The nonprofit corporation that runs the public hospital in Soldotna has been at odds with the elected service area board over public access to corporation meetings and documents.
That is a contrast to Homer, where South Peninsula Hospital Inc., which runs the public hospital there, holds its meetings in public.
"We do our strategic plan in joint sessions with the service area board," said South Peninsula Hospital Inc. President Bruce Turkington. "We've done strategic planning in retreats where we invite not just the service area board, but also physicians and key hospital staff. We do it openly, where we get better input and we can have key speakers."
Turkington said he has suggested similar procedures to CPGH Inc., the nonprofit corporation that operates Central Peninsula General Hospital in Soldotna.
The Kenai Peninsula Borough owns both hospitals and leases them to the nonprofit corporations. It has subsidized both hospitals with property taxes from local service areas. Voters in both service areas have elected boards to advise the borough assembly.
However, CPGH Inc. has excluded the public and Central Kenai Peninsula Hospital Service Area Board members from segments of its meetings that do not deal directly with service area matters.
CPGH Inc. has said its bylaws and even its policy on public access are proprietary and confidential. It has declined to provide the service area board with certain planning documents. Corporation president Diana Zirul said those contain proprietary information and making them public could give a leg up to competitors.
Competition also is an issue at Bartlett Regional Hospital, owned by the city and borough of Juneau, said hospital administrator Robert Valiant. The city-borough assembly appoints the hospital operating board, and the board's meetings are public.
"As a government agency, we're subject to the Open Meetings Act," Valiant said. "You're put in an unfair position if your competition can sit in public meetings and find out what your strategic plan is. We have trouble with it. Our competitors know exactly what our plans are."
However, the competition will find out about major improvements anyway, said David Pierce, certificate of need coordinator for the Department of Health and Social Services. To add facilities or equipment costing more than $1 million, the provider must first obtain a certificate of need from the state. Certificate-of-need applications are public.
"There would be a concurrent review with any other competing project," he said.
However, doctors offices, clinics and additions that cost less that $1 million are exempt from the certificate-of-need requirement.
South Peninsula Hospital administrator Charlie Franz said the South Peninsula Hospital Inc. board generally holds its meetings according to the requirements of the Alaska Open Meetings Act, though as a nonprofit corporation, it is not required to do so. The corporation excludes the public only to discuss items such as contractual issues, personnel matters, issues involving confidential medical records, and matters that could harm the hospital if discussed openly.
Turkington said the corporation discusses planning issues openly.
"CPGH is sometimes in competition, sometimes not," he said. "We talk about it openly. Our service area board talks about it openly. We haven't had anything down here, including the competitive part, that required us to go into executive session."
South Peninsula Hospital Inc. has provided its bylaws to the service area board, he said. The corporation finds it difficult to do strategic planning without involving physicians and the service area board.
"If you don't involve the service area board, how do you know if they support what you're doing?" Turkington asked. "The service area board is responsible for the health care needs of the community. The hospital contractually provides them. That doesn't mean that the hospital won't identify a need. But all the services we provide in our area are approved by the service area board."
Franz said competition has been an issue but declined to reveal specifics.
"As far as developing new plans or services, you don't necessarily want to talk about them in an open meeting until it's firmed up and ready to go," he said.
Providence Health System of Alaska, an arm of nonprofit Providence Health System, leases Providence Seward Medical Center from the city of Seward and Providence Kodiak Island Medical Center from the Kodiak Island Borough. Providence owns the hospital and extended care facilities it operates in Anchorage.
It has citizen advisory boards in Anchorage, Seward and Kodiak, and members of the Seward and Kodiak boards sit on the corporation's Alaska governing board, said Providence spokesperson Dr. Aron Wolf. Advisory board meetings are public, he said. Meetings of the governing board are not, but they are open to members of the local advisory boards.
If Providence planned to add new services or equipment, advisory board members who sit on the governing board could share that information with their communities, he said.
"In fact, they make monthly reports to their advisory committees on what happened at the governing board," he said.
Providence conducts much of its planning internally, Wolf said, but the corporation involves its governing and advisory boards.
In addition to the local advisory board, Providence Kodiak has a strategic planning committee comprised largely of members from the general public, said hospital administrator Phil Cline.
"We embrace public input," he said. "The competitive issues that threaten in some areas aren't really an issue here. There are some good things about being on an island 270 miles from Anchorage."
The city of Ketchikan leases Ketchikan General Hospital to PeaceHealth, a Washington nonprofit corporation that operates five hospitals in three states. PeaceHealth's lease requires the hospital to operate in the black and to provide charity service, said hospital spokesperson Wendy Gierard.
The administrator appoints advisory and governing boards from the community. Governing board meetings are not open to the public. The governing board includes independent physicians and others from the community in its strategic planning and goal-setting retreats, she said. It tries to keep the public informed of planned improvements.
"We're not generally in the business of hiding what we do," she said. "Our only competition is in Seattle. We don't necessarily have the competitive nature you do."
Ketchikan General added a bone-density scanner after requests from patients who previously had to fly to Juneau or Seattle for annual scans.
"We definitely look to the community for guidance on what services we should provide here," Gierard said.
The governing board provides its bylaws and financial statements to the city, she said, and those become public record. City voters recently approved a $10.7-million bond issue to fund a hospital addition. A 1-percent city sales tax will repay the bonds.
"We are very open and upfront with the city council. They like to know what's going on," Gierard said.
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