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January 5, 2012 Issue

Hospital impacted by economy
Slurry spilled
New radio equipment ordered for emergency services

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Hospital impacted by economy

By Carol McLeod
Staff Writer

Over the last several months, Jefferson Hospital has seen fewer patients stay overnight than in previous years. For all hospitals, but especially small, rural hospitals, fewer beds filled translates into tighter budgets.

Last week, Jefferson Hospital CEO Ralph Randall said the hospital had a deficit in 2010 and saw losses for 10 of the past 11 months of 2011 from operations.

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“We have found it necessary to draw funds from our reserve accounts in order to meet our obligations for operations,” he stated.

Randall stated the hospital is no different from many hospitals in Georgia that are experiencing a decline in inpatient admissions.

“Our average number of admissions per month was 87 in 2009, 80 in 2010 and this year, 2011, down to 58 admissions,” he stated.

Randall said the number of patients being admitted to observation has increased almost four times the number in 2010.

“A lot of our patients are Medicare or Medicaid and don’t meet criteria for an inpatient admission,” he said, adding this type of hospital stay is sometimes referred to as a “23-hour stay.”

A patient may stay in the hospital up to 48 hours and still be considered an outpatient by the criteria established by the government.

“These are folks that are too sick to go home but not quite sick enough to be admitted; but, we can still care for them in the hospital,” Randall said.

The CEO said the hospital is paid about $3,000 a day on a typical inpatient stay; but, for an outpatient visit, the hospital receives about $1,200 a day.

“It is a significant difference because you’re paid on an outpatient basis,” he said.

The number of patient visits is higher; but, because the reimbursement is so much less, the overall result is a decrease in revenue.

Mike Sombar, the hospital’s chief financial officer, said the hospital has to write off 50 percent of what is billed out for services.

“Our outpatient services and the Physicians Health Group rural health clinics overall have continued to hold steady on their volumes. We believe the changes in criteria for inpatient admissions and the weak economy have all contributed to the issues we are experiencing,” he stated.

“Unfortunately, this has also led to reducing our staffing. Each of our managers has had to make the hard choice of reducing their salary and wage budgets,” Randall said.

The administrator said in some areas, staff has been reduced to 32 hours and in other areas, positions have been eliminated.

“We are also exploring other ways to reduce our expenses, whether it is in supplies or contract services,” he stated.

The hospital is also in the process of installing new computer equipment and software for the electronic health record Randall said is part of the government’s health care reform plan and to improve the quality of patient care.

“The silver lining in this program is that once the hospital and clinics meet the ‘meaningful criteria’ these funds will be recouped via the EHR incentive program,” he said.

“The national economy’s bad. The international economy’s bad,” Randall said last week. “As a hospital, we’ve got to provide care regardless of someone’s ability to pay.”

Randall said some people may not be taking care of health care issues.

“Obviously, if they don’t have insurance, they put off going to the doctor,” he said.

Randall stressed the criteria people have to meet to qualify for insurance reimbursement on inpatient services has become stricter.

“Even if they’re staying overnight, we’re getting paid for outpatient,” he said.

Randall said the hospital has also seen a decrease in emergency room visits.

“About 6 percent,” he said. “I think it’s more to do with the economy.”

Randall addressed the concerns some residents have about the hospital and a possible closing.

“Part of it came from what’s going on in McDuffie,” he said, referring to the buyout the hospital in McDuffie County faced.

“I think a lot of it started when we had our reduction in staff,” he said, adding that was a 10-percent reduction.

Randall said the reduction was effective around the first of December.

“Mainly, it ended up being hours reduced,” he said. “We were trying to find ways to help our hospital without hurting our employees or community.

“We haven’t done any forced retirements or anything like that. Basically, it’s just been reducing our hours.”

Sombar said about 15 percent of the hospital’s patients have Medicaid. Medicaid and Medicare patients together make up between 60 percent and 80 percent, he said.

Sombar said the hospital has a reserve of money the hospital has built up over time.

“We keep it as a reserve in case we need it for larger items I can’t take out of operations, like a major repair. We have about 60 days’ worth of cash on hand. It may be a little bit more,” he said.

Sombar said there are other accounts for other things; and, they have pulled money from the reserve about three or four times in the past year.

“We pretty much carry everything on our daily cash coming in. We have payroll every two weeks,” he said, adding sometimes they have to use money from the reserve.

“It’s enough that I’m concerned but I’m not worried about it. We are optimistic that we can make some changes and turn it around. We have an optimism that we’re going to get through this,” he said.

“We’ve taken some money out during the year, maybe three times to cover payroll. This last time we took it out and we put it back in. Maybe one time a quarter,” he said.

Sombar said the last time they used money from the reserve, they were able to replace it.

“The other times we were not able to,” he said.

“When I first started, the year or two before that, I think Rita (Culvern) was having to go to the county for money to make payroll. That might have been in ‘91, I’m not sure, I wasn’t here. I know things were rough when she took over. It was just a different economic climate and the rules were different. They’ve tightened up on the rules to save money for the government and the economy’s gone south,” he said.

“I’m encouraged that we can turn things around. You have to adapt to some of these changes that the government throws at you,” he said.

“As far as the community, we’re not worried about anything happening to the hospital right now. I would say not to worry about the hospital. We’re working hard.

“Each and every employee is precious to me. We will all do whatever we can to keep it going. Times are tough and I’ll be the first to admit it but there’s an optimism that we can turn things around. I think the people in the community are having hard times, too,” he said.

“Despite these issues we will continue to meet the health care needs of our community,” Randall said.

“We will continue to look at opportunities not only to reduce expenses but also explore other services that benefit our patients. Our staff are your friends and neighbors and we want to continue to be your first choice for health care,” he said.




Slurry spilled

Bonnie K. Sargent
Intern

Since at least Saturday, Reedy Creek from Highway 17 south has run milky white.

As late as Monday afternoon, the evidence of a kaolin slurry spill was visible from bridges in Warren, Jefferson and Burke counties.

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Officials with KaMin LLC, a kaolin mining and refining plant near Wrens, stated that the spill occurred Saturday, Dec. 31, when a 12-inch pipeline failed near the Highway 17 bridge and slurry ran downhill into the creek. From there, the slurry traveled downstream.

Frank Carl, the science advisor for the Savannah Riverkeeper said that when they checked Reedy Creek, at the Highway 221 Bridge on Sunday around 5 p.m., the kaolin had turned the creek milky white but had not yet turned the water white at the Route 1 bridge. By Monday morning, he said, the water had turned white at Route 1 and by that afternoon the creek was white at the bridge in Matthews.

KaMin Vice President Doug Carter said they are monitoring the spill closely and tracking it as it moves along the creeks.

Kaolin slurry is composed primarily of the natural mineral, kaolin, and water, according to KaMin officals. They also said kaolin is used in many applications that come in contact with food and is generally recognized as safe by the FDA. There are also low levels of sodium bicarbonate along with a polyacrylate dispersant in the water, both of which are FDA approved, the company said.

“We have seen some reports that there was a chemical spill,” Carter said. “We want to make sure folks know this is kaolin, it is a natural mineral, and it is FDA-approved for use in food contact applications. It is an inert material.”

“In layperson’s terms, kaolin is just clay,” said Kevin Chambers, who works for the Georgia Environmental Protection Division.

Repairs are already underway to fix the pipeline. The pipeline is approximately 7.5 miles long and belongs to KaMin, which has Georgia offices in Macon.

Carter said the pipeline is out of service and will remain out of service while KaMin investigates the cause of the pipe failure.

Chambers said they do not know yet what the effects of the spill will be. He said the EPD is monitoring the creek at several different locations. He said they are monitoring pH levels, solids in the water, hardness of the water and such.

“So far what we are seeing is good news. There is no evidence of dead or dying fish,” Chambers said. “But it’s not over. Obviously, there is a lot of kaolin in those creeks and it’s got to clear.”

Chambers said it is too early to know if anyone will be fined for the incident.

“Our first order of business is to monitor the impact on the streams,” he said.

Savannah Riverkeeper Tonya Bonitatibus said citizens reported the incident on Saturday afternoon, though she thinks the pipeline may have begun leaking a few days before. She said approximately 600 tons of kaolin slurry had been spilled into the river before the leak was repaired.

Bonitatibus said the effects of the spill are currently unknown.

“I hope we don’t have a massive fish kill again, but it is certainly a possibility,” she said, referring to a widespread fish kill in the area that took place last October, killing more than 10,000 fish. The cause of that kill is still under investigation.

She said they would know more as the kaolin slurry flowed into Brier Creek.

“Reedy Creek is already in a bad way to begin with,” she said. “I don’t think there are a lot of fish there to kill.”

Carl said that kaolin is a very fine clay and that the fine particles can clog the gills of fish and acquatic invertebrates.

“But the fish kill in October, that originated about the same place, may have cleared the stream of acquatic life so that the current spill may not do much damage in Reedy Creek,” he said. “but it could have an effect in Brier Creek.”

Bonitatibus said one of the potential damages is drinking water from the creek. She said Waynesboro had been alerted to the danger and was told to turn off their drinking water. She said Waynesboro was not alerted to the danger at the time of the last major incident and it caused around $25,000 in damages.

Bonitatibus said they are not sure of the long term effects at this point, but there would certainly be a lot of kaolin lying on the bottom of the creek, as well as the chemicals used in the process.

Carl said the potential for a cleanup of the creek has passed.

“If caught early the contaminated water could be removed from the stream and filtered to remove the kaolin, allowing water from upstream to flush the creek bed,” he said. “Since that was not done, the bolus of kaolin will work its way downstream until it is sufficiently diluted that the damage it causes is minimal. But given the flows in Brier Creek, that may be pretty far downstream, maybe even to the Savannah River.”

Carl said that because kaolin is such a fine clay, it will wash out of the creek bed over time and end up in the ocean.

“The damage it does will be associated with the bolus of kaolin working its way to the river,” he said.

The Riverkeeper warned that if any locals have livestock that drink out of the creek, it might be best to provide an alternate water source.

“They probably do not need to be drinking this stuff,” she said.

Carl said that wildlife and domestic animals will not be harmed by the kaolin, but if there is a surfactant in the slurry, that surfactant should not be ingested.

“Surfactants are like soaps. They are used to facilitate the suspension of the clay in water,” he said. “And the surfactants, in sufficient concentration, can harm the digestive tracts of animals or humans that drink the water before the surfactants are diluted out sufficiently.”

Bonitatibus also said anyone who lives along the creek and has a well shallower than 50 feet deep should be cautious.

“Contamination of shallow wells is possible, not so much from the kaolin but from the surfactants,” Carl said. “Generally, surfactants are very soluble and can travel significant distances through soils. Shallow wells near the creeks, Reedy or Brier, could receive some surfactants depending on a number of variables.”

“It’s a very unfortunate place that we find ourselves in, just a few months after the last massive fish kill occurred,” Bonitatibus said. “We really need to get to the root of this problem so it does not happen again.”



New radio equipment ordered for emergency services

By Carol McLeod

After about a year and a half of monthly meetings and hours of discussions, Jefferson County Administrator Adam Mestres said new portable and mobile radios have been ordered.

The equipment was required in order to meet a change in regulations issued by the FCC for emergency communications equipment to be narrow-banded by the end of the year.

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The new equipment will be compliant with the new regulations and Mestres has said the equipment should be arriving in April.

In order to receive $100 off per unit for trade-ins, the equipment had to be ordered before the end of 2010.

Mestres said the total cost of the equipment ordered for the county is $86,510. Equipment was ordered for the Jefferson County Sheriff’s Office, Matthews and Hillcrest fire departments, transit department, code enforcement, roads department and E-911.

In a meeting held Friday, Dec. 9, area mayors met with members of the E-911 advisory committee to discuss the equipment. The committee had made a recommendation to the county commission earlier in the month, which the commission approved.

“The idea was to do away with the very antiquated analog system,” Mestres said during the meeting. The new system will allow all the agencies to talk with each other, he said. Macon Communications was awarded the contract to provide the equipment.

“I know money’s tight,” Mestres said. “There is not an option. The narrow banding mandate goes into effect at the end of 2012.”

He said there are plans to apply for a firefighters’ grant that, if received, would cover some of the costs to the fire departments.

“You’re not obligated to purchase through our vendor,” Mestres told the mayors.

Mestres was asked if another type of radio would work with the ones the county would be ordering.

“No. The Kenwoods won’t work. Just because it’s narrow bandable does not mean it’s narrow banded,” he said.

He said there could be fines of up to $7,000 for each incident of non-compliance.

“I know we’re talking about investment,” he said.

“Some jurisdictions may have some money set aside for public safety or maybe have some SPLOST,” Paul Bryan said.

Bryan is the county’s former administrator and is working through the next few months to assist Mestres, who began as administrator Tuesday, Jan. 3.

Mestres said this week, he placed the order Thursday, Dec. 22.

Besides the equipment for the county, Mestres included the order for Wadley, 16 mobiles and 15 portables; the county’s school board, one mobile; Stapleton, 18 portables and eight mobiles and Wrens, 18 mobiles and 25 portables.

Louisville already has equipment that will be compliant with the new regulation but will be ordering additional equipment, Mestres said.

The cities will pay for their equipment, as will the school board, Mestres said.

The cost of the radios is $645 for each mobile radio and $695 for each portable radio, he said.

That includes the $100 credit for each trade-in, Mestres said.




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