You -- not gonna hear me complain about this weather because it is Thanksgiving weather and that makes me very happy. And I hope you're having a good thing we have three great hours ahead and we're gonna begin with one that is very very interesting for every one. Very very important for Jefferson Parish. Perhaps the biggest decision Jefferson Parish council will ever have to make is who will run east and west Jefferson hospital's. What started out as a difficult and complex decision has degenerated into a more difficult and complex decision. A well known consulting firm was hired to help the council make the decision. But after one point three million dollars in fees in essentially said each hospital should get it's only -- so back to square one. In a -- voices giving opinions on what to do one stands out. Doctor jury Santana -- long time Jefferson Parish position and now the parish coroner says well let's start over again. And he's very serious about that so today we talked with doctor Stenavich to find out if it's such a radical idea. I'm delighted to have you in the studio thank you very much on along with many others read your column. And I remembered in my kitchen reading that saying out loud oh my god everybody is stepping. What's start over again after all that time and all that money. Hi Angela thank you for having me on I don't necessary tickets. And actually before it -- right I can't take it easy to Monday Morning Quarterback. And you're certainly I like to share my opinions. And you but I wonder you represent the fact that it yeah I I didn't -- it in a way Monday morning quarterbacking the of the guys. When those hospital boards. Worked so hard with good intentions. To. Ten to go through the process they hired Kaufman hall -- consultant to help -- and advise them but not make the decision for. In the one thing I'm not sure that they ever considered was what do the remic ramifications. And what are we gonna do in the event that a deadlock. And I don't know if that was planned for not but -- apparently not because we are in this deadlock in its. Dropped in the parish council -- now. Let's kind of go back just to review. It was understood my understanding is that in the big picture of what's happening in the medical world. That recent -- Jeff separate entities could couldn't really survive and flourish by themselves but it would be a better idea one to combine. And then to find any company that would at least them that would have a far far reaching that possibilities. Right the hospital. Yeah the hostile when they're rolling in in in in the metro area. A free standing community owned hospitals and you are you going to probably go the way of the dinosaur. In the future health care. So which you really one to do is. Team up with a larger system. By doing that it works for in two ways for number one you'll get better contracts with the managed care. Players. So you make more in revenue and you also save some in expenses by being able to take advantage of the group purchasing. Strength of a larger system. That's the logic behind. Teaming up and it ten years ago a lot of people talked about what -- in question -- team up. It's a good idea back then to date however it's not enough. -- need to be part of a speaker system. But let's talk about the teaming up of east and -- -- just that by itself. To me makes common sense. That you would have an efficiency would save money. Because you could you know supplies would be -- dissenter senator buying group we wouldn't have perhaps is much management management can be a big cost factor. So to me beside the other issue that should be done or should have been. And now we're really back to square one with -- -- You know it's it almost looks to the regular citizen and I'm not judging either one they're both wonderful hospitals must understand and and beautifully run but. But really. They could be five times. Right and that's a big misconception I think that people have some of these hospitals are so badly run. They're not badly run -- not at all they're very well run the problem is you can't. You can't sit across the table from the big managed care players when you've got no. Strength in numbers. So the and the concept of hiring me. I consulting firm and your right was to guide the council so they would look at and they were three players of HCA children's an option act. -- I'm sorry there are actually there were twenty -- -- sorry yes and I'm saying when they pared it down yes it got down to three. And I think the assumption wise that you pay somebody a million story. -- to do all the work that they do. And a high quality company. That at least there would be recommendation. A recommendation doesn't mean its etched in stone to the council here's a recommendation. And when they couldn't do that. I think you know red flags wanna what is that with -- and that's when the problems start. It is I think that that. -- that the very well intentioned and may I add unpaid people gifts on the hospital boards. You know. They wanted. You know that the -- they love their positions you know and and they wanted to have -- get together and make the right decision unfortunately it didn't work out that way they you know. I think that when you took ten people from the EJ board ten people from the west Jeff sport. Each of them has a natural and understandable. Allegiance. To the board that they -- to the hospital that they were appointed to represent. And there are things that I don't know the detail on but there are obviously things in the different proposals from HCA and children's. One of which favors you know you are issued HCA proposal. Is better for east Jefferson children's proposal is better for west Jefferson. I really don't know what's better for Jefferson Parish but that's what should be important. And that is why you're here because I think the gist of what you wrote was. OK we're at this impasse. Let's start over again it -- and -- think we need to necessarily start over. You know I think the council chairman made it very. Good. Recommendations seriously where he said look let's go ahead and bring in an accountant took. Look at the proposals are you and I applaud that decision I also think that he could. You know I would advise that you consider taking it a step further and say look let's bring in. Another consultant a -- it's frustrating everybody's got what's what I call deal fatigue everybody's so tired collectors make a decision -- But this is too big of a decision to make. Out of frustration. In I talked all the parish council members those guys and I Italian. They all wanted. A recommendation brought to them by the combined board they wanted to make up or down vote. That you -- that was their intention all along. And you know I don't think they expected this to get dropped and they're very frustrated. And now everybody else is frustrated and pushing him -- just get it over with already. I don't know if we need to go back to it 22 at square one I know I think in Myanmar recommendation be to sync yet another. Qualified consultant. Take another sixty to ninety days and let them reevaluate. Twenty proposals that we -- -- let them look at those twenty you know. And and before they look at him actually let them come meet with the council. Meet with the hospital boards in the hospital administration. And meet with citizens of Jefferson Parish. Find out what's important to everybody. And and and have those selection criteria. And make their selection criteria public. And then -- these consultants go back to wherever it is they're from. And take a month or two months or three months and then come back to us and ranked them. And score. Based on the criteria that we -- and here's how these hospitals school. And -- at that point you know it it certainly will make it easier and you look at it if I was in a position to have to vote on it would sure feel more comfortable. That my vote was invalidated. By thirty -- third party control. We're talking about who's gonna run east and west Jefferson hospitals and our guest today is doctor Jerry Santana pitch to. Is a medical doctor but also the coroner Jefferson Parish that were really inviting me here because he wrote a really powerful. What do -- -- the column. I'm giving your idea that perhaps. With the logjam that they're now in trying to make this decision. That perhaps we ought to just clean slate and start again you're saying not totally starting him but just let's re do what we've got. And and we have to clear the air because. But any potential conflict of interest Newman had because you are part owner of millennium health care management. You're involved in the urgent care for so one you know who. Are you will you benefit more urgent care benefit from. A particular group. Absolutely not I don't see how how would benefit or org be harmed by the choice of any of them or. Which waste you know whatsoever or delay in a choice I don't. I don't see you know and those guys are really in the same business we're in my company does business by the end of January will be and -- -- at saint Tammany Orleans Jeff he Specter Jefferson Parish West Bank Jefferson Parish. Saint Charles. Look foolish. And Obama and and terrible and parishes so. And I don't really know how you can make a connection that that -- choice when each in Westchester and perhaps a significant impact on my business. You're just talking more as a physician and somebody who knows about the medical world and this is such an important decision. On the part of Jefferson Parish as you said now it's in the hands of the council who really didn't want at the beginning they really want of this committee. Made up of both sides to come to a conclusion that hasn't happened. And now beyond consulting firm is an essence and wanted to just each choose your own. And that's like keeps saying but what has that accomplished it may be make them each happier but isn't the best thing for Jefferson -- Now let me ask you of the three that are vying HCA children's an option there. Do you have a preference. Of the three at this point I mean I see each of them has you. Mean yeah I get after people fight for so long all EC is the negatives more so than positives. You know that you they each had a negative Tosh or has the antitrust issues. That I don't you know I don't know if they can overcome. You know HT -- got their baggage of their previous. Administration with a broken promises in the lawsuits in children's has. Burden administratively. Of you know you growing by I don't know if it's six or 700%. In a five year span which I just -- Don't know if anybody. Any single hospital. Has he administrative band -- to pull it off I think it's a huge gamble you're talking about. They're now running to oral and -- soon on the LSU when they didn't they you know three I think three and a half years ago they had just children's and they took over bureau. And look their young that their success has spoken for itself. If they weren't taking the LSU hospital and the New Orleans hospital. I'd say there you know idea that that wouldn't be as big of an issue. But the fact remains they have taken over university hospital. They're going to take from the ground up a university hospital which is. Much more complicated. Beast than a general hospital and then they're gonna take the new New Orleans hospital. -- -- so it's going to be a I notice a huge strain on their administration. To be able to scale up. Response so I if I -- -- -- all three of them -- there -- issues. But it it seems as if you know. Do we see politics and everything I don't know I'm just thinking. This is such an important issue that's gonna last in that community for so long if it's wrong it can have repercussions for a long time. Not that things can change and they can but it's just important to do right. And an excellent carry on. If you might predictions I I don't know -- you know who who's the the top hospital operate in the country -- which -- said Mayo Clinic for sake of argument if the Mayo Clinic came in and took over east and west Jefferson. In my opinion there'd be a lot of turmoil in that transition it doesn't matter who takes over there's gonna be turmoil so. You know Leo it is a strong likelihood that there's going to be. And big upheaval in turmoil and the we also kind of start fallen off with either HCA or children's and area if I was one of the people voting on it I would sure want the validation. Of a third party consultant saying. Good batter in different I made the right choice based on. -- my opinion and beat the opinion of a third party expert who doesn't have any skin in the game. The your concept and is kind of go back with a new consultant. And say let's go to the criteria from which all anybody who wants to jump and instant. -- -- I think I'd go back the original twenty I don't think you can reopen it. You know because if you reopen it then you're looking at another fifteen or eighteen months and we can't wait that long OK I think we you know you. You know I think we need to make a decision soon. So I think it look you know for all I know. Third party consultant may come back and say. I guess I'm of HCA your children for -- or are for whatever may be but I would sure feel better. You know with the independent third party coming through and validating. You -- decision should there have been more public. Input or in what -- the public know about hospitals but at least showing the public more. Well. Monday morning quarterbacking would have been nice I hate you and I and I wanna make sure right now disclose I agreed with. The law changed to take away the referendum. I thought that was a bad idea this shouldn't be a popularity contest. This needs to be a very. Well thought out business decision. And -- so. I don't want this. I wouldn't want this decision made based on who has the best commercials and god only knows we've seen enough of them. You know you or what feels good I want this decision made. And did that. That's the best decision possible. I'm in it to make the best out of what's fast becoming a bad situation where their hospitals kind of let's wrap up what your thoughts are on. Where we are and where we need to -- Well I know they're waiting for the inspector general report. What you think is tomorrow and the next yes if I know -- coming up Connecticut Democrats Friday and I think they will take his report into consideration. And then. Probably vote at the next council meeting which I think is the eleventh. And down. AM I would hope that they wouldn't. I'll give you an analogy Angela by. It appeared doctors refer you to a specialist. Because you're sick and that's specialist tells you that you have a terminal disease. And you sit back and you don't trust that specialist and his or her opinion. And the process of how to your doctors coordinated with that specialist. Would you go and get a second opinion from the second specials before you start making. These life changing decisions and that's kind of -- where I think we are right now you know we've got a decision that we. That we don't trust from our specialist. And I know I would get another opinion. -- the money that would be spent. His. You know is going to be well spent. If it give guidance in the right direction and here's this validation. Of the decision. Well the report by inspector general does come out later this week but doesn't that it will television got a copy a preliminary copy. And in essence it was -- restart the process and create a clear method. Of the valuation and scoring which is exactly what we've been talking about again just to make people more confidence. About this final decision. And perhaps battling the time and amount of money will be well worth it yeah I would certainly hope so I just want them. In. That the take the that the least risky option in which is you get in the specialists and you following their recommendations. Okay we're gonna talk compliments about. Separating out east and west Jefferson let's talk about health care in general. And what's happening. With the Affordable Care Act how do you think that is going to impact. Your life. I'm not his corner but as a physician. Well. As a physician I'm more an administrative side I start a practice -- doctor probably in six hours a week. So administer -- put on the business side of medicine it it'll impact that's unfortunate I don't think we really have a good idea. Of how it's going to impacts. And Nancy a lot of moving parts a lot of people changing insurance. -- -- -- that and then. Medicare 65. Then you products for all changing it's very difficult to see where we're going to go there's a lot of uncertainty. Him and it. I give yet and example is. He has ten years ago it was in most doctors getting out of their residency or fellowship -- -- and practice for themselves and or grow joining a group practiced. Now the majority of taking employed at positions because. Everybody's uncertain as to what's going to happen. And so in I'm not sure yeah we've all seen the basic tenets of the of the 101000 page plan but I don't know if anybody can predict that unintended consequences of it I think the intentions were good I just don't know. How it's going to play out right now for instance that your urgent care centers but this is the businessmen and the doctor. Somebody comes in and they don't have insurance do you then tell them to go to another emergency room. And under the Affordable Care Act every one will have insurance now won't that help your business. Well I I'm not sure that that's necessarily true that everybody you have insurance. I don't think that is spelled out at all in the plan. -- no it's not but. You regarding how it and impacts us in the urgent care world. -- when we have somebody who comes in who doesn't have insurance today if they've got an emergency that's life threatening. Chest pain shortness of breath stroke symptoms would -- may be severe pain. In a week you bring those people in and treat them and stabilize them until an ambulance gets there to transport them to the hospital. That's how we handle emergencies at our MH themselves. That's with the venture with or without insurance. And -- understand what you're saying about there's -- -- guarantee that everybody will have the concept as that but there Clinton we've done several shows on -- -- Caron. There is a point at which there's a crack and people -- gonna fall through that. I guess I was thinking more in terms of people with existing conditions will now be able. To access insurance and rhetoric and that is great absolutely is great and we're gonna start talking about your life is coroner. Are you enjoying it. Yes I am having quarter for a year and a half now. And and again you don't do the autopsy is that you do the running of the system. Which you make some improvements where we've got. Three -- three specific functions of the corps' office won his death investigation -- but he knows that but what a lot of people may not realize is that we're also. Charge of all mental health commitments and all sexual assault. You've got examinations. So you if there's three departments within the corners office. And and now that we would talk so much about mental health and and really the tragedy of what's happening. But and as we talked about earlier so many prisons now are holding -- mentally ill rather than. Anyway it is up to your office of the family is in dire straits was a loved one. To get that child or an adult committed. Correct and there's two things -- that now I'm for products and that was it became quarter able to do one is. We went from being open from 7 AM to 4 PM on weekdays to and clothes and weakened further commitments we have. Safety taking call in coming in if we had two torn now we are. Open 24 hours a day. Monday through Friday and during the daytime -- Saturday and Sunday and and appeal to come in if needed Theriot Sunday night. He is that the police -- college or is -- the home of the person at home it's both it's been a lot and his it's mobile crisis what callers please call us. The other thing that we've done that on very proud of this we went up to Baton Rouge and got a state law changed. That allows us to set up a remote. -- video does it teleconference. Station. Three -- three for now three places in Jefferson Parish. One is in the Kenner police department two is in the feet police department threes in grand dial. The only one that just gotten stalled -- in Kenner to that wake this will be a what I saw when I was observing its people would come in. -- you're concerned about a family member who is in crisis whether it's you know it's suicide crisis whatever or any type of mental health crisis. Where they're dangerous to themselves danger to somebody else or just greatly disabled. -- you what I always -- -- people were always in a rush to get back. To take care that person -- they care enough to get him committed but a lot of time they had the leave them. To go to the courts that they would be willing to go they wouldn't have to come to the corps' office they've just taken to the hospital. So there's always a rush to get back in new transportation issues existed as well so now -- if a family members identified. That and and -- -- if they're able to go to Adobe eight they'll be able to go to Kenner police. And we will be able to video conferencing -- it's great to that they don't physically have to go all the way. Two corners are so Harvey. And you were -- it there and within a month or so we'll have them. In the feet and grand -- as well which I -- a great service for those. Yeah communities. That that is tremendous before we run time I just wanted such based on. There is a heroin problem not not just in Jefferson Parish -- out and and it's an ever growing -- your thoughts on that well. Very Michelle hunter from -- -- that great story this morning. Or she's it's on -- -- I'm not sure if it's in today's paper tomorrow but. It's. It gets a lot of statistics. About heroin deaths and overall overdose deaths and it is. You know skyrocketing in our region particularly in Jefferson Parish. We also have you other things you. In the synthetic heroin -- had some losses yet that yet there's what we had so far this year six deaths from this. I have to -- fentanyl which is. We're not sure people -- Intentionally -- -- shooting it up or if they are being sold this asked to open -- in their heroine. As a way of making that while weak batch of heroin stronger. But you know the problem with this attitude fentanyl is. It has a much stronger respiratory depressant effect on people. Then regular heroin does so and these people having difficulty tight treating it and they wind up in Spanish stop breathing and die. Horrendous -- that probably the biggest change you've seen in the year and a half and then there the deaths from heroin. Yes. Absolutely and you know it is you we always talk about you knew what the reasons you know nationally heroin use goes as -- goes up and down and I know that we. Typically. It don't mirror the national things were up higher now. You know there's been a great prescription monitoring system put in by the state pharmacy board which is fabulous makes that. Doctor shoppers. Have a very difficult time because all controlled substances. Are. Put into the system so if you come see. You know your regular doctor today and get a prescription for you know you point five I can and and come see me tomorrow and say your back hurts I can go in that system and say what about the 25 bike and you feel yesterday. So it you know so -- I kinda wonder is is this say unintended consequence of that -- tightening of that -- I I'm not by any means saying that we shouldn't have I think that's the greatest system ever. -- -- yeah I think as physicians we hate being scammed. Or used so I love the system. You know you know but I've heard people say well people have such a hard time getting their prescription drugs that they are. You going to cheaper heroin going cheaper parent and child and if it's. It's a tragedy that is every pair of shoes is suffering from an -- Jefferson in particular but even yesterday I was interviewing -- tier venture and the numbers there are -- And just very very sad and I do appreciate your time. I have to end it. And this is an all due respect I'm reading your bio and I loved. That for three and a half years you've heard the doctor on board a cruise ship. Now that's living that was that was the -- I actually after residency a signed a six month contract with Norwegian cruise line. And down three and a half years later I got off the ship it was great -- work in the Caribbean. In Hawaii and in Europe and why did you ever get off the -- you know I got off beat because I got offered a job in the emerged from Easter. That says it. And a different light but you know good for you to be young -- -- let me have this adventure it was offs and -- for a single -- if there was nothing I got a and now you have another awesome god I thank you very much for spending your time with this. -- and -- will stay in touch we'll see what how how the whole thing with east engine question on -- thank you and stay with -- everybody. We're gonna come back we're going to be talking the next hour but something affects so many people alzheimer's.