Letter to the editor triggers comeback with tentative time frame
RMCH, our vital healthcare resource, appears to be sliding into failure, and many hearts are breaking, including my own.
My connections with RMCH run deep. My grandfather, Rev. John C. De Korne, was on the Home Mission Board of the Christian Reformed Church to establish the mission at Rehoboth in 1903. Through my family’s close friendship with Dr. Marvin Vanden Bosch, I volunteered as a nurses’ aide at the old Rehoboth Mission Hospital in 1965 and 1966, out of college. My husband and I externed at the Mission Hospital for 3 months in 1971, then returned in 1980 as pediatrician and ophthalmologist for our whole careers. In the love and dedication of countless people through the years, I saw the foundation of service and caring that has been built, on which RMCH will continue to grow and thrive, in spite of its current difficulties.
In 2020, the covid-19 crisis and a special state audit showing weak financial controls led to the termination of prior CEO David Conejo. A contract was signed with the Community Hospital Corporation and Don Smithburg as Interim-CEO of RMCHCS, with hopes of getting back on track to thrive.
However, now more than a year later, continued mismanagement by Mr. Smithburg and his Board, all of whom lack a deep institutional understanding of RMCH and its culture, has led to the loss of multiple long-term and devoted staff members.
Alarming management decisions have been made with no coordination or input from long-term clinical leadership. A culture of fear and intimidation has led to multiple employees being afraid to speak up for fear of aggressive retaliation. Staff reductions and resignations have resulted in alarming patient safety issues and understaffing of busy clinical services. Lack of value placed on the local relationships of experienced staff (such as labor and delivery nurses and providers, for example) has led to their reluctant resignations, and CHC has relied on expensive temporary staff from elsewhere.
RMCH has a long history of unique strengths that have sustained it through its ups and downs for over 100 years. It has always been part of a deeply-engaged community that understands that this community cannot thrive without quality, caring healthcare. Importantly, the roots of RMCH go back to two faith-based origins:
1) The Home Mission board of the Christian Reformed Church in Michigan; Rehoboth Mission Hospital was established in 1910.
2) The mission efforts of the Catholic sisters of St. Francis, which eventually moved to the new McKinley General Hospital in 1969, and then merged with Rehoboth Christian Hospital in 1984.
RMCH is led first of all by a mission of service, knowing all of life as a sacred gift, and having a purpose of being a channel for the love of the Creator-Source for the healing of society.
Prior to the pandemic, RMCH had a strong core of long-term nursing and physician staff who actively participated in previous RMCH administrations. In the last two years, RMCH started a Family Medicine Residency, and thanks to strong direct efforts by medical staff, recruited several excellent physicians from places like UCLA, Boston Medical Center, Contra Costa (a powerhouse in Family Medicine training), and UNM.
The OB/GYN department was fully staffed for the first time in years. Dr. Valory Wangler, the Chief Medical Officer at the time, recruited Dr. Caleb Lauber, a well-known local Navajo physician who was to build a new Community Health program, and to be one of the directors of the Family Medicine Residency. These recruited physicians, who came to comprise more than a quarter of the physician staff, were drawn to the chance to nurture a strong medical educational program and to build RMCH into a model rural center committed to serving an underserved population. They showed every intention of making a long-term commitment to RMCH, buying houses and integrating themselves into the small community of Gallup.
The residency program completely filled its inaugural class (which is a mark of success especially for a first-time rural family medicine residency), and it appeared that the staff was on track to develop a powerful core of clinical leaders in rural health.
However, since CHC came on board, many of these staff have departed.
Examples and issues include:
1) The firing of Dr. Caleb Lauber, without notice or explanation, which he and his colleagues believe to be due to his vocal objections about poor working conditions and concerns about patient care.
2) The departure of the chief of obstetrics, who resigned after discovering incontrovertible evidence that the administration was moving to fire her. The other permanent obstetrician also resigned due to this culture of fear.
3) Multiple disciplinary actions have been taken against several physicians after staff spoke out about patient safety issues and subsequently sought to unionize.
4) RMCH had been without a hospital call light system since March, and patients were asked to ring a bell if they needed help. This was dangerous and frightening for patients and nurses. The physicians of RMCH pooled their money to purchase a call light system, but it was not implemented for several months, despite repeated inquiry by staff, until very recently.
The doctors and nurses who have resigned have stated that their decision was due to an unsafe, toxic work environment fostered by CHC management and active retaliation for speaking up.
At this time, per budget projections presented at the Board Meeting on 11/16/21, RMCH stands to lose $9.5 million this year alone, a loss accelerated in the latter half of the year, due to an increasing reliance on temporary staff that can cost three times as much as permanent staff.
What Is At Stake?
RMCH is at high risk of losing everything that has been built in these last few years, and losing sight of its essential 100-year mission. Without a core of teaching faculty, the residency program will not be able to continue. The hard work of RMCH’s most dedicated founders and servant leaders will be squandered. Without a clear path back to a strong educational program, a solid plan for retention of current staff and confidence in leadership’s commitment to patient safety, additional long-term and recruited staff will leave.
The community of McKinley County that depends on RMCH for its healthcare is absolutely key to letting our county and city leadership know that the current situation is leading to disaster for our “crown jewel” hospital; and with its loss, our community - and its ability to attract educators, business people, and to safeguard its citizens - will suffer.
There is a way forward, but it requires that CHC and the Interim-CEO exit, as his responsibilities for safe patient care, providing a supportive working environment for all employees and leadership opportunities for all staff, and working with the physician leaders for adequate recruitment and retention have clearly not been met. (Please see the Bylaws, Article VII). The Board of Directors should be holding the CEO responsible for his duties, and for pursuit of the mission, vision, and values of the Corporation, and is not.
RMCH demands the selection of strong, mission-oriented leadership, and a structure of hospital governance that is anchored in transparency and accountability to the community, with a clear path for true community partnership.
We expect RMCH administration and the Board of Directors to present financial and operational statements, to open its Board selection process to community input, and to demonstrate efforts to address the issues listed here. We expect the County Commissioners to demand the same, and to work with the community on developing governance structures that will do the same.
To all of our concerned community members, we ask that you use the following contact information to express your needs to the County Commission and the Board of Directors. RMCH is YOUR hospital, and it needs you right now!
Contact Information for the County Commissioners:
Billy Moore: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Genevieve Jackson: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Robert Baca: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Editor’s note: Because we felt this letter called for a response, we forwarded it to McKinley County’s three commissioners and the County Manager, Interim-CEO Don Smithburg, and every member of the hospital’s Board of Directors.
Responses received included that one member of the Board had resigned, a response from Mr. Smithburg, as well as a reply from County Commissioner Billy Moore, Dist. 1 representing all three commissioners in his comments. Information taken from that interview can be found on page 12.
By Kathleen De Korne Mezoff MD
pediatrician at RMCHCS (1980-2014) retired
