Williams dispels myths about ER designation

Dr. Kenneth Williams and his business partner Quentin Whitwell met with the Marshall County Board of Supervisors May 15 to discuss its new designation as a Rural Emergency Hospital and its role in the community and county.

“We want to get rid of any myths about our new designation and discuss how it should be a benefit for Marshall County, Holly Springs and its residents,” Williams said. “Contrary to some recent rumors, Alliance Healthcare System has not closed. We just have a new hospital designation as a Rural Emergency Hospital (REH).”

Recently, the new designation became available for small rural hospitals to apply through CMS (Medicare federal designation). Alliance applied for and was approved as the second such hospital in the United States. Alliance is the first hospital to get Rural Emergency Hospital designation in Mississippi.

“We were honored with that designation as it was created to help stabilize and prevent the increasing list of small rural hospitals from closing,” Williams said. “The hospital is a bigger issue than just a Dr. Williams business issue. It’s about our employees, this community and the county that we are here to serve.”

Whitwell said he and Dr. Williams have known each other many years.

The two became business partners initially with Whitwell serving Alliance Healthcare Hospital as COO and Chief Counsel and now that relationship has grown into an organization that owns and/or operates several hospitals and clinics including Panola Medical Center Hospital, Quitman Community Hospital, hospitals in Georgia, and Alabama as well as the Pain Clinics in Tupelo and Willow Pain in Oxford and Batesville.

“I was there (at Panola) 36 months as its CEO,” Whitwell said. Before the Panola Hospital was acquired, it had lost $8 million. “As CEO, I made many tough, but necessary, decisions for Panola Medical Center to not only stabilize it, but to grow it,” he said.

The partners bought the hospital in 2021 and have made significant improvements in that hospital’s services and bottom line.

“Also, later we re-opened a previously closed facility in Marks (Quitman County Hospital) because of the needs of the community and also got its designation restored as a Critical Access Hospital, primarily from a lot of pushing under my leadership,” Whitwell said.

He said the partners have a plan to align the three hospitals into a coordinated practice across North Mississippi.

A large part of Alliance Hospital’s struggles over the last few years, other than the Medicare Advantage Plans, has been with getting the county-supported ambulance service to honor bringing sick patients to Alliance Hospital and also getting necessary transfers from Alliance ER to other hospitals that have accepted patients to other levels of care at other facilities, Whitwell said.

Alliance closed its ambulance service some years ago when it lost the County 911 contract and is struggling to get the county-supported ambulance service (Lifeguard) to provide the necessary support for Alliance’s patients and the community.

Whitwell also said his partners are trying to get some psychiatric provisions changed in Mississippi so that the State of Mississippi can consider a full psychiatric facility at Alliance Hospital.

“With the new REH designation via CMS (The Centers for Medicare Services) it now allows us to continue with the 24/7 ER coverage we have always provided and allows us to get a fresh start and get reimbursed for out-patient ,cost-based services at a fair rate,” Whitwell said. “We have started a diabetic Infusion Clinic which has had remarkable benefits to the many diabetics in the area and we are opening a Vascular Clinic this summer at our out-patient clinic on Crescent Meadow Drive. The vascular clinic will perform procedures such as Lower Extremity Revascularization which is especially important in diabetics. Cutting off blood circulation to uterine fibroids allows the fibroids to shrink. The same procedure is used for the prostate gland allowing it to shrink.

We are also expanding our wound-care services with state-of-the-art treatment and grafts.” Williams also added that state law will not allow out-patients to stay in a Rural Emergency Hospital longer than an average stay of 24 hours.

“But our out-patient plans are expanding and truthfully the country has been trending over the last few years away from lengthy in-patient stays to shorter observation stays,” Williams said. “They got rid of in-patient codes, but it does not preclude the hospital from caring for sick patients with pneumonia, COPD, uncontrolled Diabetes or for caring for hypertensive patients in observation beds for short periods of time to get patients well.”

“Lieutenant Governor Hosemann called me and said, `we want to see that hospital building full.’ I know people at the state level support what we are doing,” Whitwell said. “We see the future as bright. This is a big opportunity. We’re bullish in North Mississippi.”

District 4 supervisor George Zinn Iil expressed support for the hospital.

“As you know, a lot of people are concerned about the hospital status,” he said. “I know when COVID hit, you went overboard to try and get that first vaccine out. Even though you are transitioning to a Rural Emergency Hospital, you are concerned about providing a hospital for this community. If we are 100 percent true about keeping a hospital here, the way to keep it here is to use the services you provide.”

“We definitely need the community support for our 24/7 emergency room and one of the best rural health clinics (Williams Clinic) in North Mississippi,” Whitwell said. “In December 2020, Congress put a moratorium on cost/based clinics. A Rural Health Clinic is invaluable. We need support for the clinic and the ER.”

Williams again discussed the importance for the county-supported ambulance service to honor its service to the community and this area by bringing emergency patients to the nearest ER/Hospital and transferring necessary patients from Alliance ER/Hospital to other facilities when requested. Alliance Hospital’s ER has been historically bypassed in favor of hospitals outside Marshall County even though it may the nearest facility and even though it is staffed 24/7 with ER physicians.

“Lately, we get about 20 runs out of several hundred monthly from the ambulance or 911 service – that just does not make sense,” Williams said.

District 5 supervisor Ronnie Joe Bennett asked if the patient or if ambulance medics decide where a patient will be taken or if the patient chooses which facility to go to.

Williams said he has documentation of patients who asked to be brought to Alliance Hospital ER, however the ambulance did not honor the request and took the patient elsewhere.

“I don’t think the public understands completely how our emergency service is run,” he said. “If we cannot take care of a problem at our ER/Facility, then we are obligated to get them to the appropriate Physician/Hospital that can care for their condition.This problem started way back before I started here over 30 years ago.”

“People’s mentality goes years back,” Bennett said.

“We are the second hospital in the country to get the designation of REH (Rural Emergency Hospital) and our hospital is State Certified,” Williams said. “We could not get this designation, if we were doing a bad job.”

“I want to support the hospital,” said District 3 supervisor Keith Taylor. “We need to get with the ambulance service to get a plan together. What is legal? Can a person request to go to Alliance or request to be taken somewhere else?”

Bennett said Dr. Williams is his doctor and Taylor said Williams was his mother’s doctor, expressing their confidence in Williams Medical Clinic and Alliance Hospital.

Williams said Dr. Gregory Stallworth, his partner as well as the medical director of the ER, should have significant say so and involvement with regards to how the Emergency Services, including the Ambulance service, responds to patients in this county.

“When a sick patient is within 5 miles of our ER and needs immediate services, you should not be taking those type patients 20-30 miles up the road until they are stabilized first,” Williams said.

Zinn said he had invited the county subsidized ambulance service representative to make a statement.

“Before we go to the ambulance, I think what you all said here needs to be said,” Taylor said. “There was a stigma in Holly Springs about the hospital long before Dr. Williams got here. The group who came here several weeks ago stating they represent the community, had bad and misgiven advice. The public needs to realize you are not the sole caregiver – the hospital is.

“The public needs to understand you need to have patients for the hospital to survive. I know personally several issues that need addressing. One issue, the ambulance service contract, was put in there and asked for “no transport” so we could focus time on sick patients for the community. I understand that you have a place that accepts those patients for admission before they leave Alliance Hospital/ER in the ambulance. I think we need to say to the ambulance service, that type of transport should be no question.”

Williams parsed Taylor’s statement.

“The word transport is being misused,” he said. “When we have someone in the hospital and we need to send them elsewhere, then they need to be `transferred’ to another ER or another facility. That’s what should be done. I understand `transporting’ non-sick patients versus transporting or transferring sick patients is a tough distinction to make at times for everyone.”

“They (the ambulance service) works with you to get the patient stabilized before a person is transferred (to another facility) or sent home,” Bennett said.

Ricky Arnold, with Lifeguard said the contract with county does not read that way.

“We need information your hospital offers so we can advise,” Arnold said. “If you call me, we will take you where you ask to go. We can advise, but cannot kidnap a conscious person and not take them where they want to go.

“Our current deployment model is based off our county contract, based to provide what you (the board of supervisors) requested in the contract.”

Taylor said the county, Dr. Williams and the ambulance service should be involved in discussions.

“In the old rule, you carry them to the nearest facility. Once we stabilize the patient they are going to go to their doctor,” Williams said. “Most patients will not need to go to another facility.”

Whitwell said the group had “a good dialogue today.”

“We want to take care of as many as possible,” he said. “They will know if they can’t give care they can take them to another facility. I appreciate you all giving Dr. Williams the recognition he deserves. Twelve years ago we had a plan to build a new hospital. We got let down. He’s got something and we’ve got something together to be a whole north Mississippi footprint. And we also are adding outpatient services.”

Zinn suggested the group meet to discuss and work out a plan.

Bennett suggested the meeting take place on the day of a regular board meeting.

District 1 supervisor Charles Terry said the board had decided to set a committee to bring back ideas to the board.

“Mr. Terry, you are right on point,” said Zinn.

“I don’t think we need that committee,” said Bennett. “Now you add the committees, you are adding trouble.” Dr. Williams agreed with Bennett. “You are saying disband the committee and only meet with our attorney, Alliance and the ambulance service?” Terry asked. Whitwell said his concern is that the hospital is a private entity.

“We are not a community (owned) hospital,” he said. “If the county wants to buy Dr. Williams out, that’s a separate issue. I think we need to start a conversation with attorney Smith, with your group and your districts. To be honest, post COVID, old-school grass roots is the best way to go.”

Zinn suggested Dr. Williams schedule a meeting. “Our contract is with you guys,” said Arnold. “We can work out our business deal with the hospital.”

Williams said the approach under discussion makes sense.

“This new thing gives us life to grow,” Williams said of the new ER designation.

He said the old facility housing the hospital is costing too much to keep up. He added that he has spent from $1.2 million to $1.5 million a year in indigent care.

“We need a mental health facility in Marshall County,” Taylor said.

“We’ve been talking about this 10 years,” Whitwell said. “We have a mental health facility in Batesville. The problem is the law won’t allow them to get reimbursed. You don’t want them (mentally ill patients) in jail. I would love to have a separate conversation about that. With your help and with the federal government and added relationships, lets lock arms and make it work.”

“It takes a team,” Williams said.