Supporters of a change at Copper Basin Medical Center will have to wait another few weeks. After a lengthy discussion Thursday night, the county commission tabled a decision on whether to co-sign a $1.4 million line of credit so the Hospital District can hire a management group and jump-start the 25-bed hospital.

Ducktown and Copperhill had earlier agreed to co-sign for 25% each and the county is being asked to guarantee the remaining 50%.

The line of credit would be used to pay past-due bills, provide operating cash, and match part of a grant to get the operating room open. The District has signed a three-month contract with Brim Management to begin turning the hospital around, with negotiations to be held on a long-term contract. District trustees also have a contract with attorney Jim Johnstone to provide legal services and serve as a liason to make sure the lines of communication remain open. (See separate story on the contracts.)

After the initial presentation and discussion, Kevin Stephens made a motion to table a decision until the next meeting, seconded by John Pippenger. That motion failed, with Greg Brooks, Wanda Cheek, Pippenger and Stephens voting yes, Mark Bishop voting no, and Daniel Deal and Daren Waters passing. Fred Wilcoxon and Buster Lewis were absent.

Chairman Bishop turned the gavel over to Brooks and made a motion to turn the proposal down, seconded by Stephens. That also failed, with Bishop, Brooks and Stephens voting in favor, Pippenger voting against, and Cheek, Deal and Waters passing.

Pippenger made a second motion to table the decision, seconded by Cheek. It passed, with Brooks, Cheek, Deal, Pippenger and Waters voting to approve, and Bishop voting against. Stephens had left the meeting during a break.

Bishop said, “We need to start all over.” He said he doesn’t like the contract with the attorney or the 90-day contract with Brim. He said the hospital district board should never have entered into a contract without consulting with the commission first, adding, “You’re talking about $1.4 million.”

He noted that county attorney Denny Mobbs had also raised some key concerns with the Brim contract. Pippenger also said he was not happy with the attorney contract but noted only the district board has the authority to change the contract. He voiced concern about the possibility that people could lose their jobs if the hospital closes. Cheek said there are too many unanswered questions. Pippenger said they need to have a meeting with all parties involved.

Johnstone had told the commission that the hospital will have to shut down if the District does not get the backing for the line of credit. If that happens, he said, the hospital’s $3.5 million debt will fall on the county and cities. Daren Waters asked who would shut it down. Johnstone said it is running out of money to operate so the current management will have to shut it down themselves.

“It’s just going to happen,” he said. Ray Ford with Brim said the current lessee will run out of money to make payroll and would have to shut it down. Waters asked if anybody would force them to shut down and Ford said no. Johnstone said the District would try anything to keep it going. “This is our best bet,” he said of the proposal for a management agreement.

He said the current management of the hospital can’t borrow money and can’t get purchasing discounts. He said Brim’s specialty is turning around sick hospitals.

Johnstone said there is a lot of bad information floating around, saying they wanted to answer questions about the plan. Under current management, he said, the hospital is going deeper into debt, with no valid explanation, and there are problems like billing not being properly coded. “There was something not being done right,” he said, adding, “We’re going to take it over.” He said the Board came to him because they could not get information from management and he has been able to open the lines of communication.

He said the current management has not told the Board about the financial situation and Bishop pointed out the hospital has been leased. Johnstone said they were not following the lease. Johnstone said they have a plan to pay off the line of credit and get rid of the debt.

Ford pointed out that 100 hospitals closed last year because they were not managed efficiently even though they had good doctors and good community support. “Stand-alones need the strength that comes from a system,” he said, adding it is better for small hospitals to think about what’s best for them rather than rely on management through a larger hospital. He said Brim’s customer is the hospital, not stockholders.

Ford said they do not take on a contract unless they feel a hospital can be turned around, noting they have turned down four proposals since they began looking at CBMC. Opening the operating room and paying off the debts so they can get purchasing discounts will make a big difference, he said. Ford said the staffing level is good, not overstaffed, so he did  not anticipate any reductions in staff. There are currently 112 employees, including some part-time for 102 full-time equivalent. “We think the hospital has the ability to grow,” he said, adding, “We can see a way to do it.” He also pointed out that employee payroll is an important part of the local economy.

Pippenger asked if the lessee, Copper Basin Hospital, Inc., is in favor of the change. Ford said it is their understand that he (CEO Mike Stevenson) would like to get out of the lease.

Bishop asked why they were starting with a 90-day agreement and Ford said they will begin working immediately on a long-term contract.

Bishop read into the minutes a letter sent by Dr. Allen Uhlik, Chief of Staff at the hospital, who asked Brim for specific information. Uhlik asked if the $1.4 million would be used only to reduce payables and pay management fees or whether any would be used to improve or add patience services. He also asked for a breakdown of the $180,000 management fee and the impact on hospital payroll for the proposed Chief Executive Officer and Chief Financial Officer who would be hired.

Uhlik also questioned Johnstone’s agreement, such as whether his fee would be paid by the hospital, where his office would be, whether he will have a management role, whether the hospital needs an in-house attorney and how he would serve as liaison.

He also asked the timeline for opening surgery and projected revenues, the plan for increased volume and whether physicians would be expected to increase their patient load, whether there would be changes in the medical staff or an increase in rent for medical offices, and what Brim means by “better patient management.”

At the meeting, Uhlik said Brim is working with old figures, adding some improvements are already in the works. He pointed out that Mike Stevenson had asked the District Board for permission to borrow $600,000 but was turned down. He said Stevenson’s plan was to pay down the debt and do the same things Brim is talking about. A year ago, it was $600,000 and now it’s $1.4 million, Uhlik said. He said it doesn’t make sense to add a $300,000 expense for a CEO and a CFO, plus the Brim management fee and attorney fee.

Board member Ron O’Neal said Stevenson never presented specific information about his proposal. Uhlik said Stevenson got a letter from Johnstone saying it would not be approved so he didn’t put his final proposal together.

Asked about the payables, Ford said the hospital owes around $1.2 million in past due accounts but they will be able to negotiate with some large vendors to reduce their accounts. Among the debts are health insurance for employees and payroll taxes. Board member Joan Pack said they are about $90,000 behind on payroll taxes, not counting penalties and interest.

Greg Brooks asked Ford if the hospital would still be opened if the commission doesn’t approve the contract. Ford said the person who can answer that was not at the meeting. Wanda Cheek asked if they could approve a motion asking the District Board to make changes in the agreements. Bishop said all they can do is say yes or no to the money, that the agreements are between the District and Brim and the attorney. Mobbs said the commission can put off a decision until the terms of the agreement are changed.

Ducktown Mayor James Talley said he understands it is a tough situation but asked the commission to look at the big picture. He said they could work on the long-term agreement to make it more acceptable, noting the cities and county could be responsible for a substantial amount of debt. “The hospital may be here in 30 days, but there’s no guarantee of anything,” he said, adding the debt is increasing and they are going down a slippery slope.

Talley added, “If we don’t take care of it, I don’t see the hospital coming out of the situation it’s in.” He said it took the threat of a lawsuit to get everybody going in the one direction.

Brooks said they all agree with the concept but need to meet with the hospital board. “We’ve got questions and have been left in the dark,” he said. He said 30 days is a fair amount of time to look over the situation and meet with the hospital board. Talley said the commission is voting on the line of credit, not the contract. Bishop said the contract “needs to be tweaked a bunch.” Johnstone said the issues Mobbs raised can be worked out in the wording of the long-term contract. Brooks told Johnstone, “You’ve got a pretty lucrative contract drawn up.”

Ford said he was pleased to hear that the current management is making improvements but added “a lot of things don’t indicate the hospital has been managed in a professional manner.”

The District board met after the commission meeting for their regular monthly meeting. Bea Tallent said “We’re dumfounded,” saying they don’t understand it. She said they hope to get with the commissioners to work it out, adding they probably should have been meeting with commissioners prior to last week to keep them informed of the situation. She said Board members are disappointed. “We have to save that hospital,” she said. “We just have to keep working.”