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Marshall Administrator
Celebrates 25 Years The organization recently adopted a new umbrella name, Marshall Medical, to better convey the many facilities and services that the independent, community healthcare provider offers. Nachtman is now the administrator of Marshall Medical. “I was told when I started that the nature of the job would eventually cause me to make enough people angry that they would force me out of the job after 25…25 months that is,” said Nachtman. “I never thought I’d make 25 years. But I’ve been very fortunate to maintain the support of the public community and the medical community on the Western Slope of El Dorado County. Together, we’ve been able to have a great success in providing top quality healthcare services for this area.” Several people got up to say a few words about Nachtman at the event including former board presidents, current employees, past employees and Bob David from the Hospital Council. This list also included recently retired assistant administrator Kay Railey, who Nachtman had worked with for the past 15 years. Everyone lauded Nachtman as an excellent, shrewd administrator. Other words to describe him included stubborn and cantankerous. They all also mentioned what would have to be considered Nachtman's greatest quality in his position - his commitment to quality patient care above all else. Nachtman was hired at Marshall Hospital in 1977, at a very volatile time for healthcare in El Dorado County. Marshall was in desperate need of expansion. There was a huge political debate swirling around whether Marshall should be allowed to expand and be the only hospital on the Western Slope, or if the expansion should be denied and the recently closed county hospital, Pioneer Hospital, be reopened and compete with Marshall. The decision was taken to the voters in the form of a ballot measure and they voted for Marshall to be the single hospital. There was still the huge obstacle of getting through the Office of Statewide Health Planning and Development’s “Certificate of Need” process before expansion could begin. “The paperwork involved with the process was overwhelming,” said Nachtman. “I had a stack of forms on my desk that was two-feet high. The bureaucracy and paperwork involved threatened to delay the beginning of our expansion for three to five years. This would have nearly doubled our costs.” Marshall eventually got approval and in 1980 undertook a complete rebuild of the hospital. Marshall then went from 46 beds to 90 beds. This involved remodels and expansions of almost every department in the hospital, along with the addition of an intensive care/critical care unit. Marshall was well on it’s way to becoming what Nachtman had envisioned when he first arrived; a “comprehensive, regional medical center.” Further expansion followed, starting in 1989 with a new, 11 million dollar surgery center, the Cedar Ravine Diagnostic Center and the Marshall Hospital Professional Center in Cameron Park. In 1992, the 14-bed Transitional Care Center was built, bringing Marshall to its current bed count of 103. Marshall HomeCare was also created that year. In 1993, MRI, radiation and medical oncology services were added at Cameron Park. The emergency department was once again expanded from 1300 square feet to 5200 feet. In 1997, the hospital partnered with a number of local family practice and internal medicine physicians to form the Marshall Center for Primary Care. Nachtman also wanted to see Marshall become a “hospital without walls”. He wanted to see the hospital take services out into the community. So the hospital increased community health programs in 1995 and 1996 by setting-up the Divide Wellness Center and the Community Health Library, and in 1998, the Broadway Health Depot and the Sierra Mobile Clinic. A great deal of Nachtman’s motivation comes from the desire to keep Marshall an independent, community healthcare organization. “The board of directors and the hospital staff have been telling me all along that the main reason Marshall is so special is the fact that it has remained independent and I whole-heartily agree,” said Nachtman. “I believe it allows us to do a better job of focusing on the patient and provide personal care. We don’t have to worry about corporate management and budget issues. Independence has been my driving force here.” While Nachtman is constantly associated with growth and prosperity, other than a brief experiment with managed care in the late 1990’s, Nachtman’s biggest moment came in 1996 when he took on the California State Department of Health Services (DHS). Two DHS officers showed up at the hospital demanding to see records concerning a complaint filed against the hospital and a physician. The hospital complied except for the “peer review records” which are confidential and protected by state law. The DHS threatened to withdraw federal funding, which would have caused the hospital to close. They also threatened Nachtman himself with a lawsuit. Peer review is a process where a volunteer group of physicians evaluates complaints and situations to ensure that patients are protected and physician’s skills are up to speed. If the records were made public, they could be used in lawsuits and the entire peer review process could break down. This could lead to substandard doctors practicing in substandard ways. Nachtman held firm during this lengthy battle as the story made national headlines. After getting support from the major medical organizations in the state, the medical community in general and a few influential senators and congressman, the DHS backed down and Marshall Hospital was once again safe. “There’s always something coming at you in the healthcare industry,” said Nachtman. “We jumped on the managed care bandwagon and that almost put us under. Now we’re faced with cutbacks to Medicare and Medi-Cal, coming up with extra money for the legislated seismic retrofits, the nursing shortage, the growing number of uninsured, affordable health insurance – there’s always some new crisis just waiting on the horizon.” Asked how long Nachtman was going to continue to engage issues on behalf of Marshall Medical, Nachtman replied, “Well, it’s a pretty safe bet I’m not going to make it another 25 years.” |
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