Six months after Loudoun Healthcare Inc. announced it had accumulated a $27 million deficit over the last two years, some community leaders and doctors are asking to be more involved with the institution's turnaround efforts. They want the hospital's board of directors to consider putting a member of the Loudoun County Board of Supervisors on the board.

"We want to be one of the players," said Supervisor Eleanore C. Towe (D-Blue Ridge), who suggested the idea. "The way they're running the hospital now is not acceptable. We want to establish a sense of cooperation.

"This is our only community hospital," said Towe, whose husband is a physician in the western end of the county. "It's supported by citizens, and citizens through their elected officials should have some link to the hospital."

Supervisor Scott K. York (R-Sterling), who will take office in January as chairman of the board, said he also is supporting the idea.

"I think it would be a good idea to have some outside community representation sitting on the board," York said. "We have a major responsibility of providing for the health, welfare and safety of the community.

"The hospital is always touting itself as a community hospital," he said. "It's high time it starts playing the game it speaks."

Marilyn Naylor, of Purcellville, resigned in October from the hospital's 10-member board. Her term was to expire in 2003. Loudoun Healthcare officials would not comment on her resignation but said the position would not be filled immediately. Naylor, a longtime Loudoun resident, had no comment.

Some residents, doctors and community leaders have criticized the board for not recognizing the hospital's financial troubles sooner.

Hospital spokeswoman Linda Roberts said Pitts Management Associates Inc., the Louisiana-based turnaround firm the hospital hired in August, is preparing a report for the board's December meeting on the board's structure and operations.

From the 1930s until the mid-1970s, the hospital board was comprised of a judge from the county's Circuit Court, the chairman of the Board of Supervisors and the chairman of the county's School Board. The bylaws changed in the 1980s, eliminating those positions and allowing as many as 16 members who are chosen by other board members to serve four-year terms.

Hospital board members generally have been lawyers, business owners, executives and physicians.

"The hospital board should not be a self-perpetuating board of friends who want to keep the governance of the board a closed shop," Towe said.

"We need to have some political input as far as the community is concerned," said William Silberman, a pathologist at the hospital. "We're here, like the school system is, to provide a community service. The community should be involved."

Supervisor James G. Burton (I-Mercer) said he also supports having a supervisor on the board, especially after the hospital moved to its Lansdowne campus despite a significant outcry from many residents in Leesburg and the western end of the county.

"There's no public input anymore," Burton said. "It began as a community hospital, and the public has given their time and contributions to it, and now we've got a hospital board of directors that pays no attention to the public.

"They've ignored the public outcries in the past," Burton said. "The whole situation is a mess there now. The public has lost confidence."

Since hiring Pitts Management, Loudoun Healthcare has cut its consulting services and some of its upper management positions, renegotiated managed care contracts and tried to improve its billing and payment processes.

The board's budget for fiscal 2000, ending June 30, "shows the hospital recovering from its current fiscal crisis with projections for a balanced budget" in later years, Roberts said. The projected loss for fiscal 2000 is $340,000.

Inova Health System has agreed to extend the terms of its $5 million loan to Loudoun Healthcare. The loan, for which Loudoun's former hospital grounds in Leesburg were used as collateral, was to expire in mid-January, but Loudoun Healthcare will now have until July to repay it, said Lisa Wolfington, an Inova spokeswoman.

An October letter to the hospital's interim chief executive, Joseph Ruffolo of Pitts Management, from Inova's Chief Executive Officer and President Knox Singleton states, "Inova provided the original loan for one primary reason. We hoped to help an essential, not-for-profit, community resource survive a critical and potentially disastrous financial situation."

Ruffolo had said he is pursuing possible new lenders, which include Bank of America, Potomac Valley, First Union, Crestar, Wachovia and Middleburg banks. Roberts said the hospital is "talking with different lenders, but nothing has been set."

Many doctors and community leaders said the loan is a crucial part of the hospital's attempt to regain its financial stability. The hospital needs better financial statements to apply for a certificate of need for more hospital beds at its already crowded Lansdowne facility.

Some doctors and patients complain of the hospital's crowded emergency room and a lack of beds. In the last two years, the number of inpatient visits has increased 25 percent while outpatient has increased 20 percent to 25 percent at Lansdowne, hospital officials said.

Roberts said the hospital is preparing to establish a "fast-track system" to expedite patient treatment in the emergency room. The system will separate practitioners treating those with minor injuries from those dealing with more serious needs.

"It would save time and cut down on the overall wait times in the ER," Roberts said.

She said the hospital plans to apply for more beds in June to keep pace with the county's growth.

Loudoun Healthcare also is in negotiations with a firm to redevelop 10 acres of its Cornwall site in Leesburg into a combined assisted-living and long-term care facility. Roberts would not comment on the negotiations.

In addition to the turnaround effort, Pitts Management is overseeing Loudoun Healthcare's search for a permanent CEO and president.