Porter officials ready for new chapter

MIDDLEBURY — Porter Medical Center officials last week publicly apologized for what they acknowledged have been almost 10 months of internal strife within the hospital, and urged physicians, nurses, staff and patients to help them turn the page to a new chapter in the organization’s 91-year history.
But officials at the March 30 PMC annual meeting acknowledged the Porter community will likely have to endure some more hardship during its transition to better times, including the announced closing of Porter Internal Medicine, one of the 12 provider practices that are owned and operated by the medical center.
Porter Internal Medicine is closing due to the resignation of Dr. Naomi Hodde, who has elected to leave in the wake of recent upheaval within PMC that has included nursing staff layoffs, the hasty roll-out of a new compensation structure for Porter providers and the sudden resignation of Porter President and CEO Lynn Boggs.
“The bad news is, there will be some turbulence,” Acting Porter President and CEO Fred Kniffin said of some stormy months ahead for PMC, which includes the hospital, Helen Porter Healthcare & Rehabilitation Center, and the doctors’ and midwives’ practices.
“We are going to lose some physicians; there’s no doubt about it.”
News of Hodde’s resignation came as a shock to some at Wednesday’s meeting.
Plans call for the Porter Ear, Nose and Throat practice to relocate into the Porter Internal Medicine office at 116 Porter Drive. Kniffin said Dr. Brad Armstrong of Porter Internal Medicine would be relocated.
“I am devastated; I just learned 5 minutes ago … that my physician is leaving,” Middlebury resident Ann LaFiandra said of Hodde. “Let me tell you, I am indescribably upset.”
“It took me a while to find a doctor I really liked, and now it’s changing,” Bridport resident Connie Miller said. “I am very upset.”
And while Kniffin promised to restore a more measured approach to employee relations and the roll-out of new initiatives, he said the hospital can “not walk back” on this past February’s layoffs that affected 17 positions (mostly nurses assigned to the 12 PMC practices), nor the reduction in benefits for some part-time workers, which was imposed last fall.
“You have to balance what’s best for the organization,” Kniffin said, alluding to financial troubles that have resulted in PMC currently maintaining 2.2 months of cash on hand — a figure substantially below the average cash reserves held by most other Vermont hospitals.
“We need to improve our financial performance.”
Wednesday’s annual meeting at Middlebury College’s McCardell Bicentennial Hall drew around 200 people — far more than usual. Among those in attendance were current and retired physicians, nurses, staff, Porter board members and longstanding community members, all of whom were keenly interested in the status of their local hospital.
Among the concerns raised by those in attendance: PMC’s transition to a new compensation system for providers that will include quality and productivity incentives instead of simply a straight salary; and the recent elimination of nursing positions within the provider practices.
Most other Vermont hospitals have already converted to the new salary system. Porter officials have acknowledged that, in retrospect, they pushed for a switch to that system too quickly here.
“We’re going to break this down into bites we can chew and digest,” Kniffin said of the major change.
Current Porter physicians listened intently to the discussion, moderated by former Gov. Jim Douglas of Middlebury. But retired PMC officials were candid in their feedback. Some — for example — said they feared the new compensation system might preclude doctors from performing comprehensive examinations on patients, but instead focus on one particular ailment per visit.
“I think we have to be very cautious,” said Dr. James “Chip” Malcolm, a retired PMC physician. “We need to be very respectful of a physician’s opinion in how we take care of that patient.”
Dr. Bill Fifield, also retired from PMC, also weighed in. He indicated the notion of rewarding doctors based on the number of patients they see in a day could have its drawbacks.
“I am concerned about quality,” Fifield said. “If, as a family physician, you see a patient with an earache or with a routine hypertension re-check who’s doing fine … you can see four patients an hour without much of any problem. But if you see an elderly patient who has hypertension, heart disease, high cholesterol, diabetes and is depressed, there’s no way you can do a quality evaluation and management of that patient in 15 or 20 minutes.”
Kniffin said the hospital will take a more measured approach in implementing the new compensation system for physicians. The Porter administration pressed what Kniffin referred to as “the reset button” on the compensation issue, setting the stage for new talks with physicians.
And that reset button has also been pushed on the administration’s relationship with the nurses’ union, according to Kniffin. The Porter Federation of Nurses and Health Professionals has raised concerns in recent months about what they believe has been an adversarial relationship with administrators that has included a lack of communication coming from the top.
Others questioned the resources PMC spent on legal fees in negotiating with the union.
Dr. Ben Rosenberg of Champlain Valley Orthopedics in Middlebury called nurses an integral part of the medical team that it takes to treat patients.
“Respect will need to be extended to the nursing staff if we are going to be successful in this venture,” Rosenberg said.
Kniffin said he has had two recent meetings with union representatives.
“They said, ‘You’ll need to walk the walk to earn our trust,’” Kniffin said, something he added the administration would do.
Retired physician Dr. Patrick Stine said Porter has stood out as a place where patients have felt comfortable both about the quality of care and for the caring way in which it’s been delivered.
“That was lost, for a while,” Stine said. “We had a lousy CEO, and at times we had compliance by board members and staff members who did not resist this change.”
That said, Stine said he is heartened by the current PMC leadership team.
“I compliment the board by their efficient actions,” Stine said. “They acted like surgeons. They recognized the cause of the problem could be replaced: Cut it out. And you did, and I am grateful.”
A board member noted that Boggs’ salary was $320,000.
Officials will now turn their attention to filling in some of its depleted provider ranks.
“Our department of internal medicine has taken a huge hit in the last six months,” Kniffin conceded, noting some recent retirements, the departure last fall of Dr. Gretchen Gaida Michaels, and the announced departures of Drs. Hodde, Lynn Wilkinson and Cynthia Smith.
“There has been a considerable exodus,” he said. “That’s what we’re faced with, and it’s going to be a challenge, for sure. We need to have high-level conversations between the medical staff, the board, the community, and talk about the future of internal medicine and figure out a road forward.”
Retired PMC physician Dr. Tim Cope warned that recruiting doctors can be an arduous process. Cope recalled serving as chairman of professional recruitment for Porter during the early 1980s, during which he said half the medical staff was brought on board. Many of those physicians have — or will soon — reach retirement age.
Cope also recalled having to postpone his own retirement plans in 2009.
“I delayed (retiring) because I couldn’t find someone to replace me,” Cope said.
Kniffin nodded in agreement.
“I agree, it does take time,” Kniffin said. “This is not going to be a quick fix.”
Cornwall resident Roth “T” Tall encouraged Porter recruiting teams to emphasize not only the quality of the hospital, but also the quality of life in Addison County. This strategy worked during a major recruitment effort during the 1960s, he recalled.
“It’s a college environment and we have wonderful things to offer,” Tall said.
Porter officials confirmed that a consultant — Stroudwater Associates — is preparing a strategic plan for the hospital that will include the notion of affiliation with a larger hospital, such as the University of Vermont Medical Center. He stressed affiliation at this point is just a concept that PMC is exploring, and any such action would needed to be vetted by the hospital board and community.
“The (strategic plan) will show us what our future might look like in three to five years if we go alone, and if we went with affiliation,” Kniffin said.
Dr. Stephen Koller, vice president of the Porter medical staff, said he has been heartened to see the various PMC stakeholders rally behind the hospital.
“In pushing back against that which we are not, we rediscovered who we are,” Koller said. “And what we are is a community — a community of caregivers nested within this, our greater community, where none of us in this room are removed from another by more than two degrees of separation.”
Maureen McLaughlin, chairwoman of the PMC board, said she and her colleagues realize they have their work cut out for them.
“Real work lies ahead, and we all have to do this together,” McLaughlin said. “There are over 800 people associated with Porter every day — doctors, nurses, staff, leadership and volunteers. We are all committed to the thousands of patients we serve every year. They are counting on us to get this right.
“We believe the healing has begun,” McLaughlin added. “We believe there is renewed optimism for Porter.”
Reporter John Flowers is at [email protected].

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