Sonoma West Medical Center

The Story of Our Hospital
A Personal Introduction
By Dan Smith

At the risk of stirring up even more confusion, I have decided to publish a series of short WACCO articles on Sonoma West Medical Center, a topic I know far more about than just about anybody. I won’t pretend that these are unbiased since I am obviously a big supporter of the hospital but will try to stick to the facts as I know them and expect that I will be corrected where I have made errors or missed important information. I also apologize for the length and likely readers might not be interested in all of the details now that we are the sound bite generation, but at least this material will be available for those with a curious mind.

By way of introduction, I was the Chairman of the 35 for Palm Drive, the community group that bought the hospital in 1999 to save it from closing. I was also the primary architect of the district and served as its first board chair in 2000, a role I left in 2001 when it became far too political for me. I was not involved in the hospital from that point until 2007 when it first went into bankruptcy. I spent the next 3 years getting it out of bankruptcy and it had a $5M net profit in 2010 when I was president of the board. During that time, my wife Joan and I donated about $2M and I served as a volunteer business advisor and later as the board chair.

I left the board in 2011 when it again became very political. In 2014, when the district voted to close the hospital, I along with hundreds of others tried to convince the board to keep it open and offered $3M to do so. After the closure, many of us got together and developed a plan to reopen it, which was accomplished in October of 2015 after some difficult political fights. I am currently the board chair of Sonoma West Medical Center Inc., the non-profit that manages the day to day activities of the hospital.

During these tumultuous times, I have been roundly criticized in the press and by anybody who wanted to see the hospital closed permanently. As an imperfect being and having an aversion to politics, some of this criticism is likely appropriate, but much of it has not been about me so much as an attempt to keep the hospital from opening by attacking its major benefactor. I have been repeatedly asked why we have worked so hard to have our hospital and though the answer has many layers, I would offer the following:

Like a lot of others, I have personal experience and have read the statistics that show that having and Emergency Room close to your home, schools, and businesses can mean the difference between life and death or recovery and disability. A Hospital is part of a system that includes police, firefighters, physician offices and other hospitals and therefore serves the regional community as well. In West County, it is one of the largest employers and brings many millions of dollars to the local economy. For all these reasons, it makes no sense to me to pay taxes for a closed hospital if you can have an open one and the best way to see if you can have an open one is to try.

My wife and I have committed the majority of our net worth to opening the hospital, (far more than we originally planned) but don’t have any regrets even if the hospital proves to be unsustainable over the long term. We have at least given it a chance to succeed and at present it appears that it will in spite of the difficult birth it has had and the continued opposition from a minority of the community.

While I respect other people’s opinion that we don’t need a hospital and others who say that a hospital is simply not viable here, there has been all manner of misinformation spread around to support these views much of which is misleading or just plain false. My hope is to spread at least some light on the subject at a time when there is yet another election that pits supporters against detractors of the hospital so that voters will understand what they are choosing.

The first of these articles will follow this post. After responding to comments, I will post another article and invite others to join me with their own. I expect that there will be plenty of comments and only ask that we can be as civil as possible as it does not serve us as a community to jump into the gutter together. If you want to engage in personal attacks, I would appreciate it if you start your own thread.

The Story of our Hospital
Part 1: Why Urgent Care Isn’t an Option
By Dan Smith

Once again, candidates for the Palm Drive Health Care District are advocating to close our Emergency Room and replace it with urgent care. This is not the first time this argument has been made by people who have little understanding of healthcare delivery in West County.

First, lets talk about the practical differences between Urgent Care and Emergency Care: Urgent care is typically defined as care that you need in the next 24-48 hours whereas emergency care is for a condition that needs immediate attention. As such, urgent care is not a ‘replacement’ for emergency care, but a replacement for a scheduled doctor’s office visit. Urgent care facilities are therefore not held to the same licensing requirements as Emergency Rooms and are generally not as well equipped or staffed as an Emergency Room. In California, urgent care centers can’t accept ambulances no matter how trivial the patient’s condition is.

In modern hospitals, Emergency Rooms are almost universally staffed with board certified ER physicians whereas urgent care is normally staffed with family practice doctors or nurse practitioners. In California, an Emergency Room must also have a full range of ancillary services attached including, laboratory, imaging, pharmacy, surgery, and beds for overnight stays. Basically, an ER has to be a part of a hospital while urgent care can be in any doctor’s office. If an emergent patient comes to an urgent care facility, they must call 911 for an ambulance and have the patient taken to an Emergency Room.

While an Emergency Room can handle everything an urgent care does, urgent care can only handle a small percentage of what the ER does. So the argument that is being made to replace our Emergency Room with urgent care is really saying ‘we don’t need an Emergency Room.’ Having personally seen many lives saved in Palm Drive’s Emergency Room, I can tell you that this is simply not true. We need our Emergency Room more than ever with the long waits at the Santa Rosa hospitals and our aging population.

One thing to be aware of is that 85% of the people who go to the SWMC emergency room get their on their own and the other 15% arrive in an ambulance. A lot of the 85% have been sent to the ER after speaking with their family physician or seen them in their office, and who has made a determination that they need emergency level care, not another doctor visit. This continuum of care from the family physician to the hospital Emergency Room and back to the family doctor is what provides the best outcomes for patients. This is why family physicians and Emergency Room doctors work so closely together, something that is difficult to achieve if the ER is in another city.

There are other reasons that urgent care is not viable in West County as follows:

· There are currently 2 urgent care centers in Santa Rosa with one open seven days a week, both of which see adult and child patients. If you are willing to drive a bit, you'll find another 3 urgent care centers within 20 miles of Santa Rosa in places like Rohnert Park, Windsor, and Petaluma.
· Sebastopol Physicians already provide urgent care in their offices 5 days a week and often with extended hours. Family doctors are on call 24/7 and often see patients after hours and on the weekends.
· In general, Urgent Care facilities only work financially if they are attached to a hospital and then only if there is a large enough population of patients, who do not have a family practice physician. West County does not have this condition. Most West County residents have a family doctor or are part of the Kaiser system and the rest can go to the Santa Rosa or Rohnert Park urgent care facilities.

I find it very troubling that the candidates advocating that the district subsidize urgent care are already aware that 24/7 urgent care comes with a big price tag for little real benefit. In 2014, Memorial Hospital proposed to provide 24/7 urgent care in Sebastopol if the district would provide $2.2 million every year, more than twice what the district is spending to have a full hospital! Urgent care is therefore not really a plan but a smokescreen for killing the hospital.

The Story of our Hospital
Part 2: How Taxpayers Got the Deal of the Century With Sonoma West Medical Center
By Dan Smith

Candidates for the Palm Drive Hospital Board have tried to inflame opposition to Sonoma West Medical Center by claiming it has lost over $11 million from operations since startup. The implication here is that taxpayers are getting screwed by supporting their hospital. but the real story is much different as follows:

1. What hospital opponents call losses are really the startup costs that have been invested in refurbishing the hospital, buying medical equipment, supplies, IT systems, drugs, hiring staff and physicians and every other aspect of opening a hospital. Very few businesses can be expected to be profitable in their first year so having losses associated with startup is more common than not. It also should be understood that hospitals are likely more expensive to launch than any other business and that SWMC has pulled off a coup by doing it for as little as it has. (Another hospital operator estimated it would take $30-40M to reopen Palm Drive Hospital.)

2. Of the money spent to open the hospital, less than 10% came from tax dollars and almost all of this was spent on bringing the building up to current earthquake standards (something that should have been done years ago) and purchasing equipment the district now owns. So the portion of money the district has provided has been invested in its own assets, not ‘given’ to the hospital’s operations.

3. While the cost of startup was higher than anticipated, no additional money was asked of the district to cover these costs., all of the additional money came from donations or borrowing (for which the district has no obligation.)

4. The other 90% came from private and foundation donations, a large portion of which was invested in upgrading the building and equipment, which I remind you belong to the district, not SWMC. Inc. Therefore, the district gained value by having an upgraded building paid for by donors. This is a very important point; the district has actually made a profit by having the hospital reopen, not lost money. Only SWMC Inc. has ‘lost money.’

5. Sonoma West Medical Center Inc. (the non-profit now operating the hospital) has assumed all liability for expenses related to running the hospital. This means that the district has no financial obligation beyond the $1M a year it has pledged to the hospital (Which by the way is only 25% of the taxes it collects every year.) In the case of a failure of the hospital, the district has no obligation to creditors, employees or physicians arising from the running of the hospital. (It is important to note that Jim Horn has tried to claim that the district would be liable even though both the district’s legal counsel and SWMC’s counsel have repeatedly affirmed these facts.

6. Sonoma West Medical Center Inc. has also agreed that if it ceases to operate the hospital, any equipment it has purchased becomes the property of the district. This means that the district will own and be able to use or sell any of the very expensive medical and IT equipment that SWMC has purchased with donations.

7. Under the Management Services Agreement, Sonoma West Medical Center Inc. cannot retain any profit from operating the hospital. SWMC Inc. only has the right to recover its cost of starting and running the hospital. Once it has recovered its costs, any profit will accrue to the district, not SWMC Inc.

8. The Hospital has received a donation of a Laboratory Information System (LIS) from a local company. This system has a value of $100,000.

9. The hospital has also received a 5-year donation of the Hospital Information System (HIS) HarmoniMD that is in use at the hospital. Ray Hino, the former CEO valued this donation as a $5M benefit to the hospital. While hospital detractors have claimed that this represents a conflict of interest, a future article will cover this.)

What you see here is that the Palm Drive Health Care District has actually received a financial gain by having its assets improved and gaining assets paid for by donors. Not only that but the value of the hospital was greatly enhanced by reopening in a timely manner. Otherwise, the license would have been lost and the hospital would just represent an outdated and empty building with no license. If a hospital operator was to be interested in buying it today, it would be worth far more to the district and its taxpayers as an operating hospital.

While there is no guarantee that the hospital will be viable over the long term, there is no reason to write it off at this point and every reason to support it since it is now developing well and showing great promise of being sustainable. It is also serving an important role in the county because there is a bed shortage across the whole region.

The reason we taxpayers got a great deal, and the reason we have an open hospital right now, and the reasons that people's lives have been saved in the reopened hospital during the past year is because of the generosity and enormous time commitment of Dan Smith and Joan Marler.

On behalf of the thousands of us who benefit from your sacrifice and commitment, I want to say thank you to Joan and Dan.

I have talked to many of our neighbors during this election season. I am shocked at how misinformed folks are about the basic funding facts around the reopening and the current hospital. Here's the skinny:

1) We pay the SAME tax whether the hospital with its life saving emergency room stays open or is closed.

2) This tax has remained constant as a contribution to the hospital of $1 million per year; while the other $3 million from our tax revenue pays bond service on the debt and administration of the District bureaucracy and funding to other health care services in West County.

3) This $1 million is less than 10% of the losses this past year.

4) Most of the losses were due to the need to re-locense and reopen the closed hospital, an irresponsible decision made by the former Board majority. The 90% of these costs were borne by private funding, much of it Dan and Joan's donations.

5) Urgent care is NOT emergency room care. Urgent care facilities cannot by law accept ambulances or provide life saving care. The West County Health facility in Sebastopol does NOT take new patients. or walk-ins, REGARDLESS OF URGENCY OR NEED! The West County health facility in Sebastopol, which the slate wanting to close the hospital and their political endorsers believe needs to replace our reopened hospital, is NOT open seven days a week or nighttimes. It is NOT a replacement for the life saving emergency room of a hospital.

6) It is shocking that anyone would run on a platform to CLOSE OUR HOSPITAL AND EMERGENCY ROOM and continue to take our tax dollars for other purposes.

Yet this is what Jim Horn. Marsha Sue Lustig and Eira Klich-Heartt say they will do if they are elected to the Palm Drive District Health Board.

7) it is even more shocking that any elected official who cares about the people of our city would endorse candidates who want to close this hospital and deny emergency room care to thousands of their neighbors. Yet Sebastopol Council members Una Glass (likely our next mayor!, Robert Jacob and John Eder are supporting Jim Horn and his plan to close the hospital, as all three listed as endorsers on Jim Horn's campaign website here.

8) Vote for Gail Thomas and Rob Cary for Palm Drive District Health Board this November, and let your friends know that if we want an emergency room for our community, we need to elect members to the Palm Drive District Board committed to opening our hospital--not the scheme to close it down.

Posting on WACCO is not what I do but I do read the posts of others pretty much every day. I don't remember ever posting before. But as a 30 year resident of Sonoma County and one of the thousands whose life was saved at Palm Drive Hospital or Sonoma West Medical Center, I am sadly baffled by those who have such a negative attitude towards those who have spent their fortunes and their spirit to offer the rest of us these life-saving services.

With an office on Main Street, I've been very mindful of the miracle that is Sonoma West Medical Center now that it has reopened, with the roaring sirens of each ambulance that passes by. I suffered when our hospital was closed, worried what it would be for one of my family to get to Santa Rosa in an emergency from my family's home out here on Burnside Road. Now that our emergency room has reopened I am reminded every day of this little miracle, and often several times a day, as yet another ambulance flies down Main Street with a patient aboard headed to our local beloved hospital.

Keeping a hospital open during this time of such turmoil in our health care systems throughout the state and the nation is no easy task. The trials and tribulations that we have faced here as a community are not unique to this community. What is unique is the dedication of Dan and Joan, two of our neighbors, who have fought both with their spirit and their pocket books to help assure that we have a hospital to go when we find ourselves needing a quality emergency room.

Demonizing anyone who has helped make this happen saddens me deeply. I know it's complicated, I know that some people feel as if somehow they have been harmed in some way that bewilders me compared to lives saved, but take it from me whose life was saved by the presence of this hospital, it is a blessing. It has been a blessing to so many of us, and therefore to us as a community, and we should feel both proud that we've come this far, and grateful to those who have made it their mission to provide this for us.

I say to Joan and Dan, thank you from the bottom of my heart.

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Posted in reply to the post by farmerdan:

The Story of Our Hospital
A Personal Introduction
By Dan Smith
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Donna,

Thank you for your kind words.
At this point, I do not take personally the attacks in the paper but I think it is important to understand why people have been opposed to the hospital and in my mind, roughly they fall into these categories (or combination):

1) People who are angry that their tax dollars have been mismanaged by the district. This is very understandable to me as I have the same feeling even though I was on the board twice in the last 16 years. By 2009, I came to realize that the real problem was the Structure of the District. Here, you have 5 volunteers often with no business background much less hospital management trying to run a very complex, competitive and highly regulated business. This simply does not work. While we could all be angry at the board members who drove the hospital into the ground (twice), really the problem was with the structure, not the people.

In 2011, I tried in vain to convince the board to turn the hospital over to Adventist Health to no avail because 3 board members with no hospital management experience refused to even discuss it. AH was very interested and if this had happened, it would have saved the hospital from closing. The best solution in my mind was to create a management structure that did not allow abuse of the tax dollars, which we have done.

2) The River corridor and Kaiser members who feel that they get no benefit front he hospital (now that Sutter is at the end of River Road.) You can understand this logic even though SWMC still gets about 15% of its patients from the River and many transfers from Sutter. Though this has been driven mostly by large landowners who own many parcels along the river, the detachers have thought that having the hospital open would make it more difficult to detach so what better way than to attack the benefactor.

3) Former Board members who mismanaged the district and closed the hospital (and their friends including the newspaper owner.) These are the most personally hostile of the bunch since we have had to do battle with them to keep the hospital open and they are connected to West County politics in a way that has city council people voting against the city's interest. (You would be very hard pressed to find ANY city council person in ANY other city endorsing a candidate who wants to close the hospital, but we have it here!

4) People who want to get their hands on the district's tax money. These people are working behind the scenes and promoting 'alternatives' to the hospital for the district to spend its tax money on (in some cases themselves) and are well connected into the political scene here and at the county level.

But adding all of these up, you would still get a very small minority of the community if people were well informed. Unfortunately, the press has been on its own mission against the hospital, mostly I think because of 3 above. What is really important to understand is that the hospital is not about Joan and I, it is by, for and about the whole community. We are just a part of the puzzle that makes it great and it is therefore not important what people say about us.

Rob Cary said that while he was campaigning in front of the market on Saturday, 4 different people told him that their lives were saved since the hospital reopened. This is what we are here for.

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Posted in reply to the post by farmerdan:

The Story of our Hospital
Part 1: Why Urgent Care Isn’t an Option
By Dan Smith

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Being somewhat new to this area I have been quite surprised to see controversy among people concerning the future of the Sonoma West Medical Center and its Emergency Room. According to a study conducted by UCSF closed emergency rooms results in more people dying.

The facts are:

Higher Chance of Hospital Death Found in Areas Where Emergency Departments Have Closed

New UCSF Study Finds Emergency Department Closures Hurt Surrounding Communities as Well as Patients

First published on August 04, 2014

In the first analysis of its kind, UC San Francisco research shows that emergency department closures can have a ripple effect on patient outcomes at nearby hospitals.

In a study of more than 16 million emergency admissions to California hospitals between 1999 and 2010, researchers found that patients who were admitted to facilities located in the vicinity of an emergency department (ED) that had recently closed experienced 5 percent higher odds of dying than patients admitted to hospitals that were not near a recently closed ED.

The odds of dying were even higher for patients with certain time-sensitive conditions, especially heart attack (15 percent higher odds), stroke (10 percent) and sepsis (8 percent). The findings are of particular concern nationwide, said the authors, because the annual number of ED visits increased by 51 percent between 1996 and 2009, while the number of available emergency departments dropped by 6 percent.

https://www.ucsf.edu/news/2014/07/11...ts-have-closed.

If all of the energy that has been expended attempting to destroy the hospital were devoted to helping it be successful it would be very successful and an even greater asset to West County!

Nearly 40 years ago while a Graton Firefighter, one night we were chasing around after an arsonist. He lit a grass fire down on Laguna Rd (I say he because almost all arsonists are male this one was never caught). We charged down there and put out that fire. By the time we got the Laguna Rd fire out we get a call for another grass fire on the other side of the district.

The arsonist’s coupe de gras that summer night was to set a giant stack styrofoam like blocks ablaze. The plastic molding company at the corner of Graton and Ross roads used to use giant styrofoam blocks to make their forms. They were about 3’ by 3’ by 10 feet. They were stacked up 20 feet high in a huge pile and were really ripping with leaping flames and dense black smoke by the time we arrived.

This was a dirty trick by the arsonist as the plastic factory was only 200 feet from our firehouse but he had us and most of our equipment half way across the district. It was a difficult fire to extinguish as it was hard to get water to the center of the pile and that stuff burned like crazy. I don’t remember if we ran out of Scottys (air packs) or we were just being cowboys and didn’t wear them or both but we inhaled a fair amount of smoke.

Chief Smith (no relation) after speaking with the plant manager and getting the material data safety information decided we all needed to get to the ER post haste. Sufficient exposure to the smoke from that material could lead sudden drop in blood pressure, unconsciousness and death. So we packed into ambulances and some of our fire trucks driven by fire fighters who came on scene later that had not been exposed to smoke and headed code 3 (high speed, lights and siren) to the all available ERs in the county (other than Petaluma or Healdsburg) They were too far away to do us any good. I still remember that ambulance ride. It felt very wrong to be a firefighter with all my gear on and be on the wrong side of the rescue.

Five or six guys were transported to Palm Drive, six or seven to Memorial, myself and five others were transported to Chanate. We took up every ER bed in the area. They monitored our vital signs for what seemed like ever. In the end none of us were seriously injured . I wonder if the fire district got a group discount that night.

The point of recalling this story and observations.

Point 1 it doesn’t take that much of a mass casualty event to fill up every ER bed in the county. It’s not if but when and how many people will need treatment in such an event. Hospitals do have plans for mass casualty events that exceed their normal limits but you don’t want to go there unless you absolutely have to. When chaos reigns it rains hard.

Point 2 The population of the county has probably come close to doubling in last 40 years. The ER beds have not. If you consider Chanate is gone and those beds have been replaced by Kaiser’s that’s a wash. We have the additional ER beds of Sutter but when Palm Drive closed we got down near the 40 year ago level.. So a great increase in population with roughly same number of ER beds we had 40 years ago if we lose Sonoma West Medical Center’s ER.

Point 3 We are being told that we need to settle many more residents in the West County, one of the potential supervisors suggests making duplexes from existing homes. At the same time the Sebastopol City Council candidates are saying we don’t need a hospital with an ER???? What is wrong with that picture?

Goat Rock Ukuele,

I (Sebastopol City Council candidate and Open Our Hospital advocate Jonathan Greenberg) could not agree more with your sense of dismay that there is indeed something very wrong with our current reality: that three current City Council members: Robert Jacob, Una Glass, and John Eder, all support Jim Horn and his shameful "close the hospital and sell the building" slate (which includes Marsha Sue Lustig and Eira Klich-Heartt) for Palm Drive District Health Board.

I am running for City Council on a platform that includes the creation of a special Sebastopol City Council sub-committee to assist our struggling hospital. SWMC is the only community hospital in the United States to close and then reopen. In an ever more bureaucratic world in which the decks of the health care industry are stacked in favor of big-city institutionalized hospitals, SWMC faces an uphill struggle, and should have the full ACTIVE support of our local government.

A number of local political insiders have sharply criticized me for suggesting that Sebastopol’s City Council can do more than the absolutely nothing it currently does to support our city’s largest employer. For suggesting, as I do, that the City ought to at least provide free water services to the hospital; it does not cost us anything extra, and if the hospital closes, there would be no water revenue coming from there anyway.

Imagine how it appears to County, state of federal officials when our hospital looks for programs or grants or funding streams without any active support from our local government. Sebastopol’s City Council should be energetic advocates of the hospital and its vitally needed emergency room. I reject the notion that our local government has no role, no power, or no responsibility, to assist this most vital of local public services.

Sadly, I am alone among the four candidates running for City Council who endorse Rob Cary and Gail Thomas in their race for Palm Drive District Board, to maintain a Board majority committed to keeping the hospital open. I am also the only candidate endorsed in my bid for Council by Dr. Jim Gude, Dr. Richard Powers, Dennis Colthurst, and Joan Marler.

Neither our current Mayor Sarah Gurney nor Council Member Patrick Slayter have yet made an endorsement in the Palm Drive District Board race, although two years ago, both of them joined with Glass, Jacob and Eder to endorse Jim Horn is his effort to block the election of the Doc and Cop (Dr. Richard Powers and Dennis Colthurst) and the successful grassroots campaign (which I was an active part of) to reopen our hospital.

In the current city Council race, Michael Carnacchi and I are the only two candidates who believe that our local government should create a sub-committee to assist the struggling hospital, and to provide subsidized water services.

Candidate Neysa Hinton and write-in candidate Craig Litwin (who is endorsed by Jim Horn backers Una Glass and Robert Jacob) would not answer questions about their positions on whether they would do anything to support the hospital, or the District Board candidates running to keep it open.

Hospital closer Jim Horn's list of endorsements (which can be read here) also includes Richard Nichols, the current leader of the ironically named 'Sebastopol Tomorrow."

It seems to me that Sebastopol now and for most of the past 70 years has included an open hospital with a life saving emergency room for our community, but Sebastopol Tomorrow has committed itself to a tomorrow in which Jim Horn sells the hospital building to pay down bankruptcy, leaving us with a health clinic that cannot accept ambulances, save lives, is closed nights and weekends, and refuses to accept walk ins who are not part of their health group.

This is not the Sebastopol of today, or tomorrow, that I, or thousands of our neighbors, wish to see for our public health.

That’s why I join our public interest community voter guide, Progressive Sebastopol, in strongly endorsing Rob Cary and Gail Thomas to keep our hospital open, and urge anyone reading this to vote for them!

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Posted in reply to the post by Goat Rock Ukulele:

Nearly 40 years ago while a Graton Firefighter, ....

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Thank You for that Jonathan. I don't live in city limits but a lot of folks I know and play ukulele with do. I will do my best to swing them your way if they aren't already there.

All The Best, Michael Smith

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Posted in reply to the post by Peacetown Jonathan:

I (Sebastopol City Council candidate and Open Our Hospital advocate Jonathan Greenberg) could not agree more with your sense of dismay that there is indeed something very wrong with our current reality: that three current City Council members: Robert Jacob, Una Glass, and John Eder, all support Jim Horn and his shameful "close the hospital and sell the building" slate (which includes Marsha Sue Lustig and Eira Klich-Heartt) for Palm Drive District Health Board....

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Why the plan to divert hospital taxes will not work:

In a recent opinion piece in the Sonoma West Times and News, Sandra Bodley, a current member of the Palm Drive Health Care District board puts forth the argument that the district should 'get out of the hospital business' and spend our tax dollars on other things. Like others, Ms Bodley has likely not carefully read the district's charter or the parcel tax language and thinks that the district can use our tax dollars pretty much for anything related to health care. Below is my response to her as posted on the Sonoma West Website:

Sandra,
Here are some of the problems with your argument that the district should 'get out of the hospital business' and spend its tax dollars on other things:

This is a quote from the LAFCO report on the Palm Drive Health Care District:
'Although the Health and Safety Code Section 1250 and Section 32000 et seq. authorizes many services including, but not limited to, general acute care hospital, acute psychiatric hospital, skilled nursing facility, intermediate care facility, congregate living health facility, nursing facility and authorized to acquire, maintain, and operate ambulances or ambulance services, the District is only authorized to provide emergency, acute care and other medical services.'

What this is saying is that the language that created the district narrowly defined the purpose of the district to 'emergency, acute care and other medical services.' Having been involved with the formation of the district, I can tell you that this was intentional and was designed to keep a district board from doing exactly what you are advocating; diverting taxes to other uses than the hospital and its supporting services.

Additionally, measure W, the parcel tax of 2004 defines the use of the tax to 'To ensure survival of Palm Drive Hospital and access to local emergency, acute care, medical and physician services, and provide for ongoing expenses, repair and improvements to equipment and technology.' This narrow definition was also designed to keep taxes from being diverted as you are proposing.

California law does not allow special taxes of this type to be used for purposes other than they were intended. The state constitution also clearly gives the power to modify or repeal special taxes to the voters. Rob Cary and Gail Thomas are only following the law when they say that without a hospital, there is no reason for the Palm Drive Health Care District (given its charter and the language of the special tax.)

I find it rather puzzling that you and the candidates you mention wouldn't take a lesson from the River Corridor, who put together a detachment (soon to be approved by LAFCO and even with Jim Horn's support) simply on the basis that Sutter is now closer. One should draw the obvious conclusion from this that with no hospital, the rest of the district will vote to detach or to simply close the district and likely to repeal the tax entirely.

I do agree that the district should not be in the position of managing the hospital, a job it has repeatedly shown it is incapable of. The district is effectively out of the day to day management of the hospital already since SWMC Inc., the non-profit has assumed all financial risk of the hospital's operations and is managing it. While leasing the hospital should be considered, it will likely be another year or two until anyone wants to take the financial risk away from SWMC Inc.

You claim that only your candidates understand health care but I note that all of the local physicians are supporting Rob Cary and Gail Thomas and none are supporting Jim Horn. The physicians are the ones who understand what we need in West County and it is a hospital emergency room with acute care.

My personal position is very clear; No Hospital, No Tax.

A Personal Thank You

We often talk about the hospital in an impersonal way but for the people whose lives are saved or who receive care, it is the most personal of experiences. Having recently had a surgery at SWMC after struggling for 2 years to get the hospital open, I have now had a very personal experience that has left me respectful of the expertise and compassion that is present every day.

In 2007, while looking for ways to enhance Palm Drive’s surgery business, I approached Dr. Mike Bollinger, the local orthopedist to see what equipment might be needed to improve care and increase business. Mike did not hesitate to say that he needed a surgery table for anterior entry hip replacement. We subsequently ordered the table, which cost about $85,000 and it was soon put to use. Except for the time the hospital was closed it has been in constant use ever since.

For those who are not aware of the art of hip joint replacement, there are two basic approaches, posterior (though the rear) and anterior (through the front.) Dr. Bollinger pioneered the anterior approach in this area and is now the recognized expert at this surgery. While not all surgeons agree (some are still in the dark ages), the anterior entry hip replacement has proven itself to be faster recovery, more stable and usually with a lot less pain. There are cases where the posterior entry is still necessary but these are now rare.

So of course when my right hip finally got to the point where I could not walk on it comfortably, I went to Mike, who scheduled me a few months out (his schedule is pretty full.) I have to say that the entire process of getting my hip joint replaced has been a breeze, including my three night stay in Sonoma West Medical Center. Joan was able to stay in the room with me for two nights but I was able to convince her to go home on the third so that she could rest better in our own bed. Just before the surgery, I asked Mike if he wanted an upgraded hip table but to my surprise, he said the old one was actually much better and has been upgraded over the years since 2007.

I won’t get into the details here but just want to publicly thank Dr. Bollinger, Kevin, Deutsche, his Physician Assistant, the OR team at SWMC, Dr. Denno (the hospital goddess), SWMC’s hospitalist, the nursing staff, and all of the support staff. After 2 and a half weeks, I am walking pretty normally though still with a cane for balance and have been going to physical therapy twice a week. Much to my wife’s distress I have been able to do a little tractor work in the last few days so things are definitely looking up.

The fact that we can get this level of care right here in Sebastopol is a blessing that we should never take for granted.

Dan, I am glad to hear that the operation was a success and that you are recovering well.

As I have campaigned and spoken to neighbors and fellow parents and seniors all around town, I found unanimous support for having a local community hospital with an emergency room that remains open. Nobody I have spoken with wants to see it close. We all feel safer since SWMC and its life-saving emergency room reopened.

Almost everyone finds it unbelievable that Jim Horn is again running for Palm Drive District Health Board on a platform of needing to sell or lease the hospital, close the emergency room, and reallocate our dedicated parcel tax dollars for other health services.

I have met not a single person, except current Board member Sondra Bodley, whom I debated on the hospital future in the town square during the farmer's market this Sunday, that supports this scenario.

That's why our Progressive Sebastopol voter guide urges everyone to vote for the only two Palm Drive Board candidates who are committed to KEEPING OUR HOSPITAL OPEN: Gail Thomas and Rob Cary.

Here is what we wrote:

This is by far the most important local contest of the 2016 election!
Progressive Sebastopol urges you to vote only for Gail Thomas and Rob Cary as though your life depends upon it, because, in fact, the lives of at least some of us in West County will indeed depend on whether the Sonoma West Medical Center and its emergency room remain open. Shockingly, a slate of three other candidates led by Jim Horn are running on the platform of closing our hospital, selling the building, and illegally diverting our tax revenue to other health services (those run by their political allies) that do not include emergency care. Yes, it remains a struggle to sustain SWMC in this day of institutionalized insurance consortiums controlling our choices. But we pay the same tax whether the hospital remains open or closed, and this is the first community hospital in U.S. history to close and reopen. There is no reason to vote anyone onto this Board who does not stand for helping the hospital that created this District to thrive.

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Posted in reply to the post by farmerdan:

A Personal Thank You

We often talk about the hospital in an impersonal way but for the people whose lives are saved or who receive care, it is the most personal of experiences. Having recently had a surgery at SWMC after struggling for 2 years to get the hospital open, I have now had a very personal experience that has left me respectful of the expertise and compassion that is present every day....

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Please vote for Gail Thomas and Rob Carey to join the 'doc and the cop' on the board. FYI, in case you didn't know, or forgot, Marsha Sue Lusting (who is running quietly, again) already led the previous board in 'quickly and quietly' shutting down Palm Drive Hospital with no involvement, notice to the community. Jim Horn also has the agenda of shutting down the hospital again. Why would we want either Lustig or Horn to 'guide' the hospital when they already have the agenda to close it down. VOTE THOMAS AND CAREY, we need our community hospital even though Marsha Sue Lustig and Jim Horn don't think so.

Re: Pt 3)
I note here once again that Sutter's bed count was reduced from 120 to 80 with the move to their new facility; If you live in the river corridor, know that you may be parked on a gurney in the Sutter ER hallway waiting for attention(common).
Detachment may be your choice, but please do your research to see how a hospital option in Sebastopol may be of benefit to you or a loved one some day.

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Posted in reply to the post by Goat Rock Ukulele:

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Point 2 The population of the county has probably come close to doubling in last 40 years. The ER beds have not. If you consider Chanate is gone and those beds have been replaced by Kaiser’s that’s a wash. We have the additional ER beds of Sutter but when Palm Drive closed we got down near the 40 year ago level.. So a great increase in population with roughly same number of ER beds we had 40 years ago if we lose Sonoma West Medical Center’s ER.

Point 3 We are being told that we need to settle many more residents in the West County, one of the potential supervisors suggests making duplexes from existing homes. At the same time the Sebastopol City Council candidates are saying we don’t need a hospital with an ER???? What is wrong with that picture?

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Unfortunately the Santa Rosa hospitals cannot always keep up with demand even with Sonoma West Medical Center being open. According to data available on the Costal EMS web site (Emergency Department Inundation and Ambulance Delays) in July of 2016 (the most recent month available) there were 35 people transported by ambulances to emergency departments in Santa Rosa who had to wait more than 30 minutes in the parking lot of the hospital before a staffed bed in the Emergency Department was available for them.

jomo,

Thanks for this info. It is important to remember that 85% of the people who go to an emergency room get their under their own power and many are just as sick as the ones arriving in an ambulance. This data is just the tip of the iceberg because getting in the door is just the first step in being seen in a timely fashion. This may take hours at busy times. I have a dear friend who spent 20 hours in the ED and only was admitted to the hospital when her family doctor arrived and demanded that she be given a bed.

Once you have been treated in the ED, if you need to be admitted to a hospital, there might not be a bed available (due to Sutter's downsizing). This can mean you wait in the ED another 10-20 hours only to get transferred to another hospital (by ambulance ride at your expense). SWMC is regularly receiving patients from Sutter who are in this status sometimes 2 a day. While Sutter would like to transfer to their Novato hospital, this creates hardships for patients and families. We will continue to do everything we can to keep our emergency room open and can only hope that the voters understand the importance of this election.

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Posted in reply to the post by jomo:

Unfortunately the Santa Rosa hospitals cannot always keep up with demand even with Sonoma West Medical Center being open. According to data available on the Costal EMS web site (Emergency Department Inundation and Ambulance Delays) in July of 2016 (the most recent month available) there were 35 people transported by ambulances to emergency departments in Santa Rosa who had to wait more than 30 minutes in the parking lot of the hospital before a staffed bed in the Emergency Department was available for them.

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In my opinion, it might be worth it to circulate fliers with facts about the need for SWMC emergency room, leading up to this election. This thread has been an invaluable source of information since it was begun by Farmer Dan. I appreciate everyone's input here. I live in Occidental & we have a rugged distance to travel before reaching Sebastopol. If the roadways are even passable, due to an earthquake or disaster larger than any we've ever had, folks in our outlying communities may not even make it to SWMC emergency. At least Sebastopol residents would have a chance. I couldn't even imagine not having emergency facilities in place at this late date. We've got a big one on its way--any day now...

I knew many folks who had worked for years as faithful employees at Palm Drive, whose employment ended without much notice. Legally they had a timeline that should have been respected. Respect wasn't accorded then & it looks like the people in charge back then, remain influential in being the agents of more community chaos and grief in the future. Why would anyone wanting to participate in the health, well-being and safety of any community, work against it by not supporting the need for something as basic as an emergency room?

Just to make clear that what I have been saying is shared at the state level, here is the conclusion from a 2015 study of California Health Care Districts. What is indicated here is that districts that do not run hospitals should be eliminated, not transitioned into general service health care providers. We have taken the first step by placing the day to day management of the hospital in the hands of SWMC Inc. the 501C3 that currently manages Sonoma West Medical Center.

'CONCLUSION
While the formation of hospital districts may have been a wise public policy in the aftermath of World War II, many of these entities are now struggling. Several districts that continue to operate hospitals are experiencing poor financial performance compared to privately owned facilities. Districts that close or sell their hospitals try to find new missions, but may not be doing so in a cost-effective manner.
Although run by elected officials, the accountability of health care districts is often much less than that of general purpose governments or school districts. Board elections are low profile affairs attracting limited voter attention. Board proceedings, budgets and audited financial statements are less readily available to the public.
Once bureaucracies have been created they are hard to eliminate. But extraneous bureaucracies hinder public sector performance. The state and county governments should consider policies that encourage healthcare districts with underperforming hospitals to close these facilities, transfer them to private not-for-profit agencies or place them under direct County supervision. Policy changes should also encourage the elimination of districts that no longer maintain hospitals. Office leasing, grant making and operating wellness centers are functions that can be performed by the private sector or general purpose governments.'