This article has been corrected to reflect errors in a referenced Financial Times article. In the third paragraph below the “Total Recall” subhead, “Department of Justice” has been changed to “Office of the Inspector General,” “physician contracts” has been changed to “physician rental space,” and the paragraph was expanded to provide clarity.
Sherrie Bell likes her chances in the upcoming election.
Bell, who is the current chairwoman of the Tulare Local Health Care District’s (TLHCD) Board of Directors, says she thinks voters will stay the course and reelect her when she faces off against newcomer Kevin Northcraft in the November 8 election.
“I think they’re good, because the hospital is doing very well, and the people of Tulare realize the past didn’t work and they’re willing to try a different way to provide health care,” she said. “Tulare Regional Medical Center has not had a good reputation over its 65 years. I’d like to change that.”
Staying the Course
The “different way” Bell would like to lead the hospital is further down the road of private management under Healthcare Conglomerate Associates (HCCA), which took over management of the District in 2013. The District’s contract with HCCA gives the company the right to buy all the District’s assets, which has caused a great deal of anger and confusion on the part of many the district is meant to serve. Yet, Bell says voters understand the current Board can get results.
“I’d like to go forward and move in a positive direction. In the first time in a long time we have a board that works together,” she said. “It may look like the five of us agree on everything, but we don’t. We communicate on an a adult level. How in discord can you bring good results? That’s almost an impossible feat.”
Since HCCA took over operations of the District, says Bell, Tulare Regional Medical Center (TRMC) has been in the black and regained much of its financial wherewithal. Others have disputed that claim, pointing to recent layoffs involving 29 TLHCD employees. TRMC was given an F rating by LeapFrog, a national nonprofit organization that conducts biannual review of patient outcomes, and received the lowest rating possible from the Centers for Medicare and Medicaid Services, an arm of the federal government that determines among other things which facilities can receive their funds.
Enough is Enough
The layoffs and poor ratings came in the wake of the solid failure of Measure I, a general obligation bond issue that would have put $55 million in the District’s coffers to complete work on its expansion at TRMC. Measure I was defeated by a two-to-one margin at the polls.
The expansion, infamously the focus of a Tulare County Grand Jury report entitled Tower of Shame, sits incomplete, and the District lacks the funding to complete it. The Grand Jury also took TLHCD’s leadership to task for failing to disclose how the original $85 million in bond funding for the tower was spent, as well as for failing to follow public disclosure laws.
Bell’s opponent in District 4, former Tulare City Manager Kevin Northcraft, thinks enough is enough. With the deadline to file for the election looming and no one coming forward to oppose Bell’s reelection, Northcraft jumped in.
“It seemed like it was crazy to let the people who caused our problems go back in office, so I filed,” he said.
‘Frustration of the Community’
Also running for a seat is Michael Jamaica, who is looking to unseat the incumbent from District 2, Laura Gadke. He joined the race, he said, out of a widespread sense of dissatisfaction.
“My interest is just looking at the frustration of the community–and myself as a taxpayer–that this tower has not been finished in 11 years,” he said. “Our $85 million bond was supposed to construct this thing; it just came to a halt. Then turmoil started among the construction companies and the Board.”
His sense is voters will welcome change.
“The support seems very well out there,” he said. “People I’ve spoken to while I canvassed the area, they’re very happy two people are running who have no special interest other than getting our hospital back on track and finishing our tower that has been sitting.”
Jamaica is a retired UPS driver and longtime community volunteer with two decades on the Tulare Parks and Recreation Commission. Gadke, who was appointed to her seat on the Board, did not respond to an interview request.
‘Poor Management’
Ironically, Bell and Jamaica agree Tulare needs a better hospital, and that management is at the heart of the problem. However, they disagree on the source of those bad choices.
HCCA, Bell said, is doing good work at the hospital, and the “poor management” is a thing of the past. That history means perceived problems with District operations are blown out of proportion, she said.
“When you’re in a small community, word travels fast. Any problem gets magnified,” Bell said. “I also believe that I know our nurses and staff give quality care. Our facility itself has been very limiting.”
Jamaica doesn’t agree.
“First, I think this contract with HCCA needs to be reviewed,” he said. “I think paying the CEO over $3 million a year is excessive. Then their CFO, he makes between $38,000 or $39,000 a month. We’re a small hospital. How can we afford that? That money could be put to something else.”
‘Everything Being Said?’
But, it’s almost impossible to know for certain how the District is performing, Jamaica said. The ongoing lawsuit between the District and its former Medical Executive Committee (MEC), as well as the layoffs in August, have raised questions in the minds of many about the true state of the District’s finances.
“If they say they’re making monthly profits, why would you want to lay off people? That’s another thing that shocked people in the community,” said Jamaica. “They’ve been doing so well, then the bond gets defeated and they have to lay off people.”
He finds the lack of transparency is unnerving.
“I don’t know what’s going on over there. Is everything being said? It’s hard to grasp what’s true that’s coming out of there,” he said. “That’s the whole thing: What’s true that’s coming out of there?”
An HCCA spokesperson said the layoffs were to ensure continued financial well-being. The Board also sought and were given an $800,000 loan in the wake of the failure of Measure I.
‘The Tulare Way’
“We need to get back our reputation,” said Northcraft of his top priority if elected to replace Bell.
Echoing Bell and Jamaica, he asserts poor management is at fault. Measure I failed, he said, was because the public no longer trusts those in charge at TLHCD. Again, he cited the lack of transparency detailed in the Grand Jury’s report.
“I went to the Board in May before they put the ballot out, and said, ‘You’re not doing this the Tulare way,’” Northcraft said. “They didn’t explain where the money had gone. They didn’t explain where the money will go if it’s approved.”
Citing his three decades of experience dealing with similar issues, including his decade as Tulare’s city manager, Northcraft called for more public input before seeking voters’ OK for any plan. The public, he said, was left out of the process, and is still on the outside looking in.
“I think we need to have those community meetings. We need to finish the audit of the old bond. We need to get good engineering estimates of how much it’s going to cost to finish the tower,” he said. “It’s the way the city does things. It’s the way the school district does things. It’s the Tulare way.”
HCCA and the TLHCD Board, Northcraft said, have rubbed citizens the wrong way.
“Tulare is a special city,” he said. “There’s a Tulare way of doing things by consensus building.”
Quality Care
Jamaica says he has a good idea of what Tulare wants from its hospital.
“In speaking with other residents in this town, they’ve all said the same thing,” he said. “They’d like to see better care given to them at the hospital.”
Jamaica cited the low ratings TRMC has had recently, specifically it ER performance.
“There’s still a four- or five-hour wait in the emergency room,” he said. “That needs to be addressed.”
According to HospitalStat.org, the average wait for an initial exam at TRMC’s ER is an hour and nine minutes. Non-critical cases see patients discharged in two hours 35 minutes on average, while those who are admitted will likely spend three hours 31 minutes in the ER, as well as another hour and 50 minutes waiting for a room. Further, TRMC has performed 22% below the national average based on mortality rates for critical illnesses.
Other Tower Money
Northcraft is also critical of the Board for seeking a new bond issue before exhausting other possible sources for construction funding. Bell, however, said she thoroughly investigated other means to pay for finishing the tower but came up empty. A new bond was the Board’s only remedy, and now that it’s failed the search has been renewed for other ways to get the job done.
“We’re looking into other means by which we can finance the tower,” Bell said. “Once we have 36 months of net margins, we can possibly get government loans, low- or no-interest loans. We’re looking into all the options.”
Northcraft is skeptical all avenues of funding lead to dead-ends. He again cited his 30 years of experience working with and for public agencies.
“I think I know more than the current board does,” he said.
Total Recall
If Jamaica and Northcraft are elected, they may become a minority on the Board, but not if Alberto Aguilar gets his way. Aguilar, a former member of the District’s Bond Oversight Committee, served Dr. Parmod Kumar, the TLHCD District 3 board member, with a notice of intent to seek his recall during the Board’s September meeting.
Kumar has been at the center of several incidents widely reported in the press. In December 2002, a Tulare County jury awarded the family of Stan Staley $4.5 million in a medical malpractice suit against Kumar. The sum was later reduced to $1.4 million.
In 2009, TLHCD paid a $2.5 million settlement following investigation by the Department of Healthcare Services Office of the Inspector General (OIG) into physician rental space at TLHCD’s Federally Qualified Health Center (FQHC). The OIG investigated the Center again in 2013, when it was alleged Kumar was seeing 64 patients an hour in the federal clinics, instead of the mandated four per hour. An article in the Financial Times of London reported the OIG found Kumar earned up to $800,000 while working under an illegal contract. Kumar and his wife, Dr. Parul Gupta, resigned from their positions at the Center following the disclosure.
Cases Pending
Kumar is also a defendant in a lawsuit filed last month by a group from the Citizens for Hospital Accountability. The suit alleges the Board of TLHCD misspent public funds to pay for the outcome of a private lawsuit filed against TRMC’s former chief of staff by Kumar, HCCA CEO Dr. Yorai (Benny) Benzeevi and TRMC chief of surgery Dr. Rebecca Zulim.
In their suit, the trio claimed Dr. Abraham Betre, the former chief of staff, disclosed private and damaging information to the Valley Voice regarding investigations into the practice of all three by the TRMC Medical Executive Committee. Citing California law protecting journalists and their sources, the judge in the case dismissed it summarily. The three plaintiffs were ordered to pay Betre’s legal costs.
The suit now pending against all five board members and TLHCD alleges public funds were used to pay those private legal costs, despite the District having no interest in the suit’s outcome. The new suit also claims the District is in violation of the state’s Public Records Act. Besides asking any public money already spent on the private lawsuit–more than $98,000–be returned to the District, the plaintiffs also want to prevent the Board from spending additional money in connection with Zulim, Benzeevi and Kumar’s suit against Beltre. Should the plaintiffs prevail, the District, and thus taxpayers, could also be held responsible for the entire cost of this latest suit.
Further Distractions
Meanwhile, the sudden replacement of TRMC’s medical staff of 135 in January is still being fought in Tulare County Superior Court. A settlement conference has been scheduled for February 10, 2017. This follows the posting of jury fees by the MEC’s lawyers in July.
In the midst of all the legal wrangling, Northcraft says something’s being forgotten.
“They’ve kind of ignored the real mission of the hospital, which is to provide health care,” he said.