The Van Diest Medical Center Board of Trustees faced a roomful of community members, many of whom voiced their opinions on the new hospital Emergency Department Transfer of Care policy.

The policy, which was implemented in early February, says that the patients who present to the emergency room must be seen by an onsite provider, and that provider has the ability to consult or collaborate with the patient’s primary care physician. Prior to the new policy, patients were able to have their primary care physicians called to the ER.

Nancy Dermand, a former hospital trustee and nurse, spoke in favor of the policy.

“I’d like to remind you that if the hospital returns to the old days as some are suggesting, there would not be a hospital in this community,” she said.

Dermand asserted that for the past 20 years, the hospital has been “controlled by a few physicians who have controlled the CEO and threatened to walk out.”

Lori Rathbun, Chief Executive Officer of VDMC, in a statement to The Daily Freeman-Journal on Monday, said that the policy now “has VCMC in compliance with Federal Laws that we must adhere to.” She specifically cited the Emergency Medical Treatment and Labor Act (EMTALA) and the Stark Law, also know as the physician self-referral law.

Linda Pruismann of Webster City Medical Clinic said an opinion from an attorney stated that EMTALA does not require this new policy. She said the attorney’s response said that EMTALA requires that patients be seen within 30 minutes and be provided with a medical screening exam to determine a proper level of care and to stabilize the patient without regard to a patient’s ability to pay.

“A medical screen may be conducted by any qualified healthcare provider there is no question that a patient’s primary care physician is a qualified provider who may perform this screen,” Pruismann said, reading from the attorney’s opinion.

“If the new policy is a way to generate revenue for the hospital, we would ask the board and administration to please be forthcoming with the community and explain that’s why it is being changed,” Pruismann said. “It may be a better way to generate revenue, however it may be detrimental to the patients.”

Kathy Baker presented the board with another set of petitions signed by 729 community members asking that the policy be rescinded.

“I feel like I’ve been slapped in the face,” she said. “I went and got these petitions and you’re just telling me you don’t want to hear it.”

“It’s our say if we want our doctor, not you guys,” she said

Robert Villier of Webster City said he has been a longtime supporter of the hospital, but added that he wants to see his primary care physician when he comes to the ER.

“I want to see somebody who knows something about end-stage renal disease and organ transplantation, not a PA who knows nothing about it,” he said.

Several other community members present also spoke against the policy with one person even calling for Rathbun to resign.

Dr. Subhash Sahai presented a letter to the board in response to one he had received from Rathbun, telling him of the ramifications of not following the new policy. In his response, Sahai spoke of five recent situations which “compromised the care provided to my patients in the Emergency Department and potentially, the hospital.”

In the letter, Sahai also asked that in non-emergent situations, “the patients be given the option to be seen by their personal physician.”

Rathbun addressed the concerns voiced by the community members in her report to the board.

“I want to reinforce that the policy decision has been widely communicated,” she said.

Rathbun added that the policy continues to support the hospital’s objectives of quality and patient safety, but doesn’t restrict collaboration with the primary care physicians.

“Our providers in the ED can call anytime they deem necessary to consult or collaborate with the local providers on treatment or care,” she said. “Our goal is to work with all providers in this community. The board elected to change the policy at this time in consultation with legal (counsel) and regarding the risk to this organization.”

Rathbun said the hospital has specific tracking related to patients in the ER. She added that there is an aspect of EMTALA law that speaks to discrimination of patients.

“You see, not all patients who ask to call providers are responded to (by the local providers),” she said.

Rathbun said VDMC did a study with 556 patients who presented to the ER. Only 27 of those patients requested that their private physician be notified or the physician called ahead, or the physician was notified early in the process by the ER staff.

“That’s less than 4.9 percent of the ER volume,” she said. “Of the 27 patients who asked for their physicians, only on 10 patients did the doctors come out to treat the patient in the ER.”

Of the 10 patients, 8 received a screening examination in less than 30 minutes, one of the requirements of EMTALA. Rathbun said the ER staff maintains a response log

“The ED staff has been routinely reminded to maintain a response log so we can assure the board of directors we are in compliance with federal law,” she said.

Rathbun said the policy has been the “responsible decision to make.”

“To the patients and community members of Webster City, we are not trying to avoid collaboration with your provider, but we do need the respect for what this board has to do to act on the laws that exist,” she said. “And frankly, we need the cooperation of the medical staff in that regard.”

Rathbun said VDMC was about 10 years behind other hospitals in implementing the policy.

“Although it was reported that other hospitals allow for this practice, they do not. Not Boone, not Iowa Falls, not Clarion, not Fort Dodge and not Ames,” she said. “And we have gone to great lengths to document that.”

Rathbun said that she would not consider resigning her position.

“I intend to uphold my position as CEO of this hospital, and I will continue to elevate quality, patient safety and service to this community,” she said. “That is how I see my role. That is why I took this job. This has nothing to do with Mercy.”

She said the market share and outmigration issues faced by VDMC has nothing to do with Mercy Health Network.

The majority of outmigration to other medical facilities is to Fort Dodge and Ames, said the CEO.

“We study these things,” she said.

Rathbun said it was disturbing to her that the hospital only has a 61 percent market share for outpatient services.

“Most critical access and small rural hospitals have 70 to 80 percent market share,” she said. “We estimate that is about $10 to $20 million dollars going outside of your community – not supporting this hospital.”

She said the management agreement with Mercy Health Network has allowed VDMC to cut expenses by working within the buying group for supplies. The hospital also benefits by receiving legal assistance, continuing education and meetings for staff members throughout the year.

“There are 144 meetings for continuing education,” she said. “And they don’t do it for any other reason than to strengthen rural health care. Their belief is if you’re strong in these outlying rural communities, then the urban health care system can be strong. And patient care across a continuum can be strong,” she said.

Rathbun said she hoped that her explanations helped provide clarity to the community about the policy change, Mercy Health Network, services provided and the hospital’s attention to laws and regulations.

“There is still an opportunity to collaborate,” she said. “I have a sense that people think that’s not the case, but it certainly is.”

She said the hospital will continue to work towards insuring greater continuity of care, growing services, adding new providers to the team and improving and enhancing patient experiences.

“We’re grateful to those who choose Van Diest Medical Center, but we will continue to implement policy to protect this organization,” she said.