Ask Mr. WMC Answer Person: "I've appreciate your stories about the hospital. What do you think needs to be done there?"

A decorahnews.com reader e-mails: "Thank you Paul Scott for being willing to conduct some investigative journalism about the Winneshiek Medical Center.  What do you think needs to be done there?"

Paul Scott replies:  I appreciate your kind comments and the favorable comments I have received from several dozen people this week.

But I'm going to pass on weighing in on either side of the local health care debate.  As I wrote on Monday, "we're attempting only to explain to the public the forces at work in local health care.  It is up to the public to decide what would be the best course for local health care organizations to take."

However, there is one simple improvement that I'd like to suggest that I don't think anyone else has suggested so far.

Right now the top four administrators at Winneshiek Medical Center do not get a paycheck from Winneshiek Medical Center.  Instead, they are employed at the discretion of Mayo Clinic Health System.

That means they are called on by the hospital's Board of Trustees to give advice about the best course of action for the hospital--but their paychecks come from Mayo Clinic Health System.

In an interview with Board of Trustees President Ben Wyatt in February, I asked what happens in cases where Mayo and the hospital come into conflict.  His answer was that the two sides always can work something out.

After seven weeks of interviews with a number of people connected to Winneshiek Medical Center, I understand now that I should have asked a slightly different question: "How can you (the Board of Trustees) be sure the advice you're getting is advice that serves the interests of the hospital--not the interests of Mayo Clinic Health System?"

There's a simple solution to this problem--the Board of Trustees needs to have at least one administrator who is paid directly by Winneshiek Medical Center and not Mayo Clinic Health System.  That way, there would be no possible conflict of interest between advising Winneshiek Medical Center while drawing a paycheck from Mayo.

Ideally, that administrator should be the Chief Administrative Officer.  Maybe it's too late to restructure this position, since Mayo has already begun screening candidates for the position.  Maybe the next time a top administrator at the hospital leaves (sources tell decorahnews.com that this could happen before the end of 2012), that position should be removed from WMC's Management Services Contract with Mayo Clinic Health System and should be set up to be paid directly by the hospital.

The Board of Trustees needs to know the advice it is getting is free of any possible conflicts of interest.  Directly paying at least one top administrator is a way to do that.

(Matthew 6:24: "No one can serve two masters, for either he will hate the one and love the other, or he will be devoted to the one and despise the other.")