For some Butler County residents, the Butler Memorial Hospital Board of Trustees is an enigma, and the board's silence on its plans to build a new hospital adds to the mystery.

A little more than a year ago, Butler Health System, which oversees Butler Memorial Hospital's operation, sponsored several public meetings throughout the county on the need for a new hospital. Those meetings came about after residents, business owners and elected officials sought more information about the new facility.

Since then, hospital officials have only talked about the project on a few occasions.

Recently, however, three former board members came forward to open a door into the workings of the board. They question the actions the board has taken in the past two years concerning the proposed construction project.

They are: Joan Chew, a former Butler County treasurer and one-term county commissioner; Dr. Ron Cypher, owner of Advanced OB/GYN, one of the largest women's health practices in the county; and Dr. Stephen Sargent, in general practice with Dr. William DiCuccio's Butler office.

Sargent had a one-year term on the board because he was president of the hospital's medical staff.

While Sargent's term ended with the end of his staff presidency, Chew and Cypher say they weren't re-appointed to the board because they questioned the hospital project and the way the board operated.

Nonprofit charitable trusts such as Butler Health System fall under regulations similar to private business trusts, said Mark Pacella, chief deputy attorney general of the Charitable Trusts and Organizations Section of the state attorney general's office.That office has oversight responsibility for charitable trusts, he said."However, unless the director or board of trustees of such a corporation are acting illegally, incurring substantial losses, imprudently investing or doing business without bothering to ask the necessary questions to make decisions, then the AG's office does not get involved," he explained."As long as the board is acting with due diligence - asking questions, looking at all the options, enacting an informed process and making prudent decisions based on that process - then it is not our function to questions a nonprofit's decisions," Pacella said."Just because some of those decisions tank or investments don't make money, it doesn't necessarily mean that the decision was an imprudent one. We have found that boards who use the best business practices usually take the best options for these types of corporations," he said.These corporations must follow the state's Nonprofit Corporation Act of 1988, Title 15, which contains much of the obligations and responsibilities of private business corporations. Nonprofit boards are asked to oversee the interests of a third party, and the decisions have to be separate from personal interests."That is called the duty of loyalty," Pacella said. "The duty of care means that nonprofit board members must make informed decisions, with this and the duty of loyalty being the two key elements of nonprofit board oversight."

Chew, Cypher and Sargent say hospital board members are not making informed decisions.An example, according to the three, is the board's vote in October on the report to the board by the Hammes Co.The board hired Hammes, a Wisconsin-based health care consulting firm, to review all the development plans the board has received since 1999 regarding the growth of the hospital.Hammes' review included a 1999 plan from Burt Hill Kosar Rittelmann Associates, a Butler-based architectural firm, to build and renovate structures on the current hospital campus; a 2001 study by Astorino, a Pittsburgh architectural firm; and a 2003 development master plan designed by RTKL, a Dallas-based firm that specializes in health-care construction.Hammes also was asked to review the due diligence, or research process, of the board regarding the planning of a new hospital.Hammes, which was paid $80,000, was not asked to introduce new information or to develop a new plan for the hospital.At the October board meeting, Hammes' consultants presented a 39-page report, which approved the board's actions and the conclusions made by RTKL about building a new hospital at a new location.Consultants from Hammes gave a one-hour review of the report for the board. Then the board was asked to accept it."We were told that there was going to be a retreat at which we would review the report with the consultants, but instead we got the report at a regular meeting and it was brought to a vote," Chew said.Cypher said he asked for time to ask questions but the entire board was given just 10 minutes to ask questions. He was able to ask two questions in that time.Chew and Cypher voted against the report because they weren't given the time to adequately review it."I was taught never to sign anything I haven't read, so I couldn't vote for the report," Chew said.Cypher agreed."With such minimal discussion and not being afforded the opportunity to read either the summary report or the full report prior to voting, I feel I was not prepared to make an informed vote," he said. "I could not, therefore, in good conscience, vote for acceptance of the Hammes report recommendations."Later on, Chew, Cypher, other board members and members of the hospital's medical staff learned Hammes had also delivered 180 pages in "support documentation" to the hospital's administration. This documentation was used by the company to conduct its review.Both Chew and Cypher asked to read the support documents and were given access to them several weeks later.It was in those pages that they found information that had not been presented to the board, such as the plan to eliminate the hospital's skilled nursing and psychiatric departments in a new facility.Cypher said when the board first approved spending $161 million to build a new hospital, board members were promised: a fully digitalized hospital, a child care center for employees, an ambulatory surgery and imaging center, a full-service cancer center, a medical office building and an administrative office building.With hospital officials hoping to build on the Butler Veterans Affairs Medical Center campus in Butler Township, the $161 million price tag also included: a VA skilled nursing facility, a VA administration building, a VA ambulatory care center and demolition of the main building on the VA campus, according to a Dec. 21 letter Cypher sent to board members.But after reading the Hammes support documentation, Cypher said he was shocked to learn what kind of facility the hospital can afford to build for $161 million.According to Cypher's letter, that hospital includes:100 fewer beds than the current hospitalNo private roomsNo full-service cancer centerNo child care centerNo medical office buildingNo psychiatric services, "(no adult or teen psychiatry, no drug-alcohol rehab despite these being one of the Butler community's main health issues)."No skilled nursing facilityAn OB/GYN department with 12 beds instead of the current 26No pediatric center."After reading the full Hammes report, it is clear that what we thought we were getting based on (the Sept. 4, 2003, vote to spend $161 million) is not what we are getting at all," Cypher wrote.Sargent agrees with Cypher: "The Hammes report that was presented to the board has a fair number of deficiencies."The administration has said all along that it has $150 million to spend on a new hospital. But the concern has been, what do you get for $150 million? You don't get what you need," Sargent said.

The hospital is making money.Its profitability has been up every year since 1999. It has a considerable amount of cash on hand, and is in good standing to borrow money, according to the information presented in 2004 by Anne Krebs, BMH chief financial officer.But Chew and Cypher say that kind of profit isn't enough to pay for the construction of a new hospital, even one that doesn't include the bells and whistles they were promised in 2003.To pay for the new hospital, Krebs explained at a public meeting in January 2004, the hospital plans to save some revenue each year so it would only take out $80 million in bonds over the course of the construction.To build a new hospital, Krebs said the health system would borrow $20 million in 2004 and then $60 million in 2008. During that time, the hospital would be able to earn enough money to pay its debt.Currently, the hospital has a $28 million debt, which has been figured into the financial analysis of the construction project.In 2003, the board determined a new hospital would have to come in two phases, the first being an outpatient surgical center, paid for with a $20 million bond issue and with another $9 million from savings.The second phase, to start in 2008, calls for the hospital to issue a $60 million bond, plus use $60 million in revenue to complete the total project.But the surgical center is no long part of the project because a group of doctors recently started construction on their own such center.The hospital board reported in December that itsprofitin 2004 was $6.6 million.But this was down from what was expected in 2004, and Chew and Cypher say the shortfall in expected revenues has put the hospital 28 percent behind its savings goal for the new hospital."They can afford (a new hospital), if they build a third-class hospital," Chew said. "A hospital will not attract new patients if it is a Wal-Mart with call-bells."

Both Cypher and Chew believe the way the board operates has a lot to do with deficiencies in the plan to build a new hospital.They cited numerous decisions made by the board even though there is a lack of communication between board members, and between the board and the public.In his December letter to the hospital board, Cypher writes, "An additional area of concern regarding communication is Mr. (board chairman William) Bessor's position that 'there will be no more public hearings with questions as long as I am chairman.' This was apparent at the annual public meeting (December 2004) when he attempted to limit questions to the board's two selected agenda items. I think Butler residents expect the opportunity to have a face-to-face open dialogue with the board of their community hospital."Cypher cited delays and the inability to get information as a board member from the hospital's administration. He also states he was denied the opportunity to discuss alternatives to the hospital's plans during board meetings, both by chairman William Bessor and Joseph Stewart, president and chief executive officer.Sargent said he is concerned there has never been a formal presentation of the Hammes report to the hospital medical staff and there has been no open discussion with doctors or nurses about what is needed in a new facility."I believe the board is being manipulated by not getting the retreat (to discuss the Hammes report) and having their questions on the hospital limited," he said."I hope they are doing what is best for the hospital, but I don't feel they have the compelling evidence to build this hospital," Sargent said.Chew said she is concerned about the hospital's future."I have lived here all of my life and I have been a patient at Butler Memorial and have received excellent care. I don't want to see the hospital do something that will jeopardize what we have or what we could have," she said.