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COLORADO SPRINGS, Colo. --Faced with budgetary constraints brought on by lower-than-expected profits, city-owned Memorial Hospital is considering cutting some money-losing programs it has subsidized to fulfill community healthcare needs. Cutbacks in reimbursements for Medicare patients contributed to the $985,000 loss suffered by Memorial's home-care agency last year, the hospital said. The loss was twice what the hospital had expected. Among the programs in jeopardy are a pediatric specialty clinic that enables children and their families to avoid traveling to Denver for treatment, as well as a disease management program for those suffering chronic illnesses, officials said. Last year, the hospital's $19 million profit allowed it to shoulder a loss of nearly $1.8 million in those two programs and others, including after-hours pediatric and adult clinics, a wound-care clinic and a radiology technical school. The losses were not surprising, but profits so far this year have been lower than expected, hospital officials said. Memorial reported net income of $5.6 million from January through May; it had budgeted for $8 million. Hospital officials said they are evaluating the money-losing services to see whether they can be saved by their becoming more efficient. No timetable has been set for a decision, and officials indicated the programs will be evaluated on an ongoing basis.

CHEYENNE, Wyo. --United Medical Center of Cheyenne and Nashville-based Healthcare Realty Trust have begun work on a $31 million renovation of one of Wyoming's largest hospitals. The 170-bed hospital, a public facility owned by Laramie County, is spending $15 million to build a new patient tower and reconstruct its front entrance. The work is expected to be completed in the summer of 2001, according to Dave Hall, hospital community relations director. The project is being financed with general hospital funds, he added. Healthcare Realty Trust is spending $16 million to construct an ambulatory-care facility and medical offices beside the hospital. These will be occupied by United's medical staff, but Healthcare Realty Trust will own and manage the building, Hall said. He added that no date has been set for the project's completion.

VALENCIA, Calif. --Nurses at 227-bed Henry Mayo Newhall Memorial Hospital voted 119-68 earlier this month to join the California Nurses Association for collective-bargaining purposes. The CNA said deteriorating staffing levels contributed to the nurses' decision to unionize. A union spokesman said the CNA would commence contract negotiations with hospital management after the National Labor Relations Board certifies the election, which is expected to take several weeks.

STEILACOOM, Wash. --The state will pay a settlement of $900,000 to the estate of a Tacoma, Wash., woman fatally bludgeoned at Western State Hospital by another patient, who has since died. Joan Renander, 57, was killed Aug. 20, 1995, after patient Martin Berns beat her over the head with a fire extinguisher. Cindy Renander, the victim's daughter, sued the state, contending it failed to take adequate precautions to protect her mother, who had been disabled by two strokes. Berns had attacked Renander twice before, in May 1995, and had a history of violent and threatening acts, both in and out of the hospital, according to court records. In 1996, Berns was convicted of murder in the case, and he died in prison of complications from AIDS. The state didn't admit liability in settling the case, which would have gone to trial in three weeks, said Gordon Schultz, spokesman for the state Department of Social and Health Services, which operates the hospital.

IDAHO FALLS, Idaho --A steady increase in patients and waits of up to five hours have prompted the city's lone hospital to plan an expansion of its emergency room. The addition would increase the number of ER beds at 286-bed Columbia Eastern Idaho Regional Medical Center to 30 from 17 and double the number of doctors on duty. Groundbreaking is possible next year on the multimillion-dollar addition. Doug Crabtree, the hospital's chief executive officer, said ER traffic has hit an all-time high. Doctors and nurses are seeing 20% to 30% more trauma patients and 5% more nontrauma patients. Last year the hospital served 35,000 emergency patients. Crabtree estimates the hospital already had reached that number by the end of July. "We're just seeing more of everything," he said. "We have become a referral site for the region based on the expertise of our medical staff." Crabtree said the intensive-care unit has been full for the past several months, requiring doctors to refer patients to other hospitals or delay surgeries.

MESA, Ariz. --Mesa General Hospital agreed to meet federal requirements by providing a sign language interpreter for hearing-impaired patients in the future, state Attorney General Janet Napolitano announced Aug. 16. Napolitano said a hearing-impaired patient told authorities she was refused treatment twice, once following an auto accident when she was left strapped on a gurney for hours, and another time when she took a daughter to the hospital. As part of a settlement, Napolitano said, Mesa General agreed to adopt and implement a new policy on providing auxiliary aid and service and to better train its staff to deal with the hearing impaired.

GARY, Ind. --St. Catherine Hospital has been ordered to pay more than $110,000 to a business that claimed the hospital did not complete physical examinations for employees in a timely manner. A Superior Court judge made the ruling Aug. 9 after hearing testimony from officials at the East Chicago hospital and from northwest Indiana-based P.D.Q. Maintenance and Rust Precision Cleaning Services. The 190-bed hospital, part of Lakeshore Health System, must pay $111,926 to P.D.Q. for lost wages resulting from the delayed exam results. The lawsuit involves a verbal agreement P.D.Q. reached with the hospital in 1989, allowing employees to be given physical exams at the hospital, with results promised within 24 to 48 hours, the lawsuit states. When Rust Precision contracted 58 P.D.Q. employees to do work in July 1994, those employees went through routine physical exams at the hospital, but the results were not made available for weeks. As a result, Rust opted not to hire those employees and substantial wages were lost, the lawsuit claims.

COLUMBUS, Ohio --Home-care providers have been overpaid up to $10.3 million because of inappropriate billing and a lack of oversight, according to a preliminary review from Ohio Auditor Jim Petro. From 1995 to 1997, the state spent $789 million in Medicaid funds for home health services ranging from nursing care to meals for more than 160,000 Ohioans and provided by nearly 400 home health agencies. Part of the problem, the reviewers said, is that regulations differ among the four state departments that administer home-care programs: Health, Human Services, Aging, and Mental Retardation and Developmental Disabilities. For example, the Aging and Mental Retardation and Developmental Disabilities departments grant waivers to allow providers to bill services by time increments, such as charging for a half-hour physical examination and a half-hour of therapy during a one-hour visit. That conflicts with the traditional state plan that requires billing on a per-visit basis, which allows only one charge, said Kim Norris, spokeswoman for the auditor. Auditors used state data on a small sample of providers for the preliminary review, but the Department of Health has asked for further auditing, including field visits, Norris said. Petro urged the departments to recoup overpayments, improve oversight and stress the need for providers to document services.

BOLIVAR, Pa. --A small Westmoreland County community will keep its only local source of medical care. Conemaugh Memorial Medical Center in Johnstown runs Bolivar's single-doctor medical clinic but is slated to close the clinic Sept. 1. Conemaugh's neighbor UPMC Lee Regional Hospital in Johnstown has volunteered to provide a full-time doctor and physician assistant so the clinic can reopen a week later. "The community is a little panicked, and we want them to know (they needn't be)," said Tom Kurtz, practice management director at UPMC Lee Regional. He said the hospital's plan must still receive board approval. But representatives from the hospital visited the clinic and said they could handle the need, Kurtz said. Conemaugh has operated the clinic since 1958. Conemaugh spokesman Pat Kane said the hospital decided to close the clinic because the facility didn't have enough patients to stay afloat. About 350 people per year use the clinic. Conemaugh announced last month that the closure would help cut $20 million from its budget.

WATERBURY, Conn. --St. Mary's Hospital has laid off more than 50 employees, citing reduced federal aid and payments from insurers. Last month, the 206-bed hospital offered early retirement to 117 employees in an effort to reduce costs and balance its books. Since only about half of that group accepted the proposal, hospital officials said they were forced to cut 56 positions earlier this month. The layoffs involve managerial and supervisory positions eliminated as part of the hospital's effort to deal with an expected $2 million budget deficit by the end of this year. "Cutting staff is the last thing we like to talk about in times like this," said Peggy Lawlor, vice president of community affairs. "It's certainly not the only thing we have considered. But we're facing what other hospitals are facing around the state." Lawlor said more than half of the employees being laid off are eligible to apply for a number of other positions that will be filled at St. Mary's.

LEXINGTON, Ky. --Appalachian Regional Healthcare will lay off 190 of about 5,000 full-time employees. Many of the jobs will be lost in eastern Kentucky, where ARH owns seven hospitals, said spokeswoman Sally Malmer. She and others blamed the job cuts on $11.3 million in reduced federal payments to ARH resulting from the Balanced Budget Act of 1997, which established a new payment system for Medicare and Medicaid outpatients to help control rising costs. Lexington-based ARH, a private, not-for-profit system, operates 10 hospitals in eastern Kentucky and West Virginia. It also operates clinics and home-health services. Malmer said job cuts at the 288-bed ARH hospital in Hazard, the system's largest hospital in Kentucky, would be "substantial." In Harlan, Ky., ARH spokesman Mark Bell said the hospital would lose 36 of 477 jobs. "Every reduced payment by Medicaid and Medicare hits us hard because they make up 70% to 75% of our patient volume," he said. "That's how heavily dependent on government resources we've become because that's the population we serve."

CAMERON, La. --South Cameron Memorial Hospital may have turned the financial corner with an $800,000 loan. The public hospital obtained the short-term loan--with a 6% interest rate--from the Louisiana Public Facilities Authority, a public trust corporation, rather than issuing emergency hospital revenue bonds. The Louisiana Department of Health and Hospitals is expected to repay the loan in October. Jim Parks, LPFA executive director, said that since the authority had the money in a reserve fund, it opted to lend the money to the hospital rather than to issue revenue bonds. The Louisiana Bond Commission authorized the hospital to issue bonds to ease its cash shortage. The hospital is more than $3 million in debt, which was discovered after the abrupt disappearance of former Chief Executive Officer Joe Soileau in early June. In the weeks since, a Cameron Parish grand jury indicted Soileau on four counts of theft totaling $425,882 from Aug. 5, 1998, through Oct. 22, 1998.