Tulare - The dean of USC's Keck School of Medicine, whose urologists are currently doing robotic surgeries here, says the school wants to develop more affiliations with Tulare Regional Medical Center.
“Our plan for Tulare is to really work with the Tulare physicians and hopefully build other relationships here,” Dr. Carmen Puliafito told an audience of about 130 people at the Heritage Complex last week.
Puliafito also said the school would like to have third- and fourth-year medical students do a primary care rotation here. “I think they'd find that this is a great community,” he said.
Before addressing the gathering of doctors, hospital officials, Tulare Hospital Foundation members and community leaders, the dean spent the day with TRMC officials.
“This really shows the commitment of USC to the community,” Tulare Regional CEO Shawn Bolouki said. “USC is here to help us take our facility to a higher level.”
Calling the new relationship “really exciting for everyone,” Puliafito reported USC “selected Tulare Regional Medical Center because of its really extremely high quality, its visionary leadership.”
Live feed
Puliafito praised Dr. Inderbir S. Gill, a world-renowned surgeon who is professor and chairman of the USC Institute of Urology and who is performing robotic surgeries at TRMC.
USC recruited Gill from Cleveland Medical Center 2 ½ years ago and he brings “a minimally invasive approach” to surgery and “a great enthusiasm about building a bridge between USC and Tulare,” Puliafito said.
Later, as guests ate a four course meal catered by The Vintage Press, they watched a live feed of Gill and his urology team as they removed the prostate of a 70-year-old man, using TRMC's new da Vinci robotic equipment. It was the second surgery he had performed at Tulare Regional.
Dr. Mihir Desai, head of the robotic surgery program at USC, served as moderator for the evening, pointing out the intricacies of the surgery and relaying questions to Gill.
Desai asked the audience to notice the “crystal clear view” that the da Vinci equipment was providing Gill and reported the magnification was 10 times that of the natural eye.
He and Gill also pointed out that most men who don't have sexual dysfunction or urinary incontinence before this type of robotic surgery probably won't have them afterwards, which was not the case in the past.
Kamboj unhappy
A three-year contract requires TRMC to pay the USC urology group $475,000 annually for surgery and clinical services.
The hospital, under a separate contract, also has agreed to pay Dr. Virinder Bhardwaj, a Porterville urologist, $25,000 a year for medical administrative services he will provide in connection with the clinic.
The hospital also will reimburse USC for out-of-pocket expenses, setting a limit “after some experience with actual expenses related to travel and overnight stays,” the contract says.
Terms of the contract, a public record, appear to refute hospital board member Dr. Prem Kamboj's allegation that TRMC is paying USC $100,000 a month for its services.
CEO Shawn Bolouki took issue with Kamboj's public statement recently, saying he would go to jail if he were paying that much because it would not be fair market value.
The cost of the contract with USC was established after a consulting firm conducted an independent analysis of the fair market value of the program and concluded the amount was “reasonable.”
Kamboj has been critical of the hospital's spending on the urology contract and the lease/purchase contract for the robot. He also appears adamantly opposed to a proposal to build a second medical tower.
The hospital will pay $1.65 million, plus $1,000 in delivery fees, for the robot this year and $140,000 a year for the second through the fifth years of the contract.
Tulare Regional officials said the hospital planned to purchase the da Vinci equipment, even without the USC contract, as part of the first tower project because local physicians and potential recruits had requested it.
Kamboj's dissatisfaction prompted him to e-mail members of the district's bond oversight committee – a citizens group – on Dec. 15, after a scheduled meeting was cancelled.
He acknowledged the groups enthusiasm for the proposed project and told them the hospital was borrowing money to bridge the gap for first tower expenses, a reference to the Tulare Local HealthCare District board's decision to establish a $6 million 1.9% line of credit to cover costs of the robot and other equipment for which it is not permitted to use bond money.
He also said the hospital has lost money for the first four months of this fiscal year and cash on hand is down. His comments are based on reports the board received from Chief Financial Officer Fred Capozello and financial consultant Gary Hicks earlier this month.
Capozello said last week the hospital is monitoring productivity and supply expenses daily so the hospital will end the fiscal year (June 30) $4 million in the black as projected.
Besides the rising cost of bad debt and charity cases, the hospital has spent considerable money to convert to an electronic medical records system. Capozello said the federal Medicare system requires the conversion to maintain the existing level of reimbursement and will reimburse the hospital district for a “not insignificant” amount of the cost.
In his e-mail Kamboj accused hospital officials of canceling the Dec. 15 bond oversight meeting because they don't want the committee to hear a dissenting opinion. “So the meeting is very conveniently postponed to January, when I am out of the country,” he said.
Hospital officials said they didn't
know Kamboj was going to be out of the country and said the meeting was
canceled because Bolouki had to testify in a case in Los Angeles and Mike
McGuire, who is in charge of the tower project, was on vacation.
Minutes from the bond oversight meetings indicate Kamboj has not attended
the last five oversight committee meetings, held in May, June, August,
September and October.
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