Santa Rosa's new Community Hospital with Administrator Larry Hood and Medical Director Dr. Frank Dornfest

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the nineties with your host, Rich McGlinchey, how you doing everybody? I'm Rich McGlinchey and as you know the program, Sonoma County in the nineties and on this particular edition of our show, we're gonna talk about favorite institution of mine. It's community hospital, we're gonna talk about

not only the hospital itself and its programs, but family practice and a few other things. We're gonna be talking to. Two of the key people in that institution, Larry Hood who is the administrator of the hospital and dr frank Dorn fist, who is the medical director

of the hospital and gentlemen, I'm glad you're here. Yeah, we're gonna talk about community hospital. I go way way way back with the community hospital before this guy I think was even alive. I'm not sure you know, I actually worked as an orderly there when I

was my last year of high school, an ambulance driver at night and that's when I ran into some cardiac problems. I wound up out there and they did a beautiful job. So I do have a very fond feelings for community hospital, but I'm also very proud

of it and I think you will be have to hear some of the things he's done. And I have to say about not only what's being done out there, but the equality of medical care that's out there dr frank. Nice to see you. We see you

up there once in a while, but I got a chance to talk to you down here. Uh frank. I think everyone knows that community hospital is very proud of its residents program, but I don't think everybody knows what a residency program is. So why don't you

for the sake of our audience explain it. Well, residency program, which is a program in which people who have already qualified as doctors or physicians get training in a specialty area in medicine and in our program at community hospital, we train physicians after they've completed their

basic training. We do three years of training to become family doctors or family physicians Digress. Just for a moment. Family practice, which we'll talk about is now a medical specialty is that's correct. Something like a cardiologist or something that's correct. Has been since the early 1970s.

Well, now, if these resident physicians are in training, how well prepared are they to take care of patients? That's a good question. When they come to us, they're already, of course graduated qualified doctors and have had two years of exposure under supervision to the care of

patients. And of course when they're working in our institution, they do so under supervision. And the kind of supervision we give depends on the level of training that they're having. So right at the beginning and the first year they'll get very, very close supervision and as

the three years go along, they'll get greater and greater degrees of independence. I know that our residency program, I've read this, I've heard this and I've had the pleasure in past years of publicizing it, that it's a highly regarded program. But why is it so well

regarded? Well, we are indeed. I'm very proud to be part of the program. It's been there for 50 years. One of the first residency training programs, it started off as a general practice training program. It's over 50, it wasn't about 38, it's 50, I think we're

52 years old now. So it was one of the first family practice or in fact in fact at the beginning was a general practice residency training program, then became a family practice residency training program. And we are very well regarded. And evidence of that, I think

is the kind of caliber of people who come to our program from all over the country. So our residents are not just from California, although about half of them are. The others are from medical school's right around the country. We get about somewhere between four and

600 applications for our 10-13 1st years positions every year. I mean that really speaks highly of the program itself, doesn't it? Yes, I think so. 14. How many can you take In the first year? We take 13. We've expanded our program of about maybe five or

600. And those are the kind of the cream of the crop, we think so, there's no official count. But our estimate is that we get our residents from amongst the top five or 10% of residents or graduates around the country right now, Who participates in the

training of our resident physicians? Well, we're very lucky. We have a large faculty, we have 19 physicians who are part of our core faculty, which means that they either work half or full time in the residency program training training residents and seeing patients. And then we

have a large medical staff at community hospitals. You know, personally some 400 physicians and all of those participate in a greater or lesser extent in the training of the residents. Well, community hospital has a long and varied history, but community hospital in certainly since brotherhood over

here, I think came up originally with Nme and now is the administrator on his own. But going back to that time since that date forward, the quality of community hospital, I know that for a fact in the eyes of other medical institutions around northern California has

risen unbelievably and it's it's a high quality facility now, I think our quality of care is second to none in the country. I agree with you, I absolutely agree with you. Is the program associated with a major medical school. Yes, we have an affiliation with the

University of California at san Francisco, there's a department of Family and Community medicine there and we're one of their five residency training programs. They only have five and you're one of them five family practice. When we say you're connected with them, what do they do for

you and you do for them, so to speak? Well, I'm the vice chairman of the Department of Family and Community Medicine at the University of California and they grant all of our academic positions. So all of our faculty of academic positions. We also have a link

with the University of California Davis. We not only train residents who also trained nurse practitioners and we're one of the first programs to do so I know about that. Is that no, that's been going on for many years christmas that I know of your nurse practitioners,

many of them and I know what a splendid job they do. And they used to perform all examinations for county department heads that sort of thing. But I did not realize that they Davis is involved. We were one of the first programs in the country to

be associated with the university in that kind of way? Well now you said you're associated with the University of California Medical School. Are you associated with him in any other way other than the residency and and the and the nursing, if every practice, what nurse practitioner,

family nurse practitioner, that's not really know, that's how major affiliations to affiliation. Alright, a moment ago here, one of the comments you made is that the resident physicians are being trained in family practice and that's what I mentioned earlier, I jumped the gun a little bit,

but family practice is an accredited medical specialty now. Uh but what exactly is family practice? Well, there are many, many ways to try and explain what family practices and probably the easiest way is to try and remember back to the old style family doctor, general practitioner,

general practitioners, the Marcus Welby type and that we still make house calls. Actually, it's a significant yes, it's a significant part of our activities and significant part of our training program, in fact, is how to do house calls, there's a science in how to do house

calls. Essentially, a family physician is is a family doctor, is a doctor who's been trained over a very broad area of medicine, all of the sub specialties of medicine and our family doctors are trained to be able to cope with between 95-97% of everything that any

patient could possibly bring to them In the other five or 3-5% of cases, they will require some help from one of the sub specialists in caring for that patient. But by and large they were able to render primary care first contact care to 95% of the

people that come to them. So it's a broad specialty training area of emphasis is in the area of the family, family interactions, understanding where the person is within their family, within the community, within the largest setting in which they operate. One thing I think should be

mentioned, certainly in regard to family practice, correct me if I'm wrong, but it's the only medical, especially I know of where you have to get re certified. Is that still, in fact, that's correct. As far as I know, it's the only one which requires re certification.

So we have our physicians re certified every seven years now there's a voluntary voluntary re certification, I think in pediatrics, but that's voluntary. It's required in family practice. This is really marvelous. So that means that you've not only turned out a high class physician, but you

make sure that he's updated at all times and we can guarantee modern medicine. We can guarantee our docks are never more than seven years out of date. They'd love to hear that. Hear, hear uh, what do you believe that patients in Sonoma County really want from

a health care system. There's an awful lot of talk about this. Well, as you know, the health care system is a very difficult system to negotiate for patients. Obviously the first thing they want is excellent health care. The next thing I think they want is somebody

to help them to negotiate their way through the system because it's very complicated, very difficult for a patient to try and decide which specialty their problem falls under. And so many of the generalists, that's the general Internal Medicine family Practice pediatrics assist patients in entering the

health care system. So I think they want excellent care. I think they want cost effective care and I think that's another hallmark of family practice is that it's very cost effective. A personal side frank. We've talked many times briefly, but in this lengthy conversation, do I

detect a certain english or bostonian accent? No, it's it's African, is it, is it really? Where did you get your mental training together? Cape Town, South Africa, is that right? That's it's a lovely, lovely accent. Um The theme of the series in this program, we count

in the 90s. Um how do you see a residency program influencing or contributing to the health care in Sonoma County type of health care? We just talked about in this coming decade, decade rather than 1990s. I think it's very important in any community our size to

have a some form of academic focus. I think it changes the character of medicine practiced in the county. I think it will continue to do so, I think that many of the physicians in the community enjoy the academic stimulation that goes with having a residency program

right here in Sonoma County. Secondly, I think the focus of training is very important. I think the focus on cost effectiveness, focus on humanism in medicine. The focus on ethics are all very important in influencing the direction of medical care in the county. And then of

course the probably the something which is near and dear to the individual person and to industry is the cost of medical care. More and more medical care is going towards prepaid medical care and managed medical care. And it's very important to have somebody who can act

as a gatekeeper to the health care system to try and contain costs really. The health care system and larry. I know this will be part of what we'll mention to you in a moment or two, but the health care has, has risen enormously in in in,

in the past few years, probably for the service you're getting and the and the excellence of medical care that that rises not so drastic as it seems, but in dollars and cents, it seems to have jumped substantially now, will that continue, Do you think? I'm sure

it's going to continue? I'm absolutely sure. And there are various ways of looking at that. Some people say we're not spending enough money on health care and some people would compare that to how much we spend on other things which are perhaps less desirable like tobacco

and alcohol and drugs and various other things. But most, most people are very concerned that the cost of health care will interfere with with the financing of education and other things which are very important to us. And I think that's going to be a continuing challenge.

Well we're gonna come back in a moment and talk to Larry but I want to commend you frank for doing a splendid job as a medical director up there. Hear nothing but good report. Something about you. And secondarily I think that you can be very, very

proud of family practice in the community hospital because they've done a splendid job. Ladies and gentlemen, we're gonna be back in just a moment after these important public service announcements. I'm gonna talk to none other than Larry Hood, the administrator of the county community hospital, County's

community hospital I should say. And that will all take place in just about 30 seconds. You've taught your Children to be polite and friendly but have you taught them when not to be high there. Do you live around here? Uh huh. You're going to school? Yes.

Well I could give you a ride last year. 50,000 Children disappeared. Many of them from nice safe neighborhoods. Okay, come on talk to your Children about not talking to strangers and do it today. A message for your child safety from the american Medical Association. Hey hi

this is bob hope and I want to talk to you about the Hanna Boys center in Sonoma California. Hanna Boys center is a residential treatment center for boys between the ages of nine and 18 and at Hanna Boys Center a carry and concerned staff give boys

the help they need help heal the hurt of these boys by giving a hopeful gift to Hanna Boys center, P. O box 100 Sonoma California 95476. Do it today. Welcome back ladies and gentlemen to this edition of Sonoma County in the nineties and we're talking about

community hospital, which is a very fine medical institution and has risen in stature tremendously over the last decade or so. It's always been there and has been providing quality service for 50 or 60 years. It's really risen to the top in the last few years. And

one of the people that's responsible for that I think is the gentleman we're gonna talk to you next. Larry hood Larry originally appeared at the Community hospital as a member of the National Medical Enterprises I think was the organization that was there at one time. And

larry larry handle that administration for that group. Turned the thing around from about $2 million loser to a medical institution that is for the county people in his community medical institution And it now breaks even and makes a little money. So you taxpayers have been spared

about $2 million let's get down to the hard, needy gritty here. One of the things we've heard is that there's a nursing nursing, not nursing but nursing authorities in Sonoma County. And if that is true, how does it affect community hospital area? Well, one of the

things that you've graciously said rich is the the quality of the medical care and the attempts that we've made to make sure that there are, you know, sufficient personnel in the institution to do the job that that everybody wants. Uh We've experienced nursing shortages from time

to time. Uh This one right now is is particularly acute uh nationally um and there are just not uh enough nurses in the system to do the job that needs to be done. And speaking specifically of there are more um opportunities for nurses to work outside

of the hospital, home health care, various and sundry things that they're doing in that in that regard. So the nursing shortage needs to be narrowed. I think in terms of the shortage as it affects acute care hospitals. Um What do you think contributes to the lack

of RNS right here in central County? I think that there are more choices for nurses, They have more job opportunities, they have more places to go other than the acute care hospital. The acute care hospital gets most of the attention uh So therefore it's easy to

focus on the hospital and look at the supply side of of the nurses but I think they are working in more more places. I also think nurses have left um nursing and moved off into other professions because they have more opportunity. I think nursing historically a

woman's profession, women now have many more choices to make about careers. So I think it's a very complicated, complicated issue. Well Larry as the administrator or heading your staff, what what can you do to well let's say solve this problem or partially solve it. We've heard

it referred to as a recruitment and retention problem. I think it's mostly retention problem. I think what you have to do or attempt to do is try to find out what your nurses are interested in as as professionally as people etcetera. And then try to design

not necessarily programs but at least options that try to fit as many of those uh issues that that they want to have solved. Not necessarily just uh salary, but there are lots of things that they seem to be interested in that you try to solve. So

you try to make your nursing department a nursing department that would would appeal to a broad spectrum of of nurses and that encompasses lots of different smaller issues. Uh Up until now, Larry we've had two quality medical institutions in our area community hospital and the Memorial

hospital. Now there's going to be a Kaiser's hospital pretty soon. When will that new Kaiser's hospital open. Well that is the question isn't it? When um currently I've heard when we like to prolong I presume March 21 is the date that I have heard that they're

gonna start moving services that we provide to their institution. They'll do it in a I don't think in a in a wholesale way but they'll open certain services on a gradual basis. The emergency room at Kaiser I understand will open february the 28th and they'll open

various departments over time until they get their hospital operational. So community hospital will see a reduction in the number of patients that we see which are Kaisers? That will be uh they'll be going over to Kaiser Community hospital right at the present time. If I'm correct

in this what I've heard does most of the Kaiser plant inpatient work right now today, is that true? I would have to say that a substantial amount of work that Kaiser's is ours to the degree that we do all of their work. I I really couldn't

say. But we do a lot of Kaiser's inpatient work. Yes. And some of their outpatient work. There's a painful question, how will the opening of Kaiser hospital affect community hospital in dollar terms? Or I I guess we better hit the dollar terms. We've projected about $15

million in revenue that currently comes to the hospital will be moving over to Kaiser. That's a substantial amount in it. Yes. I don't know what percentage is, I don't even want to know, but that's a lot of money and that will come from be taken, so

to speak, from community and will probably go to the new facility over there. That's correct. Well, community hospitals still do any specialty work for the Kaiser plan Members that, yes, we will Kaiser uh discussions I've had with the leadership of the local Kaiser hospital and their

clinics, we will continue to do uh level two intensive care nursery work for them. Um It's highly possible we may even do some high risk obstetrics for them. Um Some testing in the uh magnet which I refer to the magnets, the magnetic resonance imaging unit. They

don't intend to do that. Um So various high technology services that we currently have. Uh Kaiser doesn't intend to duplicate. We will continue to do that work, but for all intent and purposes, for our planning purposes, we're watching Kaiser opened its hospital and we're assuming that

there will probably be little to no business at all from Kaiser. And we're making our plans on that basis very not too long ago experienced a strike. How was the hospital done after that employee strike strikes are very difficult, as you know, it, this is the

first strike I've been through and I've been in the business for 20 years or so. Um And I've heard it categorized, it strikes, bring out the worst in everybody and I think that's true. I think that's true. Uh, everyone's position is correct. They absolutely, absolutely. Um

However, from my particular position and management's position, whatever the issues are after the bargaining is over, after the strike, all the emotions and so forth. We still have the duty and obligation to put the hospital back together. And I think all during the strike, I was

involved in the issues, understood the issues. However, my thoughts were, what's going to happen when it's over? How do we deal with it when it's over? And I spent a considerable amount of time thinking about that, trying to figure out how that was going to going

to work for the hospital. We um, did some things at the hospital. We sensitized management to the stresses that we're gonna be there. Um, and I think we tried to work with the various polarized positions to bring them back and say we still have to work

together. So I think we've pretty much come out of a lot of the bad feelings and so forth. I hope so. I hope so. We still have work to do in the nursing department. We don't think that we've done um enough of the right things to

try to make the nursing department an attractive place in a comfortable place for, for lots of different nurses to work in our hospital. And we're gonna be addressing those issues fairly soon with the board. Uh, the hospital has community hospital has grown in so many ways

and since uh, the last few years it's been helping with the were helping with the psychiatric deal. And you got the family practice, faculty practice all these various things that are taking place up there. It is a very dynamic institution and has moved, but it does

have, has had these setbacks such as the strike. And if you've been able to heal that by now or partially, so, or the healing process is going on, uh, you're well along the way in the right direction and I sincerely hope that that is true. Um,

I know in the past few years people have really also made some tremendous advances in offering new services and obtaining new equipment. And that's my question here, are there any new equipment or major equipment editions at community and the ones that the public should know about

at this time? And what are they? A few years ago we made a decision to compete for trauma center designation, inside of the trauma center designation. Um, the hospital staff felt necessary and compelled to upgrade lots of different services, the emergency room, the operating room, uh,

and various equipments. We moved forward in the cardiac cardiac Cath lab, we established the cardiac Cath lab, did a lot of planning and so forth and hopefully very soon we'll be offering open heart surgery as a new service at the hospital. But in the interim, we

added a magnetic resonance imaging unit, which is a very sophisticated piece of equipment, um, that produces almost the incredible images with little or no radiation. It's done with ultrasound waves. Uh, and it's, uh, an excellent piece of equipment for physicians who want to diagnose various aspects

of the body, cervical, cervical neck. Um, various things that you can diagnose with this this particular. It's very expensive piece of equipment. But the doctors who use it, uh, say that it produces incredible images. It's the only inpatient or unit in a hospital available for in

patients. You know, one of the things we don't talk about very often. I don't think we've even mentioned it at the time or two we visited. But there's a kidney dialysis unit there at the hospital, isn't there? Is there is there, are there many of those

around? Yes. There are. Its inpatient kidney dialysis at the hospital. It's a service that we offer. It's a contracted service. Local physicians, uh, supervised the service. We've been doing that for many years. I know you have and that's in fact, the late Andy Devine, the movie

actor was, we saved his life up there for a period of time when he was severely ill from kidney failure, I guess, wasn't it? Yes. Yeah. Well, we're been about a minute or so to go. What thoughts would you like to leave the audience with Larry

is regards community. I know you can invite them to come there when they're ill. but what would you like to leave? Well, I think we have made great strides. I think as far as the quality of medical care that we provide for patients, we think that

the efforts that we've put into the residency program through family practice, through the, through the quality of the teaching program. Quality is a difficult thing to, to see and measure, but it's not difficult for doctors. Uh, they can see it, they can feel it, they understand

it. Um, and I can only say that the physicians that um, that I talked to are very impressed with the quality of medical care, the quality services that we provide for the patient. So I think if I had to leave anything that would be the thing

that I would say because they are the ones who know it, administrators don't know quality can't understand quality, but Well, thank you Larry and thank you frank, which is about out of time. Um, I wish you all the good luck in the world and keeping community

afloat and highly afloat. And I think in hands like you too, I think it's gonna be fine. Uh, in weeks ahead we're gonna be talking to James, Good Doctor Good Doctor Price who both have associated with community a great deal and also john Dervin who works

with the family practice program. So we look forward to talking to them and hope that they have viewed you too on this program and we'll know where to go from there. Thank you. Larry. Thank you. Dr. Northwest. Take care of yourselves, both of you. Ladies and

gentlemen, The program at Sonoma County in the nineties. I'm Rich McGlinchey. We'll be back next week with other members of the county government family Until then tonight, good luck and good health to each and every one of them.