Adventures in the Medical Business

In making the rounds to the various cost centers to introduce myself and talk budgets, I met a manager in the same building I worked who had something called a Wang Word Processor.  I had heard of such a thing, but this was the first time I actually saw one and I asked him to show me how it worked. He did. When I learned how little he utilized it for his own department I boldly went a step further and asked if I could share it.

Each month we printed out a budget report, which was sent to several people, with portions going to specific cost centers so the managers could see their numbers. With 192 cost centers it was a fairly thick report, not overly complicated, but certainly repetitive and a pain to do every month. Sue had to type the original, then do the various copies on a photocopier.

The report had a summary page of the Medical Center as a whole, then breakouts by each hospital and finally sections on every cost center.Each portion consisted of a listing of all cost categories with columns comparing actual to budget for the particular month and for the totals year-to-date. Most of the lines did not change a bit month-to-month, but all the number data did. It required a complete retyping of everything each month. 

With the use of the Wang processor I could program in all the boilerplate and only the numbers had to be updated. I would write the new number in on the previous report and Sue would enter them into the Wang and it did all the formatting and printing. It saved a ton of time, and error, and I could utilize Sue in other ways, especially in increasing the analysis of the data so we could help units improve and stay on top of their expenditures.

It also freed up Sue to help me put together the next round of budgeting. We began the setup of the budget packets not long after the New Year. I had finalized the fiscal 1978-79 budget by the end of December, only six months late. The former Budget Director I had replaced left before it was finished. I was not unhappy to see him go. He was a friendly man, but I got tired of his, “We always done this way” attitude and his lackaday approach to deadlines. At the start of the calendar year this baby was all mine and I was determined budgets going forward would be completed and approved and disseminated by July 1, the beginning of the fiscal year.

I had started improving communications with the various managers the prior year, now I went around to every cost center again in January and emphasized I was there to help them with budgeting and that a packet would be coming to them in February. We were going to start the process as early as possible. I put together the plan and packet and hand delivered it myself, clearly (I hoped) explaining it to each and every manager.

Getting everybody on board was quite an education. I learned to sit in the chair nearest the door so I could exit quickly at the end of any meeting before it turned violent. Three areas were the worse: nursing, doctors and the upper administration.

First of all, I discovered the nurses were not big fans of the doctors. These women (there were no male nurses at MCMC that I’m aware of in 1979) felt the doctors took them for granted, which was true. The nurses felt they spent more time with and treating the patients than the doctors did, which was also true. But the doctors ran the wards as their own little fiefdoms and the nurses and orderlies as serfs, who should snap to at the doctor’s orders and never, ever question anything. The nurses felt the doctors’ arrogance made them susceptible to sloppy work and error. And of course there was a great discrepancy between what nurses were paid and what doctors earned. Despite all this, the nurses still held a good bit of power at the Medical Center, so I didn’t want to cross them. If they turned against me they would have made my life hell.

The doctors themselves were like a bunch of spoiled children when it came to budgeting, all yelling, "I want, I want, I want" or “If he can have it, why can’t I”.

Hospitals consist of many different disciplines of care, oncology, cardiology, pediatrics, orthopedics and so on and so forth. Some, perhaps all, need some sort of equipment beyond a stethoscope and sphygmomanometer. Equipment can range from a CT Scan to an EKG Monitor and the individual prices stretch from several thousand, maybe even up to a million, dollars and just a few hundred. For instance, a hospital bed can run from around $600 to over $3,000, and certain treatment beds can exceed $13,000. A CT Scanner can cost $2.5 million and a MRI Machine as much as $270 million. Both these were relatively new developments when I was in the medical industry. The first CT Scan was in 1971 and the MRI was 1977. I'm certain MCMC did not yet have any MRIs and I don't know about the CT Scanner.

In our capital budget meeting where doctors would state equipment they hoped to buy in the next fiscal period things could get testy. The chief of cardiology might say he wanted something costing $100,000. He might even give very valid reasons why this was required. Therefore, we might list it on the submissions list. Immediately, I would have several other physicians clamoring for an equipment budget of $100,000 as well. I might know that for one or more of these departments there was nothing in that range  they needed, but because one doctor got $100,000 they thought they were equally entitled. 

This type of grasping was  even from jealousy directed toward other hospitals.

In one case, a doctor requested a very expensive and very specialized machine that only had application in fairly rare cases. It hardly justified the cost of purchase, but before someone hit me with the old "if we can save one life isn't it worth any cost" bromide (and I would even argue that concept with you) this was not a matter of putting a limit on the value of a life. There was a Philadelphia Hospital that had this particular equipment and specialized in that affliction. All such cases in the region were sent there and were so rare that it could adequately handle any and all sufferers. There was no call for a second hospital to compete for these type of patients. He simply wanted the equipment because someone else in his field had one. 

The biggest challenge was the upper administration. I am not talking about people like Jim Schlief or any other secular manager of high title; I am speaking of the nuns who actually owned and operated the medical center. They too got to make requests and in the end would certainly have the final sign off on the budget. During this period they got it in their minds that the hospital needed a helicopter and a heliport. Why? Again, because some other area hospitals had helicopters and heliports. It was sort of a glamour of it thing.

Low cost transport helicopters today can cost a million dollars. They may have been cheaper in 1979-80, but they were still highly expensive, plus you required pilots, insurance, maintenance and fuel. The vast majority of people could be gotten to the hospital just fine by ambulance. If someone was in such dire distress that a helicopter was their only hope there were area hospitals they could be flown to. Ours did not have to join those so equipped. It was not financially feasible and could have led to insolvency.

With this or any expenditure you received two responses from the nuns. “It is for the patients” or “We’re a non-profit, we don’t have to worry about cost.” 

Yes, sometimes you spend extra money for the benefit of the patients; however, the patients did not need a helicopter. That money would best serve the patients by not being spent on such an ostentatious item.

As to this being non-profit, it was very difficult getting them to understand this didn’t mean you did not have to concern yourself with expenditures. True, you did not have owners or stockholders you had to please by the profit you generated, but you had to make a profit anyway. We didn’t call it a profit, of course, and it didn’t go into a Capital Account, it went into Reserve. Yeah, you could break even and you could carry a deficit, but what if you needed emergency funds or expansion? Prices do go up and funding sometimes goes down and you must have some money to operate. You don’t want to have to borrow a lot and build up liabilities. Being a non-profit does not mean throwing away good business practices. I would often ask, "If you want that, what are you willing to give up." Naturally they weren't willing to give up anything. I pointed out if they got something like a helicopter then someday they would have to give up something else, and it could be the hospital.

One other thing concerning medical costs, at least then,  perhaps the rules have changed these near 40 years later. When we budgeted for supplies we had to select from registered medical supply houses. This was Federal Law. These suppliers usually charged much higher prices that we could have gotten something for elsewhere. The example I remember best were the metal ice buckets. I know when I’ve been in hospitals the ice buckets have usually been a thin plastic, but in this case the request was for metal ice buckets and he had to buy them from one of the official medical suppliers. The cost was $100 per bucket. My goodness, they weren’t bad looking buckets, but nothing special about them. I looked in a nearby Woolworths and could have purchased the exact same buckets for $10 each, but of course I couldn’t do that because Woolworths wasn’t a certified medical supplier.

I did have a budget in place for the new fiscal year on time, something they told me hadn’t happened in a decade. We were running a decent department, I felt. We were communicating, which the cost center managers liked and being on time with the budgets. Our monthly budget reports were coming out sooner in the month thanks to the Wang Processor. Going into 1980 everything was coming up roses again.

Even the snarky Mr. Simon was about to disappeared from my life.

Life is a Checker Game: Move Here, Move There

The announcement came sudden and unexpected. 1976 had been a record year for Welded Tube, $80 million in sales. 1977 started off looking like it would be even better, but then as we crept toward 1978 things turned the other way.

For years I had come to work and been busy, busy, busy, between the accounting and running the technology. Now I was finishing up by lunch and sitting about twiddling my thumbs a good part of the time. We all were.

Why so? Nothing had changed with our product. We were still top of the line.

Yes, we were, but in 1977-78 the Empire of Japan began dumping lower priced steel in the United States. Mr. Baylis, unlike a number of other manufacturers, was stubbornly loyal to the idea of buying America. We continued to purchase coils from domestic companies at a higher cost than we could get it elsewhere and consequently we had to sell product at a higher price than our competitors who were not so patriotic. In the fall of 1978 it was announced the Philadelphia operation would be shut down and sold. Headquarters and all operations would be moved to our Chicago plant, where apparently both supply and shipping were less costly. 

It was a shock and Lou Bailis could not have been happy about his own decision. The Philadelphia area had been his home and it was here that he founded and built the company. We were told by the end of the year this location would be gone. I had been called upstair to the main office where they offered me a 47% raise to stay with the company and go to Chicago with them.  It was a difficult situation.

I was torn, but my wife was adamant that she didn’t want to move. We had lived all our lives in this area, our family was here as were all our friends. She did not want to move, and honestly, I didn’t either. But not to do so meant we would face that old bug-a-boo, unemployment and the challenge of finding a new job. Not only that, it wasn’t just us anymore. We had a baby now.

It was a new crisis to take to Laurel Hill Bible Church for prayer.

Then in the middle of October the phone rang. It was Jim Schlief (left), who I had been reporting to at Welded. He had left the month before the announcement was made having seen the handwriting on the wall and obtained a new position as CFO (Chief Financial Officer) for Mercy Catholic Medical Center. He called to see if I would consider coming there as the Budget Manager.

Of course I was.

I would start my new job in early November. I immediately let Welded Tube know I wasn’t going to Chicago with them and in fact was giving them my two-week notice. They were upset by my decision and tried to dissuade me by offering even more money, but our mind was set. 

It was a relief to know I wouldn’t face unemployment when Welded Tube closed up come January, but there wasn’t time to dwell on our good luck, if you could call it that. I didn’t know what I was in for at Mercy Catholic. We did know we would have to change addresses. The headquarters for the Medical Center was on Main Street, Darby, Pennsylvania.

Actually, it sat just outside the town proper and behind Holy Cross Cemetery at the border of Yeadon. Main Street had been South Lansdowne Avenue until the street crossed West Providence Road. There was irony in this for a decade earlier we had lived in The Lansdowne Towers, which sat along West Providence Road in walking distance of Mercy Catholic.

We weren’t in walking distance where we currently were. Between Chalet at Ski Mountain and my new workplace was a distance of 24 miles. If you look it up on Google Maps its says a

35-minute trip. Yeah, right, if you’re the proverbial crow. I’d be traveling during rush hour up Route 42 out of Jersey, crossing the Walt Whitman Bridge onto the Schuylkill Expressway until Route 291. This would take me through southwest Philadelphia, pass the airport, eventually through Darby to the Hospital, and then reverse it every evening. Maybe you could do it in 35 minutes if everybody else died and the highways were clear, but not in that daily traffic and certainly not on Friday evenings and Monday mornings during the Jersey shore season. No, the only sane thing to do was move and do it quickly.

Lois did not want to go into another apartment, but we didn’t have enough money to afford a down payment on a house. We drove over to a Real Estate Office in Springfield, Delaware County and we told the Agent we were looking for a house to rent, one we could stay put in it for a while. We emphatically insisted we didn’t want any place that the owner planned to sell in the short term. We wanted to rent from somebody who only wanted to rent their property for several years.

The Agent assured us she had the perfect home right there in Springfield. It belonged to an older woman who had no interest in selling. We began moving our furniture and stuff there on November 8. We left Laurel at my parents over the weekend. We moved to 338 Rambling Way on November 11. When we picked Laurel up on Sunday evening we had managed to move two more loads that day, but still had a couple more to do.

(Probably all those blasted books I had accumulated. My personal library grew year after year until a couple years ago I had over 5,000 volumes. (Only a few show in the photo.) Every time we moved the boxes loaded with books was greater. A decade ago I donated a great many to the local library. I only have a few hundred volumes left.)

My mom and grandmother were down on the 16 to help Lois unpack. They brought dinner with them. My dad got there in time to eat with us. They thought the house was nice. We had Christmas at our house that year. My parents gave Lois a washer and drier.

I have not mentioned anything for a long time about my wife’s Bipolar Disorder. I recall the house as being fairly decent, but she claims it was a decrepit dump, falling apart with the bathtub coming through the ceiling, a place she feared would collapse about us at any instance. (Photos of 338 Rambling Way’s interior line the sides along these passages.)

It certainly wasn’t perfect, but it also wasn’t on the verge of collapse. I have no recall of bathtub legs sticking through the kitchen ceiling. The basement was somewhat spooky, but most basements are. It had the furnace I think they used to terrify Kevin in “Home Alone”, but otherwise I didn’t fear for my child living there.

It had a nice backyard and the neighborhood was quite.

The home was conveniently situated, sitting less than a block back from Baltimore Pike, the main drag through Springfield. It had easy access to stores and restaurants, yet if you walked away from Baltimore Pike it was a quiet, peaceful stroll.

The house still stands nearly 40 years since we lived there and looks the same, except for a picket fence about the yard. (How the house looks today on the right; not much different then the first photo that I took when we moved there.)

It was only a 12-minute drive to the headquarters of Mercy Catholic Medical Center (MCMC) and my new job as Budget Director. MCMC consisted of, besides the administration building, two major Philadelphia Hospitals, the 204 bed Fitzgerald Mercy in Darby (on the right) and the 157 bed Misericordia Hospital in southwest Philadelphia (on the left).

In the years since I left they have changed the names to Mercy Fitzgerald Hospital and Mercy Philadelphia Hospital. That is okay, I always thought Misericordia was a terrible name for a hospital; sounds too much like misery. Actually, Misericordia is the Latin word for mercy.  The Medical Center also included a nursing school and several ancillary clinics scattered about the area. It was owned and operated by the Sisters of Mercy (a misnomer if ever there was one).

I was nervous about the size of the complex and the fact I had never been a budget manager before and wasn’t at all familiar with hospital accounting, but I was also looking forward to working with Jim Schlief again. I would soon be rudely awakened to a different reality.

I walked into a disaster. First of all, the fiscal year, as it is for many non-profits, ran from July 1 through June 30, not by calendar year. I began my new job in early November and discovered on day one that the 1978-79 budget was not yet in place. We were better than a third through the fiscal year and no budget had been completed. The former Budget Director, the man I was replacing, was still on board. He was a nice guy and a jovial sort, and he didn’t see this situation as very serious at all. He laughed it off. “We didn’t get a budget set until almost May last year so we’re ahead of the game. It was even worse the year before that.” No wonder they were bouncing this guy. He showed me around both hospitals, introducing me to department heads, but he showed no sense of urgency about inquiring where they were in the process. Well, I knew where they were, almost five months behind.

He left after another week and the department was all mine. I didn’t hardly know where to begin, but I knew it had to quick. I personally began visiting every cost center and I issued a memorandum that all budget paperwork needed to be in my hands within two weeks. That is when I discovered a lot of these managers had never even received paperwork or if they had, couldn’t understand it. I therefore carried extra paperwork with me and sat down with any manager to explain it. Now frankly, this stuff was new to me too and I was learning it as I taught them, but we got 'er done. Before Christmas came we had a budget in place and at the end of December we were comparing budget to actual. It wasn’t totally accurate, but it was better than nothing and I had made myself known to every cost center head in the system.

My second shock came as I was finalizing this budget. One of my biggest reason to be excited about my new employment, besides actually being employed, was the opportunity to work for Jim again.  It was not to be. Jim was the Chief Financial Officer, which meant he sat up top. He wasn’t the guy giving the day by day orders to my level. I seldom even saw him. There was an in between management position of Finance Department Vice President. The new boss started sometime that December.

We hated each other from the start.

He was a short, snarly man named Simons, a New Yorker with a heavy New Yorker accent full of curses. The first thing he said to me was I should fire my secretary. My secretary, Sue, was a nice middle-aged lady who had worked for the Center forever, meaning at least 25 years. She took orders well and did her job without mistakes and was very dedicated to MCMC. She had the monotonous task of typing up all those repetive monthly budget reports, pages and pages,  and did so without complaint and with efficiently. Why should I fire her? 

I asked him that very question. 

“Because then the other employees will fear you,” he answered

That was his management philosophy, rule by putting the fear of God, and he saw himself as god,  and he did fire a number of long time employees and people did fear him. I didn’t show the same fear. I refused to fire Sue. He didn’t like me from that time forward. Unfortunately for him he had to walk cautiously where I was concerned. He knew that Jim Schlief, who was his boss, and I had a prior relationship and friendship, and Jim had hired me. He would have to have a real good cause to fire me and that he didn’t have. I had done something the last two Budget Managers had failed to do, pull a budget together.

He never spoke a kind word to me the whole time I worked for him; in fact usually, sneered when ever he saw me, but for the most part he stayed away from me.

My home life during 1979 was fairly normal, no big traumas.  Our old friends had dwindled down to two couples, the Rubios (right) and the Ernests, we had moved away from everyone else.

Joe and Linda Rubio had their first child in 1973 and named her Meredith after me. In September 1978, shortly after having their second child, another girl whom they named Kristen, they visited us at 338 Rambling Way. The photo shows Laurel, Meredith and Kristen playing together. Meredith was one month older than Laurel.

This visit would be the last we saw each other in person. Not

long afterward ARCo closed its Philadelphia headquarters on South Broad Street and moved to downtown Los Angeles (Right, ARCo headquarters, L.A. in 1980). Unlike myself, he went with his company to the West Coast, buying a home with a swimming pool. We corresponded for a while, but that drifted off. I do not know where Joe is today. 

Victor (left) and Marsha Ernest continued their friendship with us a couple more years, but with the closing of Welded Tube he moved on elsewhere as well. He and I still went golfing on weekends, but by 1982 they disappeared from our lives. I heard from Victor a year or so ago, but nothing since. Both of them have serious health issues. 

In January 1979 I had to go take a driving exam to get a Pennsylvania Driver’s License to replace my New Jersey one. On February 3 we dropped Laurel off at my parents and they took her to a birthday party for her cousin Kelly. Lois and I went to a party at the Ernests.  (right, Kelly and Laurel.)

On March 3 we had a intimate party for Laurel’s first birthday. My mother, father and grandfather were at our place for dinner, as was Mr. Heaney and Evelyn Weinmann, Lois’ lifetime friend.

We were to my parents for Easter Sunday, as usual. 

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On May 19 my parents and grandmother came down for a belated Mother’s Day. We took them to the Longhorn Ranch Restaurant on Baltimore Pike in Glen Mills. We enjoyed that eatery and took Laurel there often. It had a Western theme with live country bands performing in the dining room. We always had a table ringside and  the bands fell in love with Laurel because she kind of flirted with them. When we sat down they kept directing their music at her. (This was different a different Longhorn from the chain restaurants using the name Long Horn today.)

It eventually closed and a nightclub called Pulsations was built where it had been. This was very popular for a couple years, drawing long lines, but it too closed and disappeared.  We never went there.

On June 27 for my birthday, we met my mom and grandmother and went to Dutch Wonderland. This was an amusement park that was brand new in the ‘sixties and rather limited in rides at the time, but they added a new ride each year and became fairly large.  

In August was the Wilson family reunion. We also received the bad news in August that we would have to move again. Despite the assurances of the Realtor when we rented 338 Rambling Way and that the lady owner had no intensions of selling it and never would, she did just that. She offered it to us, as a curtesy, she said, but we couldn’t afford to buy and thus it was sold out from under us and we had to be gone by the end of September.

So October 1 found us were moving our stuff once more.

This was a nicer, if smaller house, on Congress Avenue in Springfield. The owner hadn’t wanted to rent to a family with children, but the Realtor assured her we were a very nice family and talked her into it. The Realtor felt guilty because she had told us the first home would never be sold and it was. Boy, were we getting tired of moving. This was the ninth time since we married. That was nine times in less than 20 years.

On October 30, Lois and I were baptized by emersion at the Lowndes Free Church, also known as the Blue Church, where we were now attending after having to move from Laurel Hill Bible. Mr. Heaney and my parents and grandmother were there. It was a Sunday evening service. I had been baptized in the Grove Methodist Church as a baby and had reaffirmed my baptism at Laurel Hill, but I felt strongly we should be emersed and so we arranged it.  (On left is The Blue Church in Springfield, Delaware County.)

Thanksgiving was at my parents, but once again we had Christmas at our home and this would be the pattern for years to come. I didn’t think it was fair to pack the kid up after they opened their gifts and hauling them several miles away for the day. Let them be home and enjoy their new toys, and boy did Laurel get new toys.

You could say 1979 was a typical family year, little drama on the home front, other than the unexpected moving to a new home. The turmoil remained with Mercy Catholic Medical Center and the years immediately ahead.