With a year to date loss that topped $1.5 million with a month remaining in fiscal year, Booneville Community Hospital’s administrators faced their toughest line of questioning to date during last week’s city council meeting.

Alderman Larry Mitchell was the most vocal in the questioning, posing inquiries about administration salary amounts, the number of employees, how the hospital could afford machine maintenance, the last time there was a pay raise, as well as what plans are in place to get out of the financial problems.

In his most pointed question Mitchell asked, "where do we get to the point we say call in the cavalry and say we can’t do this anymore? There’s got to be a line drawn in the sand somewhere, you can only carry this out so far."

Before receiving an answer, Mitchell motioned having to find someone to purchase the hospital and asked a follow up question of, "are we going to get to that point where we go so far it isn’t going to look like an investment to anyone?"

Hospital chief executive officer C. David Hill flatly insisted that would not occur, but he also said hospital officials have explored other management arrangements.

"No way," said Hill. "We won’t talk details with you but we’ve looked at other options. That’s all I’m going to say about it, but we’re not going to get to the point that you describe."

Mitchell asked if the council would ever be informed of the "other details" but he was interrupted before an answer was rendered.

Talk then returned to the loss of $377,383 in May. When the council last met, in April, a then-year to date loss of over $1 million was presented as breaking even in cash when depreciation, a change in bad debt loss calculation from previous administrators and application of a cost report reimbursement.

The latest deficit, chief financial officer Stuart Lisko, is due partially to a lawsuit loss to former employee Cannan Champion. Champion, a Certified Registered Nurse Anesthetist (CRNA) won a breach of contract suit and was awarded $92,511 in May. The hospital anticipates a loss, including attorney fees, of $150,000, Lisko told the council.

Hill and Lisko both said the hospital is running with as few employees as possible, both administratively — to include billing and medical records — to the number of patient care employees, keeping in mind the legal requirements.

The hospital has a payroll of about 120, Hill said, but has 85 to 88 full time equivalent employees. When census demands are not sufficient to keep all employees at work, some are sent home via a process known as flexing.

"You run a risk if you send somebody home too many times. They’re counting on that 40-hour a week job. They will find employment elsewhere," said Hill. "We will flex but we also have to be cognizant of that. They didn’t sign on to come to work for us to be sent home every Friday or every Wednesday."

The way out of the financial position, Lisko and Hill said, is not further cost cutting — he said all that could be done has — it is only through revenue generation.

Lisko said money remains tight although the hospital has restructured loans, used money from debt service to pay bond payments, a $100,000 CD has been used.

"That’s what my concern is," said Mitchell. "There’s only so many times you can rob from one account to cover expenses. The next thing you know is our bills end up not getting paid. You can only juggle for so long."

"You’re not going to reduce your expense by cutting costs. So many of these essentials we have, we only have one of," said Hill. "We only have one nurse in the ER — you can’t eliminate that. We’ve got the minimum in administration. We’ve got the minimum in house keeping."

"We’ve got to get additional physicians in here. We’ve got to get additional revenue," said Lisko. "We’ve got to get the people of the community using the services we provide at the hospital. "