BLOUNTVILLE, Tenn. — Even Ballad Health’s most ardent supporters are frustrated with the health care system’s seeming failure to respond to concerns about patient care.
“I was all for the merger. I’m still all for the merger, but I am totally against the leadership of the merger. Period,” said Dr. Jerry Miller, founder of Holston Medical Group. “When you’ve seen as many patients as I have and you’ve dealt with 60,000 patient visits, people run into you. It’s so disconcerting when you hear these stories and every one of us is expected to do something, and none of us can do anything.”
Miller serves on the Local Advisory Council that was set up by Tennessee when the state approved a COPA, or certificate of public advantage, that allowed Wellmont Health System to merge with Mountain States Health Alliance and create Ballad, a health care behemoth that covers an area about the size of New Jersey. Ballad has a monopoly in Tennessee’s Tri-Cities region and Virginia’s coalfields. Virginia maintains similar regulatory control.
The council’s meeting Thursday centered on members’ continued frustration with Ballad over its lack of public response to complaints.
Ballad said in a statement, “There are many changes occurring, and we are learning how to better communicate. We appreciate the advice of the state.”
Many of the members said council service is the most demeaning and frustrating experience they have had, as they are inundated with complaints to which they have no ability to respond. Their role is to ask the state’s monitor to look into potential COPA violations; concerns that don’t deal with the terms of the COPA fall outside their purview.
Many of the problems involve patient care at Holston Valley Medical Center in Kingsport, where Ballad plans to downgrade both the trauma level in the emergency department and the level of care for newborns and move the services to Johnson City. Ballad has said that the region’s declining population does not support having more than one top-level trauma center and specialized nursery, and that it could better attract and retain specialists at one center. Protesters have camped outside the hospital since May 2, when Tennessee approved Ballad’s plans to eliminate the neonatal intensive care unit and move the sickest babies a half-hour away to Niswonger Children’s Hospital.
Dani Cook, who has led the protest, said Thursday she was skipping the advisory council meeting, as the group has ignored their concerns. Although Ballad has served her legal notice not to trespass on its property, Cook said she continues to hear complaints from patients and their families that they’ve had to wait hours to be seen in the emergency department, that once they are admitted they wait up to 12 hours for a bed, and that patients are receiving treatment in the waiting rooms and shots in the hallway.
“We have people sitting up there in the street 24/7. While I disagree that’s the way to do that, there is a reason these things are happening,” Dennis Phillips, chairman of the advisory council, said during the meeting at Northeast State Community College in Blountville.
Council members spent much of the meeting expressing their frustration. They said they receive emails, calls and complaints without any way to address them. People don’t understand that their role is to advise Tennessee’s health commissioner, not Ballad, they said.
Miller said he received an email a week and a half ago wanting to know what he was going to do about a wing being closed at the hospital.
“I went to the hospital to see that, and yes, there was a whole wing of the hospital closed down, and I asked them why. They said, ‘We don’t have any staff, Dr. Miller,’ ” he said.
Council members said they understand there is a bedside nurse shortage everywhere and a shortage of rural area physicians . But what they don’t know is whether the merger has prompted staff to depart.
“I get calls all the time, and I try to be as positive as I can because everybody is working on this, and there is no easy solution. But I just wish we could have more input or more sessions on education of people,” Miller said. “Communication from Ballad ought to be better than it is.”
They had asked Larry Fitzgerald, the state’s COPA monitor, several months ago to look at the issue of physician retention.
“Ballad has suggested to me to get that data would be hard, but not impossible,” he said. Council members asked him to press for the information.
Ballad said the national nursing shortage is well documented and it is responding by increasing nurses’ wages.
“The U.S. government recently released a study saying that by next year, Tennessee may only be able to meet half the demand for nurses. So we are working hard to protect our patients from this national problem.”
Jeff Ockerman, director of Tennessee’s division of health planning, said that he and Fitzgerald are discussing the wait times in the emergency department.
“Some of what we heard about is distressing. We are doing some work on that to try and figure it out,” he said.
He said Ballad will be scored on patient safety issues during the state’s annual review.
Following the meeting, he said the scoring would most likely occur this fall but the report would not be ready for the public until March 2020. He said it has taken longer than expected to gather data for the Jan. 31, 2018, baseline — the date of the merger — on which Ballad’s progress will be judged.
“We have encouraged Ballad to do a better job of communicating. So many things from the state’s perspective have just not been communicated far enough in advance or clearly enough, and sometimes not at all, like the oncology center,” Ockerman said. “We keep telling them to do a better job.”
Ballad had moved a stand-alone oncology center into Indian Path Hospital in Kingsport, which allows it to bill a higher hospital facility fee, but also gives it access to medications at lower prices.
Council member Dr. Brenda White-Wright said her husband had been going to the cancer center for years.
“It is only because of complaints from other people through email — the same kinds of complaints you all get — that I found out the cancer oncology-hematology center on Stone Drive had shut down,” she said. “We never got a letter. We never got a phone call. We never got anything about it. I think we have a communication issue. I think it’s going to take all of us listening to our citizens and responding to as many of their concerns.”
The state is developing an online form to handle complaints and to sort whether they should be investigated by the COPA team or by another department.
White-Wright said people need to hear back. She also pushed for the council to create a committee to come up a better way to hear public comment.
Ballad’s hospitals in Virginia are smaller community hospitals. Pre-merger, Wellmont’s hospitals transferred patients who needed a higher level of care to Holston Valley, and Mountain States transferred them to Johnson City.
Virginia does not have a local advisory council but plans to rely on the Southwest Virginia Health Authority to fulfill that role.