Deal Gives HCCA Right to Buy Tulare Regional Medical Center

Various documents mentioned in the article below are available to view, download, and print by clicking here.


In an agreement largely kept concealed since it was signed in May of 2014, the Directors of the Tulare Local Health Care District (TLHCD) have granted an exclusive right to buy all its assets — including Tulare Regional Medical Center — to the company it hired to oversee its operations.

Though the agreement, known as the Management Services Agreement (MSA), was signed by the Board of Directors and TLHCD manager and Healthcare Conglomerate Associates (HCCA) CEO Yorai “Benny” Benzeevi on May 29, 2014, it did not become public knowledge until sometime near the end of 2015. Of particular concern is an additional document signed by Benzeevi as HCCA’s representative, and the Board, on the same day. Known as the “Option Agreement,” that document’s terms grant HCCA the “irrevocable and exclusive” right to sign a 30-year lease to control all the District’s assets, including Evolutions Fitness Center, all five of its health care centers, its pharmacy, services center, X-ray center and laboratories, or to purchase them outright at fair-market value.

HCCA paid TLHCD $100 for the consideration.

The documents were signed by Chairwoman Sherrie Bell, Vice Chairman Dr. Parmod Kumar, Secretary Rosalinda Avitia, and members Laura Gadke and Richard Torrez on the District’s behalf.

HCCA Paid 130% of Employee Costs

The deal is even sweeter for HCCA, almost unbelievably so. In two other documents signed that day, the Board agreed to pay Benzeevi and HCCA an “employee lease payment” of 130% of “the salary or other base compensation but excluding, without limitation, employee benefits, insurance, …” and other employment-related costs. While Benzeevi, according to sources who wish to remain anonymous due to fear of reprisal, has allegedly said the additional 30% is to cover costs such as employee benefits, the MSA specifically states TLHCD will pay them. Bell, Benzeevi and HCCA have not responded to a request for an interview.

Making the deal sickeningly sweet for HCCA is an amendment to the MSA that allows HCCA to bank that 30% over-payment against the future purchase price of the District’s assets. That option can be exercised at the “manager’s sole and absolute discretion” at any time. It is not known if HCCA has already begun banking the payments against the purchase of District assets or if it is taking the District’s cash instead.

In November of 2014, all District employees were terminated and rehired by HCCA, and labor became a purchased cost for the District. During the fiscal year ending in June 2014, the District spent nearly $31.5 million on salaries and benefits, according to an independent auditor’s report performed by Armanino Consulting. For the fiscal year, 2015, the District spent only $11.9 million on salaries and benefits; however, its cost for “medical and other fees and services,” where employee contracts were listed, went up by $21.4 million, more than $1 million more than had been budgeted for salaries and benefits during that cycle.

Assuming the HCCA’s employment costs rival those of the District, the 30% payment it garnered for 2015 could be as much as $9.45 million above payments it already receives from the District. The term of the management agreement with HCCA is 15 years, and includes a $225,000 monthly payment to HCCA for its services. That number, however, has likely risen since the MSA was signed, triggered by riders in the contract, and it could now be as high as $269,000 a month. No documentation is available from the District, and HCCA and the District did not respond to a request for the information.

The agreement also contains an automatic 10-year renewal clause.

Can Buy Hospital at Any Time

Under the terms of the agreements, HCCA can exercise its option to buy the District’s assets at any time by delivering a written notice to the Board. There appear to be no other restrictions in the more than 200 pages of documents signed by the parties. It is not known if HCCA has exercised the option to buy or if it intends to do so. The option agreement specifically states it will not be recorded; though both parties were required to have the signed agreement notarized, and HCCA may record it at any time.

Further, the agreement allows HCCA to make a down payment on the purchase of the TLHCD’s assets of just $500,000. Its monthly payments would be $100,000 a month for the first three years; $200,000 a month for the next three years; and the balance would be paid over four years.

The agreements also allows HCCA to transfer this right to any company that buys its assets or with which it merges. It may also transfer those rights to another party with the District’s consent.

HCCA also has the right to purchase “all furniture, fixtures, equipment, supplies and other tangible and intangible personal property owned by the District and used in connection with the operation of the Hospital and the Clinics and the Other Facilities.”

A second amendment to the Option Agreement, also signed by the same District and HCCA representatives but not dated, requires payment of the District’s bond debt or the consent of the bond trustee before the transfer of assets can take place. The Option Agreement also requires voter approval of the transfer, but only if that approval is required by law.

Sale Wouldn’t Cover Construction Cost

Practical realities of the real estate market make it unlikely the District could recoup what it spent during the last seven decades to build Tulare Regional and its other facilities, should it be forced to sell. While the Option Agreement requires HCCA to pay fair-market value for the District’s property, that number would likely not come close to matching what it spent to build them.

According a legal expert familiar with similar situations but who wishes to remain anonymous, the value of TRMC could be very low. In 2008, a sell-off of seven hospitals in Southern California owned by Tenet Healthcare Corporation, all of them larger than TRMC, resulted in an average sale price of just $3.3 million. Only one of the hospitals, one on the campus of the University of Southern California, was sold for an amount nearing the $500 million cost of its construction.

District Asking for More Money

The revelation of the MSA’s terms comes against the background of recent turmoil at the TLHCD. The District recently discharged and replaced its medical staff, triggering a lawsuit with its former Medical Executive Committee (MEC). Despite the judge in the case declining to issue an order immediately reversing the decision, the lawsuit continues, with plaintiffs alleging the District’s action is not allowed by state and federal laws that require a separation of powers between the medical staff and the hospital’s administration.

The District was also recently the subject of an investigation by the Tulare County Grand Jury, which found, among other things, that the District had “routinely circumvented” laws requiring disclosure of how it spent $85 million in publicly approved bonds. The Grand Jury also found TLHCD’s Board “intentionally or unintentionally” misrepresented the District’s ability to fund the difference between the $85 million voters approved and the $120 million estimated cost of building its five-storey expansion.

Now, with the tower still unfinished, the District has decided to ask voters to allow them to float another $55 million in bonds to finish the project. At a meeting of the Board on March 29, it formally stated its intent to pay for completion of the tower with that $55 million bond issue. However, the scandals surrounding the District and its management team seem to have lengthened the timeline for going to the polls. The District originally intended to ask for voter approval in a mail-in ballot in August. The deadline for that ballot has passed, and the TLHCD did not file the paperwork required.

Controversies Continue

Like almost everything surrounding the District these days, the attempt to drum up community support for the bond issue has been touched by controversy. In support of the delayed bond issue, the District released a full-color pamphlet detailing the need to finish the hospital’s expansion project. While the pamphlet correctly states the hospital must meet state seismic requirements by 2030 or face closure, it also intimates failure to pass the bond will create “economic ruin” for Tulare with $100 million dollars in annual losses.

The source for that dire prediction is a study performed by the Center for Economic Development at California State University, Chico. A member of the community, another who wishes to remain anonymous to avoid negative consequences of speaking out, said he attempted to get the text of the study from HCCA and was rebuked.

“I tried to get a copy of this and was refused. I requested a copy from Bruce Greene (attorney for HCCA). Their excuse was it’s a privately-funded document,” the source said.

Benzeevi was named in connection with paying for the study, the source said. The source also called the study’s author at Chico, who confirmed it was funded privately by HCCA.

Community Letter in Question

Another controversy erupted in the form of a letter signed by 15 community leaders taking the California Medical Association to task for its opposition to the sudden replacement of TRMC’s MEC. The two-page letter is addressed to Dr. Steve Larson, head of the CMA, and declares the leaders’ support for the TLHCD decision to replace the MEC. It also threatens legal action against the CMA for attempting to intervene on its members’ behalf.

The letter sent to the CMA may not be the same one some of those who signed it were originally presented. The letter was apparently first circulated on or near January 17. The decision to remove the MEC was not made until a meeting held January 28. The letter to CMA is dated January 31. It is reported that at least three of the individuals who signed the letter have said the body does not match the letter they were asked to sign.

Francine Hipskind, executive director of the Tulare County Medical Society, said Tulare City Council Member Carlton Jones has confirmed to her the letter he signed and the one sent to the CMA are not the same. There appear to be two versions of the letter, one two pages in length and the other four pages long. The switch will not play into the MEC’s case against the District, Hipskind said.

“I have indeed spoken to Carlton Jones, but it wasn’t anything that would substantially do anything in one way or the other,” she said. “I have asked him to speak with whoever he thinks would be appropriate coming forth with that. It wasn’t anything that was new.”

Council Confrontation

Two of the other signatories have made statements questioning the authenticity of the letter, including Tulare Mayor David Macedo, who allegedly had a heated confrontation regarding it with former Tulare City Councilman and fellow signatory Skip Barwick. Sources report Macedo was upset the letter sent to CMA did not match the letter he was told he was signing. Macedo did not respond to requests for an interview.

Of the 15 who signed the letter, only Tulare City Council Member Maritza Castellanos, Tulare County Supervisor for District 2 Pete Vander Poel and Assemblyman Devon Mathis (R-26) have said the letter sent to CMA was the same letter they signed. Mathis’ office, however, provided a copy of the letter with spaces for two additional signatories who were not listed on the letter sent to CMA.

The others who signed the letter include Tulare County District Attorney Tim Ward; Tulare County Sheriff Mike Boudreaux; Tulare City Fire Chief Willard Epps; Mark Watte, chairman of Cotton Incorporated; Manuel Mancebo, CEO of Kings County Truck Lines; Larry Stone of Stone Chevrolet; Tony Taylor, president and CEO of Res.Com; former TLHCD Board member Rosalinda Avitia; and former Tulare County Supervisor Lali Moheno.

All of the signatories were contacted directly by the Valley Voice. Only Mathis, Vander Poel and Castellanos replied. All three said the letter sent to CMA was the same letter they signed.

The Valley Voice’s inquiry with Mathis office prompted a letter from HCCA attorney Bruce Greene that inaccurately describes the contact with Mathis’ office and frames this reporter as “clearly so biased he will go to any length to vent his frustration.” The letter threatened “immediate and severe consequences … if any such article is published.”

Greene has made no attempt to contact this reporter with regard to this. In his communication, he did make a statement about the questions about the authenticity of the community letter.

“This, of course, is absolute nonsense,” Greene wrote.

He did not state why he believes this reporter is biased or why he believes this reporter has “a personal vendetta against the hospital.”

Ignorant Board?

Several members of an unofficial group that opposes the actions of HCCA and the Board, and have been nicknamed the “Gang of Eight,” have reported they were told by TLHCD Board Chair Bell she had not read the entire MSA before signing it. Further, they allege she was not aware of the 130% payment or of HCCA’s option to buy the District’s assets. The serendipitous meeting took place at a local restaurant when Bell joined a conversation already in progress, the source said.

Bell did not respond to a request for comment.

“[One of the Gang of Eight] pulled out the contract. She admitted right there she didn’t know parts of it were in there,” the source said. “He went out and brought the contract back in. He showed her the 130% thing. That HCCA had first right of refusal.”

The source said Bell came close to tears during the confrontation. It has since been stated during a TLHCD Board meeting that Bell read the contract prior to signing it. There is, of course, no way to confirm this.

Still No Bond Audit

With so much fur flying near the intersection of Cherry Street and Merritt Avenue, one almost might not notice the TLHCD and HCCA have still not provided an accounting of how they spent $85 million in voter-approved bond funds. The Grand Jury recommended full release “without delay” to the public of how the $85 million in bond funding was spent during the period from September of 2007 to December 2015.

Al Aguilar, the member of the Bond Oversight Committee appointed to watch those funds, hasn’t forgotten. With his attempts to get Mathis to initiate an audit with the state Joint Legislative Audit Committee going unheeded, Aguilar has since turned to Assemblyman Luis Alejo (D-Salinas) for help. A future article in the Valley Voice will detail the results of this most recent effort for disclosure and transparency.

Requests for Help Ignored

In letters dated December 28, 2015 and January 14 of this year, Aguilar asked Mathis to request an audit of TLHCD bond funds. Mathis, Aguilar said, did not respond to his first letter. He later talked with Mathis during an event in Tulare. It was then, Aguilar said, that Mathis told him he would not ask for an audit of TLHCD because of his relationship with Benzeevi.

Mathis, Aguilar said, attended the event with his district director, Trevor Lewis, and staff member Grace Robinson.

“Both of those individuals came to Tulare for the MLK March. Trevor Lewis and Grace Robinson were the only ones with him,” Aguilar, a retired postal worker, said. “When we spoke, we (Mathis and Aguilar) were alone. I wanted to know if he’d received what I sent to his office and if he intended to go forward. That’s when he told me he would not because he owed Dr. Benzeevi a favor.”

Mathis, through his communications director, has denied the exchange took place.

“At no time did Assemblyman Mathis say that he owed Dr. Benzeevi a favor, nor did he refuse to look into a JLAC audit as has been alleged,” wrote Matt Shupe. “This is a local issue and should be pursued through all local channels first.”

Mathis did not respond to requests for interviews before the original article detailing Aguilar’s efforts to unearth information on TLHCD’s bond spending was published. Mathis has accepted multiple donations to his campaign from HCCA totaling at least $7,700, according to documentation Form 460. Mathis’ office also did not respond to questions regarding additional possible donations from HCCA, Benzeevi or their associates.

Mathis’ district includes parts of Inyo County, where the struggling Southern Inyo County Hospital District recently agreed to give HCCA control of its small hospital. The SICHD Board had been seated just three days before approving its deal with HCCA.

‘Transparency and Accountability’

While looking into how TLHCD spent that $85 million, Aguilar said he discovered, with the help of late former TLHCD CEO Bob Montion, that more than $130 million has so far been spent on the Phase 1 Tower Project. Montion put together a package of 21 exhibits detailing the spending, all of which were provided to Mathis when Aguilar made his requests. Aguilar has made the documents available to the Valley Voice, which intends to publish them on its website, ourvalleyvoice.com.

“What I’m after is transparency and accountability,” said Aguilar. “I want to know what happened to that $85 million. That’s all I’ve ever asked for.”

He chafes at the accusation he lied about his conversation with Mathis, and his frustration has led him to seek the help of Assemblyman Alejo.

“I’ve done a little research, and there’s another assemblyman who’s had the state do an investigation in Salinas,” Aguilar said. “I sent the letter off to him Saturday.”

Getting a clear and accurate accounting of TLHCD’s spending is the job he was given, and he intends to see it through no matter how much opposition he faces from the Board, HCCA and its attorneys. Aguilar was appointed to the Bond Oversight Committee by former TLHCD Board member Rosalinda Avitia, one of the community letter signatories, who he helped get elected.

“One of the things she was trying to do was find out where the money was going. The first thing she did was ask me if I wanted to be on the Bond Oversight Committee. The Board said no way,” Aguilar said. “She went to Dr. Kumar, (and said) ‘All the other board members get to choose two; I only want one.’ Dr. Kumar wrote a nice letter getting them to let me on the committee. Once I started asking for the contracts, the invoices, all the data I could get my hands on, once I started making waves, they wanted to get me off the committee. It came from the members of the committee and the attorney … (not Greene) that I was a loose cannon and causing trouble.”

As is their apparent reaction to anyone asking questions about the District’s business, HCCA’s lawyers threatened Aguilar for doing his job too well, he said.

“When they found out about it, their attorney sent me a letter saying there could be consequences. They are vicious. Everyone who stands up to the Board and says something is threatened,” Aguilar said. “Bring it on. Let’s bring all the laundry out. I kind of wish the Grand Jury had asked the DA to go after them.”

Meetings of the Tulare Local Health Care District Board are held on the fourth Wednesday of the month in the Allied Services Building’s Second Floor Conference Room 2, 869 N. Cherry Ave. The next scheduled meeting of the TLHCD Board is at 4pm on Wednesday, April 27. The public may attend.

In Depth: Tulare Regional Medical Center

31 thoughts on “Deal Gives HCCA Right to Buy Tulare Regional Medical Center

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  1. F—ing crooks. The whole bunch of them. Completely screwing the employees and the community😡 This is what we have seen coming for a very long time..

  2. Get there early because they bring in employees to fill seats so no one can sit down. A Manger was heard on her cell phone telling her employees to hurry and get up there to fill the seats. Also why not have a meeting at 6pm not 4pm so the average Joe could attend. They don’t want us to attend

  3. Excellent job guys ! Thanks for not being bullied by these thugs and unearthing the evil empire with all the local elected politicians on the take. Unfortunately , nothing is going to happen at the local level uNLESS the citizens of Tulare STAND UP .
    Great Civic duty , David & co !!

  4. commentors on this page are spreading false information. There were many employees at the meeting giving up their seats for public citizens to sit. A majority of the seats were already filled due to a meeting prior to the board meeting taking place. As a citizen you should be proud that employees want to attend the meeting for their hospital to stay informed and voice their opinions about hospital operations. They have just as much of a right to be there as you do.

  5. So tell me there are that many people who get off at 345pm, who don’t work normal hours 8-5 or 12 hour shifts. Or they are getting paid to be there. Hmmmmm really there are alot of employees there but funny how none will speak up wonder why.

  6. I would like to set the record straight regarding the 1/31/16 letter to the CMA signed by Willard Epps on 2/2/16 and then withdrawn on 2/9/16. On February 2, 2016 Mr. Epps was contacted by an ex -Tulare City Council Member and asked to sign a letter in support of Tulare having a hospital. The first thing he was shown was a signature page containing the names and titles of numerous elected officials and business people. Mr. Epps, signed above the line with his title as City of Tulare Fire Chief. After some thought he realized that his signature with his title could be mistaken as the City of Tulare Fire Chief Willard Epps was supporting the letter, when in fact he signed it as Willard Epps private citizen. On February 9, 2016 Mr. Epps contacted Mr. Skip Barwick and delivered to him a letter requesting that his name be removed from the letter to the CMA. The letter in part stated …”My support and concerns is for the betterment of the citizens of Tulare. These are my personal views and has nothing to do with my career profession.”… When the letter was given to Mr. Barwick he informed Mr. Epps he would give the letter to Dr. Benzeevi.

  7. Why are community members acting as board surrogates? Was Mr. Barwick circulating a letter before the upset of the medical executive committee? What did he know about it if the 7 new people just came forward. Was there a plan? So many things unanswered.

  8. Great article Dave and thanks to all of those individuals who contributed. Due to their lack of integrity, transparency and accountability ALL of the Board Members should resign and the service agreement with HCCA expunged. The service agreement between TRMC & HCCA is inconsistent with Resolution #832 adopted by the Board on April 17, 2013, specifically the Guiding Principles of the resolution for the selection of an appropriate affiliation partner: (a) Alignment with an affiliation partner that has the financial strength and operational expertise to promote the long-term financial and operational viability of TRMC; (c) Commitment to ensure completion of the medical tower expansion and commitment to future expansion as necessary to meet the needs of the district, etc., etc.. HCCA’s service agreement fails to make any financial contributions to complete the Tower and/or for any expenditures towards the hospital. Resolution #832 is a public document.

  9. Wait…your last article you sai Agular spoke with Alejo and he WAS asking for on audit. Now it’s change and Agular sent him a letter on Saturday? LOL. I called Alejos office, something you should have done, and they’ve never heard of Mr.Agular and have no intention of asking for an audit. Further, didn’t all the stuff Mr. Agular is upset about happen between 2010-2012? Did you happen to look into when HCCA wa hired. No you didn’t…clearly. I’ll save you the trouble. It was 2014. Can you say disconnect?

  10. So you removed my comment about Mr. Agular not telling the truth about Assemblyman Alejo? I guess we see that you do have an agenda and it’s not seeking truth.

  11. One typically does not see this type of investigative reporting on a local level, but Dave Adalian and the Valley Voice are your Tulare 60 Minutes and Dateline.

    I am a physician in Santa Clarita, 140 miles south of you, but this article caught my eye
    as similar financial takeovers of hospitals are occurring throughout the State. Healthcare facilities like Tulare Regional Medical Center are prime targets by ruthless business people so I ask Dave to keep “following the money.” This seems to go beyond the Tulare County Grand Jury, and may need scrutiny by the State Attorney Generals Office.

    Of major concern to me is the illegal ousting of the Medical Executive Committee (MEC) with replacement by those selected by the Board. This is a dangerous precedence which allows medical decision-making to be made by business people, and not by doctors. Citizens of your area should be mindful hospitals are now a businesspersons ATM, and they mightily strive to extract huge profits, and leave the community with poor patient care.

    Added to watching TV investigative reporting, I will now carefully monitor the Valley Voice and their incisive coverage by Dave Adalian.

    To assure quality patient care to you, your family, and the Tulare community, I hope you do too.

    Gene Uzawa Dorio, M.D.
    Santa Clarita, CA

    • I’m the editor/publisher, and I’d like to thank you for your kind words. It’s a complicated situation with many moving parts and Dave remains hard at the oars. We face some threats and dirty tricks–if you see “Steve’s” comments on this page know that in reality he is Devon Mathis’ (R26) chief of staff. As you know from reading the article, Mathis refused a request to put in for an audit.

  12. This is an excellent piece of investigative journalism! I would love to see the local news media report on some of this. I wonder how many Tulare people know what is going on.

  13. Just to be clear. I did speak with Mrs Hipskind. I did NOT say that the letter I signed was different then the letter in question. I told her I would have to compare the 2. I told her I saw 4 pages. A two page letter with 2 pages of signatures. I did make it clear to her that it was NOT my intent nor to I feel it’s my place to suggest who the Hospital hires and fires. I support our hospital as a community hospital. My intent was to help with the requirement of new, talented doctors. I DO NOT and WILL NOT support any intent to sell the hospital to a private company. If the community is or is not happy with the direction the hospital if going, it should be addressed to the board and the election or re election of the board members. As a council member, I am held to the same level of accountability to the citizens of Tulare

    • There goes Carlton doingj the CARLTON SHUFFLE! You always do this…. one step forward then get frightened and take one step back. Just so you know Carlton you are held accountable not just by what you say… you are held accountable by what you do. Many times actions speak louder than words.

    • How long will it take to compare the two letters? Do you know what was written in the letter you signed? Are you going to get back to us after you find out whether or not the letters are the same? Were you misled, or perhaps deceived, as to the meaning of the letter? Do you realize how very VERY important these issues are?

  14. 1.Tulare needs a hospital. 2. Tulare needs physicians who will be held accountable for quality patient care. There are so many things the public is not in tune with when it comes to how a Medical Staff works. 1. It would devastate the city of Tulare should this hospital fold. I have not seen one bit of support for just having a hospital and having some answers on how to keep this hospital alive. Just a lot of back and forth and gossip. 2. Yes all the doctors outside of Tulare are all about how a supposed illegal ousting of the MEC. No one knows the full details you can’t even speak to what has happened at Tulare Hospital. Hold those opinions and wherever you have privileges be a positive integral part of that hospital or leave if you don’t want to be there don’t just stand there and fight unless you’re fighting to make things better. Too many opinions about the wrong issues. Tulare’s Hospital can be better than any neighbor or big city we as Tulare Citizens need to support the move for a better hospital. All you naysayers get the heck out of the WAY.

  15. 1.Tulare needs a hospital. 2. Tulare needs physicians who will be held accountable for quality patient care. There are so many things the public is not in tune with when it comes to how a Medical Staff works. 1. It would devastate the city of Tulare should this hospital fold. I have not seen one bit of support for just having a hospital and having some answers on how to keep this hospital alive. Just a lot of back and forth and gossip. 2. Yes all the doctors are all about how there was a supposed illegal ousting of the MEC. No one knows the full details you can’t even speak to what has happened at Tulare Hospital. Hold those opinions and wherever you have privileges be a positive integral part of that hospital or leave if you don’t want to be there don’t just stand there and fight unless you’re fighting to make things better. Too many opinions about the wrong issues. Tulare’s Hospital can be better than any neighbor or big city hospital we as Tulare Citizens need to support the move for a better hospital. All you naysayers get the heck out of the WAY.

    • Everyone who has commented on this subject HAS SUPPORTED HAVING A HOSPITAL, WANTS TO KEEP OUR HOSPITAL, AND HAS GREAT RESPECT FOR THE MEDICAL STAFF AT OUR HOSPITAL. What we don’t like is the way this hospital board conducts its business. So no…the good citizens of Tulare have no intentions of “getting the heck out of the WAY”!

    • Lioness, you’ve commented that “No one knows the full details you can’t even speak to what has happened at Tulare Hospital”.
      So let’s get the full details, let’s have some transparency; that’s what most people seem to want. Nobody, that I know of, wants Tulare Medical Center to close. But people do want to know HOW it is being run. For example, is the hospital being run in a correct, fair and legal manner?

  16. I am an employee of Southern Inyo Hospital, I will not give my name for fear of loosing my job. I wonder if Board President, Mr. Fedchenko, could explain the fact that HCCA has “loaned” SIH a substantial amount of money? Apparently, the hospital will pay back the loan. However, HCCA has made no effort in their “management” of the facility to ensure the hospital will be able to pay it back.

    We have no positive administrative leadership here from HCCA and are afraid to question why.

  17. Before the sale can be approved to HCCA, the Tulare Hospital District (Citizens) have to vote to approve the sale. Did I miss this information in the article somewhere?

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