The Medical Center of South Arkansas is the leading health care provider for both El Dorado and Union County, as well as some other areas in the region, both in south Arkansas and north Louisiana.
So when the hospital came under scrutiny in 2021 after medical providers there voted no confidence in MCSA administrators, the community was shocked.
Medical providers at the hospital alleged in the summer of 2021 that decisions made by hospital administrators, in particular former CEO Scott Street, led to a decline in patient care and staff morale. MCSA's parent company, Community Health Systems (CHS), investigated the troubles, and Street ultimately resigned from his position in August, 2021.
David Fox stepped in to lead the hospital as CEO on April 11, 2022. In the year since, MCSA has been working to improve the patient experience, expand care options and improve employee morale, and Fox said he thinks efforts have been successful.
"I'm focused on the present and future -- totally focused on the hospital today, delivering health care consistently, in a way that's meaningful for the residents of Union County," Fox said earlier this month.
Workplace culture
The vote of no confidence in 2021 was initiated and executed by members of the hospital's general medical staff. Doctors, nurses and ancillary employees reported to the News-Times issues ranging from an over-crowded ICU and cross-contamination between COVID patients and others to a lack of respect from administrators and missing hazard pay.
Fox said that since he started, MCSA has worked to establish and renew employee engagement initiatives.
"Morale is strong," he said. "A culture of collaboration, transparency, compassion -- we work hard to build that up... If we take care of our own, everything else will come."
The MSCA Pathways Program was created last May to offer employees opportunities to advance their education and further their career.
"We have launched the MSCA Pathways Program and enhanced employee benefits," Fox said. "That helps team members achieve their personal and professional goals. We help with student loan repayments, licensure, tuition reimbursement."
Regular in-house activities for employees and facetime with leadership are also ways Fox said employees are acknowledged.
"I round frequently with the staff, we do down-the-halls. We've been very intentional with our engagement with the staff, with employee activities on a monthly basis," he said. "Feedback has been very candid, open, honest. They're enjoying our time."
MSCA changed staffing agencies in 2021, resulting in several physicians with established careers at the hospital losing their jobs. The decision to change staffing agencies was met with criticism from some of those affected; a lawyer representing some of the doctors who participated in that summer's vote of no confidence suggested the decision might have been retaliatory.
Fox said any employee who left the hospital in good standing were invited to rejoin MCSA's staff.
"We implemented a welcome home campaign," he said. "They could come rejoin and enjoy their same benefits."
Some employees have been at MCSA for several decades.
"I have an (operating room) nurse who's been here 40 years. Another nurse has been in a health care for 50 years, but not all of it here, and then we just celebrated a nurse recently that put in 55 years of service. It's just remarkable. This kind of loyalty to health care and Union County is unheard of," Fox said. "People generally work somewhere for two or three years; this shows remarkable commitment to this community.
"I couldn't put together a better team than the one I inherited," he added.
Patient care
A native Arkansan, Fox said he has a personal interest in improving the health and well-being of people in the community, as well as, of course, treating acute illness or injury.
"I love my state. I love being a difference-maker in health care," he said. "I wanted to pursue (this job) and learn more about how I could be impactful for the citizens in El Dorado. I felt like with my demeanor, positivity, approach in health care and leadership would be well-received, and I think I could make a really positive difference in this market."
The U.S. Centers for Medicare and Medicaid Services (CMS) gave MCSA a four-star rating, out of five-stars, while patients rated the hospital with three stars.
The rate at which MCSA patients encountered medical complications or died as a result of medical conditions was, as of January, on par with the national rate. The death rates of COPD, heart attack, heart failure and pneumonia patients was slightly above the national rate, while the death rate of stroke patients was slightly below the nation's. Patients were re-admitted for the same medical issue they previously faced at a slightly lower rate than the nation, on average.
Patients did, on average, spend slightly more for health care services at MCSA than the national average payment for services including heart failure treatment, hip and knee replacements and pneumonia care. They paid slightly less for treatment for a heart attack, according to CMS.
"Our relationships with patients have certainly gotten better," Fox said. "We continue to drive service enhancements with the improvement in our quality."
Since last April, MCSA has added two general surgeons to its team and opened its 18-bed behavioral health unit.
"There was a need; there was a void here," Fox said of the behavioral health unit. "We're pleased to have that inpatient unit, which is exceeding our expectations. We have a fantastic doctor who is medical director for that doing a wonderful job leading it."
The behavioral health unit, which treats adult patients suffering from acute mental health distress, is focused on crisis intervention, Fox said. Patients experiencing symptoms like depression, social isolation and/or suicidality are who it's geared toward.
"You think of those who are in crisis in their emotional state and need emergent care. People who are having difficulties with their mental health, need assistance with therapies and medicines, those are the folks we try to focus on and help," he said. "It's not really an Alzheimer's unit or an addiction unit."
Fox also touted MCSA's Women's Center, and in particular its Family Connects program, where nurses make home visits to new mothers to provide a medical check-up and answer questions.
"We've heard of a number of other hospitals in the area that have either chosen to forego or no longer continue their (obstetrics) programs, so we're a catchment for that area. People are coming even from out of state, Louisiana, to deliver their children in a safe and nurturing environment," he said.
On Thursday, MCSA will celebrate National Doctors' Day. Fox said he wanted to thank all of the hospital's physicians, as well as other health care providers in the community, for their work.
In the works
In addition to reexamining MCSA's relationship with the people who work there and trying to improve the quality of care patients receive, Fox said MCSA also hopes to continue growing.
During Street's tenure, MCSA billed itself as a "destination health care" facility, and since 2019, $19 million has been invested in expanding and renovating its facilities and services.
Fox said the hospital is still working to improve services, though he declined to go into detail about projects that are in the works currently.
"We do have a couple things in the works, but at this time, I'm not at liberty to say or share," he said earlier this month. "Now is not the time to share a couple new projects we've done some work on -- affiliations and joint ventures I hope come to maturity and will give us the opportunity to expand."
The hospital currently has alliances with Survival Flight, which provides air medical evacuation services for MCSA; Arkansas Children's Hospital, which facilitates the at-home visits to new mothers; Arkansas Heart Hospital, which brought in a cardiologist to provide care in El Dorado; and Arkansas Urology, which gave MCSA the ability to provide urological care.
In 2019, the University of Arkansas for Medical Sciences announced that $500,000 had been anonymously gifted in support of the creation of a regional UAMS campus in El Dorado. A spokesperson for UAMS said at the time that it was working with MCSA to create a family medicine residency program. The campus would be UAMS' ninth in the state.
El Dorado previously supported a similar program, then called Area Health Education Centers (AHEC) until 2013.
Fox said MCSA is still working on the new residency program, which was, as of March 2022, scheduled to begin this year.
"That always takes time to establish, or, in this instance, re-establish. It will be a slow, rigorous process, but we are making progress," he said. "It will be some time before we see the fruition of our effort; it will take a bit of time for that to be visible to the community... It's just on the horizon; it takes quite a bit of work to establish."
Community health
In need of improvement, generally, is the Union County community's health. According to County Health Rankings, a program of the University of Wisconsin Population Health Institute that provides data on health in almost every county in the U.S., Union County has some of the worst health outcomes in the state.
Union County ranks 69th out of the state's 75 counties in length of life, according to County Health Rankings. There are more premature deaths, more COVID-related deaths, more child deaths and more infant deaths than the state or national averages, as of 2022.
"I just recently saw data did not reflect favorably on our obesity, congestive heart failure (rates). We have a higher rate than other parts of the state with cancer diagnosis," Fox said.
Preventative care could improve the health outlook for local residents, though, he said, which some of the unannounced projects in the works at MCSA are focused on.
"We're discussing about how to work with another of the state's premier providers about improving access to care, he said. "I understand as I have conversations with other organizations, parties that might not be a part of Union County and invite them in for joint venture or affiliation, that has real, meaningful impacts related to the betterment of health care for all."
COVID-related admissions at MCSA are down, Fox noted, but hospital workers are still taking precautions to prevent the spread of the virus inside the facility.
"We have seen a decrease in the number of admissions and a pretty significant decrease in the number of transmissions," he said. "Is it still around? Yes. Do we still have to contend with it and are we still being safe? Yes and yes."
Earlier this month, former El Dorado resident Michelle Temple held a community meeting focused on making AED (automatic external defibrillator) devices publicly available throughout the county. Fox attended, and was the first to make a commitment to purchasing several AEDs for public use.
Temple, whose son Grayson died at 16 due to sudden cardiac arrest, is leading an effort to initiate an AED PAD (public access defibrillation) program in Union County, to give local residents the tools they need to respond if someone suddenly goes into cardiac arrest at a public place.
"I think it's an important initiative that can be supported by coming together with the city, government officials and people in the community to create a good, consorted grassroots effort from many folks coming together, creating an environment that makes all boats float," he said. "MCSA can't put them everywhere, but I can make a commitment that MCSA will bring two to four and then others see the example. And perhaps it will save a life for someone at the time of their greatest needs."
The hospital is also involved in charitable efforts, like a recent food drive where MCSA collected peanut butter. The hospital also contributes to the United Way of Union County.
"This is an intentional effort we're making to stay connected and help in giving back," Fox said. "We do care about our neighbors, friends, loved ones, so we're trying to give back."
So what should people think when they hear someone mention MCSA?
Fox said he hopes local residents imagine a place where they can go when they're hurt or sick and get better.
"I hope they know that this is a place they can get well, return to a quality life; that they'll receive excellent, compassionate care," he said. "We genuinely do care about the citizens of our city and county and surrounding counties we service, so if people come to us for their care, we want them to have the best experience possible. That's what we strive for. That's what we hope to achieve."
MCSA CEO David Fox speaks during the hospital's Healthy Heart, Healthy You luncheon in this February 2023 News-Times file photo.
Medical Center of South Arkansas staff members pose together during a Super Bowl party at the hospital. (Courtesy of MCSA/Special to the News-Times)