DUKES COUNTY HEALTH COUNCIL – MEETING MINUTES
Date June 30, 2003
Project Facility Master Plan
Martha’s Vineyard Hospital
Oak Bluffs, Massachusetts
TMP No. A00103
Present Tad Crawford
Frank Case
Kathy Louge
Patsy McCornack
Michael Dutton, Selectmen
Fred Rundlet, Wampanoag Health Service
Laurie Perry, Wampanoag Tribe of Gayhead
Michele Lazerow, Chiropractor/Acupuncturist
Melinda Loberg, E.M.T., Mental Health (Ret)
Peter Strock, Dentist
Tim Walsh, CEO
Tim Sweet, MVC
Cathy Brennan, R.N., Hospice
Nancy Gilfoy, Lic.Ac., M.Ac., Whole Health Alliance
Joyce Steward, AIDS Alliance
Bob Tonti, Foundation for Island Health
Sarah Kuh, Health Access Coordinator
Dylan Suede, Umass. Medical School student
Basil Rousos, Thomas, Miller & Partners, LLC
The following is a summary of our understanding of items discussed and decisions reached during the referenced meeting. Please notify the Architect of any clarifications to the content or intent of the statements made. These notes, and subsequent clarifications, form the basis for future decisions.
· The meeting was held at the West Tisbury Public Safety Building on Thursday June 19, 2003. It began at 7:30am.
· Tad Crawford introduced Basil Rousos, the representative from Thomas, Miller & Partners, the architecture firm retained to provide a facility master plan. All persons present were introduced. It was proposed that Basil Rousos take the meeting minutes.
· Basil Rousos agreed. Thomas, Miller & Partners understands that Martha’s Vineyard has complex healthcare issues and is willing to hear all stakeholders.
· Tim Walsh stated that Martha’s Vineyard Hospital is falling into disrepair and that the remedy to this crisis is quickly becoming too expensive. Renovation of the facility would be at an exorbitant cost.
· Kathy Louge urged that in the construction of a new facility we learn from the mistakes of Windemere. She also observed that the major structures on the island seem to have major issues relating to their construction.
a. Who else should be included in the hospital campus, how is it organized, and how is it responded to by the architecture?
b. On the campus the hospital should have priority, then ancillary professional buildings
· Joyce Stewart stated that the services provided by hospital should be proportional to the service utilization. This could be derived from the daily census.
a. Community health center
b. Anonymous HIV testing – provide privacy and comfort
c. Provide systems for the sharing of information
· Bob Tonti asked if the census information was readily available.
· Tim Walsh and Tim Sweet responded affirmatively.
· Tim Sweet added that current and future hospital is not profit driven.
a. Provide departments for community use regardless of utilization
b. What need is the hospital based on?
c. Possibly the Emergency Department (E.D.)
· Nancy Gilfoy stated that acupuncture practitioners are included as a member of the Whole Health Alliance. How do islanders receive care that is not through the E.D. or primary care?
a. Wellness – holistic preventative medicine
b. Plaintree model – centered on patient, family, health education
c. What does the core hospital respond to?
d. Planning process – will it involve consumers or islanders?
· Cathy Brennan inquired as to the fate of Windemere. 1/3 of the hospice is based in Windemere.
a. New site vs. current site – how does this affect Windemere?
· Joyce Stewart stated that rehabilitation services should be close to Windemere.
· Michele Lazerow stated community involvement is needed to fully utilize an integrated wellness/health center.
· Patsy McCornack stated that we must consider the entire concept of healthcare on the island.
a. Architects accept public input from users
b. How many licensed beds are needed?
c. How is pediatrics involved?
· Melinda Loberg inquired as to how the hospital becomes a healthcare destination. Identify healthcare services that make a profit and apply this to fund other services. Procedures like cosmetic surgery could be used.
a. 4 different emergency services on island need to be consolidated into one service.
b. Paramedic intercept service
· Frank Case inquired as to which healthcare services are making a profit.
· Tim Walsh stated that opportunity to provide plastic surgery could be available if a doctor could be convinced to begin a practice on the island. Surgery at the hospital is currently very successful as is diagnostic services. Martha’s Vineyard Hospital currently has state of the art diagnostic equipment and is on the Massachusetts General Hospital protocol system.
a. Links to Boston healthcare facilities
b. What services and surgeries are lost to off island care?
c. Primary care doctors refer islanders to Martha’s Vineyard Hospital
· Peter Strock inquired as to the board’s mission for the hospital.
· Tim Sweet stated that the hospital should and will continually upgrade the care given to patients. Martha’s Vineyard Hospital is a microcosm of how modern healthcare is delivered to the public. In general we have a frustration with the modern healthcare system.
a. How big and how much should the hospital be?
b. Are there enough resources to provide everything?
c. How does the hospital provide healthcare for the entire island and be successful?
· Peter Strock encouraged everyone to think about healthcare outside of the “box” and to provide healthcare for the entire island.
· Tim Sweet identified the problems with the current hospital location as well as some of the issues of selecting a centrally located site.
a. Drawbridge at beach road
b. High volume of traffic at Oak Bluffs and Vineyard Haven
c. Currently EMT’s do not have trouble getting to hospital
d. New site – find a location that has better proximity and ease of travel for all parties
e. New site – politics, expense
f. New site – puts fate of Windemere in jeopardy
g. If a new site is purchased then the current site cannot be sold with Windemere remaining.
· Peter Strock observed that Martha’s Vineyard Hospital has a public relations problem due to the disenfranchised residents of the island and its past record. The islanders want a community facility. Martha’s Vineyard Hospital needs to offer the community an image in which it can be included.
a. Does the community need to have fundraising for a portion of the new facility?
b. How is acute care, health education, etc. included in the new facility?
· Tim Sweet recalled that 10 to 30 years of mistakes by Martha’s Vineyard Hospital has affected community opinion. A new facility needs to physically accommodate flexibility and expandability. The presentation of a new facility needs to be made in a way that the community can accept and believe in.
· Melinda Loberg informed the council that there are 3 unused public access television stations that could be used to inform the community at large by way of recording all meetings pertinent to the planning of the new facility.
· Laurie Perry spoke from the county perspective. Incorporate health and human services, regional services, and tribe resources.
· Fred Rundlet spoke from the tribal perspective. He has built many facilities and sees a need for clarity regarding the time frame for the master plan. The post offices and grocery stores are the place to find island opinion.
a. Mission of island healthcare
b. Tribal healthcare mission – “To enhance and maintain the health of the tribal community”
c. Healthcare should be modeled around wellness and not sickness
d. Tribe is willing to work with Martha’s Vineyard Hospital for uncovering potential funds
e. Federal grants available to the tribe
f. U.S. Department of Agriculture could help with loans and by granting money to the tribe
g. 80% of construction labor could be through military (Air Force reservists) programs which features a special group for healthcare facilities
h. Volunteers could help with construction labor needs
i. Use Aspen Valley Hospital as a model
j. Wellness hospitals – Aspen Valley Hospital/Kaiser Permanente/ Indian Health Service/AmeriMed
k. How do you meet new needs?
l. Thomas, Miller & Partners was requested to provide many different healthcare models to the community
m. 100% behind new facility
· Bob Tonti urged that the thinking behind the planning process not be based on current financial limitations. A flexible tactical plan allowing for future growth is needed.
a. Financial tail waging the dog
b. Willingness to listen but not to do
c. Share the dream of island healthcare with the community
· Tim Walsh emphasized the need for strategic planning.
· Tim Sweet stated that a time will come later in the planning process when the limitations will have to be identified. The only reason for rebuilding Martha’s Vineyard Hospital is due to the geographic remoteness of the island and due to that in a traditional hospital is needed. The master planning timeline date ending in August was used to frame the process so that a beginning and end could be identified. The planning of the new facility will however go on as long as needed in order to do the job right.
· Bob Tonti stated the need for a strategic mission. How is the E.D. organized? How do the triage, walk-in, emergent care, and the emergency department function together?
· Tim Walsh stated that strategic plans in general are driven reimbursements. The changes in technology have effects upon how healthcare is given. Thus the new facility will have to change and adapt.
· Tim Sweet stated that any strategic plan is typically only good for 6 months to 1 year due to the changes that frequently occur in reimbursements which in turn change how the hospital does business.
· Sarah Kuh emphasized the need to foster the development of integrated healthcare for the island. The current dental center at the hospital is too small. Urgent care lies between the E.D. and primary care; how is urgent care given? A health center/clinic needs to address flexibility.
a. How are the uninsured accommodated by the hospital and primary care?
b. To whom does the responsibility lye to offer healthcare?
· Dylan Suede commended those involved in the planning process for including users, patients, and in general all parties.
· Tad Crawford noted that the hospital is part of healthcare on the island. Currently groups are finding ways to receive health care off of the island. A genuine 2 way dialogue is needed in order to plan for a new facility. The hospital has a unique opportunity rethink how healthcare is provided. A new facility needs to encompass a community driven integrated network allowing all components to work together in a system of care.
a. Facility not driven by hospital but by community care
b. Hospital networked into the system or care
c. Instant access to Boston hospitals
d. Service overlap between Martha’s Vineyard Hospital and those in Boston are not necessary
e. Provide urgent care on island
f. HIPSA designation on island
g. Accommodate Martha’s Vineyard Association of EMT’s
h. Accommodate mental health practitioners
i. Promote health of school children
j. Community health/wellness center
k. New facility – 3 separate structures and satellite facilities
· Fred Rundlet stated the new facility will have to remain flexible changes in medical technology. Martha’s Vineyard Hospital has philosophical, ethical, and legal responsibilities to fulfill if it is to serve as the sole provider of island healthcare.
· Bob Tonti noted that Dr. Klein and Dr. Neider are available for telemedicine.
· The meeting adjourned at 9:30am.
Summary of action to be taken, based on the notes above.
1. TMP will proceed with development of space program.
2. TMP will proceed with development of master plan.
Prepared By: Basil Rousos
copy: Marc Rowland, AIA, TMP Partner-in-charge
Tim Walsh, MVH
Tim Sweet, MVC
BR/MR/A00103gf
p:\2003\a00103\phase\1-progr\01 meeting notes 6-16-03.doc
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