Special Meeting October 20, 2015, 6:00 p.m.
KVH Kafé



A special joint meeting of the Klickitat Valley Health (KVH) Board of Commissioners and Medical Staffwas held on Tuesday, October 20, 2015 at 5:30 p.m., in the KVH Kafe. Commissioner Connie Pond was the presiding officer. A quorum was present including: Commissioners John Quinn, Jim Daniel, Mark Sigfrinius and Dennis Carver. Leslie Hiebert, CEO & Superintendent was also present. Medical Staff in attendance included: William Bothamley, MD; Michael Garnett, MD; Jacinto Orozco, MD; Angi Thomas, FNP; Rebecca Nelson, ARNP; Annie Stone, ARNP; Kayla Elliott, PA-C; Louissa Gordon, PA-C; Alvin Massenberg, PA-C; Michael Braun, M.D., Anh Nguyen, M.D., David Schlosser, CRNA; Jeff Teal, Ph. D; additional Senior Leaders in attendance included: Charis Hill, HR Director; Jamie Eldred, Controller; Kasey Schneider, RN, DNS


President Connie Pond called the meeting to order at 6:04 p.m.



Leslie Hiebert, CEO provided an overview of the Master Facility Plan and Strategic Plan status. She provided handouts that included the data findings that were reported by Jody Carona of Health Facilities Planning and Development to assist with developing a plan that will address future health care facility and community needs. Discussion was had regarding the Districts current demographics and market share and how that relates to our consideration of healthcare services for the future.


Leslie reviewed some of the highlights of the year including the clinic move to the new location and the upcoming helipad construction.


Dr. Nguyen reported that the Skyline Hospital remodel was very successful in that the work flow was very good. The providers supported the idea of the entrance of the hospital being moved to the south side with Angi Thomas reporting that she had given a patient orders for an X-ray and told them that the easiest way to get there would be to drive around the buildings to the other entrance because it is difficult for patients to find their way through the building to ancillary services such as Laboratory or X-ray located on the other side of the building.


Dr. Nguyen expressed concern about the lack of advertising, noting that with our current focus of radio and newspaper advertising we are missing a large group of potential patients. She noted that this group is more readily engaged through social media. Leslie Hiebert agreed that we have been slow in advertising on social media. Dr. Nguyen also expressed her concerns regarding patients not understanding how the new same day appointment system works therefore they opt to go to The Dalles instead of figure out the new system. She also commented on a concern regarding OHSU referring patients to The Dalles for follow up instead of to Goldendale. She suggested that it may be appropriate to arrange a meeting with OHSU to address the issue. Dr. Nguyen commented that it would be good to get the faces of the new doctors out more in the public via facebook and ad boards. Charis Weis noted that the new billboards that will be released soon have all eight of the clinic providers.


Dr. Bothamley noted that he sees sprucing up/updating the current acute care wing/swing bed wing as very important, whether that would be done by a new wing being built or updating what is currently there. Leslie Hiebert noted that it is evident from watching the results of recent school levy attempts that we will need to show the community why we need what we need and that it would not be cost effective to renovate the facility before going out for additional funds.


In addition to the acute care rooms being antiquated, Dr. Bothamley also noted that the basement area space should be used more effectively. He suggested that it may be a good area for Physical Therapy with easier patient access and more departmental space.


Dr. Nguyen noted that Dialysis would be a good service to provide as well. Leslie Hiebert noted that KVH doesn't have a certificate of need and that the current one is held by Da Vita. There was some discussion regarding how the certificate of need process works.


Dr. Bothamley noted that there have been huge changes in the Clinic with new Providers, new location and development of EMR with much success and few glitches. He noted that an area of concern for him is the support staff. He noted that he feels as though the support staff have not received as much attention as needed and that is an area that the clinic is trying to address, how to develop the support staff and help them to help the providers be more productive.


Dr. Garnett, Kayla Elliott, PA-C and Louissa Gordon, PA-C have started a coagulation clinic; Angi Thomas will be starting her foot care clinic in early November. The foot care clinic will primarily focus on toenail care for diabetic patients at least initially. Dr. Bothamley noted that he and Rhonda Turner have begun a COPD clinic day that will be similar to the Diabetes clinic day. He noted that the clinic providers and staff are trying to be innovative.


A suggestion was made for flyers to be made and handed out at the Senior Center to people who require toenail/foot care at a level that the visiting home health nurse is unable to accommodate at the Center.


Dr. Bothamley noted that the Greenway program can be used for so many things that could be used to save staff time, he noted that it also presents challenges that take more time. He felt that there is much more that can be tapped into regarding the programs use. He noted there are also upcoming changes with ICD-l O. Dr. Bothamley expressed thanks to the Board of Commissioners and Administration for the support that has been given to the Clinic and Providers.


Dr. Garnett commented on the patient portal. He noted that the providers would like to be able to communicate with their patients regarding lab results, etc. via the patient portal and eventually use the scheduling options. He felt that overall new implementations and changes have gone smoothly.


Dr. Nguyen expressed her appreciation of the Greenway system currently in the ED. She noted that it works great and that the patient notes are quickly and easily obtained. She noted that Greenway and T-Systems are working well, but that CPSI continues to be an issue. She noted that there is not much that can be done in regards to the situation other than continue to determine the best ways to make it the most effective for KVH.


Dr. Bothamley noted that in regards to the scribe model currently being used, everyone is trying something different. He noted that the importance of tying up loose ends to ensure patient satisfaction. He noted that he was very optimistic that it could and would improve. He reiterated that a small thing, such as not being able to quickly obtain a patients information during an appointment can quickly snowball into a bad experience for the patient. There was discussion regarding some negative and some positive reactions to the same day appointment model, as well as ways of improving the public's understanding of how the system works via facebook postings, etc.


Several of the new providers noted that they would like to have business cards to be able to give out at appointments or when working at a sports event and they do not currently have anything. Leslie directed Barbara Bostick to ensure that Gail Garcia, the Clinic Director, order business cards for the new providers as soon as possible.


Charis Weis explained that the there are many companies that provide social media advertisement campaigns. She noted that this is something that we will be doing in the very near future.


Angi Thomas, FNP, suggested that next year it may be worth consideration to do a flu shot similar to the sports physical day to be open to the community.


Leslie thanked the providers that have been attending the games and noted that the community notices it and is appreciative of it as well.


Dr. Garnett noted that even with the upcoming addition of Dr. Nathan Armerding the clinic will still need to be recruiting for an additional MD. He explained that Dr. Armerding will fill many of the needs that have been identified, but in filling those needs his work as a primary care physician in the clinic will be reduced.


Kayla Elliott, PA-C expressed her appreciation of the physician hiring process. She noted that she was impressed with the interview process, as well as the family feeling that resounds within the facility. She appreciated our commitment to the quality of care that is provided, not just the quantity of patients seen.


Charis reported that it was apparent in the meeting with clinic medical support staff earlier in the day that everyone is invested in making things work successfully, there are the right people on the bus to get where we want to go.


President Pond expressed her appreciation for everyone coming to the special meeting and for sharing their thoughts.



There being no further business to come before the Board of Commissioners, a motion was made by Commissioner Sigfrinius and seconded by Commissioner Carver to adjourn the meeting. The motion carried unanimously and the meeting adjourned at 7:45 p.m.


Minutes Approved and Signed by President M. Connie Pond and Secretary John Quinn.

Note: Printed copies are available at a charge of $.15 per page.