Hospital Gives Nurses Raises Despite Financial Challenges

Tulare - Tulare District Hospital nurses and phlebotomists are getting increases in salaries and benefits that total about $851,000, even though the increases will plunge what had been a delicately balanced 2007-08 budget into the red.

The increases are needed to remain competitive with Kaweah Delta HealthCare District, Sierra View District Hospital and Hanford Community Hospital, said Tulare Local HealthCare District board members, who unanimously approved the pay hikes at their July 25 meeting.

“We’re in the time of a nursing shortage. . .” Board President Dr. Parmod Kumar said. “We have an excellent staff we need to retain.”

Board member Deanne Martin-Soares said after the meeting that if the hospital can’t hire enough nurses, it would have to turn to registry or traveling nurses.

“That’s going to cost more than having a full-time employee with benefits,” Martin-Soares said.

Board members voted knowing their action would wipe out a projected $480,000 surplus in the current fiscal year budget which they adopted later in the meeting, and they directed Interim Chief Executive Officer Bob Kelley to prepare a cost reduction plan to help off-set the salary hikes.

Hospital nurses are getting a 3 percent salary increase, which includes the impact of annual merit increases. This will set the pay range for entry-level nurses to between $31.81 and $44.03 an hour. Kaweah Delta’s recently adjusted salary range for new nurses is between $34 and $46.50 an hour, Interim Chief Nursing Officer Patricia Mathewson reported.

This is the second pay increase nurses have received in the 2007 calendar year. In January registered nurses and coordinators received a 9 percent increase and supervisors and directors got a 6 percent increase, Mathewson reported.

State prisons, which have attracted many local nurses in part because of their very high salaries, announced another pay increase in July, said board member Roger McPhetridge, a nurse who works at a local prison.

Dr. Prem Kamboj said while there was no way for Tulare District to compete with the prisons, it was imperative to remain competitive with other facilities. He also spoke of the need to maintain a good work environment for nurses.

“We want the nurses to know that, as a board, we appreciate what they’re doing,” Kamboj said.

The financial reports the board got last month were a mixed bag, although overall they reinforced the notion the hospital will have to curb spending and find new ways to attract patients and increase revenues.

Operating expenses, including salary and benefits, have increased faster than net patient revenues over the past two years, Interim Chief Financial Officer John Church said in an unaudited financial statement of the fiscal year ending June 30, which was presented to the board.

Patient days in the hospital have decreased 6.34 percent over the past two years, outpatient surgery procedures have seen a 20 percent decrease and cath lab visits have dropped 43 percent, the report said.

The impact on the hospital’s bottom-line has been significant. Here are the unaudited numbers that worry the board and the hospital’s financial staff:

·    The hospital had an operating loss of $4.2 million in the fiscal year ending June 30, which was higher than the $2.8 million that was anticipated. When $2.8 million in district tax, investment, interest and other non-operating revenues are plugged into the equation, the loss drops to $1.4 million.

·    The adopted budget for the fiscal year ending June 30,2008, anticipates $65.1 million in operating revenue—$1.95 million short of  the projected $67.03 million in operating expenses. Unless changes occur, a projected $2.4 million in the non-operating revenues will, for the second consecutive year, not be enough to cover the shortfall.

Even if non-operating revenues were enough to fill the gap, revenue and expense figures are too far apart, hospital board members and financial staff agree.

“The goal should be to get closer [numbers] in operations,” Martin-Soares explained. “You don’t want the loss to be what the loss is right now. We’re going to have to control it.”

Kumar reminded the board it had anticipated the loss for the previous fiscal year and had asked Kelly at its May retreat to develop recommendations to reduce costs.

“I want you to move ahead “full charge,” Kumar told Kelley at the July meeting, adding later that “it is very stressful to sit here and see those kinds of numbers.”

Martin-Soares said one of the things the district needs to look at is its rising average length of stay at the hospital, which she said has increased from 4.8 days to 5.8 days

Longer hospital stays do not mean more money to the hospital, she said later.

Medicare officials reimburse hospitals not on the actual number of days stayed but on what they have determined the average stay should be for a particular condition, Martin-Soares said.

An increase of ¼-day can mean a $1 million hit to the hospital, she said.

This is not a popular thing to talk about but the hospital needs to look at it, she said.

Kamboj has previously indicated making changes in the physician recruitment process and in the contracts offering subsidies for new doctors could help the hospital’s bottom line.

The good news in the fiscal report the board got is that the hospital’s cash-on-hand, which had dropped to $19.7 million in the third quarter, jumped to $23.8 million in the fourth quarter.

This is very good news as the hospital embarks on an expansion project that will require district funds as well as the $85 million in general obligation bonds that voters approved in 2005. (The board authorized its bond team at this same meeting to sell up to $15 million of the bonds.)

Martin-Soares said $1 million of the $4 million gain represents a $1 million payment from Medi-Cal to resolve an old issue.

Kamboj praised Nancy Korvalis, director of admitting and financial counseling, for the work she and her staff have done in working to collect xxxx in payments from self-pay patients and to get people who qualify linked with Medi-Cal and county insurance programs.

The July 27 board meeting showed no signs of the acrimony that had marred many of its sessions this year, a fact that didn’t go unnoticed in the community.

By mid-morning the next day, community leaders were spreading news of the peaceful session, with many commenting they hoped this marked the beginning of a turnaround in the board members’ interactions with each other.

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Tulare Vet Recognized for Animal Welfare Efforts

Tulare - At some point in his career, Tulare veterinarian Dr. James P. Reynolds said people started thinking of him as “the cow vet who would defend the cows in this state.”

But in recent years Reynolds’ reputation has spread well beyond the state as is evident by the American Veterinary Medical Association’s decision to give him the 2007 Animal Welfare Award in recognition of his efforts to advance animal well-being, dedication to animal care and contributions to the community and society.

Reynolds, who is chief of clinical services, dairy production medicine, at the University of California, Davis, Veterinary Medicine Teaching and Research Center in Tulare, received the award at the association’s annual convention in Washington D.C. in July.

“I’m a farm kid, so it’s very hard for me to accept awards,” he said.

Reynolds was born in San Diego County and raised on his family’s dairy farm. A veterinarian for 25 years, he has been involved in organized animal welfare issues for about 10, he said.

In addition to his job at the teaching and research center, he also works for a company that does farm animal welfare audits.

“We go out to dairies to certify a dairy is feeding the cows properly … housing and caring for them appropriately,” Reynolds said.

These audits are not required by the government, but are an industry-led attempt to develop a system to make sure cows are cared for well.

“This is being driven by customer concerns to assure animals are being taken care of well,” he said.

“Right now the audits are voluntary, but it appears that starting next year, they’ll become mandatory,” he said, again stressing it is not the government but the retail and marketing industry that will take this step.

“Most dairies do a very good job of taking care of animals,” Reynolds said, adding that the audits he does are requested by dairy owners for a number of reasons.

“Some dairies request welfare audits because they want to be recognized for doing a good job,” Reynolds said. “It’s a pride sort of thing. Some others may have potential problems with groups.”

Other dairies use the audit as a check on their management system to make sure they are doing what they should be doing, he said.

The American Veterinary Medical Association (AVMA) Animal Welfare Award is usually awarded to a small animal veterinarian, so he is especially honored to have received the award, Reynolds said.

“It shows a cow vet in the area of animal welfare,” he said. “We’re not [typically] thought of as welfare-friendly.”

Reynolds is the vice chairman and chairman-elect of the AVMA Animal Welfare Committee and founder and secretary of the Professional Animal Auditors Certification Organization. He is past chairman of the American Association of Bovine Practitioners’ Animal Welfare Committee and received that organization’s 2004 Quality Veterinarian of the Year award.

At the UC center in Tulare he is responsible for clinical services, including the teaching of veterinary and graduate students in clinical dairy production medicine in the core herds serviced by the school.

Reynolds has traveled to Madagascar, Tunisia, Lithuania, Mexico, and Armenia to consult on dairy projects and was sent to England during the Hoof and Mouth outbreak in 2001 to assist English veterinarians in examining more than 80 million livestock to halt and eradicate the disease.

In addition to actively promoting efficient and humane production medicine techniques for livestock farming, he also conducts field work in disease control and epidemiological research addressing problems of food-producing animals. His goals include working on disease control on a herd, area of country basis and to help provide livestock health management systems to developing countries for food production.

Reynolds and his family live in Visalia.

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Commissioners to Consider 7 percent Water Rate Increase

Tulare - Now that the City Council has approved developer impact fees for new groundwater recharge basins, utility commissioners will consider a 7 percent increase for city water customers in November.

Proceeds from the proposed rate hike are expected to raise $250,000 annually to purchase additional water in wet years to fill the recharge basins and replenish the groundwater supply.

Public Works Director Lew Nelson said he expects to bring the proposed rate hike to the Board of Public Utilities in November, after property owners receive a 45-day advance public hearing notice as required by Proposition 218.

The City Council unanimously approved a series of groundwater impact fees on July 17 that range from $1,073 per single-family unit to $3,717 per commercial acre and decided they should be collected when building permits are issues.

Approval came over the objections of Bob Keenan, president and chief executive officer of the Home Builders Association of Tulare and Kings Counties (formerly the Building Industry Association).

Keenan argued the fee should be collected at the time of annexation or map approval, which would exempt the 5,000 “paper lots” currently on the book, but the council refused his request.

“He wants it both ways,” Vice Mayor Phil Vandegrift said, explaining Keenan and his group convinced the city in the 1970s to collect impact fees at the building permit phase.

The city had considered groundwater fees in May but delayed action to investigate Keenan’s contention the city could not charge the fee because it was not a condition of approval of the lots.

The Home Builders Association also asked the city to calculate a water rate increase that included the cost of the ponding basins. A consultant determined the city would have to raise water rates 64 percentinstead of 7 percent—to over the cost.

The city is trying to get about 1,000 acre-feet of ponding basins built by the next wet year, Nelson said.

The last water rate increase was in July 2003, when unmetered residents saw a 9.5 percent increase, which brought the monthly fee to $15.72. A 7 percent increase this winter would bring the charge to $16.82.

Metered-rate customers got a 5 percent increase four years ago, which brought the base rate for the typical metered-rate customer to $9.21 for the first 10,000 gallons and 50.4 cents for every additional1,000 gallons. A 7 percent increase would raise the base rate cost to $9.85 and the cost per 1,000 gallons to about 54 cents.

All of the city’s 14,440 customers are expected to be on water meters by next May.

In other water matters, he reported:

·    A recent groundwater study indicates the “alarming” drop in the water table at the south end of Tulare is not occurring anywhere else within the city.

·    Appraisal on the cotton gin property on Cartmill Avenue west of J Street is due Aug. 21. The City Council has authorized city officials to offer the gin board the appraised price. The land would be used for a ponding basin and for the railroad grade crossing at Cartmill.

·    A consultant has raised concerns because the gin property is very close to the edge of the Corcoran clay layerthrough which water cannot passbut the city would do testing before making a purchase, Nelson said.

·    As of July 23, the city had installed 3,882 water meters or 38percent of what it will take to put everyone in Tulare on meters.

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Fugazzis: Nothing's Abbreviated Here

Tulare - Many people thought Tulare’s Fugazzis was going to be an abbreviated version of the popular downtown Visalia restaurant, but wrong they were.

The new bistro with its signature art deco/metropolitan look is a full-service lunch and dinner restaurant with seating for 90 and a menu of salads, pastas, pizzas, wraps, sandwiches, seasonal specials and appetizers that more than matches its Visalia sister.

“We have everything our Main Street restaurant has, except we’ve added Stix,” general manager Kortney Lewis said. “It’s more of a healthy choice.”

Stix, which resembles shish kabob, comes in a variety of meat, fish or tofu and vegetable combinations. Customers can choice from one of six sauces: barbecue, blackened seasoning, cilantro/lime, creamy pesto, Thai or sweet & sour. The Stix is then placed on a bottom of red potatoes, brown rice, beans or fruit.

“It’s kind of a new funky item we want to promote,” owner Mike Fligor said, adding the item is also served in his Clovis bistro.

Stix and the willingness to substitute tofu for any meat or seafood item on the menu are  tips-of-the hat to the fact the restaurant is located inside of Evolutions Plaza, where Tulare District Hospital operates a fitness and rehabilitation center. The restaurant, as are other businesses inside the center, is open to the general public with entrances from both outside and inside the center.

After a week of operations, the restaurant scrapped the ordering-at-the-counter approach, which was in effect for lunch only, and now offers traditional full table service for both lunch and dinner.

Fligor, who owns the restaurant with his wife, Debbie, said he originally planned to open a Fugazzis-on-the-Go like his West Cypress Avenue operations off of Akers Road in Visalia, but changed his mind...

His strategy now is to go to smaller towns like Tulare, which are biting at the bit for more quality full-service restaurants, and put in the whole Fugazzis concept, constructing the on-the-go restaurants in larger communities such as Fresno, where he plans to start building his fifth endeavor at Palm Avenue and Nees street.

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Study Forecasts 2,790 Motor Sports Complex Jobs

Tulare - The first of two economic and fiscal impact reports on the proposed Tulare Motor Sports Complex indicates the project could eventually bring 2,790 permanent jobs to the area and $953,000 annually in taxes and fees to the city’s coffers.

The analysis prepared by Southern California Edison also said the project could bring in annually $835,000 to Tulare County’s coffers and $7.2 million to the state’s.

The impacts are “very substantial,” City Manager Darrel Pyle said.

The study, which was released Friday, is one of two that will be prepared in connection with the project. The other will be part of an environmental impact report that is in progress, Pyle said.

The report also looked at the impact from construction of the speedway, drag strip, four hotels, retail outlets and other features of the project, which are planned for 700 acres adjacent to the International Agri-Center.

Edison, which used a research model created by  Elliot D. Pollack & Company, concluded the project would result in 7,680 construction jobs—which are temporary—and bring in about $1.5 million in fees and taxes to the city, $3.2 million to the county and $35 million to the state.

In addition to the jobs that would directly result from construction and the operations of the sports complex, job totals include a projection of indirect jobs that would be created within other companies providing goods and services to the project and the induced jobs that would result in companies providing the same to direct and indirect employees and their families.

The 2,790 permanent new jobs the study is estimating is close to the 3,000 figure economic development officials used when the proposed project was made public in 2006.

The study is based on several assumptions, including the following;

· Construction of the racetrack will cost $150 million and the drag strip $50 million.

·  The racetracks would employ 750 people with an average annually salary of $30,000.

·  Construction of the four hotel will 684 rooms would cost $100 million.

·  Hotels would employ 230 people.

·  Building the retail and office complex will cost $150 million.

·  The retail/office portion of the project would employ 500 people with an average at an average salary of $10 per hour or $20,800 per year.

·  Retail sales would total an estimated $56 million annually, an amount based on the current sales tax amount Preferred Outlets at Tulare pays to the city.

In announcing the findings of the Edison study, Pyle said the city is still in the early stages of assessing the project.

“And as with any other proposed projects there will be ample opportunity for the public to review and make comments to the Planning Commission and City Council as the project moves forwards.”

A copy of the report is on file with the Tulare City Clerk on the second floor of City Hall.

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