Much Ado at Montrose Medical

The public hospital board having control of such hospital after its establishment and turning over to its management may in its discretion rent or lease the said hospital, for such rental and for such term as it deems reasonable and proper, to any corporation not for pecuniary profit duly organized under the laws of the state of Colorado for the purpose of conducting a hospital.

Colorado Revised Statutes, Section 25-3-313

If you follow the local news at all, it’s been hard to ignore the dispute between the Montrose County Commissioners and the trustees of Montrose Memorial Hospital, which is owned by the county with the trustees appointed by the commissioners.  

I don’t live in Montrose, and I’m not an expert. I have worked in both government and health care, and have an understanding of the operating cultures of both. So anything that I have to say will be framed by my perception of both the positive and negative aspects of those respective cultures.

The hospital trustees claim that they undertook the establishment of a non-profit corporation, and the leasing of the hospital to that corporation, within the letter of the law that governs their operation as a public board. This would likely include the advertising of meetings to conduct business in advance, and this advertising would likely include legal notices in the primary newspaper(s) covering the area. In this case, that would be the Montrose Daily Press.


The Daily Press, through its Publisher, Stephen Woody, seems to have taken the hospital’s side in this, by accusing a commissioner in an op-ed of seeing “conspiracies” by the hospital, and by providing a prominent link to the hospital’s response to the commissioners on the main page of their website.


Depending upon the content of any legal notices published in the paper that may have announced the trustees’ intent to do what they eventually did, I’m wondering if the editorial side of the paper was conveniently ignorant to what the classified side was printing, at least until the bulk of the trustees’ work had been done.

The hospital trustees have contended that they followed the letter of the law in announcing their intent to the public, and the statute quoted at the top of this page would seem to support their authority to do what they did.

However, the spirit of the law, and the assumption by many citizens that public servants should be working in cooperation with each other for the promotion of the common good, appears to have been ignored by the trustees. They appear to have chosen to provide the minimal, cursory notification to the commissioners and to the public. They’ve chosen a course of action that could largely remove many of the publicly owned hospital’s operations from public scrutiny. They behaved like, well, a hospital.

Hospitals and other health care provider organizations are by their nature insular, highly specialized entities that embrace a hyper-credentialized pecking order of sorts. At the top of the pyramid are insurers and physicians. The medical staff has publicly sided with the trustees.

These organizations eschew, if not abhor, public scrutiny and media attention, and apply management strategies more in line with a for-profit, more intensely competitive enterprise. Part of this approach is necessary to assure consistent compliance with a large regulatory burden, from both within and outside the profession. Along with their statutory responsibility to protect patient information, this burden belies the public perception of a more benevolent, charitable approach to operations, that while still present is not what it used to be.

The Chairman of the trustees has been quoted as saying that they took the action the way they did because they felt that the commissioners would not approve of their plan. Too bad. The commissioners needed to be kept in the loop, whether they could legally do anything about the trustees’ action or not. Like them or not, they are the ones with the statutory authority and responsibility, and the trustees needed to respect that.


The trustees’ stated concerns about the hospital’s assets being used as collateral for economic development activity does not absolve them from their obligations as overseers of a public asset, or from exercising civility and straightforwardness in their dealings with the commissioners, their own employees, and the community at large.


This isn’t to say that the nature of government operations, as manfested in our elected officials, is without fault here. The often fickle nature of representative government, and the manner in which it can be bypassed in Colorado through the initiative process, makes it difficult for a complex, expensive operation such as a hospital to be able to develop sustainable business plans that can weather the storms created by changes in philosophy that come from changes in elected officials, or the potential passage of ill-conceived ballot measures that threaten the stability of government and those who operate with or within it. Luckily, the electorate has seen fit to soundly reject this year’s proposals. 


The Daily Sentinel has so far been the calmest, most reasoned voice among the many in this debate. In their October 28 editorial on the subject, they stated:

“Now, those who are served by both the commissioners and the hospital have a lease plan that may be in legal limbo. They will end up paying for both sides in (the) court dispute…Worse, a well-respected health care facility that is critical to Montrose and surrounding communities is now caught in the middle of this political turmoil.”
The Sentinel editorial board also called both sides out for failure to discuss and act upon the issues surrounding this debate in the transparent and accountable manner that their positions as guardians of the public trust demand.

Now that the dispute is in the very public domain of the courts, there will undoubtedly be additional reporting and scrutiny until some sort of resolution is achieved. The next round looks to be this coming Friday. Unfortunately for all that rely on Montrose County government and their hospital system, the intangible fabric of trust and cooperation that is essential to our system of governance may be in need of some serious mending.

Perhaps this just comes down to the failure to adequately recognize and deal with the symbiotic nature of the relationship between government and health care, and the deterioration of important lines of communication as a result.

Have a good day.

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