(December 16)  JOSHUA TREE — The Hi-Desert Medical Center’s governing board on December 11 voted unanimously to promote Robert Tyk, the hospital’s chief financial officer for the last 11 months, to the position of chief executive officer.
The board’s action follows by less than two months what was termed a mutually agreed-upon  decision  for current chief executive officer Lionel “Chad” Chadwick to depart at the end of the year.
Tyk will officially take over the reins of the hospital on January 1.
The decision to hire Tyk came during a half hour-log closed session in which Dianne Swella was not present but participated by the means of a remote communication device.
The same secrecy that shrouded Tyk’s selection attended Chadwick’s departure. Throughout the first nine months of 2013, Chadwick appeared to be working diligently on the financial challenges facing the hospital district. On October 29, however, the district made an abrupt announcement that Chadwick would be leaving his position on December 31. Despite statements to the effect that all parties were amenable to the departure, an indication of the board’s discomfiture with Chadwick came in the form of the terms of his departure, which did not include the conferring of a severance payment.
A terse press release that went out with the announcement of Chadwick’s pending departure cited “irreconcilable incompatibility of management approach” between Chadwick as hospital CEO and the board. “Dr. Chadwick has made meaningful and appreciated contributions to the district’s mission and operations,” according to the release. “We thank him for his many contributions and wish him well in his future endeavors.”
The hospital district’s financial woes are variegated, consisting of burgeoning patient care costs and dwindling revenue from solvent patients, insurance carriers and governmental programs set up to cover the medical costs of indigent patients or those otherwise eligible for subsidized medical assistance.
Many of the services rendered at the hospital by doctors are not billed for by the hospital but by the  physicians themselves, who are not employees of the hospital, by law.  The hospital does not now have clearly delineated revenue sharing agreements with local healthcare providers such as Oasis Healthcare and the county of San Bernardino.
A major portion of Hi-Desert Medical Center’s financial travail is attributable to the persisting economic recession, which has been accompanied by the reduction of government payments to hospitals, including 25 percent cuts from the Medicare and MediCal programs, entailing an annual loss of revenue to the institution exceeding $500,000.  Simultaneously, federal law mandates that hospitals deliver emergency care whether or not patents have medical coverage or the ability to pay for that treatment.  This has been coupled with steady increases in the cost of delivering medical care.
Chadwick had advocated the aggressive use of case management to discharge recovered patients earlier and reduce the length of time they remained in the hospital consuming costly services. This was of only limited success.
In order to remain operational, Hi-Desert Medical Center has for the last three-and-a-half years burned entirely through its operating budgets and tapped into financial reserves.  Chadwick’s attempts to stem this hemorrhaging of red ink have failed, resulting in the consternation of the board. Chadwick’s efforts to directly lobby both state and federal legislators for relief, coupled with similar requests of other civic and community leaders he had enlisted for that cause were largely ineffective.
In a last-ditch effort to right the hospital’s listing financial ship before he was essentially forced out, Chadwick in September induced the board to vote to put a tax initiative on the November 2014 ballot.
That move was considered a long shot. In the less lean economic atmosphere of 2005, the hospital sought voter approval for Measure N, a tax bond that would have added $24 to individual homeowners’ annual property taxes to provide funding for emergency room improvements and other hospital service enhancements. Measure N went down in defeat in a mail-in ballot election.
The board, led by board president Korina Cole, is staking the hospital’s future on what it hopes will prove to be the superior financial management skills of Tyk, who boasts more than three decades of experience in the healthcare industry, including a stint as chief financial officer for Roswell Regional Hospital in New Mexico and interim financial management and reform work at several institutions while he was with Kaizen Consulting.
Tyk said he took pride in his selection by the board to “lead our healthcare district through these challenging times. I look forward to working with this board, our physicians and staff to ensure the viability and future of our healthcare district.”