Triage, Not Planning, at Island Hospital

Gazette Senior Writer

The wreckage now includes one chief executive officer, two good doctors and a dozen Nightingales.

When Kevin Burchill announced last week that he would resign as CEO at the Martha's Vineyard Hospital, the crowd absorbed the news in stunned silence. Hospital trustees assured the public that they support Mr. Burchill, but the spoken words stood in sharp contrast to the seating arrangement: After his announcement, Mr. Burchill did not sit at the table on the stage in the front of the room with the board of trustees, but instead took a place at the back of the Tisbury School gymnasium.

The unspoken words hung in the air: How is it possible that the hospital is in disarray again? And what is the board's responsibility in all of this?

On Saturday a grim-faced board of trustees couched their explanation to the community in a lot of finger-pointing. They said it was not easy. They said they were misunderstood. They said they were working hard. They said it was complicated. They blamed the press.

Leadership, vision and good communication: The words were all there, but for hospital trustees on Saturday they were like wisps of smoke floating in the air - visible, but too elusive to grasp.

"The hospital is not broken," declared outgoing board chairman Fred B. Morgan Jr.

Perhaps not broken, but far from healthy.

Nowhere was this more evident last week than in the simple oral report from Tim Prince, the health care consultant who was hired last year to give an assist to the hospital strategic plan.

He said the hospital has relationship problems, problems with trust, problems with its own community. These problems, Mr. Prince said, are a roadblock to any good strategic plan.

"Intra-medical staff relationships and the medical staff-to-administration relationships are contentious and pose a significant barrier to the pursuit of any strategic initiatives," Mr. Prince wrote in his written report.

"Mistrust and skepticism run deep and will need to be overcome with perseverance and openness," he also wrote.

Dr. Greg Culley, a hospital trustee who heads the strategic planning committee at the hospital, said the strategic plan is still in its infancy. "We've only just started," he said.

In truth, the strategic plan at the hospital has been in the works for more than four years, and it has hardly followed a straight line unless you count the money thrown at consultants along the way. The early abstracts for the plan were developed when the hospital was still in bankruptcy and under the leadership of an emergency board of trustees.

Ironically, during that period - arguably the hospital's darkest hour - public confidence in the institution was higher than it had ever been. After they turned around the crisis, eliminated the crippling debt and put the hospital on stable financial footing, the emergency board immediately set its sights on a long-range plan. At the center of that plan was a new hospital to replace the decaying physical plant, and a capital campaign to pay for it. Money was also needed to replenish the endowment fund. The outlook was good, and the hospital was operating in the black for the first time in memory. The board made a pledge to the community to keep it that way.

Today among hospital leaders, a sort of selective amnesia prevails about the work of the emergency board, and the simple goals of the early strategic plan have been lost in self-important rhetoric and finger-pointing. Hospital trustees have zigged and zagged their way across the last four years, accumulating fresh debt, convincing the taxpayers to contribute $500,000 for the hospital, holding a few fund-raising events and putting out an annual appeal, but all the work has been accompanied by a short-term view. Fund-raising dollars are used to offset operating losses, and the long-range plan and capital campaign are not even subjects for discussion anymore.

"What is your vision?" one Island resident asked hospital trustees on Saturday.

Trustees stumbled in their answers.

It was not the only uncomfortable moment.

"You don't have enough women on the board," declared another resident. The remark touched directly on the real Achilles' heel of this board, which has never completely recovered from the resignations of seven trustees three years ago, amid sharp differences over leadership and judgment. Five of the trustees who resigned were women, and all of them were known as thoughtful, talented people with strong leadership qualities and broad backgrounds in business, fundraising and legal affairs. The women were a key component of the newly constituted board of trustees that had succeeded the emergency board. They were directly connected to large donors and were expected to help launch a solid development plan for the hospital.

The women have all since moved on to play influential roles in other charities, both on and off the Vineyard.

Today there are only two women on the board, one of them a representative of the medical staff. The hospital has a development director who is so far below the radar screen few people even know who he is. Ditto for most of the trustees.

The conflict between Mr. Burchill and Dr. Richard Koehler is now over, but the damage has been done. Mr. Burchill will leave the hospital, and so will Dr. Koehler and his wife, Dr. Kathleen Koehler. The Nightingales will not do any more gala fund-raising events.

And still the question hangs in the air: What role does the board play in all of this?

More than one member of the Vineyard community left the forum last weekend with a heavy heart. Roger Wey, an Oak Bluffs selectman who has followed hospital affairs for years, was sharply critical. "I am so disgusted with this board - we have got to stop this revolving door; we are losing two great doctors and one great CEO," Mr. Wey said. He continued:

"There is a problem, and this board is like an ostrich with its head in the sand. This is the good old board again - it's never them, they always sit in the background while everyone else gets into a crisis. All of a sudden the plug is pulled and we have to go back to the dark ages. I think they should dissolve this board."