(February5)  Two of the hospitals serving San Bernardino County’s vast desert area recently experienced departures of key members of their leadership teams.
In Joshua Tree, the vice president of the Hi-Desert Medical Center’s board of directors, Paul Hoffman resigned.
Eighty-five miles away, in Barstow, the chief executive officer of Barstow Community Hospital, Sean Fowler, has departed.
Hoffman, who had served on the hospital board since 2000, announced his resignation on January 28. Fowler, who had been chief executive officer at Barstow Community Hospital since July 2011, left to head another California hospital in Southern California.
Both Hi-Desert Medical Center and Barstow Community are in a state of flux.
The Hi-Desert Medical Center’s governing board, including Hoffman, on December 11 voted unanimously to promote Robert Tyk, the hospital’s chief financial officer,  to the position of chief executive officer less than two months after what was termed a mutually agreed-upon  decision  for the hospital’s previous chief executive officer, Lionel “Chad” Chadwick, to depart at the end of 2013. Tyk took over officially on January 1.
The Hi-Desert Medical Center and its board of directors are facing a series of financial challenges to the institution, including 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, most notably 25 percent cuts from the Medicare and MediCal programs, entailing an annual loss of revenue to the institution exceeding $500,000.
Moreover, 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.
The Hi-Desert Medical Center is mandated by federal law to deliver emergency care whether or not patents have medical coverage or the ability to pay for that treatment.
The situation in Barstow is less dire.
Barstow Community Hospital relocated to a newly constructed facility in October and on January 7 the parent company of the hospital,  North Naples, Florida-based Community Health Systems, announce it would subsume its major competitor, Health Management Associates Inc.
Community Health Systems is the largest for-profit hospital system in the United States. It utilized its own capital as well as borrowed money to take on ownership of Health Management Associates in a $7 billion transaction. The takeover was completed last week. Simultaneously, Fowler departed.
John Rader, the spokesman for Barstow Community Hospital, told the Sentinel, “Sean has departed for a hospital in the South Bay Area that is not affiliated with Community Health Systems. Because his transfer there has not been announced internally at that institution, we are not at liberty to disclose which hospital that is.”
Community Health Systems transferred Steven Foster, who had been the CEO of Community Health Systems’ Oklahoma City-based Deaconess Hospital, to  serve as interim CEO in Barstow.
Barstow Community Hospital is conducting a national search for a new CEO. The selection committee is to consist of the hospital board, medical staff and hospital management.