I recently did a couple of public information requests to the Somervell County Hospital District. In particular, I asked for communications between doctors/other medical personnel and board members.Here is the latest request I did, on October 23, 2014

I am requesting, in electronic format, the following. I would like this sent back in email or if not possible, would be happy to come inspect the records in person at a mutually convenient time.

All communications between any and all current hospital board members and any and all doctors and/or medical staff that work for Glen Rose Medical Center and/or Pecan Family Medical Center since 10/14/2014 through this date (10/23/2014). This includes all emails, notes or text messages (any form of written communication), excluding any information that could violate HPPA laws or attachments in emails that are publicly available.

I received the following directly as responsive to that request from the board president. Honestly, I was pretty shocked to read this, my comments below. (I blacked out the name of the doctor who wrote this letter).

Now, here is a transcript of what this letter says, interspersed with my comments

To the Board Members of Glen Rose Memorial Hospital

As some of you may know I have been striving for improvements at our hospital for the past several years. When I first started, I would take my concerns directly to Ray Reynolds and point out problems and situations that were putting patients at risk. After several months it became apparent that my concerns were being ignored. I told Ray on multiple occasions that we needed strong clinical nursing leadership in our med-surg dept. Other doctors expressed some of the same concerns. I continued to point out that failing to have strong nursing leaders was leaving the floor nurses to flounder with no support, endangering their licenses and putting our patients at risk. After an extended period of time I quit wasting my time going to Mr. Reynolds. What I should have done was be more forceful and document the reporting of these concerns. Unfortunately,due to my lack of tenaciousness, I started to see evidence of what I had been warning about. I saw what I believe to be at least two, and possibly more, patients die in our hospital due to a lack of proper care. When I reported these episodes I was told that it would be looked into, but I saw nothing done to address the problem.

I empathize with this doctor. In my own experience, when I was going out getting signatures on the petition to dissolve the hospital district, I found many people that were leery of GRMC. I heard a number of horror stories. 

After the most recent episodes, in frustration, I stated in the next med-staff meeting that "we are essentially killing patients in our hospital". The next day I wrote a letter to Ray clarifying my comments. I pointed out that we, as physicians, shared in some of the blame because as physicians we should have insisted on changes immediately. I then pointed out that, in my opinion, since the administrators had been warned for more than a year, they were responsible for these deaths. I thought that surely this strongly worded letter would prompt rapid change. Unfortunately, it did not. I and some of the other doctors started pursuing other ways to circumvent Ray to try to improve the care and safety of our patients. Our efforts started to show results, and I believe, because it was making Ray look bad, he intervened, stopped our efforts on that front, and threatened to fire a hospital employee that wsa helping the doctors improve patient care.

At this point I wrote another strongly worded letter to Ray to try and facilitate improvements. Ray told me that I was the only doctor that had these complaints and that none of the other doctors felt this way. I would have to disagree. When showing the letter to one doctor they said they agreed with the statements but thought it was worded "too harsly". Another doctor read the letter and said they could understand questioning why the problems weren't addressed more quickly. A third doctor read the letter given to Ray and said that he would have to agree with most of it and stated that most of the doctors felt the same but were not as vocal as I was. On presenting the letter to a fourth doctor, I asked if there was anything in the letter with which he disagreed. This doctor stated that he agreed with all of it. A fifth doctor shown the letter was the chief of staff and he added to the letter and signed it with me. 

I called a colleague that has been a hospital administrator for over thirty years and discussed the situation with him and requested advice. He encourged me to take all of this information to the hospital board. He reported that he would be concerned that Mr. Reynolds would not only be at risk for civil penalties for ignoring the warnings, but might even be at risk for criminal prosecution. He also strongly recommended that we contact TORCH to come in and help our hospital.

At this point I was unsure of the new hospital board and the "four" that were reportedly against the hospital and did not know if some of them would use this information to harm the hospital.

Interesting to me to see that the baloney pushed by those who don't actually READ seeped into the doctor's heads.I keep hearing that the *4* board members want to close the hospital,which is a complete lie. I, as a voter, actually READ their positions and know what they are for or against, and it isn't the rumours and insinuations that are made by the irresponsible.

So instead of reporting this to all of the board members, I approached some of them individually and showed them a draft of the letter sent to Ray. I expressed my concerns, asked for their help and told them about TORCH. One board member simply reported that they understood my concern for it taking so long for improvements to occur. A second board member listened to my concerns, took the TORCH information and appeared to be interested, but nothing happened. I met with a third board member and after showing him the draft of the letter, explaining my concerns and telling him about TORCH, he openly said that Ray was a friend of his and that he would be too busy fighting against the *four* other board members to be able to help.

Since there is 4 and then 3, I'll bet I can guess who the one is that is a pal to Ray Reynolds that would be *too busy* to actually work to improve the hospital because too much time taken to fight against the other 4. Shows you that one's priorities, eh? Also begs the question, who really is harming the hospital? The ones that seek to improve it by examining the details, pushing for better patient care, looking to help out the community with lower taxes if possible, or the ones that listen and do nothing for whatever reason? 

With nowhere left to turn, I contacted one of the *four* members that were supposedly against the hospital. After questioning him cllsely concerning his plans for the hospital, his interest in improving the hospital, his interest in patient care and his integrity, I finally felt like I had contacted someone that would fight along with me to put the hospital and patients first and foremost. I then shared with him my concerns and gave him the information on TORCH. Finally, some action was taken. He called a board meeting and the board voted unanimously to bring in TORCH.

Bravo to this doctor for continuing to push for improvements in the hospital and patient care. And bravo to the board member, president, who got TORCH put on the agenda. I personally haven't followed TORCH closely except that my understandiing is that a consultant affiliated with TORCH was hired in some way, and that on Sep 11, the board went into executive session to discuss and on Sep 18, implementing TORCH recommendations. and again on agenda on Sept 25.

When the representative from TORCH came in he recommended making some of the same changes that I had been requesting for years. I was hopeful that this would force Ray to make these changes but it appears that he is fighting against them vigorously. The representative from TORCH has said that he has never had an administration that didn't readily welcome him to come in and help much less fight against it so vehemently. Regardless, he has stated that he believes he can work with Ray to help him improve as a hospital CEO if Ray will allow this to occur.

This leads me to several question. Why is Ray Reynolds fighting against the changes recommended by the expert? Why is the hospital board no longer unanimous in their support of TORCH?

Interesting to see who it is that is against TORCH. Ron Hankins.  And apparently Ray Reynolds.

And finally, since I have never dealt with a situation like this, are we obligated to inform the family members of these patients that died or do we need to have an independent agency come in to investigate to see if there is evidence of negligence or wrongful death? 

Please share this with any of the other board members that you believe to be willing to put patient care first. 

I'm sure it was really difficult for this doctor to come forth with his concerns but thank goodness we have doctors affiliated with our hospital that feel so strongly about patient care. For me, I, along with everyone I have spoken to, want a hospital here, but always love the idea that the people in charge or affiliated would provide excellent care WHILE ensuring that taxpayers concerns about higher taxes are addressed (and I STILL want to see the board go for an RFP to find out about leasing to a 3rd party hospital).  I appreciate this doctor.

UPDATED 12/7/2014- some of the documents that came back from my public information request I had not had a chance to look at. Just did. Notice that one of the other staff is extremely concerned about patient procedures. GO READ.  I redacted some of the names and dates myself. Note that ANYONE can do open records or ask elected officials for information. ANYONE.