Rivalry Between Hospitals Isn’t Healthy Silver Valley, Shoshone Medical Centers Need To Cooperate To Survive

Maybe the next movie they make in Shoshone County should be about dueling hospitals.

The hero’s pivotal line could be: There’s not room for both of us in this here valley.

Or, maybe: Can’t we all just get along?

The real-life players are the Silver Valley Medical Center in Silverton, near Wallace, and the Shoshone Medical Center in Kellogg.

They’re 10 miles apart, competing for a relative handful of patients. Both are supported by local taxes. Both are struggling. Officials at both say, if they’re going to survive, they must cooperate.

But they don’t.

“Part of it is that East-West, Wallace-Kellogg-high-school-type rivalry,” said Lake Puett, a local talk show host.

“The Silver Valley Medical Center board probably just does not want the Shoshone Medical Center board to win. It’s like a football game.”

It’s a game with enormous stakes. A state Health and Welfare Department investigation last year found major inadequacies in SVMC staffing and procedures, to the extent that lives were put at risk.

Those problems had a lot to do with SVMC reopening after being closed for three years. While the problems were corrected, “we have ongoing concerns,” said John Hathaway, chief of the state’s Bureau of Facilities Standards. “We’ll continue to monitor that situation.”

The situation has its roots in prosperity. Shoshone County had a strong economy for decades. It could support two hospitals.

Then, in 1981, the Bunker Hill smelter and refinery shut down. Low silver prices put miners out of work. Federal timber harvests eventually dropped, costing logging jobs.

Silver Valley hung on for a decade, then closed.

There was heated debate about consolidating the east and west valley hospital districts.

Instead, the eastside SVMC board decided to reopen its one-story hospital in 1994. That was possible, said board chairman Robin Stanley, because of the support of Dr. Chris Christensen.

The family practice doctor actually was recruited from California by Shoshone Medical Center, said Stanley, but liked what he saw in Silverton and agreed to be the chief of staff there.

“He wanted the hospital re-opened,” Stanley said. “Dr. Christensen was up for the fight.”

It was an uphill battle to stay open. In fact, SVMC administrator David Hughes was sent to Silverton a year ago by his hospital management firm to close the place.

Instead, Hughes said, he turned things around. A second doctor has joined the staff; a surgeon and psychiatrist are making regular visits. The respite care program, which helps people in their homes, is thriving. The debt has shrunk. Seventy people are on the payroll.

The hospital is like a phoenix that’s risen from the ashes, Hughes said. “We’re in a growing mode.”

Still, only six of the 23 beds are filled at a time. About six patients a day come to the emergency room, which is served by doctors who are on call, not on duty.

Hughes thinks the county’s 15,000 people are enough to support two hospitals, if the two will share services.

“My goal is somehow to put these hospitals under a parent agreement,” he said. “I can save them both. We can make them go.”

But Hughes said his suggestions to share equipment, medical specialists and even accountants go unheeded by Shoshone Medical Center administrator Bob Morasko.

“Every time I put something on the table we could share, he says ‘No. I want you closed.”’

Morasko denies wanting to close the Silverton hospital.

“If we make suggestions, then (they think) we’re saying, you shouldn’t be a hospital.”

He agrees it would be good to cooperate. But, Morasko said, SVMC’s suggestions for shared services always are short on specifics, especially when it comes to sharing costs.

“There’s just not enough resources to support two full-service hospitals.”

Sharing specialists is tricky, said Morasko. If there’s only one anesthesiologist, for example, who decides whether that doctor helps the surgery patient in Silverton or the one in Kellogg?

The Kellogg hospital offered SVMC its successful North Idaho Addiction Recovery Center. In return, it asked for all the emergency and acute care.

That didn’t wash.

An emergency room is what Silverton hospital supporters want most, said Hughes.

Unlike SVMC, Shoshone Medical Center has doctors in its emergency room 24 hours a day. Kellogg has recruited six or seven doctors and the number of babies born there each year has risen from six to 100.

But the emergency room still is a money-loser and Medicaid reimbursements are lower than they would be if there weren’t a competing acute-care hospital. On any given day, there are patients in five or 10 of Shoshone Medical Center’s 36 acute-care beds.

A lawsuit is adding to ill will between the hospitals.

The Silverton medical center is trying to join the North Idaho Hospital Network and says the Kellogg hospital is keeping them out. At stake is the ability of Silverton doctors to get patients who belong to the Blue Cross health maintenance organization.

Morasko said he doesn’t understand why SVMC felt it necessary to sue over that. And Morasko defends another action that aggravates Hughes: the complaints that Shoshone Medical Center filed about SVMC with the state Health and Welfare Department.

Some of those complaints - which Hughes called “a big crock” - led to last year’s investigations.

Stanley, SVMC board chairman waved a white flag a few weeks ago, suggesting that the two hospital boards sit down and talk. Last week, Jerry Cobb, chairman of the Shoshone Medical Center board, accepted the offer.

Such meetings have gone nowhere in the past, Cobb said, because each hospital wants to offer the same services.

The boards could ask the county commissioners to dissolve both hospital districts and build one joint facility. But that’s unpopular at the Wallace/Silverton end of the valley because the east side has fewer people so is unlikely to get the building.

“At some point, it would be really nice to see everybody pull together for the good of the community,” said Cobb.

Meanwhile, patients develop fierce allegiances to one hospital or the other. Or to neither.

“Some say to hell with it, and go to Coeur d’Alene or Spokane,” said Cobb.

“Around here, we spend so much time and so much effort protecting turf, sleeping in our letterman’s jackets - and we’re not hurting anybody but ourselves.”

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