Defending Palm Drive

[carolb]

Sorry, I misspoke. It is an 11-member board that is being proposed to run the hospital. One of the board members is a medical doctor and one is a PhD.

... There are no doctors on the board of that foundation.

[Gus diZerega]

I am not in any sense an expert or deeply informed on Palm Drive's specifics. I attended the night time vigil because I had heard about the doctors' having come up with a plan for keeping it open and wanted to suupport them for twoi reasons. First, Palm Drive is a extremely important part of Sebastopol and West County. Second, the record of organizations managed by those who work for them is very good. One physician spoke at the gathering and explained that he and other doctors had developed a plan where physicians would essentially run the place and the Board for whatever reason preferred shutting it down.

The doctors were putting their time where their mouths were, as in keeping ER connections going in front of Palm Drive.

I trusted and am trusting their ability to know the institution's needs better than I ever will, and likely better than just about anyone else.

Given that the alternative as presented is closing Palm Drive, my position is to trust the doctors' judgment. If they cannot manage it, the place will close down anyway. They and Dan Smith claim the money exists to finance their plan. I take their claims seriously both because Smith has donated a great deal to keep it going in the past and because the Board apparently made its final decision in a meeting closed to the public.

But I am not privy to the details of their proposal- only to the way it has been presented to those of us at that meeting.

[Rustie]

Well said Gus, thank you - I suspect that we might find privatization at the root of the boards actions & decision.....

Petaluma has the Alvarado Street Bakery. Been around 30 years. Bakers run it. They make about $80K a year and their CEO gets no more than 3X the lowest paid worker. They manage just fine in good times and bad and have far less technical education than any doctor.

In Spain similarly operated worker managed businesses range all the way from Europe's largest R&D operation that works in nanotechnology and with Microsoft to a university to one of Spain's largest (and most solvent) banks.They have done this for over 50 years. The Mondragon Cooperatives number about 80X worker members along withn many other worker cooperatives operated on somewhat different principles. The magnificent art museum in Bilbao was built by worker cooperatives.

I imagine doctors can do as well with an operation in which they have both expertise and maximum personal stake. And as I understand it it is far less radical than these successful examples of worker management,

And the business types have not exactly impressed anyone with their expertise or even respect for the law with their secret meetings.

But perhaps you would rather have no hospital at all?

[Richard Nichols]

The Hospital is a public institution and the voters would have to approve privitization. That charge has no basis.
The BOD was forced to close becuase the hospital ran out of money. The question is how we can help get the hospital open. No easy answer to that one, but I do believe attacking the BOD is a waste of time. They are intelligent community oreinted volunteers.

Would somebody help us understand what the Foundation proposal involves. All I know is that the foundation would run the hospital, but the BOD would be responsible for what?

Well said Gus, thank you - I suspect that we might find privatization at the root of the boards actions & decision.....

[Dianala]

One piece of information I heard at the vigil is that the current District Board has their own plan to replace all current staff with an outside clinic for urgent care at the hospital site. The existing clinic already operates in Occidental and this would be an expansion of their business. If this is true, shame on the Board for not presenting their plan to the public well ahead of closing the hospital down. This is in violation of their mandate to oversee the hospital, which to me includes CARING about the doctors, nurses and staff. And, who knows how this violates the Brown Act. The Board needs to come clean with what they have been planning asap. If this is an unfounded rumor, clear it up now!

[Richard Nichols]

There is so much information and rumor flying around that I really don't know what to believe. I do know that there are good people on the BOD and I find it hard to believe that they have purposely created this mess.
So please, those making accusations, give us some evidence and not just accusations. I also call on the Board to clarify thier actions.

[carolb]

Thank you! Now I understand better what you mean. Great!

I am not in any sense an expert or deeply informed on Palm Drive's specifics. ...

[carolb]

You can read the entire proposal by Googling Palm Drive Hospital, A New Beginning, It will take you right to it. It's easy to read, a lot of ideas.

...Would somebody help us understand what the Foundation proposal involves. ...

[Dianala]

Yes, I think that is the Foundation's proposal and idea sharing. What is the District Board's plan?

You can read the entire proposal by Googling Palm Drive Hospital, A New Beginning, It will take you right to it. It's easy to read, a lot of ideas.

[carolb]

Yes, we'd all like to know that! I think they are planning on holding community meetings.

Yes, I think that is the Foundation's proposal and idea sharing. What is the District Board's plan?

[Rustie]

It is my understanding that the board already thumbed their nose at “the laws” that supposedly govern them when they made their decision to shut down Palm Drive in a closed session. Why the unlawful secret session?

It is also my understanding that the board was not forced to close the hospital. There was a proposal on the table which included $1 million in financial backing. The boards' argument against the physicians proposal was that the physicians could not provide an adequate level of care to meet patients needs. So how does no hospital meet those needs?

If I may speculate for the purpose of addressing the requirement of voters approval for privatization – how long would Sebastopol residents hold out against privatization with no local emergency services or facility?

With all due respect Richard I believe that your position suggesting that the BoD have acted beyond reproach has little basis. Thus far, in my opinion, the board has not acted honorably. They first hold an illegal closed session then, flippantly respond to the people when questioned about their actions in violation of the Brown Act. Secrecy breeds contempt, I think it unwise to deem the consideration of the possibility of malfeasance on the part of the board a waste of time, but that's just me.....

The Hospital is a public institution and the voters would have to approve privitization. That charge has no basis.
The BOD was forced to close becuase the hospital ran out of money. The question is how we can help get the hospital open. No easy answer to that one, but I do believe attacking the BOD is a waste of time. They are intelligent community oreinted volunteers.

Would somebody help us understand what the Foundation proposal involves. All I know is that the foundation would run the hospital, but the BOD would be responsible for what?

[Richard Nichols]

I never said they acted beyond reproach. Under certain circumstances elected boards can meet in closed session. I honestly don't know the situation. My main point is that they don't deserve a public lynching. Energy is better spent on trying to fix this awful mess.They have nothing to gain by closing the hospital and were forced to do it by the simple fact that the district is broke. I believe they are open to finding a solution, but given how complex the issues are, it won't be easy, and just throwing more money at it won't work.

...With all due respect Richard I believe that your position suggesting that the BoD have acted beyond reproach has little basis. ...

[Dustyg]

I do not believe anyone is 'lynching' the Board. We are reviewing their conduct, their leadership, the results of their 'direction' of Palm Drive Hospital. According to the reports we read, among other decisions that did not serve us well, they had hired people from out of town at princely salaries to manage the hospital. It is prudent, in light of the drastic circumstances of a closed hospital (which the community wants and needs to have open and running) that the decisions that have been made (or not made) by this Board have not served the hospital or the community well. Let's move on with some new ideas. ASAP.

[Rustie]

To my knowledge this was not one of those circumstances in which the board could meet and act in a closed session. Furthermore they were aware of that fact and yet they chose to act in violation of the laws that govern them. How do you know that they do not deserve “a public lynching” or more aptly stated, to be replaced, if you are not willing to examine the possibility?

As I have already illustrated in one possible example, there could be a great deal to gain by closing the hospital if privatization is a consideration. In fact if the simple fact is that the district is broke privatization might well look more appealing than a community “co-op” facility operated by local physicians, nurses and other medical professionals.

One unlawful closed session has left us with no local hospital facility. I think it prudent to keep a close eye on the board, ask hard questions, demand complete transparency and be willing to consider their replacement.

I never said they acted beyond reproach. Under certain circumstances elected boards can meet in closed session. ...

[Barry]

You can read the entire proposal by Googling Palm Drive Hospital, A New Beginning, It will take you right to it. It's easy to read, a lot of ideas.

Here's the proposal Carol is referring to:

https://ehrinternational.com/PDPhysi...einventPDH.pdf

As for my , I can't speak about management structures aside from I like the idea of at least 1 active Dr. sitting on the board.

My house is around the corner from Palm Drive, and I'm getting older, so I really like that it is there. But that said, I think it should only be offering services that are not duplicated at the Santa Rosa hospitals unless the closer location is critical, rather than merely convenient. And the service should be emergency triage and stabilization and then transported to Santa Rosa if needed/appropriate.

It can also services that are not offered at the Santa Rosa hospitals.

Location dependant services that come to mind are:
- Cardiac/stroke triage
- Birth Center (If we were planning a hospital birth for my second daughter, she would be been delivered someplace on Hwy 12!)
- Urgent Care
- I'm sure there must be others where the 30 minutes can make a difference.

Unique services that come to mind include:
- Advance alternative and complementary medicine
- telemedicine

I'm OK with the current level of public support. If more support is needed, I think more oversight is needed as well.

[Dustyg]

I'm upset. We still have a Board of Directors, but no hospital. I believe we should have a hospital and excuse this Board of Directors....we need a new start without them.

[Richard Nichols]

What's new, everyone is upset. I don't think excusing the BOD will help, but others do. Since the hospital district requires a BOD, who will take their place?Energy better spent on finding solutions. We can get some form of the hospital back probably.
How about a Kaiser satellite?

I'm upset. We still have a Board of Directors, but no hospital. I believe we should have a hospital and excuse this Board of Directors....we need a new start without them.

[Dustyg]

While this BOD was at the helm, we went from operating to out of business. What is the problem with replacing this BOD. West County, Sebastopol, has a plethora of talented, successful, thinking, conscious people who have been leaders...both quiet and extrovert....we have the talent...what on earth makes this person think that this current BOD, who steered us into closure, cannot be replaced???? Stop and think for a minute! Look around you....check out our history here....we're known for courage and the willingness to do the right thing..certainly not how our current BOD is known. If it works don't fix it, but if it doesn't work, FIX IT.

[Rustie]

Kaiser satellite - that would be privatization now wouldn't it..... and please explain to me how that would address the emergency and medical needs of the entire community?

What's new, everyone is upset. I don't think excusing the BOD will help, but others do...

[jbox]

I'm upset. We still have a Board of Directors, but no hospital...

At this point I'll settle for a property tax refund.........though I bet the taxes everybody pays for Palm Drive go on for another 30 years regardless of whether it is open or shuttered. Good money spent badly long ago.

[Bryan]

I volunteered with the Hospital starting in 2000 on and off for over 10 years, although not in the recent 3-4 years. Some of what I understand is based on talking with folks I know there.

I spent a lot of time after the earlier bankruptcy helping the CEO and the CFO work through the financial problems exacerbated by their computer system.

I learned a lot about healthcare finance. I see the issues of private insurance companies and government medicare are played out nationally with major local consequences. Most insurance compensation to hospitals is based on medicare - did you know that your insurance uses medicare rates plus some percent above to reimburse your doctor and hospital? We are all effectively getting medicare 'plus' now while people want to think they are paying for better, 'private' insurance.

When the current Board learned in March that their financial projections from the financial staff were wrong, they found themselves in crisis. From what I understand, they owe $6 million more than after the last bankruptcy. When I hear how 'we were profitable recently', I have to wonder how then did we need to borrow $6 million? I assume because we needed to borrow.

There were apparently significant changes recently in Medicare reimbursements substantially lowering rates to hospitals. That trickles down to private insurance reimbursements eventually since they follow the leader.

Additionally, much if not most of the money coming from our taxes was borrowed against during the earlier crisis. During several weeks, the PD BOD held executive sessions to review their situation. They brought in outside advisors - which is NOT the first time this happened at PDH. They were already in management contracts with Marin General but that couldn't fix this situation. PDH has tried numerous times to partner with other hospitals, starting with Warrick (now closed and being converted to SAY project).

The BOD did not violate any Brown acts afaik, as they OFTEN have executive sessions to discuss business issues that require the entire board in session but some privacy just like a regular business.

Eventually they must reveal the nature and results of these closed door sessions.

While I believe that this closure was a huge issue, folks should not all act completely surprised.

Palm Drive has had declining business while costs keep going up. The current board did not borrow against the taxes but they didn't have that resource to continue to buttress up the finances. While PDH does get money based on utilization, it does not have any financial equity in some of the profitable practices that use the hospital. Instead, it is reliant on insurance reimbursements. So if a main practice is effectively outpatient, but the hospital is staffed for beds, there is a huge gap in business structure. I know there were recent cutbacks (Jan 2014?) but really the hospital needed to be recreated with different restrictions. Many of the existing requirements of a hospital were created 30 years ago to keep doctors from draining off profitable surgeries. It seems to me PDH, by having our ER, fell into a financial trap over time due to legal requirements that were never meant to damage small hospitals. Rural designation was an issue with getting lower medicare (and insurance) rates, although I don't know if that was ever resolved in PDH favor either.

When a business BOD is repeatedly told that things are fine by its financial staff, and then find out that the bottom has dropped out, and they have no resources to turn to , a closure is almost inevitable.

I do believe PDH needed to more aggressively build its business - but I see plenty of people who needed to actively work on that, not just the BOD or the CEO. However, the competition from Sutter (who put an office into Sebastopol to drain patients to its own hospital) and Kaiser is quite fierce.

Now, I believe the board should make arrangements with the foundation to reopen the hospital.

I am not personally involved in any of these discussions. I do know the foundation really needs some cash in the bank to reopen. I believe Dan Smith and his wife Joan Marler recently made a strong financial commitment at the recent Sebastopol city council meeting. They should be congratulated for stepping up again to help.

I also know that the hospital really needs the various doctors to have a stronger direct stake in the finances. Otherwise these doctors will have to turn to the bigger players in Santa Rosa for their practice. Many local doctors struggle financially, while others are doing well due to how our insurance decides who to pay and who not to pay.

Together they would be stronger if they chose to see the need to build a business together, as opposed to the existing model. As an optimist, I hope that the local doctors, ALL the doctors, now see that they can work together to build their own business under the Foundation.

Right now, much of the local business is being drained away by Kaiser and Sutter. Memorial is now also positioning itself to take the rest - if Memorial leases out PDH, for an urgent care, we won't have our emergency room and the 'profitable' surgeries will be done in Santa Rosa. Local doctors may close as they prefer to be close to a hospital where they can visit patients that are admitted. Note that under Kaiser, your doctor will never visit you in the hospital - they assign a hospitalist to act as your doctor for everyone on the floor.

I also strongly support changes in state laws to exempt small hospitals like Palm Drive from the very expensive add on requirements of an emergency room. I have talked with 2 legislative aides of Marc Levine, our assemblyman, who is very willing to help PDH and waiting for us to let them know what is required.

I don't know if the foundation has put together a list of changes /exemptions to these requirements.

I also support moving to a more Kaiser business model and hope new insurance vendors like Western Health can more fairly compensate small hospitals. Parity is a big issue as bigger chains get more money from your health insurance than small independent hospitals. When PDH lobbied Sacto about 10 years ago for parity, we got our *ss handed to us by the insurance lobby in those hallowed halls.

I don't know exactly what is holding up the new deal with the foundation. To my mind, this is a simple business transaction requiring due diligence on the part of the board. Given that most of the staff was already employed directly by the board,
they have done that work. There is liability as always, but as a public agency, the board has a lot of protection and also carries its own insurance. I feel their concerns should be in writing to the foundation so it has an ability to resolve outstanding concerns.

I hope we all hear some specific issues around these negotiations.

[Victoria Street]

Kaiser satellite - that would be privatization now wouldn't it..... and please explain to me how that would address the emergency and medical needs of the entire community?

I am a Kaiser member and, I like it. It's consistent, streamlined, I know my costs upfront, and I know that I will receive care in an emergency. Is it perfect? Of course not! Do I feel frustrated sometimes? Sure! And sometimes I have had to go elsewhere, and pay for treatment (out of my own pocket) that they do not provide, but that is the rare exception. Their infrastructure is second to none. Their website, online appointment scheduling, drug refills, etc. is great. With Covered CA, my premium is now HALF of what it previously was (Thank you Obamacare). If you take a proactive approach in your own healthcare and go to your medical appointment prepared with questions in hand, you won't need to be in the doctor's office chewing the fat for hours! I would love to see Kaiser in Sebastopol. They have it together. Unfortunately, Palm Drive didn't, and as a payer of property taxes, I really dislike paying for an entity that really should have been taken off life support long ago...

[Rustie]

My point is not the pros & cons of Kaiser but rather the idea that a Kaiser satellite is not an appropriate replacement if you are attempting to service the entire community with local emergency services and a hospital that is open all, regardless of which health insurance pirate they have chosen.

Is it your intention to suggest that a private, member only facility such as Kaiser would be a valid replacement for the local, non-profit hospital that serviced the entire community? Is the notion that all Sebastopol residents in need of &/or desiring access to their local hospital should simply convert to Kaiser as their health care choice? But then that wouldn't really be a choice now would it.....

And since you brought it up – let's talk Obamacare..... I'm guessing you sing the praises of this bizarre legislation because you, and possibly many or most of your friends and colleagues have been in the class of lucky recipients of reduced premiums. This of course is not true for all people but good for you. However, has it occurred to you what is really happening in this paradigm? Your premiums have dramatically dropped because the federal government, by way of your tax dollars, is picking up the cost difference. No problem with that, better spent there than on funding the war effort, right? But think - where are those federal funded dollars going? Correct, directly into the pockets of the private health insurance industry's coffers. Long story short, we are subsidizing private, for profit health insurance conglomerates like Kaiser, Blue Cross, Blue Shield and Health Net, just to name a few in the very short list of participating insurance giants. This is one of the most blatant shill games of corporate welfare that I have ever seen and the public seems to be dancing in the streets with glee over their new low insurance premiums rather than screaming for National Health Care.

I am a Kaiser member and, I like it. It's consistent, streamlined, I know my costs upfront, and I know...

[Victoria Street]

My point is not the pros & cons of Kaiser but rather the idea ...

Thank you, Rustie, for your thoughtful reply. I am sorry you felt a need to be snarky. I was simply responding to your negative remark about a Kaiser satellite. Yes - Kaiser works for me. No - it is not a replacement for a community hospital. Yes - I am glad we have Obamacare. No - it is not perfect and I am sorry that not everyone directly benefits, including yourself. Yes - I am glad that more people than ever in the history of this country have affordable health coverage, including myself. No - I do not have a problem with "for profit" entities, as long as I am getting value for my investment. Yes - I would like to see a "nonprofit" community hospital flourish, but so far this hasn't been the case here locally, hence this discussion. Yes - Kaiser considers itself "nonprofit", but hell - you and I both know better than that! So please - before you go gettin' your tie dye all in a wad, just remember - I am not the enemy! I would LOVE to see a community hospital here locally. But it would need to be financially solid before I would willingly trust it with my life.

[treasure]

I live next door to Palm Drive Hospital and would be extremely disappointed if it turned into a Kaiser satellite. Would only be helpful to members of Kaiser, right?
treasure

What's new, everyone is upset. I don't think excusing the BOD will help, but others do. Since the hospital district requires a BOD, who will take their place?Energy better spent on finding solutions. We can get some form of the hospital back probably.
How about a Kaiser satellite?

[Richard Nichols]

I have no idea how a Kaiser satellite would work, but because PDH is a public hospital, something would have to be worked out.

Anyway, I just tossed the Kaiser idea into the mix to see if there are any coherent comments.

So far, other than a rant here and there, not much in the way of how it would work. Does anyone have any idea how such a thing could legally work? Maybe not at all.

For the sake of disclosure, I'm on medicare and I use Kaiser. Please don't jump on my case for that. I've been with Kaiser since I was a little kid.

I live next door to Palm Drive Hospital and would be extremely disappointed if it turned into a Kaiser satellite. Would only be helpful to members of Kaiser, right?
treasure

[Victoria Street]

I have no idea how a Kaiser satellite would work, but because PDH is a public hospital, something would have to be worked out...

Since Kaiser is funded by paying members, I can't imagine it being an option. So everyone CAN RELAX! In a recent article in the PD regarding the closure of Palm Drive, it mentioned low bed occupancy as one of the "problems". At first I thought "Great! People are healthier!", but of course, no, that wasn't it. People are choosing the larger hospitals in Santa Rosa (yes, like Kaiser for example...) Fine for those of us who make that choice. Not so fine when we need emergency care here. I wanted to support Palm Drive. I really did. I pay $188 a year with my property taxes to support them, which I voted in favor of twice. But the continual financial situation did not instill confidence in receiving quality care. I am not alone in this regard. People chose to go elsewhere. However - we still need a community hospital.

Can the doctors run it? Perhaps. How much more is it going to cost us? A hospital is not a bakery. I thought that doctors had enough on their plate - too much paperwork and not enough time for patients. How are they going to find the time and energy to run it? I'm not saying it can't be done, but rather than reinventing the wheel, it would be worthwhile to investigate other examples of doctor run facilities - both successful as well as unsuccessful. Only then, in my opinion, can intelligent dialogue take place.

[Rustie]

Sorry you refuse to respond to the actual content being posted and rather choose to presume non-existing perspectives and attitudes as a justification for your agenda. My initial comments were neither negative or positive about Kaiser they simply stated two facts 1) A Kaiser satellite would be privatization, a point I had previously presented which was addressed by some as not likely and thereby unreasonable to mention 2) A member-only facility such as Kaiser would not respond to the needs of the entire community. How you derive a negative remark about Kaiser out of that is beyond me.

My apologies for misinterpreting your previous comment that you would “love to see a Kaiser in Sebastopol”. I now understand that you do not think that Kaiser would be an appropriate choice to replace Palm Drive, thank you for clarifying that point.

Meanwhile you never bothered to address the government subsidy of the private health insurance industry that Obamacare is now providing. Instead you tried to turn this into a conversation about the acceptance of “for profit” entities and the value of investment. This is very disingenuous on your part. At no point in my discourse did I suggest in any way that I am an adversary of for profit business. I merely pointed out that the federal government, via Obamacare, is now utilizing public funds to subsidize private for profit entities, specifically the giant health insurance corporations. In my opinion this is inappropriate. I don't believe that our tax dollars should be given to private industries to ensure their bottom line profits and CEO bonuses.

This is not about investments for which you are getting value and it is offensive that you attempt to color it as such. An investment and any value derived from said investment is a personal choice – Obamacare is a federally mandated law. Aside from that subtle distinction it might behoove you to notice that your “investment” in the for profit health insurance industry is not providing you a value. Case in point, health care costs in the U.S. are double that of any other industrialized nation which has National Health Care. This reality is a direct result of our health insurance “for profit” model. And don't kid yourself that the value is in our outstanding medical services. The U.S. is ranked number 37 in the quality of care provided. That means there are 36 nations ahead of us, all with National Health Care, that provide better medical services for less money. You might want to re-think your investment strategy.

I don't see you as the enemy, I see you as misinformed and overly eager, as are many, to accept the rhetoric spewed by self serving interests to sell a fatally flawed health insurance system. Why do you accept the premise that a local community hospital must be independently financially solvent yet you are willing to subsidize the private health insurance industry? Under a National Health Care system Palm Drive Hospital would have never closed.......

And for the record, I personally did benefit from Obamacare and I don't wear tie dye.

Thank you, Rustie, for your thoughtful reply...

[Victoria Street]

Sorry you refuse to respond to the actual content being posted and rather choose to presume ...

1. This is a thread about Palm Drive - not Obamacare.
2. By "investment" I was talking about the bang I get for MY buck - be it medical or otherwise.
3. I support a national healthcare system. I'd wave it, but my magic wand is in the shop...
Sheesh...

[Rustie]

Singing the praises of a system designed by industry insiders and sold to the public by deception and lies serves only to divert attention away from our health care crisis and the vital importance of implementing National Health Care. The current system in this country that we pass off for health care has in fact a direct relationship to the closure of Palm Drive. We can't fix this situation without identifying the culprit destroying the machine. Conversations considering Kaiser, or similar institutions as a replacement, rather than our local community medical professionals, is the antithesis of supporting a national healthcare system.

You don't need a magic wand. Just stop waving your staff of diversion by willful ignorance.

1. This is a thread about Palm Drive - not Obamacare.
2. By "investment" I was talking about the bang I get for MY buck - be it medical or otherwise.
3. I support a national healthcare system. I'd wave it, but my magic wand is in the shop...
Sheesh...