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Hospital raises are questioned, criticized, then compromised

POSTED October 25, 2017 1:33 p.m.

At the newly created joint Finance and Human Resources meeting, some strong opposition was voiced by Lafayette County Board member and committee member Tony Ruesga regarding requested raises at Memorial Hospital of Lafayette County (MHLC). The meeting took place Oct. 20 2017 at 8:00 a.m. in the County Board Room, after chair David Hammer called the meeting to order.
    The first item on the agenda was ‘requested raises and positions at the MHLC’.
    Lindsey VanMatre, Lafayette County Finance Director, provided the committee with the hospital requested raises with job descriptions and an added position requested. Julie Chikowski, Hospital Administrator provided information to finance.
    Chikowski said, “I’m wondering if we could take the certified trainers proposed raises at the MHLC, and do those separately, because I’ve got comparables from the neighboring hospitals, how many staff they have, how many trainers they have and what they pay for additional training, that kind of a thing. That is kind of a separate, if that would be okay with the committee.  Hammer answered, “Put it this way, I will listen to you.” Chikowski  answered, “Thank you, I appreciate that.” 
    Ruesga asked to speak and said, “Like I said at a previous meeting, I was going to go do some research and I sure did.  I have spoken to every one of the hospitals that Julie mentioned.  I asked Julie where she got those $3.00 figures from so I reached out to HR at Upland Hills, Monroe Clinic and Southwest Health and they assure me that no one got any kind of wage adjustment for learning EPIC. They said that it’s personal growth and development for those positions and there is no wage adjustment for those positions in any capacity. 
    Ruesga continued, “I have since looked into these descriptions that were provided to me. They were provided to me late so I didn’t have an opportunity but I did reach out to one of the hospitals and just for instance, Deanna Wright.  I provided them the information as far as what you provided in this one paragraph that looks like a job description and I’m not going to name the hospital but I was basically laughed at.  They couldn’t believe that we are paying that much, that we would even suggest to pay $41.00 to somebody to do that job.”
    Ruesga - “I can tell you from experience with Monroe Clinic, there are two supervisors that run the Emergency Room.  There are almost 30-plus employees, one of them quit, they did not replace the position immediately so the one person is actually in charge of all the emergency nurses and now the CNA supervisor quit and that person is now in charge of all the CNA people with no wage adjustments.  I asked why they don’t adjust and they said it is just part of us doing business.  They answered, if we were to wage adjust every time, then we have to try to get that money back.  The staff is just told, if you are taking on these leadership positions, from time to time there will be adjustments.  That person at the Monroe Clinic makes $38.00 an hour and right now she has almost 40-plus employees under her command.  So, I am not for these large raises.”
    Ruesga - “I’m actually tired of seeing the hospital get these large raises when the rest of our employees are getting .25 cents.  I think it is a slap in the face for the rest of the employees and we must not forget that the hospital is owned by us and since it is owned by us, you worked for us. I feel that it has gotten to a point where we almost work for you and so I would like to see some more contribution from the hospital as a way of paying back at the end of the year.  If anybody owns a business and you make a profit, then you should see that profit, and that doesn’t mean profit goes back into the pockets of the hospital employees.  I think if anything, it should go into the pockets of all employees.  So for that reason, I will be voting “no” for any type of raises at this point.  I think that .25 cents that was given across the board should be applied to the hospital.
    Ruesga - “The hospital is not its own entity.  It actually is just part of the whole picture that we have here in Lafayette County. Some of these salaries that I’ve been looking it, they are not based on our tax base, they are based on some type of performance or some type of… ‘well we’re making this kind of money’.  I’m tired of hearing that they are not in the levy. We already know they are going to be in the red.  That was told to us by Wipfli when we bought the clinic.  We already know there is going to be some problems there and Argyle Clinic hasn’t come into compliance yet. We still have issues there.  There is just a lot going on and I honestly think that we need to slow things down to see where we’re at, see how well EPIC actually works and see us get past the clinic situations before we go about giving $3.00 raises and paying people $41.00 an hour, $36.00 an hour.”
    Ruesga – “They are already the highest paid employees of this county and now we’re giving these huge adjustments for learning a program. Law enforcement just learned a program, Spillman.  It is a very hard program to learn.  We have super-users, not a single one got a wage adjustment. I know what is going to be said, apples and oranges, I get it but we all learn programs throughout our careers and in 20 years I’ve been working, I’ve never had a wage adjustment for learning a program. So I think that we are going the wrong way and I think it is irresponsible for us to spend that kind of money not knowing what the ending figures are going to be and what the future holds for the hospital.  That is my two cents.” 
    Jack Sauer, County Board Chairman, asked, “How many employees do we have to train in total between the clinic and hospital.”
    Chikowski said, “I want to give you this information from Upland Hills Health.  I didn’t go to Southwest Hospital because we don’t work well with them.  I went to Upland Hills. I went to Grant Regional.  I went to Monroe, Monroe has 1,000-plus employees and they have thirty-one IT staff to support those people.  Let’s just get that out there please, so that we have good information.  As far as asking for money for people to learn programs, I’m asking for money to keep our certified trainers so that we don’t have to add additional positions.  I’m asking for  $23,000 for my administrative staff to learn a whole new program and to support the learning so that I don’t have to pay $500 to $600 dollars per person to go to EPIC and I don’t have to add additional positions.  Additional positions, if you brought in a clinical nurse which Lancaster did and Upland Hills did and, again, Monroe has thirty-one IT staff to support their EPIC staff.  We have one and a half in our hardware and we have 1.0 FTE in our clinical application specialist and I’m asking four people to take on additional pieces of jobs and asking for $23,000 to support those four people.  The information is all here. We need to be able to train our people on EPIC before they can start.  We contracted with our Emergency Room doctors.  That means just in time, they need 12 hours of training.  If I have to send them someplace for that 12 hours of training, I’m paying $120 an hour for them to learn someplace else. I don’t have access to them on-site and I’m paying an EPIC certified trainer.
    Ruesga said, “My understanding is these employees already have been trained and, in speaking to some of your staff who will remain nameless unless I need to use them, one of them is prepared to talk here in front of us, they said that these raises were promised well before EPIC even became a real thing.  When EPIC was being brought up, these employees were already thought of throughout the process. There wasn’t any type of selection process, these four employees were already singled out as the people who would take over EPIC and promised a substantial raise to take over this responsibility and I’m tired of that.  That is one of the things that I’m really tired of and this happens at the Manor.  There are promises being made without proper channels and I’m sick of it, and that needs to end.  There are reasons why committees exist.  There is a reason why the county board exists.  Raises and other things like that cannot be promised prior to being brought to our attention, period. 
    Chikowski answered, “We took it to the committee when we knew we had to have EPIC certified trainers.  We told them we would need to compensate our trainers in order to keep them once this was done.  It was not a decision that was made unilaterally by administration.  We took it to the hospital committee.  They knew we needed to have certified trainers.  They knew there was going to be compensation to keep them.  When you look at the positions that other hospitals have added in order to support this program and if you want to throw out the .25 cents super-user certification, I ask for it and if no one else in the county got any kind of a bump for being a super-user, I can absolutely support that.  If I lose one of these people, I’m going to have to hire another clinical applications specialist and that is going to cost us between $70,000 and $100,000.
    Ruesga - “If you lose one of these people who are going to be paid $36.00 an hour and $41.00 an hour, then I cannot even fathom what the problem really is, because if I was getting $41.00 an hour, it would take a lot to have me frustrated enough to leave a department.  They are getting paid so much money that they are making more money than most people in this whole area.  They are definitely the highest paid people so if they are leaving because they are not getting the $3.00 adjustment and they are already making $38.00 or $33.00 an hour, we have a bigger problem with the hospital.” 
    Chikowski – “Tony, you have criticized this hospital that has 25 beds, we have many people doing multiple jobs.  In other hospitals, if you look at the two other critical access hospitals that are referenced here, Grant Regional has 251 employees and Upland Hills Health has 500 employees. They have one person doing one job.  We have many people doing multiple jobs.  We do not have the luxury of having people each having one job.  That is not the case here in Darlington.”
    Ruesga – “Exactly, and you hit it on the point, so that is not the case here in Darlington.  The case here in Darlington is that we have a certain tax base.  Grant County has a different tax base.  They can afford to pay or have one person in those positions.  We cannot.  So we need to start focusing on what is really happening in Lafayette County, not really what is happening in Grant County or Iowa County.  You were asked to do a comparable based on those descriptions and where you got $3.00 from which to me is like some magic number, you could have said $5.00, I mean it just doesn’t make any sense to increase $3.00 an hour for learning a program so they can train somebody.  We’ve all learned programs and we’ve all been responsible throughout our careers to train other people.  That has to stop, every time they learn something new that we’ve got to dump more money at them.  We can’t keep up.  This county cannot keep up because when they do quit, if they do quit which the people that are in those positions, I doubt they are going to quit because I doubt they are going to find somewhere where they are going to get $41.00 and $38.00 an hour, I doubt they are going to find anything like that.  If they quit, then I guess we’ll have to start all over but the reality is that we probably are not going to start at $38.00 an hour or $41.00.  I think we need to start focusing on what is actually happening in Lafayette County and stop worrying about what is happening in Grant County.”
    Chikowski - “And we don’t need to worry about what the other counties are doing.  Let’s look at critical access hospitals in general.  We’re talking about Deanna Wright.  In critical access hospitals, they have one Medical Surgery Manager, they have one Infection Control Preventionist and they have one Clinical Application Specialist.  Deanna is doing all three.  Nicole Lewis is our Emergency Department (ED) Director.  She covers the whole entire ED plus she is a .5 Clinical Application Specialist.  Both of these ladies have gone to be certified trainers.  They are training all the docs and all the nurses in the hospital.” 
    Ruesga – “Great, and I think they are being compensated at a very good rate, already at $33.00 an hour and already at $38.00 an hour.  I think they are already being compensated at a nice wage and I don’t think we need to adjust their wages $3.00 extra dollars because they learned EPIC.”
    Hammer said, “In my experience working in industrial work, we learned a lot of things and we never got a $3.00 an hour pay raise for learning those things. I’m inclined to agree with Tony. I think this is getting out of hand and I don’t see your financials.”
    Chikowski answered, “My financials were presented to the Finance Director. We actually are ahead of budget from last year.  Our cash is healthy.  Lindsey, you got our latest financials.”
    Ruesga – “Sorry Lindsey but before you speak, the other thing with financials is every time that somebody questions the financials, we get people being told they are bullies and that is another item that is going to stop.  Everything is going to be questioned.  I’m really glad that Jack gave me the opportunity to be on this committee because I will be questioning everything and I think Lindsey’s job is to question everything and she’s been attacked since taking on this position because she questions and only by one person and that is you (pointed to Chikowski) and the hospital and so that portion of it has to stop as well.  Sorry Lindsey. 
    Chikowski – “We have an HR Director who is leaving today because of the atmosphere that she works in.  Today is her last day.  Come on Tony.”
    Ruesga – “That has nothing to do with finance.  And there is a lot more to it.” 
    VanMatre said, “I’m not going to stop questioning things if I don’t think they’re right.  I don’t want to create tension with Molly. I love working with Molly, but now I feel there is tension and that upsets me because I felt like we had a really good relationship. Most of my questions, I just don’t know, I’m new, I don’t know how things are done and I guess I just felt kind of slighted when I asked for the financials that get handed out at the meetings because when I read it in the paper, I want to have that information and I know that Molly didn’t want to provide me with that until they were final and I get that but I get questioned about every number that gets put out there so it would be nice if I had that information.”
    Chikowski – “And as soon as they go to committee, the process is that you’ll have them.  Right?”
    VanMatre – “But I was told they had to be reviewed by Admin staff and then they would come to me.” 
    Chikowski – “They go to the committee and soon as the committee approves them, you have them.”
    VanMatre – “I don’t have anything past August.”
    Chikowski – “Well it is October.  As soon as we have them, you’ll have them.”
    VanMatre – “And that is what I thought so at the meeting when it was presented at the meeting, then I just said could you forward on to me during that week and it was made clear that when they are approved by certain channels at the hospital, then I would get them.” 
    Chikowski - “When they are approved by committee.”
    VanMatre - “And that is what I thought.  Maybe Molly and I were just not communicating on same level.  I just dropped it at that point because I don’t have time to fight over every little thing.  I have a budget to do.  That is the main priority so I just let it be, because I don’t want to have to fight with somebody.”
    Chikowski - “As soon as they are approved by the committee, you’ll have them Lindsey.”
    VanMatre – “Okay.  Maybe this isn’t something that even needs to be said but I’m sorry if Val feels like she is leaving because of me or my questions.  I think that is a bit extreme.  If something is not right, I’m going to ask a question like how come we’re doing this?  I want to know and if it doesn’t coincide with what we’ve done before or what it in the handbook, that to me is we’re opening a can of worms.  We know everything that goes on here gets repeated and repeated and repeated throughout the courthouse, the county, everywhere.  So if we’re setting a precedence or something, let’s do that but we have to follow it.  It just worries me.  I’ve already been told there are a lot of things we’re doing that could possibly be construed as a legal issue, so I don’t want to deal with that.  And I don’t think that I should but it falls in our lap.” 
    Val Steiner, Human Resource Director, said, “I think the atmosphere in the courthouse right now, it is so toxic, it’s really changed.  I just hope that you’ll be able to get through now and you guys will be able to address and do what you need to do to conduct business and the way you need to conduct it.” 
    Ruesga – “The thing is that these people are already trained.  They should just train our staff.  They are already getting compensated to work here and they are the highest paid employees that our county pays.  I don’t see why we would need to adjust their wages when they are already making more than everybody else, by a lot.  It is just part of their job. I don’t understand why we would do that.  Our highest paid people in law enforcement that took on the Stillmann project, they went away for weeks to train.  It cost our department money to backfill their positions.  We didn’t ask for one single adjustment and that includes the Sheriffs Department. There wasn’t a single adjustment done, they were just expected to take on that responsibility.  If the responsibilities get too much, then we shook other responsibilities to other people; hence why you have corporal positions who did get a little bit of a bump but not a $3.00 bump.  I don’t know where these numbers are coming from.  It just seems to me we’re handing the hospital an open check book and letting them write out checks and I’m not too sure that at the end of the day, we’re going to be able to cash all those checks. 
    Chikowski - “We need to take into consideration that we looked at two different EPIC models.  One EPIC model was that they were going to come in and they were going to train our people.  That was going to cost us $500,000 a year for maintenance. We’re paying Unity Point Health $340,000 a year maintenance with the agreement that we have our own certified trainers who will do the ongoing training, who will do the training on the updates and parts of it is that we will provide the infrastructure with these certified trainers.  As you can see, we do not have a certified trainer in our operating room and we do not have a certified trainer in our Medical Records yet.  I’m asking we be allowed, because every time we change a position in Surgery or HIM, we need to pay a trainer and it is not going to be $70.00 an hour, it is going to be $95.00 an hour, at a minimum.  You have to look at the big picture.  We looked at two different EPIC’s.  We can either pay them to come in and do our training or send our people up to EPIC and we will be mileage, maybe not hotels because it is in Verona, but we need these certified trainers and our trainers went away for 12 weeks.  For 12 weeks they were training, 12 weeks they were learning, six weeks they were learning, six weeks they were actually in a process of training.  EPIC comes with a cost, but we need EPIC.  We need to be able to speak to the other hospitals that we work with and we’ve done it in the most economical way that we can.” 
    Ruesga – “That $28,000 that you speak of is wages, right?”
    Chikowski – “Yes.”
    Ruesga – “Is that fringes?  I don’t think so.  We are only talking about wages so when you pay somebody at that added price, which totals about $6,000 a year. It also increases the fringe benefit so this is not an accurate number.  That is one of the biggest problems that Lafayette County has.  We forget about how well of a benefit package we actually have.  You don’t find that in other areas and so that $28,000 is simply a mathematical, how much it is going to cost us per hour.  We’re not taking into account any overtime that may be taken out, we’re not taking into account any fringe benefits, we’re not taking into account any other of those things.  That number is a low.  It is the lowest number.  In actuality, it is probably more like $40,000.  It is just hidden figures.”
    Chikowski - “And it may be $40,000 but Tony, do the math.” 
    Ruesga - “Okay, but what I want is real facts.  I want it to stop that you are talking about these numbers like well it is only $28,000, and you drill that into the committees, one of them being here and the hospital but in actuality, you are talking about $40,000 or $45,000.  It is just that those hidden figures are not figures that you are being willing to bring up because it is another argument you must make.”
    Chikowski - In the budget, those raises, all of the additional social security tax, retirement, all those things are added into those $3.00 and $2.00 and $1.00 an hour raises. 
    Ruesga - “Chairman, I think we’re just spinning our wheels here, so I think we need to move on and make a choice.” 
    Sauer said, “Years ago when people used to come in, a lot of them wanted reclassifications and I got tired of them saying, well I’m doing more duties than I did before.  I finally asked the question that certainly irritated the people I asked it to and probably a lot of other ones, if you’re doing more work in eight hours, were you twiddling your thumbs two hours a day before or four hours a day or three hours a day?  There are eight hours in a day and if I have a lot to do, I can get a lot done in a day and if I have a little to do, I don’t get much done.  There are only so many hours in a day.  These guys, I’m assuming, had things to do before but you still have so many hours in a day to get things done.  So if you are doing more duties than you did before you are actually having to let go some of the duties you had before.”
    Sauer continued, “As I looked at $3.00 an hour raise which is about $6,240.00.  I’m first going to suggest we cut them in half.  I’ll just go down my list. Sally Blackbourn I would cut from a $1.00 to .50 cents; Dena Dammen from $2.00 to $1.00; Nancy Edwards $2.00 to $1.00; Head cook position .35 cents, I guess I would leave that the same; Nicole Lewis $3.00 to $1.50; Amie O’Brien $1.00 to .50 cents; Mary Wedige at .50 cents leave the same; Bridget Whited $3.00 to $1.50 and Deanna Wright $3.00 to $1.50. And the super-users I would take up to .35 cent.”**
    Sauer - “That still at $2,080 increase in pay for the same number of hours work.  I realize the work you are doing is a little different, your duties are a bit different but you’re still only putting the same hours in a day.  I don’t know whether that is palatable to anybody.  That is quite a cut from what we were talking about but it is still a good increase in pay.”
    Sauer - “The other thing, I think at least two and maybe three of our finance meetings, the .25 cents an hour that we’re giving across the board isn’t much, I understand that, but at a neighboring hospital, a health care incentive, they got a 2.5% raise which is quite good. Their health insurance program and there is only one available, is about $340.00 a month out-of-pocket.  We have one here that you can get for $19.00 a month out-of-pocket.  That is a heck of a difference.  Now if we start charging everybody $340.00, we could give bigger raises.  It is all in the bottom line when you get done.
    Larry Ludlum said, “I’ve been on the hospital for several years.  I get a little bit irritated when I hear the hospital gets everything they want all the time.  They don’t get everything they want all the time.  We sit there month after month and Julie will make requests and we try to compromise and keep the people compensated for what they do.  Julie does an excellent job with moving people around.  We’ve lost some good people.  We could lose some more.  We have to compensate people for what they do but you don’t have to give the whole thing away.  I think we’ve worked over the years with Julie.  As far as I’m concerned, her compromises and I’d like to work with a compromise and it really bothers me a little bit too when I hear about some animosity between people.  That has to end.  I’ve been doing some figuring here and what Jack was saying.  I don’t think maybe they need $3.00 an hour.  People that are getting .50 cents, that is fine but I think we should try to come up with a compromise.  It is really hard to compare the hospital with some of our other departments here in the county.” 
    Sauer – “And I would raise the super-users the .35 cents.  The reason I would do that is because nobody on this list is going to get the .25 cents that goes county-wide.  So really only the super-users are getting10 cents more. Fair or not, that is a compromise that I would be willing to support.”
    Ted Wiegel, county board member. Said, “I make that motion.” (**the changes that Sauer suggested) Ludlum seconded. Roll call vote. Hammer - Yes. Ludlum – Yes. Ruesga – No. Wiegel – Yes. Sauer (voting for Heimann) – Yes. Approved.
Added Positions
    The hospital has proposed adding five positions. The committee approved creating the Specialty Clinic Registration position at $15.33 per hour. No action was taken on the Lab Tech Clinic and maintenance positions until more information is provided.
    In other business:
    •Approved two raises in the District Attorney’s office (these were previously approved at a Finance meeting).
    •Will fund the new county website with $5,000 for 2018 and that will be run through Economic Development. Approved a motion to take the funds from the state sales account.

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