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Leader builds a career in a small town

James Dooley moved to Geneva in 1978, expecting to stay a few years. He was 30 and had recently been hired as CEO of Geneva General Hospital.

Landing a CEO job-his second as a hospital administrator-was a coup, Dooley thought. But he had bigger plans than running a 170-bed small-town hospital.

It was not only that Dooley wanted to work for a bigger, more sophisticated organization. He had grown up in Boston as the youngest son of a large family with deep roots in the city’s south-side Irish Catholic community. His wife, Caryl, whom Dooley had started dating when they were in high school and married soon after she graduated from college, also had family in Boston.

"I thought I’d be here three, three and a half years and then work my way back east," Dooley says, leaning back in his chair 31 years later as he contemplates the polished cherry expanse of the conference table in Geneva General’s board room.

He now heads Finger Lakes Health, a health system with two hospitals and four nursing homes. It includes Soldiers and Sailors Hospital in Penn Yan as well as Geneva General.

Part of what kept the couple in Geneva was their two children. The Dooleys adopted their first child, son Paul, now 31, shortly after moving to Geneva and adopted daughter Katelyn, 26, several years later. They came to think that a small town might be a better place to raise children than a big city, Dooley says. But it was not only Geneva’s charm or Seneca Lake views that kept Dooley there. The job turned out to have its tribulations, but it also held rewards.

"After a while," Dooley says, "I started to realize we were doing cutting-edge stuff."

In the late 1970s, the earliest rumblings of issues that are still roiling U.S. health care were starting to be heard. The basic question still bedevils Congress: How can rising medical costs be contained while still ensuring that as many people as possible have access to high-quality care?

One answer regional health care planners saw then was to cut the number of hospital beds, a process that inevitably would involve closing hospitals and consolidating their operations.

Few communities willingly accept such shutdowns. And when he accepted the Geneva General position, Dooley unwittingly positioned himself to be at the center of more than one bitter hospital closing debate. He also would be on the ground floor of a movement that would see the increasing consolidation of U.S. health care facilities from freestanding and independently run hospitals, clinics and nursing homes to integrated health care systems.

Formation of multi-facility health systems in Rochester and much of the country did not begin to take hold until the mid-1990s. Under Dooley, Geneva General anticipated the trend by nearly a decade, merging with and absorbing 50-bed hospitals in the nearby Seneca County towns of Seneca Falls and Waterloo in the late 1980s and early 1990s.

By the late 1990s, an already experienced Dooley was bringing in the financially challenged Soldiers and Sailors Memorial Hospital in Yates County.

In financial terms, the closure and absorption of Waterloo’s Taylor-Brown Hospital and Seneca Falls Memorial Hospital along with Geneva General’s 1998 merger with Soldiers and Sailors, which remains open as a critical-care facility providing inpatient care but not inpatient surgeries, until recently have been a success.

Berger Commission
In 2006, the state formed the Commission on Health Care Facilities in the 21st Century, commonly called the Berger Commission, to investigate and come up with a plan to deal with a statewide oversupply of hospital and nursing home beds.

For most communities, the commission’s recommendations, which had the force of law, were harsh, calling for heavy bed reductions and facility closures. The counties of Monroe, Ontario and Wayne, which already had shed many hospital beds, were spared.

When Dooley testified before the commission’s regional advisory committee in 2006, he reported that Finger Lakes Health, then a $120 million operation, was able to realize a 3.8 percent operating margin in 2005, a ratio it maintained until 2007.

In much of the country, 4 percent or better is seen as a minimally safe level for health care facilities. But in New York, where more than half of the state’s hospitals trail red ink, such margins-some two points better than two of Rochester’s health systems-put Finger Lakes Health in the top quartile among health systems.

The system’s financial stability has made it able to maintain a level of care and services residents might not otherwise enjoy in the rural and semi-rural areas and small towns it serves, says Lawrence Farnand, Finger Lakes Health chief financial officer and Dooley’s longtime right-hand man.

After Taylor-Brown shut down, Finger Lakes Health built a new nursing home on the former hospital’s site. The health system includes skilled-nursing facilities and primary-care clinics in Ontario, Wayne, Yates and Seneca counties-regions where relatively low population density would otherwise make it hard to attract and retain specialists and top-quality nurses.

The busy Soldiers and Sailors emergency room is staffed with emergency medicine specialists and its acute-care floors with hospitalists who rotate between there and Geneva General. Geneva General has a dialysis unit. Although state approval so far has escaped the hospital, Dooley hopes also to add a cardiac catheterization laboratory.

"If we hadn’t done those consolidations, we couldn’t have attracted those doctors and nurses," Farnand says.

In shepherding the consolidations needed to create Finger Lakes Health, Dooley was a visionary, says Timothy McCormick, Unity Health System CEO. Dooley and McCormick, who plans to retire at the end of this year, have a 30-year history as professional colleagues and partners in a golf foursome.

"Tim helped me out quite a bit when I first came here," Dooley says. 

The men have a halfway serious rivalry over their respective lengths of service and believe themselves to be the longest-serving hospital or health system CEOs in the state. McCormick, who has been an administrator with the Unity/Park Ridge organization for 38 years, is older than Dooley and has worked in the state two years longer. He has held a CEO title, however, for 32 of those years, giving Dooley a six-month edge.

"I will never catch up to him now," says McCormick, noting his upcoming retirement in mock lament.

Dooley chuckles about "stealing" Farnand from Park Ridge, where he had worked as controller under CFO Warren Hern for several years before Dooley offered Farnand a CFO position some 30 years ago.

"I was in a meeting with Warren and Tim, and I noticed that every time I asked a financial question, Warren kept going out of the room to get information from somebody, so I asked to meet the guy he was going to. It was Larry Farnand," Dooley says. "Later, I offered him a job."

The main trick in successfully melding disparate institutions into a new entity, says McCormick, who oversaw a merger of St. Mary’s Hospital in Rochester and Park Ridge Hospital in Greece to create Unity Health System, lies as much in getting the institutions’ separate cultures to accept and work with their new partners as in mapping out administrative and operational changes.

Dooley, a politically astute judge of character with street smarts to match his administrative skills, excels in both areas, McCormick says.

Tough start
Dooley’s start at Geneva General was a baptism by fire that put the young administrator through a crash course in navigating New York’s health care system. It ranks as one of the most tightly regulated in the country.

"I wouldn’t have admitted it at the time," Dooley says, "but for my first three months on the job, I felt like throwing up on most days."

The hospital was in the middle of a $6 million upgrade of its operating rooms, intensive-care unit and radiology department. Soon after starting, Dooley learned that the hospital was $1 million short of funds needed to complete the job. The shortfall was due to an oversight: Planners had neglected to figure in the cost of new X-ray equipment. But the why was irrelevant. Dooley’s job was to find the $1 million and see the renovation through to completion.

Dooley, whose previous job had been as an assistant administrator for the Guthrie Clinic in Sayre, Pa., made frequent trips to Albany, interceding with state Health Department officials to get the hospital’s certificate-of-need application amended.

In New York, that approval is a precondition of health care facility construction or major renovation. The radiology program had been approved in its inadvertently incomplete form. The reviews, which are done by a succession of panels, typically take a year to complete.

Dooley, who managed to thread the state’s bureaucratic needle to get the extra equipment added to the project, recalls the exercise as a quick course in "Mother may I."

That effort was dwarfed by the complexities of forming Finger Lakes Health, a process that called for creative thinking and drew on Dooley’s political skills.

"There were years when I used to have someone else start my car," Dooley recalls in a deadpan exaggeration of the heat he took from Seneca Falls and Waterloo residents.

Though no one physically harmed him or his family, Dooley says, he fielded more than a few late-night calls from irate citizens. There were also potential bureaucratic hurdles. Even if the state went along with consolidation plans as proposed, the certificate-of-need process would slow any action.

Dooley had started laying groundwork for consolidation of the Geneva, Waterloo and Seneca Falls hospitals in the late 1970s by drawing the three institutions’ board members into a Finger Lakes area hospital group.

Geneva General also held merger talks with F.F. Thompson Hospital in Canandaigua, but the two institutions were not a cultural fit, Dooley says. In the Waterloo and Seneca Falls talks, getting the disparate board members on a single body helped to bring them together and foster cooperation.

"I’ve found that if you get people from different organizations or backgrounds together in a neutral body, they completely forget their individual concerns," Dooley says, waving his arms as if to shoo parochial concerns out of the room.

The group produced a study, concluding that Taylor-Brown and Seneca Falls Memorial, which sat three miles apart, should be closed and folded into Geneva General.

Working with Binghamton attorney Richard Pille of Hinman, Howard & Kattell LLP, Dooley employed a legal tactic that let the hospitals skirt state Health Department approval of the merger.

The three hospitals were organized as corporate member organizations, a structure in which community members with voting power are the institutions’ owners. Members could approve a merger with no state approval or review.

"We went to DOH and told them what we were doing in advance. They weren’t very pleased," Dooley says.

When he later used the same member tactic to arrange the Soldiers and Sailors merger, he did not tip off the state in advance, Dooley says. To create a merged organization, Finger Lakes Health appointed "mirror boards" whose members were also directors of the component organizations.

Geneva General today has 120 medical-surgical beds, 50 beds fewer than the three hospitals started out with. Soldiers and Sailors has 30 acute-care beds; 130 of the hospital’s beds have been converted to long-term care.

The leader
As a boss, Dooley shows a relentlessly positive attitude and goes to some lengths to acquaint himself with frontline workers’ issues, Farnand says. On holidays, for example, Dooley visits Finger Lakes Health facilities as a gesture of solidarity with workers who have pulled holiday shifts.

Dooley is a big man who stands just over six feet. He has a full head of gray hair and a direct, off-the-cuff manner.

He traces his people skills to childhood and early teen years on the streets of Southie, on Boston’s south side. His family was "lace-curtain Irish," Dooley says, but not far removed from more working-class roots.

Both of his parents were Boston College graduates. Both are deceased. His mother was a homemaker, and his father taught school. There were seven children in the family; Dooley was the youngest boy.

Gangs, loosely organized along ethnic and racial lines, were a prevalent social structure in the neighborhood, but they were not the violent gangs of today. Rather than automatic weapons or nail-shooting zip guns, they used homemade weapons that shot lighted matches at rivals.

Still, they were not church choirs. An older brother, who is now a union carpenter, was an accomplished hot wirer of cars and spent time in reform school.

Dooley was thrown out of Boston Latin School, a high school that claims to be the oldest public school in America and is known nationally for its adherence to a tough, traditional curriculum. Admission requires good academic standing and a good grade on its admission exam.

For reasons he says he does not remember, Dooley threw a chair at his French teacher and was expelled after less than a year. On hearing that he would go to a public school, nuns threw one of his sisters out of her parochial school. Ironically, Dooley says, he went back to a parochial school and his sister ended up graduating from a public school. After his brother was sent to reform school, the family moved out of Southie, decamping to a more upscale suburb. The move put him on a less self-destructive path, Dooley says.

Breaking with his family’s Boston College tradition, Dooley went to St. Anselm College, a school run by the Benedictine order in Manchester, N.H. Disconsolate over his son’s defiance in spurning Boston College, his father barely spoke to him for a year. Dooley’s mother secretly handed him a laundry bag and told him to bring it home when it was full. His father relented after Dooley was elected class president at the end of his freshman year.

Because his parents hoped he would be a doctor, Dooley majored in biology. He played hockey in college, developing a lifelong interest in the sport. In Geneva, Dooley coached a high school hockey team for a number of years and coached a girls hockey team after his daughter showed an interest in playing. He has not played in years but gave up coaching only three years ago.

Dooley maintained his position as class president for the rest of his four years at St. Anselm. Realizing that he enjoyed his presidential duties and political role more than his biology labs, he dropped plans to go to medical school.

After an adviser suggested a career in hospital administration, Dooley applied to several schools with good graduate programs in hospital administration and ended up attending the University of Minnesota. He graduated with a master’s in hospital administration in 1972 and went to work for the Guthrie Clinic shortly thereafter.

When a Geneva General board member approached him several years later to interview for the Geneva hospital’s top job, Dooley was reluctant but decided the job could be a stepping stone. Now he says that he accepted Geneva as his home long ago and has no plans to leave the community.

He and Caryl have a home with a dock on Seneca Lake. Dooley recently bought a 21-foot inboard motorboat.

System’s future
After keeping Finger Lakes Health on a stable track through the ’80s, ’90s and early years of this century, Dooley is facing a less congenial future.

Geneva General recently won state approval for a $55 million upgrade of much of its emergency department, operating rooms and intensive-care unit, and for a new suite of private-room medical-surgical beds.

The project would create new nursing education space. The upgrades are needed, Dooley says.

However, Farnand says, Finger Lakes Health’s financial picture is clouding. The health system’s operating margin slipped from 3.8 percent to less than 2 percent last year and is likely to end up in negative territory this year.

Dooley is not panicking yet. To a large extent, the system is hostage to larger events. State cuts in nursing home and hospital reimbursements largely are responsible for its financial slippage, Farnand says.

Eighty percent of Finger Lakes Health’s nursing home residents are on Medicaid, as are some 15 percent of its hospital and clinic patients. And the state-administered government insurance program notoriously pays providers less than their cost to deliver care. In more populous areas, nursing homes and hospitals often are able to offset Medicaid losses with profits from first- and third-party private payers.

That option is not available in the communities Finger Lakes Health serves, Farnand says. Yates County is one of the state’s poorest.

Like his boss, neither is Farnand worried yet. The organization has a strong balance sheet and little long-term debt. Over three decades, Farnand says, he has seen Dooley pull out of financial funks before, and the CFO is certain Dooley can do it again.

10/16/09 (c) 2009 Rochester Business Journal. Obtain permission to reprint this article.


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