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By Casey Christie / The Californian
BY JAMES BURGER Californian staff writer email@example.com
Days after a long and impassioned debate in front of the county Board of Supervisors, partisans in the battle over what to do with the Kern Medical Center family medicine residency program remain on edge and continue to display raw nerves.
It matters because the supervisors will take up the subject again, on Tuesday.
Kern County Board of Supervisors Chairman Mike Maggard said Friday that he will be keeping a tight rein on the meeting.
"We'll have a very modest opportunity for additional input" from the public, he said.
Then there will be a report from county staff and supervisors will take up the discussion and forge a decision.
"Emotions have nothing to do with this," Maggard added.
Doctors defended the hospital's program, which supervisors seem inclined to remove because of a financial crisis at the county institution.
Steve Schilling, director of Clinica Sierra Vista, where the residency program might be relocated, sat quietly through last week's debate but erupted Tuesday night with a sharply worded email.
"I won't sit quietly thru (sic) the next meeting next week, and the next time some (expletive) doctor gets up to 'bad mouth' (Clinica Sierra Vista), I'm coming up to the podium to recount 40 years of horror stories about KMC," he wrote in an email to county staff obtained by The Californian. "Believe me, I have plenty to fill a morning."
At last week's hearing, doctors complained about KMC's Chief Financial Officer Sandra Martin and consultant Kiki Nocella, criticizing their evaluation of the amount of money the county could save by ending educational programs for student doctors in family medicine.
Dr. David Moore, program director for family medicine at KMC, fired back, pointing the finger at other hospital programs that have worse medical records.
"Over the last two years our program has been discussed as if it's a troubled program in need of a total overhaul. Nothing could be further from the truth," said Moore.
Other speakers accused Clinica of trying to dump patients on the residency program's Sagebrush Clinic.
Schilling, who is known for blunt discourse, had more to say when contacted on Thursday.
He complained about what he said were major problems with how doctors are paid -- including their ability to work second jobs at off-site clinics and retain large portions of the payments patients make for services. Schilling said this is money that should go to KMC.
He said the county needs to take a complete look at KMC operations and solve some of the problems with what he called a staff culture of entitlement that has built up over the years.
KMC doctors argue just as passionately that they are not abusing the system.
"As the lowest paid full-time physician at KMC, whose graduating residents in their first year make more than I do, I bristle when its suggested that I and my colleagues are overpaid," Moore told supervisors on Tuesday.
Some physicians, however, agree that changes might improve KMC's financial situation.
"I completely agree with Steve," said KMC family medicine physician Dr. Paul Miller. Decades ago, he said, Kern County supervisors proposed physician moonlighting as a way to increase doctor's pay when the county couldn't afford raises.
Miller said he understands that the system now looks cumbersome and acknowledged concerns about having doctors spend 20 percent of their time outside of the hospital where they are employed.
"I get that. The plan is to move everybody under the KMC umbrella," he said. "But what you have to do as an administration -- you have to come up with a plan."
Doctors are now invested in their outside clinics and bringing them back "under the umbrella" needs to be done in a collaborative way, Miller said.
County wants solution
Miller predicted that the core of Tuesday's discussion will be about money and data.
He disagrees with the county on three questions he believes are central to the decision supervisors will make Tuesday.
"Can you trust the financial information you are getting? In my personal opinion you can't," Miller said. And, "are you really getting a true comparison of the programs apple to apple?"
Finally, he said, will the funding systems that Clinica Sierra Vista uses to run its new residency program endure and keep the program operational?
"I'm just hoping the board can step back and really answer those three questions," Miller said.
Schilling, who took the KMC doctors' attack on county data personally, believes county staff needs to meet the conflict head-on.
His Tuesday night email, addressed to unidentified county staffers, said:
"If you want to win this battle and send a message to all the other remaining component parts of KMC that they need to shape up and fly tight, then you are going to have to come out with guns blazing and stop trying to protect all these fragile egos you've been asked to protect. I sure as hell didn't see any of those fragile folks hesitating to tear you up today."
County Administrative Officer John Nilon said he understands tempers are hot.
But the county and KMC financial staff won't be letting off steam this coming Tuesday, he said.
"What we want to do is talk about the family practice residency program," Nilon said. "We will not shy away from giving facts. We just won't engage in emotional mudslinging."
Supervisor Leticia Perez said she believes the board is committed to solving the financial problems at KMC.
"This board is not going to allow KMC to operate the way it has been," she said.
But the financial aspects of the residency program also have to be balanced by the community's need for services, she emphasized.
And the discussion has to be constructive.
"I think Steve has been wildly successful. I love the Sierra Vista model. I'm a Clinica Sierra Vista baby," Perez said. "But I don't think being at each others' throat about it helps anybody."
Schilling said he is offering to partner with KMC, at the county's request, because Kern County needs the hospital.
"What we've got to do in this community is save this critical" institution, he said.