Defending Palm Drive

[Gus diZerega]

Last night I drove over to Palm Drive Hospital to join the candle light vigil protesting its closure by its elected Board of Directors. Even though it was 11:30 on a Sunday night it looked to me that over 100 citizens were there. I did not bring paper to make notes, and was holding a candle anyway. But what we were told was important for all of us to know and here are the high points as best I can remember them.

• The Board made the decision to close Palm Drive in a closed session. Such decisions are required by law to be held in open sessions. When reminded they had broken the Brown Act for public meetings one replied “Nobody enforces the Brown Act.” This means their actions were not accidental, they were a deliberate and unapologetic flouting of the law and the people who elected them. What are they hiding?

• Our Police Chief, Fire Chief, and DA all oppose the closure of Palm Drive. When the Board reportedly asked the police to plan on arresting peaceful demonstrators, they were told no way. The DA, Jill Ravitch, said don’t bother, I won’t prosecute.

• Those who know the hospital best, its physicians, believe they can run it on a sustainable basis. They have well over $1 million in funds raised to back them up. The Board argued that these physicians were not capable of providing the level of care that patients needed.

• Many physicians and nurses have made it clear they are willing to work for some weeks free in order to get the hospital up and running again since the actions of the Board are making this task much more expensive than it would be if they acted as genuine supporters of the community and of the people who elected them.

• Doctors and nurses will be providing emergency room service to people who need it from a desk set up in front of the hospital entrance. Other doctors have volunteered their offices nearby for those needing it.

• Many doctors and staff plan to refuse to leave the hospital when it is officially closed at noon, and will stay at their posts. Palm, Drive is a public building, not the property of a lawless Board of Directors serving some instated goal far removed from the well-being of the community that elected them.

• Palm Drive is being terminated when the closure of Hwy 116 at night is in the immediate future. Cal Trans will begin working on improving the bridge, and in the process limit the road to one lane while working. This will add considerably to the time it takes for ambulance service from Santa Rosa. Night time health issues will become much more threatening than day time ones.

• Any one thinking doctors cannot run a hospital because managers have secret skills mere mortals lack need to take a look at the history of worker run enterprises, the closest major example of which is the Alvarado Street Bakery. They generally do better than the corporate suit-run ones. Palm Drive is closing because the Board that mismanaged it is refusing to let anyone else prove it can be done better.

Not every Board member is acting against the interests of the people of Sebastopol and West County, but a majority is. All need to be contacted continually, politely, and incessantly, and urged to do the right thing and adopt ohe physicians’ plan to keep Palm Drive afloat. If they cannot do this they should do us all a service by resigning.

The Board members’ email addresses are:

Nancy Dobbs <[email protected]>

Chris Dawson <[email protected]>

Marsha Sue Lusting <[email protected]>

Sandra Bodley <[email protected]>

Again- the thing we need to do is not aggressively denounce them, one member supports us and another seems to have moved in our direction. From what we were told last night, only one more needs to shift. Community pressure, polite but unrelenting, is what is needed.

[Jean-McG]

In all public discussions the Board of Directors refers to a Hospital. In so doing it applies sttandards associated with that definition. At the very least, let's use this existing resource to develop an ER for critical care & stabilization. Seems to me there was much more energy around drive up service that some don't want than keeping a life saving gem that already exists here. Our local treasure; local employees; local families; local business. Makes absolutely no sense to toss it away. Jean

[Dianala]

I totally agree with Gus. Pay attention to what the District Board members are really up to. One or two of the district board members has/have a hidden agenda that must come out in the open. Ask them what their plan is that was formulated behind closed doors without public knowledge or comment. I am extremely disappointed in some of the elected district board members whose integrity is seriously compromised.

Write to these Board members now!

Last night I drove over to Palm Drive Hospital to join the candle light vigil protesting its closure by its elected Board of Directors. Even though it was 11:30 on a Sunday night it looked to me that over 100 citizens were there.

...

The Board members’ email addresses are:

Nancy Dobbs <[email protected]>

Chris Dawson <[email protected]>

Marsha Sue Lusting <[email protected]>

Sandra Bodley <[email protected]>

Again- the thing we need to do is not aggressively denounce them, one member supports us and another seems to have moved in our direction. From what we were told last night, only one more needs to shift. Community pressure, polite but unrelenting, is what is needed.

[Jerry Green]

I sent this out today:

Begin forwarded message:
From: Jerry Green

Date: April 28, 2014 4:45:32 PM PDT

To: Nancy Dobbs , Chris Dawson , Marsha Sue Lusting , Sandra Bodley

Cc: Tui , [email protected], Joan Marler , [email protected]

Subject: Palm Drive Hospital: Local Management?

I'm a resident of Sebastopol for 14 years now, and have followed the ups and downs of Palm Drive over this period. I was privy to a conversation last night among others who were concerned about its closure, and I shared about having met PDH administrators at least twice, and on each occasion the CEO was employed by an out of state hospital management company. I said it was easy to see why local ideas may not have appealed to an out of state manager.

I am left wondering if the Board ever considered hiring a director in order to collect and implement local resources to develop a plan for the hospital's continued survival. Though I find it hard to believe this hasn't been considered, I am writing to offer this suggestion in the event that I may be wrong.

You can't expect a local solution to come from out of state management.

Jerry A. Green, JD
Greener Mediations
Medical Decisionmaking Institute
Post Office Box 72
Graton, CA 95444
707.824.4344
https://www.medagree.com

[Dustyg]

I am disturbed at the closed door actions of the Board. I have felt for some time, based on some extraordinary expenditures by the Board in the last few years, that we do not benefit by having this Board of Directors in place. Of course the doctors can run this hospital, and the community supports it. We need to have a community minded Board in place too. Let's start from scratch with a new Board. And, to the old Board, thank you for your service, and now we need to move on without you in a new direction.
Signed, A concerned citizen and longtime user of Palm Drive Hospital.

[Eller]

Just sent my emails off. Hope others do too.
Eller

[Dustyg]

I've contacted each board member by email too. dustyg

[courtneyarnold]

Just sent my emails. Posting this thread to Facebook, too.

[Imagery]

Perhaps I'm completely off-base here, but want to add my in.
What has the objective of this hospital been for the last several years? In 2009, when I had my first heart attack, I wound up in the ER at Palm Drive. They had me transferred out of there for an expensive (and I considered it unnecessary) drive to Sutter within a couple of hours. Why? I felt the level of care I was receiving at Palm Drive Hospital was adequate, and they (Sutter) didn't even bother with the stent installation for another month.
At that time, I had a BMW policy (better than a Cadillac policy) for health insurance, so payment was certainly not an issue.
Each time I've been there, it's been a "stabilize and transfer" station. If they had to justify each transfer as much as they seemed to have to justify keeping me locally, they'd still be in business. I'm certain I don't have all the facts, and am not expressing my opinion like I do have them.
Please enlighten me...

[Richard Nichols]

There are many reasons for the Palm Drive closure, but none of them are based on the hysterical "dereliction of duty", "remove them from office" attacks on the Board. Hospital finances are very difficult to understand and for reasons beyond me the CFO didn't even tell the Board that the hospital was totally broke and $6 million in debt until March. The rules governing hospitals are also complicated, so any last minute fix proposed was to late. The hospital is so broke it can't even pay PG&E.

That said, the BOD wants to see it reopen, the burning question, is there any business plan that makes sense in this miserable, broken medical system? If you read the Time Magazine article on the last year on the medical system, it explains how crazy the billing system is.

Anyway, everyone wants the hospital open. I'm 72 and 3 minutes from the ER, which sounds good to me. So let us get over the accusations and look for a solution.

[Dustyg]

Hospital finances are very difficult to understand and for reasons beyond me the CFO didn't even tell the Board that the hospital was totally broke and $6 million in debt until March. The rules governing hospitals are also complicated, so any last minute fix proposed was to late. The hospital is so broke it can't even pay PG&E.

Again, I wonder, who is minding the store? How is it possible that the CFO didn't mention these drastic finances (if true). Doesn't the Board hire the CEO, and isn't that CEO accountable to the Board. And the CFO must be accountable to the CEO at least. I just think the hiring issues with CEO's has been out of whack for a couple of years...there was, and this my memory isn't great any more, something related to a $55,000 pay for a temporary CEO a couple of years ago. For a month? Or was it more?

I still believe we need new policies and definitely a new Board of Directors for Palm Drive Hospital. We need this hospital and we need people who are involved and good stewards to guide its future.

[Richard Nichols]

Trying to remove the BOD comprised of very good community oriented people would be a huge, painful distraction from the real issue of how to get this thing straightened out and get the hospital opened. Everyone, including the BOD, wants that.

... I still believe we need new policies and definitely a new Board of Directors for Palm Drive Hospital. We need this hospital and we need people who are involved and good stewards to guide its future.

[Dustyg]

This Board of Directors, God Bless 'em, has been in place for some time and we have gone from the frying pan into the fire. I do believe we need new leadership, new stewards, to guide us prudently into the future. I don't believe it is a distraction at all, but one of the elements that is not functioning well and needs review. It's like saying that a tenured teacher, even though no longer an effective teacher, should stay in place just because of tenure. Let's make some changes for the better, that is one of the things Sebastopol is known for...the courage to change things that need to be changed.

[Richard Nichols]

I respect and understand this point of view. If you can prove that this BOD is in dereliction of duty, that they caused the financial failure, then I would agree. But the fact is that the hospital has been in trouble for years and this BOD did not create that, they just inherited it.

This Board of Directors, God Bless 'em, has been in place for some time and we have gone from the frying pan into the fire. I do believe we need new leadership, new stewards, to guide us prudently into the future. I don't believe it is a distraction at all, but one of the elements that is not functioning well and needs review. It's like saying that a tenured teacher, even though no longer an effective teacher, should stay in place just because of tenure. Let's make some changes for the better, that is one of the things Sebastopol is known for...the courage to change things that need to be changed.

[Dustyg]

I have not said that the BOD is responsible for the financial situation. However much it inherited, I don't know, but what they did inherit they have not managed or resolved in a positive, prudent way. And I don't know just how much that was, perhaps more than you are willing to acknowledge. Why are you so attached to this BOD? They are decent people, no doubt, but they are not making decisions that move the hospital in positive direction. Only in March did they find out how disastrous the finances are? What's with that?????? If they were managing a small private company, they'd be out of business...

[carolb]

I have not said that the BOD is responsible for the financial situation. However much it inherited, I don't know, but what they did inherit they have not managed or resolved in a positive, prudent way. And I don't know just how much that was, perhaps more than you are willing to acknowledge. Why are you so attached to this BOD? They are decent people, no doubt, but they are not making decisions that move the hospital in positive direction. Only in March did they find out how disastrous the finances are? What's with that?????? If they were managing a small private company, they'd be out of business...

I understand the frustration and the desire to replace the Board, but the question is, replace them with what? Those behind the recent negative campaigning would replace the current elected District Board with the board of a nonprofit Foundation, whose members are not elected, but select themselves. The District Board, because it is elected, has to follow the state Brown Act and hold meetings in public, make financial documents available to the public and so on. A nonprofit Foundation would not have to follow those rules (although they say they will) and can meet in secret if they like. They have no duty to be transparent with the public..

[Dustyg]

How transparent has this Board been? It was not even aware of the state of the finances of the hospital until March. Who was minding the store? Replace them with whom, you wonder? Well, Sonoma County in general, and West County/Sebastopol in particular, have a population of creative, conscious, community-minded people who are generally well educated--if not formally then certainly wise in the ways of the world. Let's be creative and do some new thinking....a doctor run hospital could work. Sebastopol had the first all-green City Council in the United States, and we have been first in many other ways too. We have the courage to step up and do the right thing. We need an effective, accountable Board of DIRECTORS, effectively directing our hospital into the future.

[carolb]

How transparent has this Board been? It was not even aware of the state of the finances of the hospital until March. Who was minding the store? Replace them with whom, you wonder? Well, Sonoma County in general, and West County/Sebastopol in particular, have a population of creative, conscious, community-minded people who are generally well educated--if not formally then certainly wise in the ways of the world....

I'm not arguing, but the people you mention need to stand up to the plate and run for election. What I'm trying to say is if you have publicly elected officials, you have some rights, however feeble. If you have a privately run hospital, you don't even have that. A doctor-run hospital would be a privately run hospital.It's just a case of whether ratepayers want any say in hospital operations or not. Maybe that's not important. And of course there's the whole overarching question about whether the economics and demographics will support any kind of hospital, or whether we need to focus on keeping an emergency room or an urgent care center or something like that.

[carolb]

Just FYI, the Board got rid of the out of state management company about 18 months ago. We have had a local CEO at the helm since September 2012.

...You can't expect a local solution to come from out of state management....

[dominus]

My husband had a hernia repaired at PDH. We found the medical care and service to be outstanding. Without any question, we need a hospital in this part of the county. Is it realistic to hope that a consortium of doctors could take over PDH?

[Gus diZerega]

I don't pretend to be an expert on Palm Drive, but I am bothered by the fact that the Board made its final decision in secret and think it likely the doctors have more knowledge than anyone else how to make the hospital solvent while keeping it effective. Many seem quite confident they can do the job- why not let them try?

My husband had a hernia repaired at PDH. We found the medical care and service to be outstanding. Without any question, we need a hospital in this part of the county. Is it realistic to hope that a consortium of doctors could take over PDH?

[Dustyg]

I agree with the last two posts. Why not let them try? They have a vested interest in keeping Palm Drive gonig and healthy, and so does the community. We've done the traditional, current Board of Directors, and when all is said and done, for whatever reasons, the hospital is on the verge of a shutdown, certain insolvency.
Let's try something different...we certainly have the resources in doctors, technology, and a caring community who want their local hospital to be here, be well. The Doctors take an oath to do no harm, so should the Board of Directors. When in doubt, go to the community. The closed door work the Board has been doing is against transparency and community. Let's get going on a new tack; let's let our doctors direct our hospital.

[Richard Nichols]

While docs may be qualified to treat patients, that does not mean that they are qualified to run a business.

My husband had a hernia repaired at PDH. We found the medical care and service to be outstanding. Without any question, we need a hospital in this part of the county. Is it realistic to hope that a consortium of doctors could take over PDH?

[Gus diZerega]

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?

While docs may be qualified to treat patients, that does not mean that they are qualified to run a business.

[Richard Nichols]

I could do without the rhetorical flourish about whether I would have no hospital at all.

The point is to find a way to get the place back on its feet, but none of this is easily solvable given the complexities of law and finances and the broken medical system. Do doctors really have facility operations expertise? I'm sure some do, but I'd guess that's the exception.

The cooperative idea sounds interesting, but within a cooperative there are still different skills. A good bakery, for instance would have good bakers, a good book keeper, a good personnel person and so on. A cooperative hospital would be the same: a surgeon goes surgery, a janitor does cleaning, an executive does management. And they all cooperate to make it work.

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?

[Gus diZerega]

Not just a rhetorical flourish. The directors have closed it. So far as I know the only people who have offered a plan to keep it open are the doctors who work there. I imagine doctors are aware of the need for other skills you mention - and since it is not a cooperative of the Mondragon sort,they can hire people to do the work, very much like what is done today. Maybe even the same people.

Why do you think doctors cannot figure this out and hire people to do that work?

In my opinion buying into the supposed necessity of business organization as usual has two severe costs. It blinds us to alternatives even when they are very successful and it encourages us to think that managers have special talents that other people cannot hope to approach, hence justifying their obscene salaries.

It even seems able to blind people to the point of preferring closing it down to trying alternative organizational structures proposed by the people who work there.

I could do without the rhetorical flourish about whether I would have no hospital at all. ....

[carolb]

Just wanted to point out that the doctors' proposal (YouTube: Palm Drive Hospital, A New Beginning) increases the number of managers in the hospital administration. Now, Palm Drive has a CEO and a CFO. Under the proposal, there would be a CEO, a CFO, a CAO and a COO.

[Gus diZerega]

The issue is not managers, the issue is whether they are so special that the rest of us mortals should be subservient to them while paying them princely incomes. Managing is an important skill but it does not mean they should be superior to the rest of us.

I am not an expert on Palm Drive finances, nor do I want to become one. But that the alternative at this point seems to be closing it or having doctors run it, and since variants of that approach have many successes in different contexts, why not try it?

The resistance to the doctors' proposal mystifies me. People praise their professional care and judgment but assume they are incompetent in terms of business. Yet the professional mangers have not done a very good job or it seems to me we would not be in this situation.

Why oppose giving them a chance? What is really going on here?

Just wanted to point out that the doctors' proposal (YouTube: Palm Drive Hospital, A New Beginning) increases the number of managers in the hospital administration. Now, Palm Drive has a CEO and a CFO. Under the proposal, there would be a CEO, a CFO, a CAO and a COO.

[carolb]

Maybe we're talking about two different things. I have absolutely no problem with the idea of doctors running the hospital, and I support the idea of cooperatives. The problem I have -- and that's why we may be talking about different things -- is with the proposal now being considered that calls itself a physicians' proposal but would actually have the board of a nonprofit foundation run the hospital. There are no doctors on the board of that foundation.

The issue is not managers, the issue is whether they are so special that the rest of us mortals should be subservient to them while paying them princely incomes. Managing is an important skill but it does not mean they should be superior to the rest of us. ...

[dominus]

I imagine a big part of the problem is that each hospital has a certain amount of beds which must be filled and if they are vacant due to lack of need, there isn't enough revenue coming in to pay the bills. This can't be an isolated experience. It has to be happening elsewhere as well.