Two of the Tulare Local Healthcare District’s potential partners have indicated that the Tulare Regional Medical Center’s reopening in October is unlikely.
RFP responses obtained by the Valley Voice indicate that both the Kaweah Delta Healthcare District and Community Medical Centers would not be prepared to reopen the hospital by October. According to the hospital’s interim CEO, two other entities have not ruled out the possibility of an October reopening.
“I think they’re looking at their schedules and have other priorities,” Kevin Northcraft, the chairman of the Tulare Local Healthcare District board, said.
Both entities have been offering help throughout their process, he said.
The Hospital’s View
“We’re committed to the hospital being in better shape when we reopen than it was when we temporarily suspended. Several things need to be done. But that’s all being scheduled and waiting for funding,” Northcraft said.
Larry Blitz, the hospital’s interim CEO, agreed that the potential partners may have other priorities.
“I think it’s an independent analysis that each of them are making, and either these entities are going forward because they feel it’s an opportunity and they can meet the guidelines, or they can’t. That’s up to each individual entity to determine whether they can go forward within the guidelines that the board has presented,” he said, adding that all four would be able to run the hospital successfully.
He said that Adventist Health and Dignity Health have both indicated that, so far, they may be able to reopen Tulare Regional Medical Center by October 29.
“We won’t know until the [entities’] presentations to the ad-hoc committee and subsequently the potential presentation to the board on June 27, what the exact stance each of the potential suitors will be,” he said.
Two to three of the entities contacted could be making presentations, Blitz said.
He added that because the board’s current goal is to open the hospital as soon as possible, and certainly before October 29, he did not believe the board would request an extension of the hospital’s suspension.
A long-term lease as theorized in the district’s request for proposals would need voter approval, he said, requiring the filing of a measure at least 88 days before the November 6 general election.
“The board is pleased and the administration is pleased that all four of the targeted individual organizations were interested in the possibility of affiliation or a lease. That, to me, means that the future of this hospital is very very good. Where we have differences in how, when, and where we would open the hospital; and, each organization is different,” Blitz said.
A one-page response from Tim Joslin, President/CEO of Community Medical Centers, states that “…CMC has determined that significant capital is required to replace aging equipment, finish construction projects, address seismic compliance, and complete critical safety and infection-control repairs.”
Representatives from Community Medical Centers have previously been on the grounds of Tulare Regional Medical Center, but it is not clear whether they have performed an in-depth inspection of the hospital’s facilities.
He specifically mentioned Community’s involvement with Tulare over the last 12 months, including making legal services available, providing consulting services at no cost, and providing access to loans as part of their commitment to “all residents of Central California.”
An October 2018 reopening would risk the hospital’s financial future and would not allow time to address critical needs, Joslin wrote.
Representatives for Community declined to comment beyond the RFP letter.
“We’ve been in discussion with the Tulare Healthcare District for more than a year, and it’s very possible that discussion will continue in some way. That’s for the District to determine, of course, and we won’t comment further on our RFP response letter,” John Zelezny, Community’s Senior VP/Chief Communications Officer, told the Voice.
Kaweah Delta’s View
A three-page letter from the Kaweah Delta Healthcare District, written by CEO Gary Herbst, outlines the Visalia-based hospital’s conditions for entering into a partnership.
Herbst stated in the letter that Kaweah Delta was not able to perform necessary due diligence to submit a formal RFP proposal.
He states that it is “not in a position to invest in or loan TRMC the requested $22 million of funds referenced in your RFP,” and that “given the lengthy closure of TRMC’s hospital and facilities and the manner in which it was maintained and managed by HCCA, we must be allowed sufficient time to perform a comprehensive assessment of the condition of TRMC’s facilities..”
The letter goes on to state that “we believe it is unrealistic to try and re-open TRMC by October 1st (as stated in the RFP) or by October 29th (which we understand to be the one-year anniversary of the license suspension),” and that “we believe you must immediately secure an extension of the license suspension to December 31, 2018.”
He elaborated on the statement further with the Voice.
“I haven’t been in the hospital in well over a year and same with our staff, so I’m essentially basing that on the conclusion that I would walk into a hospital that is for the most part empty, and I don’t have any idea what the condition is of their infrastructure, electrical, plumbing, just the operating capacity of their ORs, things of that nature,” Herbst said. “I believe that it would take Kaweah Delta at least a full month just to conduct a comprehensive assessment of all of the different systems, and the things that go into the operation of the safe and high-functioning hospital, because certainly the day we open or reopen we would want that very first patient to experience nothing but a highly safe, efficient high quality service.”
He said that press reports showing that the hospital had sold its supplies and equipment played into that conclusion.
Kaweah Delta’s assistance began in September of 2017, when the newly-elected board reached out to Herbst and he provided them with a “Healthcare 101” presentation, he said. Throughout his time assisting Tulare, he stated that his motivation has only been to assist a sister district hospital.
“I’ve just tried to maintain a very collegial, supportive relationship with them, most recently I wrote a letter on their behalf to the state to help support their request for funding out of the governor’s budget, for this coming fiscal year,” he said.
One unique form of governance that Herbst’s letter touched on was the potential of a Joint Powers Authority between Kaweah Delta and Tulare, or potentially Kaweah Delta, Tulare, and the Sierra View Local Healthcare District. The Sierra View district runs Sierra View Medical Center in Porterville.
“Joint Powers Authorities are legally created entities that allow two or more public agencies to jointly exercise common powers. Forming such entities may not only provide a creative approach to the provision of public services, but also permits public agencies with the means to provide services more efficiently and in a cost-effective manner,” according to Best Best & Krieger, LLP.
Herbst stated he was in active discussions with Donna Hefner, the CEO of Sierra View Medical Center, about potentially combining certain functions in a Joint Powers Authority. In his letter, he states that a potential Joint Powers Authority arrangement could potentially be used to manage Tulare Regional Medical Center.
“We never approached Tulare with a formal proposal, but I referenced it in my letter to kind of differentiate where Kaweah Delta is a bit more unique from Adventist or Dignity or Community, essentially we’re kind of a sister district hospital. The 3 hospitals in Tulare County are all district hospitals, whereas Adventist Community Dignity are all private, non-profit hospitals,” he said.
Herbst said that he had not received any indication that Kaweah Delta’s conditions were rejected or unacceptable, and that Kaweah Delta had been asked to provide a presentation to the Tulare district’s ad-hoc RFP committee; he stated that because the RFP was so fresh, there was not such a presentation prepared, but that he would be able to sit with the committee and discuss potential affiliation options.
Northcraft stated that the decision of whether the two companies would be able to continue in the RFP process would be one for the district’s ad-hoc RFP committee to decide.