2 mills was approved by voters.

Blue Cross Blue Shield is expected to repay the hospital an estimated $250,000 for expenses incurred by the hospital from patients covered under the insurance, Mr. Nelson reported.

"Right now we are in a better position than we had hoped for," Mr. Anderson told The St. Ignace News, "especially on the hospital side of things. These past three months have been significantly busier."

Nine patients are staying at the hospital now, he reported. The maximum number of in-patients the hospital can hold is 15.

The number of patients for the hospital's swing bed program, which allows small critical access hospitals like Mackinac Straits to provide necessary medical care and rehabilitation to Medicare patients, has grown immensely over the year, reported Mr. Anderson. Since October, the hospital has had 1,130 swing bed occupants, compared to 134 in 2006 at that time.

State Surveyor Checks LTC

Complaint;

RN Staffing Needs Adjustment

A state surveyor visited December 3 through December 5 and reviewed the operation and care system at the hospital's Long Term Care (LTC) Facility, in reaction to a complaint that was called in from one of the residents or resident's relatives earlier that week, reported Barb Davis, the hospital's director of nursing for Long Term Care.

The complaint, she said, was about a lack of staffing over a weekend, which, Mrs. Davis said, was the result of a winter blizzard that caused some worker absences.

The surveyor told Mrs. Davis that she was satisfied with how her staff has handled the situation, however, the surveyor noticed the hospital was not meeting one state requirement, which is having at least one registered nurse providing direct care for LTC patients at least eight consecutive hours, seven days a week.

The hospital has two full-time and two part-time registered nurses (RNs), however, said Mrs. Davis, the hospital has traditionally used licensed practical nurses (LPN) for care during weekends.

Only registered nurses are allowed to be in charge, according to the state.

"We do fine during the week, when I'm there and others on staff are there, but on the weekend, it's not unusual to have three LPNs on as charge nurses and not have an RN," said Mrs. Davis. "We have RNs on call, and RNs down at the other end of the building for acute care and [for the emergency room], and we felt that that exempted us from that particular rule."

The surveyor explained that RNs must be directly at the site and being "in the building" was not adequate enough, Mrs. Davis told the board. She also said the state used to allow waivers to that rule, but no longer does so.

RNs are allowed to manage more advanced intravenous therapy to patients, said Mrs. Davis.

Her staff is now meeting the requirement, however, she believes it is excessive for a facility like Mackinac Straits Hospital.

"Most nursing homes are freestanding, where normally a hospital and staff are miles away," she told The St. Ignace News after the meeting. "These rules don't fit our hospital because it is attached to Long Term Care."

Mr. Nelson told the board he will contact the Michigan Hospital Association to see if the hospital can receive exemption from the state requirement. The association consists of CEOs and administrators of hospitals across the state and is an important lobbyist in the Michigan Legislature.

In other action, board member Richard Smith asked fellow board members who have yet to make a donation toward funding the construction of the new facility to do so, to show the USDA that the board is behind the effort as a whole, and individually.

"It's important that we have 100% participation on the board donating to this cause, simply because the big donors almost demand that 100% of the board and a substantial number of employees be involved to show that they are interested in this," said Mr. Smith. "I'm asking to give until it hurts just a little bit."

Slightly more than half of the 11-member board has already donated to the construction of the new facility, reported Mr. Smith.