Valley Health Responds to Negative Portrayal Related to Services and EMS Drug Box Program Cost Realignment

(Writer’s note: Other business in the August 20th meeting agenda will be covered in a separate Royal Examiner story. Here we will focus on the Valley Health response to recent board chairman criticism and its presentation of an alternate perspective on its role in State-mandated changes to the EMS Drug Box Exchange Program.)

Representatives of regional medical provider Valley Health appeared at the August 20th meeting of the Warren County Board of Supervisors to respond to critical comments from Board Chairman Cheryl Cullers regarding their stance on coverage of costs regarding State-madated changes to the EMS Drug Box Exchange Program involving municipal Emergency Medical Service responses. County Fire & Rescue Department personnel explained at an August 13 supervisors work session that Valley Health was declining to cover prescription drug use and distribution costs under the new system that currently they said Valley Health recouped through the billing of emergency response patients brought to their facilities, primarily the new Warren Memorial Hospital, by Warren County Fire & Rescue units. That number was cited as 90-percentile plus of local EMS calls.

That transfer of cost responsibility to local emergency services was forecast to increase operational costs from $200,000 to $250,000 for materials, and as-yet-to-be-determined personnel costs. As readers will recall, Cullers, a retired public schools nurse, reacted in frustration at the situation as described, saying she felt Valley Health managment were “just being jerks” in a situation where they could recoup their costs, and even turn a profit, through continued billing of Emergency Medical Service patients transported locally to Warren Memorial Hospital or other Valley Health regional facilities. LINK: ‘Acting like jerks’ is Board Chair’s Assessment of Valley Health Stance on Rx Billing Tied to State EMS Operational Overhaul

A week later Valley Health had a different perspective.

Another side of the story

Two, of four Valley Health officials who were present, addressed the Board of Supervisors after Vice-Chairman “Jay” Butler moved they be given time to make their presentation as a meeting agenda addition. First was Jennifer A. Coello (7:34 linked video mark), who introduced herself as a North River District, Warren County resident, and Vice President of Operations and Administrator at Warren Memorial Hospital. “I am here today to address some misinformation from recent board of supervisor meetings and news articles, so I may assure our community and its citizens that they have extraordinary health care right here at home,” she began.

Opening Valley Health speaker Jennifer Coello cited what she characterized as “extraordinary health care” provided by the new WMH. Below, second VH speaker Chris Rucker alleged misinformation on the County side about VH’s role in the existing and coming changes to the EMS Drug Box Exchange Program. We hope to eventually see a County reaction to the materials Rucker said would be left with County officials in support of VH’s side of the story.

Second Valley Health speaker was Winchester-based Valley Health Vice-President Chris Rucker (11:53 video mark) , who noted he has been in the Northern Shenandoah Valley 15 years, somewhat longer than his predecessor to the podium. He indicated he would reference that longer tenure in addressing recent criticisms of Valley Health locally, particularly at the previous week’s supervisors work session where he noted references to Valley Health leadership as “fat cats and jerks” and Warren Memorial Hospital as “a band-aid station”.

And it was Rucker, who later in his remarks first addressed the EMS Drug Box Exchange Program that launched Chairman Cullers negative characterizations of the Valley Health administrative role in those coming State-mandated EMS process changes. And since his description from the inception to current practice of the Drug Box Exchange Program ended up 180 degrees from what the supervisors heard from administrative staff and Fire & Rescue personnel a week earlier, we will start there over what appears to be a vast misunderstanding somewhere along the line.

About that Drug Box Exchange Program

In criticizing the “band-aid station” characterization of Warren Memorial Hospital Rucker mentioned that reference coming up during the discussion of the State-mandated changes to the EMS Drug Box Exchange Program, even though that charcterization largely expressed discontent with the absence of some medical services, most prominently the lack of a Maternity Ward, at the new Warren Memorial Hospital.

“I’d like to clarify that, and make very certain that you have on the record, we’ll leave the necessary information, that we have long provided medication to area EMS agencies. That is a legacy function that dates back to when most of the agencies were volunteer and didn’t charge for services. And that was the hospital’s way of supporting those volunteer agencies,” Rucker said, adding, “What’s not true is that Valley Health doesn’t bill those patients. We can’t bill the patients, we didn’t administer the medication. It wasn’t done under our license. It wasn’t done in our hospitals. We have no ability to bill patients or their insurance companies for that.

“So, we have been giving those medications for free for decades. And nobody’s ever said ‘Thank you’ for that,” Rucker said of Valley Health’s perspective on what appears to be a classic “Failure to Communicate” (with a nod to publicity for the 1967 film classic ‘Cook Hand Luke’ starring Paul Newman) between municipalities and their regional medical services provider on emergency service calls prescription drug costs and compensations through the decades.

Moving past his simmering outrage on the above-referenced negative characterizations, Rucker pointed to a next step:

“It is my intention to work with (County Administrator) Mr. Daley in the next few days to develop a pricing agreement. We’ll begin selling those (Rx drugs) to you until such time, November 27 I believe is when you need to resolve how you’re going to do that (regionally or by individual municipality). But we’re certainly not going to interrupt care, but we’re not going to continue to provide free medication.”

County Administrator Ed Daley and County Attorney Jason Ham were among the interested observers to Valley Health’s response to last week’s negative characterizations based on a combination of issues related to the regional medical provider’s service and role in an EMS-involved Rx Drug Box Program.

Here Rucker pivoted that full 180 degrees from the scenario that raised Chairman Cullers ire as it was explained to her board a week earlier. “You should also know by the way, that the free medication we’ve been providing to you is generally paid for by most insurance companies. You, your Fire & Rescue Service, has been billing insurance companies for medications and care that we provided for free. You’ve been profiting off what we give you, not the other way around.”

As to Valley Health’s role in promoting the State-level mandate on an altered EMS Drug Box Exchange Program, Rucker said, “It’s been suggested the Drug Box changes were a choice that Valley Health made and that hospitals in Northern Virginia were handling it differently. Let me be completely clear, every hospital in the state is handling it in a similar manner.” He added that he would leave “statewide communications” as well as “all the communications from the Northern Virginia hopitals and their EMS agencies” for the County’s review that he said would support his assertion that it was being handled in a similar manner statewide.

By the way, it’s a pretty good hospital

In leading off the Valley Health response, Coello followed through on her promised assurance to the community that their hospital was more than a “band-aid station”.

“First, as to our capabilities, Warren is not a bandaid station as was described at last week’s meeting. At an investment of more than one-hundred-million dollars and an expanded footprint of 42-percent to allow for future growth, we are one of the state’s newest and most technologically advanced hospitals. We operate a 24/7 Emergency Department that cares for 25,000 patients annually; three operating rooms that perform 1600 surgeries annually; and one cardi-cap lab that performs 500 cardiac procedures annually.”

She continued to note, “36 in-patient beds, each equipped with high-definition cameras and video screens allowing consultation with 28 different types of specialty physicians.

“Beyond the investment that was made to the hospital proper,Valley Health also invested in physician training and recruitment through its sponsorship of a three-year, family practice, physician residency program. This program is based out of Warren Memorial Hospital and serves as a pipeline for recruiting primary care physicians to our community,” Coello observed.

Graphic of the new WMH looking NW toward the hospital’s upper levels panoramic view of the Northern Shenandoah Valley. Below, a file photo of Feb. 2018 citizen protest at old WMH at news the new facility would not have a maternity ward. See story for VH explanation of why that decision was made.

As to specific criticisms, Coello said, “A frequent criticism directed towards Warren Memorial is the availability of women’s health services. This seems generally to refer to child birth. However, it is important to note that women’s health services are much more than child birth. It includes services like the prevention and early detection of breast cancer, which is the number one cause of death in women.

“You are undoubtedly aware that the best way to prevent premature death is through screening mammographies. But were you aware that Warren County is among the lowest in the state for breast cancer screenings? Valley Health has recognized this and created additional mammography capacity at all of our facilities to improve screening rates.

About Maternity Services

“As for the issue of child birth, while I was not here when that decision was made to move maternity services to Winchester, I can tell you that still today Valley Health’s philosophy remains the same. We will not seek to provide any care we cannot do safely. And there are simply some services that are not safe in a smaller community. And unfortunately maternity service is one such service,” she asserted. This reporter later contacted Coello about why maternity service in a small community was considered more dangerous. This is what she told us:

“In small community hospitals, where specialized care such as maternity care is less frequent due to population size and need, caregivers do not have the opportunity to regularly provide that specialized care. In some instances, it can be days or weeks without caring for a patient with unique needs. This may allow infrequently used skills to atrophy, resulting in an increased risk to the patient …

“Therefore, in this instance, maternity care at Warren Memorial Hospital has been centralized at Winchester Medical Center, just 23 miles away, an award-winning maternity care hospital with a dedicated full-time labor and delivery and mother and baby unit, as well as a Level III NICU.”

At the August 20th meeting she continued, “Lastly, I’d like to comment on what seems to be a general sentiment that Valley Health is not committed to this community’s health. I, along with the 269 credentialed physicians and nearly 400 clinical and non-clinical staff providing care, many of whom I would add, live in Warren County, beg to differ.

“Here are some of the services we provide: orthopedics, cardiology, emergency medicine, general surgery, family and internal medicine, endochronology, ears, nose and throat, and audiology, gynecology, pulmonology, behavioral health, and wound care. This list is not exhaustive but privides insight into the wide breadth of services provided locally. And what we do, we do well,” she told the supervisors, citing support of her “we do well” assertion:

“Warren Memorial Hospital has been recognized by the independent health care safety organization the Leap Frog Group seven consecutive times with their highest level of recognition, a safety grade of A.” She continued to note a “top 100 community hospital in the United States” recognition from another medical services watchdog group. “I’m incredibly proud to lead our award-winning team of dedicated professionals at a hospital that has faithfully served this community for over 70 years and is well positioned to do so for many more years to come,” Coello said in closing her opening volley from Valley Health.

Earlier in his comments, second Valley Health speaker Rucker asked the supervisors if they would consider issuance of an official group apology as a move toward improved joint efforts to correct any conflicting perspectives on the provision of medical services to this community. In justifying his call for a group apology to try and mend fences, while the chair was the one expressing her frustration with Valley Health at the previous week’s work session, Rucker pointed out that none of Cullers colleagues present (Cook was absent, as she later noted) expressed a cautionary reaction to such pointedly negative characterizations of Valley Health’s administrative leadership from the chair. In fact, he said the negative impact on the local Valley Health community had extended beyond the administrative branch to the medical and non-medical staff.

“As I share these thoughts with you I want to let you know that they’ve had a very demoralizing effect on our staff and our physicians. These are people who have dedicated their lives to the service of others. And to think that their community’s leaders think so little of them is quite disappointing, quite upsetting to them,” Rucker told the county’s elected officials.

He continued to point to Valley Health’s collaboration with community agencies, including financial support for programs like Domestic Violence and Sexual Abuse counseling, for at-risk youth, CPR community training, and safe babysitter classes, and AEDs (automatic external defibrillators) in schools he said Valley Health had paid for, among other interactions.

Click here to watch the August 20, 2024 Board of Supervisors Meeting.