With Election Underway, No on I Holds Forum

Measure I proponents held signs and chanted outside the No on I forum. Tony Maldonado/Valley Voice
Measure I proponents held signs and chanted outside the No on I forum. Tony Maldonado/Valley Voice

No on Measure I advocates held a forum in Tulare on Wednesday, inviting Tulare voters to hear why the group believes Measure I, the $55m Tulare Regional Medical Center hospital bond, should be voted down.

These advocates were joined by their counterparts: Yes on I protesters held signs outside the site of the forum, the Olive Branch Masonic Lodge, and on the streets intersecting where the building sits.

The forum, which ran for two hours, was attended by roughly 100 people and featured nine speakers; each cited various aspects of the hospital’s operations, oversight, or contracts that, in their opinion, made the bond measure an untenable option.

Among the speakers were Bill Postlewaite and Alberto Aguilar, former members of the TRMC Bond Oversight Committee and Dr. Prem Kamboj, Deanne Martin-Soares, and Lonnie Smith, former members of the TRMC Board of Directors. Speakers were given questions by the audience to answer.

Dare to Compare

Postlewaite opened up the forum as its first speaker. He invited the audience to draw comparisons between Measure D, the 2005 $85m bond measure, and Measure I.

“Like Measure D, hundreds of workers are involved in Measure I, many of them paid. So, compare the two campaigns. Measure D was well documented, Measure I, no documentation for a $55m request. Measure D, funded by many donors,” Postlewaite said. “Measure I, funded by one large donor, an older Tularean. Measure D, hundreds of unpaid volunteers, Measure I, many paid workers. Measure D, passed by 83 percent, Measure I, many people are expressing concerns.”

“Tulare has a long history of supporting not only their hospitals but their schools, but voters have always expected to be well-informed regarding how the money was to be spent,” Postlewaite continued. “They won’t tell us what happened to the $85 million. They won’t tell us how the proposed $55 million is to be spent. We deserve better.”

The Other Suitors

Dr. Patricia Drilling, a Tulare dentist, spoke about the process by which the TRMC Board of Directors, and the Tulare Local Healthcare District, came to choose Healthcare Conglomerate Associates (HCCA) as its management partner.

Drilling stated that the board, at that time, had hired Medical Development Specialists, LLC — now known as Vizient — to field offers from companies interested in managing the hospital.

The board wanted, she said, a detailed history from each company: details of each facilities the companies had owned or operated, financial statements, details of each company’s experience and expertise in the industry, and track records of operational success. Instead, Drilling said, the board chose to partner with HCCA, which was legally formed two days after it was chosen.

Drilling also compared the fee structure the board sought, to what it ended up choosing: the board wanted to pay the potential suitors a management fee that scaled with the hospital’s income, and even make the management partner responsible if the hospital faced losses.

Instead, the agreements with HCCA provide the company a flat-fee arrangement of more than $250,000 per month, increasing either five percent per year or with inflation, whichever is greater.

“There’s really no incentive, as I see it, for success,” Drilling said. “If you’re getting a flat, base fee, there’s no way that there’s any incentive for that.”

Drilling’s final comparison showed what the board wanted from a potential management company in relation to finishing the stalled tower project.

“If the bonds are spent, then they want the management company to kick in something — to have some skin in the game,” Drilling said. “What we got was a request for an additional bond right now.

“None proposed the closure of any facilities including the ER,” Drilling said. “And that is a fact, although it’s been said otherwise, there is no data to support that.”

Talking Money

Ken Nunes, a Tulare CPA, spoke about the effect the bond, combined with the first bond, would have on property taxes, giving an example of the taxes on a Tulare home assessed at $150,000.

“Measure D is still in place at $125, but we now would add on another $80 for Measure I, so you can see the percentages here that would rise to about 11 percent of your taxes would be going to Measure D and Measure I,” Nunes said.

He then compared that tax percentage — 11 percent — to a percentage referred to in a mailer against Visalia’s Measure H, a similar bond measure with a higher price tag.

Dr. Benny Benzeevi, CEO of HCCA, the company that runs TRMC, was a major donor to the political action committee that sent out such mailers, Nunes said.

“District taxpayers are already paying a 2.2% property tax, Measure H would increase the total KDHCD taxes to a staggering 6.8%!,” the mailer reads.

“If you recall the percentage that I showed you in a previous slide, I ask you — what’s the difference here?” Nunes said. “If it’s good there, I think it’s good here.”

Nunes also spoke about the four bond financial reports, referred to by some as audits, in response to a question from an audience member — specifically, whether those reports were audits.

“There were no audits performed on the bond,” Nunes said. “As a matter of fact, they all contained that one sentence that says, ‘we did not audit, and had we, we may have come to some other conclusion.’”

Nunes also noted that two of the four reports reflected more than $1m in “non-qualified expenditures” of the original $85m bond.

“So when you get a flyer that says there were four examinations done and they found no unauthorized expenditures,” Nunes said, “that’s just plain, ah… not correct.”

The Contract

Joseph Soares, a Tulare lawyer, took the audience into a deep dive on the contracts between HCCA and TRMC.

TRMC and HCCA have entered into a total of four major contracts: the Management Services Agreement (MSA), Interim Joint Operating Agreement (IJOA), Long-Term Joint Operating Agreement (JOA), and the Option Agreement, which would allow HCCA to purchase the hospital or enter into a long-term lease of the hospital facilities.

HCCA and TRMC currently operate under the MSA. The MSA lasts for 15 years and automatically extends itself for 10 years, unless it is superseded by the IJOA.

The MSA, Soares said, allows HCCA to have unlimited hiring ability, with the expenses of those hired paid by the district, without the district’s prior approval.

The agreement also transfers all employment of hospital employees from TRMC to HCCA; TRMC is then expected to pay HCCA for all employee benefits, and 130% of the base pay, Soares says. He noted a point in the contract that would allow HCCA to defer those payments towards the purchase price of the hospital.

Under the MSA, TRMC would also be prohibited from soliciting any of the employees transferred to HCCA for employment for a period of two years after HCCA’s operating period.

The agreement also disallows the board from doing anything that would cause HCCA to be viewed in an unfavorable light, including criticizing HCCA or revealing confidential information that could cause HCCA to be brought into “public disrepute, hatred, contempt, scorn, scandal or ridicule.”

More seriously, the agreement does not allow members of the board to access the hospital, clinics, or other facilities except upon prior arrangement with HCCA, except in case of an emergency.

The IJOA, Soares said, can only supersede the MSA when the bonds are paid off, or if the bond trustee approves of the shift; it would increase the amount paid to HCCA significantly, and allow HCCA to determine on its own accord that loans are needed without the board approving them.

The district can terminate the agreement, Soares said, but at a cost of $87,500 per month, for a total of up to 120 months — a maximum possible amount of $10,500,000.

The long-term JOA, Soares said, introduces even more perks: if HCCA determined that improvements to facilities are needed, it would not need to seek board approval — either the board allows for the costs to be financed, or the board will simply pay fair market value for the improvements anyway.

It would also allow HCCA to take 95% of the hospital’s profit and leave the district the remaining 5%.

“Who’s in control?,” Soares asked. “We think HCCA is.”

View and listen to each speaker’s presentation by clicking here.

In Depth: Tulare Regional Medical Center

15 thoughts on “With Election Underway, No on I Holds Forum

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  1. To put it nicely. The citizens have been taken advantage by the board that is supposed to work for sus. Bell and Gadke are up for election soon and Kumar needs to be recalled .

  2. The citizens of Tulare need to know the hospital WILL NOT CLOSE IF this bond doesn’t pass. Kaweah is still open and their bond didn’t pass. We need to rebuild the board with correct people and replace HCCA get a true fiscal audit and move forward maybe then we could pass a correct bond

  3. so if they don’t have the money to move into the new Tower by 2030 will they close? The answer is YES!! Then NO people are a group of mostly EX employees and Doctors who were caught by the state of California for not doing their job properly so now their MAD and want to get even at any cost. Not passing the measure just delays the process even more.

    Furthermore, KDDH too will close if they do not have the funding to properly retrofitted their hospital if any of these people tell you any different they are lying to you .

    • So you are saying that an ex employee is not an informed voter and able to make sound decisions? I find that offensive!

  4. I don’t know how people from the “Yes” side could have sat in this forum and heard everything the “No” side had to say and still think they should vote yes! It is mind boggling that this board and group of a few doctors have managed to brainwash people into thinking they are good people and have their best interest at heart! It is laughable!!

  5. As a physician not in Tulare, I am carefully watching the problems doctors are having in your community. California has laws assuring profiteers do not gain a foothold against the public’s medical interest running any hospital.

    The recent assault by the financially conflicted Board of Directors eliminating the existing Medical Executive Committee is a threat to all doctors and patients in your community. Physicians though around the State are watching this conflict as the consequence of putting patient medical decision-making into the hands of businesspeople jeopardizes the healthcare of all citizens.

    Your hospital will NOT close. Don’t believe the naysayers who are ignorant of the facts. Support your vocal doctors and community leaders who understand how important it is to vote NO on “I.” We must all have equality, and transparency needs to remain in the forefront. Greed and profit are at your doorstep. Don’t open this door and imperil the healthcare of those who might become ill.

    Voice your opinion by voting NO. This is our right.

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

  6. HCCA has taken over this hospital. HCCA should pay for the building. It is their business now. It is not a public hospital anymore.

  7. We need to
    1- elect a new board
    2- force that board to take hospital back from HCCA
    3- Then & only then pay any new taxes to build the new building.

    We have 14 years to achieve this goal.

  8. I find it ridiculous how both sides are completely stupid! You have turned this town into a he said, she said! When you all should be working together to save a community hospital. Aren’t most of you in the business of saving lives? Not politics!!! At what cost? Until some disaster happens and KDDH can’t accommodate Tulare’s intake then what? Huh? What’s your solution then? Turf them out when minutes count? We all know emergencies have 50/50 chance survival rate. That percentage decreases every seconds services are delayed. Morons!! You mention that all the No leaders were ex board members. Why did you step back, why?! You sat around until it blew up in all our faces!!! You are partly to blame! Where your voices before it all hit the fan?? Most of you are ex board members, workers and MDs that are disgruntled. All those Doctors are not as innocent as you may all think. Fools! This all just makes you look as shady to bring up all this out into the light now! When you should have been speaking up years ago! And Advance Register you need to get some real news reporters instead writing nonsense biased BS!! You are a bunch of instigator reporters bored with your Hicksville life!!!

    • You say that these former TRMC Board members, bond oversight committee members, and physicians are a bunch of disgruntled people who should have been raising red flags years ago. Well a number of them did just that and no one was apparently paying close attention, especially the news media and the District Attorney’s Office. Where were our City leaders? Where was our elected member of Congress? Certainly not demanding a State Audit! Why did this town put up with the TRMC Board of Directors year after year with their continued arrogance and lack of transparency? Many in this town fell asleep at the wheel in regards to what was taking place at our hospital….letting the Board handle things without demanding real oversight of the Board members themselves. Well luckily everyone is awake now and saying vote NO on Measure I. By the way NoBShere, in regards to folks not speaking out years ago…..I do not recall seeing the name of “NoBShere” raising red flags these past years or did you go by the name of “BShere”?

  9. Thank you to the YES on I people for the hard work to help insure our tower is completed. The naysayers from the NO group is comprised of ex-employees board members and doctors that by choice choose not to come to TRMC even though their patient’s request it . So a BIG thank you to everyone for the support they have shown to the citizens of Tulare to help make sure our Tower is completed.

    • The NO group is mostly business leaders and most of the others do have a medical background. That’s how they know what they’re talking about.
      If you would look at the past board minutes and oversight committee minutes you’d spot the problem.
      The issue with the Dr’s now is they can not practice at TDH until they have admitted so many pts. and have to job shadow with these NEW Dr’s. How would you like it if you had privileges at the place for 25-30 years or more and now all the sudden you are told you’re not in charge of your patients when they get admitted.
      Do you attend any board meetings? Do you read the minutes?
      Is this new MEC board improving patient care? Not from the latest reports…….not withstanding what Benzeevi states, because someone is embellishing the truth.

      • It appears that they are not concerned with “actual” facts. They were given their talking points and obviously are sticking with them. No free-thinking with many of the “Yes” group. By the way there are many folks who have never worked for TRMC in any capacity who do not support the passing of Measure I. They go by the title of “Property Owner / Tax Payer”.

  10. Oh Barb!! You are funny! you saw one piece of my opinion and comment and rolled with it! See you at the next Tea Party! ; )

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