Hospital Looking for ER Solutions

Tulare - Board members are looking for ways to improve Tulare District Hospital’s emergency room, which must continue to serve the public until a new one is built in 2012, and they’re finding the going is tough.

Two physicians were elected to the board in November, following a contentious race fueled in part by allegations the board was not doing all it could to improve the existing emergency room.

Drs. Prem Kamboj and Lonnie Smith reported dealing with more than a few patients who did not want to have procedures done at the hospital, even though they had never used its services.

The problem, they said, was other family members or friends had used the emergency room, which adversely influenced their opinion of the hospital. They argued six years was too long for the community to wait for a larger, more efficient facility.

Kamboj contended the hospital could expand the emergency room for a reasonable amount of money and have a much improved facility in operation long before 2012.

“But now I’m having second thoughts,” he said after hearing a report from architect George Christensen and others during a recent board study session.

Costly Endeavor

Christensen had drawn 43 different floor plans. What he, the hospital staff and the board considered the best of them added two beds and increased privacy at an estimated cost of between $1.2 million and $1.5 million.

Then-Chief Operations Officer Denise Perry reported the board could probably slash the price to between $750,000 and $900,000, if the project were done in-house rather than hiring an outside contractor.

Even though Mike McGinnis, a financial consultant, had just minutes earlier told the board it must take major steps to curb spending while the new hospital was being built, it appeared timing more than money was the major issue in board members’ minds.

“If you can do this project in 18 months, I think it is worth doing,” board Chairman Parmod Kumar said.

Kamboj said he thought the money would be worth spending if the project could be finished by 2009.

Perry estimated the job could be done in less than two years, if the job was done in-house. But Christiansen and Pat Brietigam, project manager for the new hospital, said they thought the project would take two to two-and-a-half years to complete.

The board asked Bob Kelley, interim chief executive officer, to again look at the cost and timeline for the project.

“I think the most important part is the timing,” Kumar said.

Shifting focus

Kelley and Kamboj said recently a task force has been formed and the focus has shifted to looking at ways to improve internal operations to get patients seen and out the door or admitted to the hospital faster.

“Their goal is to have the patients seen within an hour—that’s what they’re working on,” Kamboj said, adding he is not on the task force but Dr. Asit Shah, a colleague in the Tulare Pediatric group, is.

Kelley told the Tulare Noon Rotary Club that long emergency room stays are not an uncommon problem in the U.S., where “once you get a patient undressed, they’re there for four hours.”

From his experience in Madera County, Kelley said he knows there are ways to speed up the process.

Board member Deanne Martin-Soares said during the study session that she was surprised the Emergency Department’s Fast Track—eight beds for patients who have coughs, colds and other non-emergency situations—was not operating to the extent the previous board had directed.

The board directed Kelley to look into that situation also.

Attitude Change

Kamboj said he is confident Tulare District residents will see emergency room improvements, because a change of attitude has occurred.

“Everybody is now accepting the fact we need to improve,” he said. “In the past we had some resistance. My feeling is you can fix anything once you accept there is a problem. I think in a month or so it will be resolved.”

His confidence, Kamboj said, is also bolstered by the return of Patricia Mathewson as the hospital’s interim chief nursing officer. She had left Tulare District in late 1999 after working 22 years as the head of nursing.

She now works for B.E. Smith Interim Services, a company that provides interim hospital managers, and for the past 18 months served as interim emergency department manager at Methodist Charlton Medical Center in Texas, a 42-bed emergency department that saw 65,000 visits annually.

“They had the same issues [as Tulare District] and she helped improve that,” Kamboj said.

Kamboj has been critical of the previous board, which he insists should have taken steps long ago to expand the existing emergency room—a move the board had considered many times between 2001 and 2004.

In each instance the hospital’s need to conserve money to build the new hospital was a major concern. The original expansion proposal had a $5.5 million price tag and was rejected.

But the board and hospital staff made many attempts to address emergency room problems and in the spring of 2004, the board approved a $1.4 million proposal to reconfigure the Emergency Department.

This resulted in many changes including:

· Conversion of administrative offices to include a 2,500-square-foot registration and waiting room with 36 seats—up from 15—and three registration desks that offered patients and their families more privacy.

· A triage room that gives patients more privacy as they report their medical problems to a nurse.

·  The addition of two treatment chairs in the Fast Track, bringing the total number of beds to eight.

The hospital was also getting complaints about the attitudes of emergency room physicians and in August 2005, the district contracted with a new company, TeamHealth, to provide that coverage.

By September 2006, hospital’s satisfaction scores compiled by Professional Research Corporation, a national marketing research company specializing in health care marketing research, had improved dramatically.

Those approval scores, according to a memorandum provided the board, rose as follows:

· Registration process, 67 percent, up from 25.

· Respect for privacy, 53 percent, up from 20.

· Overall safety, 41 percent, up from 27.

· Doctor/nurse teamwork, 63 percent, up from 32.

· Doctor’s caring, 70 percent, up from 28.

· Nurse’s caring, 45 percent, up from 19.

While the percentage of people likely to recommend the hospital to others also increased dramatically, the overall percentage 31 percent—up from 12—was still low.

Tulare District’s board members have said a lack of privacy remains a big issue with emergency room patients and it is a problem they have not been able to address entirely with internal remodels.

Kumar, for example, recently went to the emergency department with abdominal pains.

As he was taken on a gurney to have a CAT scan, he said he had to say “hi” to people he passed in the hallway on the way.

News that he had been in the emergency room traveled and the next day, he said he had many calls from people asking if he had had a heart attack, which he had not.

“I did not have any privacy in my own emergency room,” he told the district’s bond oversight committee.

That will change when a 24-bed emergency room is built as part of a new three-story tower, which will house the hospital’s major patient services.

In a recent board meeting, Kumar referred to a study consultant Michael Gallagher did after more than 80 percent of Tulare voters approved an $85 million bond for the new tower.

The study showed the district was losing 20,000 hospital days to neighboring hospitals, Kumar said.

“If we improve our emergency room, many of our patients will come here,” he said.

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Rate Hikes Fail To Halt Garbage Fund Deficit

Tulare - Despite three consecutive 5 percent rate increases, the city’s garbage collection program continues to operate in the red and is expected to suffer a net operating loss of $378,930 in the 2007-08 fiscal year.

This loss, combined with those from previous years, will leave the solid waste and street sweeping division slightly more than $1 million in the hole.

“It’s frustrating,” Public Works Director Lew Nelson said. “It’s impossible right now to get a handle on what the problem is.”

A new utility billing software program that the finance department recently started using is expected to help find an answer within the next two months, Nelson said.

Solid waste revenues are now co-mingled in one fund and any effort to go through manually and separate the income according to users would be “horrendous,” he said.

“This new system will do all that for us,” he added, explaining it would help the city figure out if it’s undercharging residential customers, commercial customers are both.

Before the Board of Public Utilities approved the rate increases three years ago, commissioners were told the city could expect to continue to lose money in the first year—which it did to the tune of $90,730—come close to breaking even in the second and end up the black in the 2007-08 year.

That is not happening. The solid waste division is expected to end this fiscal year on June 30 year with a $36,310 loss. The $378,930 deficit projected for 2007-08 includes the third 5 percent rate increase, which goes into effect July 1, Nelson said.

The losses are even more puzzling because of the city’s growth.

That growth should be helping the financial situation “unless it’s costing us more to serve them than what we’re charging them,” Nelson said. “We have new customers coming on all the time.”

The city has had to purchase several new garbage trucks in the past three years to keep up with the growth, which could be contributing to the deficit because the truck are costing about $65,000 more than they did eight years ago, Nelson said.

Board Chairman Wayne Hinman, a certified public accountant, also decried the amount of money the public utility funds must pay to the city’s general fund for the administrative services provided by other city departments.

Those fees are expected to total $2.44 million in the new fiscal year, which is up from $2 million this year and $1.9 million in the 2005-06 year.

The solid waste division, which includes street sweeping,  is slated to pay $576,070 in administrative fees in the new year, compared with $505,540 this year and $484,460 in 2005-06.

Nelson explained the fees are based on the revenues each division receives, including proceeds from bond sales. (The city is involved in a large wastewater treatment expansion project that involves the sale of bonds.)

“It’s not a particularly fair way of calculating,” Hinman said. “Percentages are easy, but that doesn’t make it right.”

Nelson and Finance director Darlene Thompson said a consultant will look at all the costs and the method of calculating the fee.

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Mathewson's Return Restores Calm at TDH

Tulare - Things appeared to have calmed down at Tulare District Hospital, where new interim Chief Nursing Officer Pat Mathewson has come aboard, bringing with her a respected prior history with the hospital.

Mathewson replaces Paula Richards, whom interim Chief Executive Officer Bob Kelley placed on administrative leave on May 30. She was told she would be dismissed two weeks later and subsequently resigned.

Richards’ sudden departure was unsettling, reportedly prompting more than a dozen nurses to ask Kelley to reinstate her and Tulare Local HealthCare District board members Deanne Martin-Soares and Roger McPhetridge to call for Kelley’s resignation.

“It was a god sent that Pat [Mathewson] was available,” Dr. Prem Kamboj said. “She’s the best nursing director I’ve seen in this hospital in 30 years.”

Kamboj said he believes the nurses are happy with Mathewson.

“I think the community should be reassured we have four managers….and between them they have more than 120 years of management experience,” he said. “It’s a very experienced and successful management team.” (He was referring to Kelley, Mathewson, interim-Chief Financial Officer John Church and deputy administrator Meade Hallock.)

Martin-Soares and McPhetridge, both nurses who have worked for Mathewson, agreed she is an exceptional nursing director.

“She’s a very strong leader and I have a lot of confidence in her,” McPhetridge said. “She’s very staff and patient oriented.”

Martin-Soares said Mathewson has the assessment and leadership skills to lead the nursing staff.

“I think they need that right now,” she said. “I’m sure there are still people very discouraged by Paula’s situation.”

Martin-Soares and McPhetridge had wanted, but did not succeed, in getting the board to meet in special session to talk about Richards’ pending dismissal. Three of the five board members are needed to request a special meeting and her attempts to get Dr Lonnie Smith to join them failed, Martin-Soares said.

Martin-Soares has asked for four items to go on the board’s regular June 27 agenda.

She said she wants pubic discussion of the district’s priorities and of the idea of holding board meetings twice a month on at least a temporary basis.

She also has asked for a closed session to discuss Richards’ situation and possible disciplinary action against Kelley.

A week after his meeting with Richards, Kelley issued an “open letter” to the community that scolded the media for using terms such as “turmoil” and “leadership crisis” in their headlines and for leading people to believe a crisis existed when it did not.

“I suspect these phrases hurt you as much as they hurt me,” he said in the lengthy two page letter. “I am a newcomer, but I know that many Tulare residents have heartfelt memories and powerful hopes for this hospital. Those sentiments cannot be diminished by inflammatory and wholly inaccurate headlines.”

While Kelley, Kamboj and others alleged inaccurate and overblown media coverage, many close to the nursing situationincluding Martin-Soares and McPhetridgeindicated nursing employees were reeling from news of Richards’ departure and some were even contemplating leaving.

There also were reports senior hospital employees were considering a recall of Kamboj and board President Parmod Kumar, who they and others believed directed the action against Richards. A person did request information about conducting a recall, but as of Monday no one had filed papers, a county elections official said.

Speaking to the Tulare Rotary Club on June 6, Kelley said the board at one of its meetings had told him to “do what’s necessary” to bring the budget into line. He indicated he was making what might be considered unpopular decisions, so when a permanent CEO was hired, he or she would not have to make them.

Richards said Kelley had questioned her financial skills when he placed her on leave, even though she had proposed changes that would reduce the number of nursing positions and save the hospital $2 million.

Kelley again criticized the media during his Rotary presentation, suggesting a young surgeon the hospital district was recruiting may have changed his mind about coming to Tulare because of the bad publicity.

“Nobody wants to go into controversy,” Kelley said. He added the surgeon told recruiters his wife didn’t want to move here.

Before Mayor Craig Vejvodawho managed Dr. Prem Kamboj’s successful hospital board campaign last fallintroduced Kelley to Rotary members, he reported studies indicated only a very small percentage of incumbents lose their seats in an election.

“When incumbents [two in the hospital board’s case] don’t get re-elected, I’m going to say to you the public wants some change,” which can be “tedious” and “painful,” he said.

Speaking of the interim-CEO and interim-Chief Financial Officer John Church, Vejvoda said he thinks “God put these two gentlemen in Tulare” to improve conditions at Tulare District.

Kelley was appointed in a 5-0 vote and “he is a true blessing to us,” he said, adding that Kelley and Church worked together in Madera and “they turned that place around.”

Early in his address, Kelley announced the hiring of Mathewson, who had worked for Tulare District for 27 years, 22 as head of nursing. She is now employed with B.E. Smith Interim Services, a company that provides interim hospital managers, and most recently was interim emergency department manager at Methodist Charlton Medical Center in Texas.

“Bringing Pat Mathewson back is the smartest thing anybody’s done in 10 years,” said Rotarian Melody Tucker, who is a former Tulare District Hospital employee. “She was not only an excellent nurse; she was an excellent nursing director.”

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Ross Gentry: Retiring After 38 Busy Years

Tulare - Ross Gentry, who will retire as assistant superintendent of the Tulare Joint Union High School District on June 30, likes to tell colleagues that every person brings joy to the world—some when they enter into a room and some when they leave it.

“In Ross’s case, it definitely was the former,” Tulare Union High School teacher Wayne Welch said..

“He’s a genuinely good guy who immediately makes everyone around him feel at ease,” Welch said. “When he strikes up a conversation, it is with genuine interest in you, your family and what is going on with your life.”

As a result, Welch said it was not the best thing for his self-esteem when, as a brand new teacher 12 years ago, he took over Gentry’s classes after he was promoted to administration.

“The students wanted to know where their beloved teacher went and who was the interloper trying to take his place,” he said. “And even years after Ross was no longer teaching, former students still would drop by to visit and would be stunned and disappointed to find me instead of him.”

Welch is not the only one who cites Gentry’s deep interest in and commitment to students.

“I think Ross has always been student oriented and his chief concern has always been the achievement of kids, the welfare of kids and the treatment of kids and that’s what I’ve always appreciated about him,” Superintendent Howard Berger said. “As a teacher, counselor and administrator, I think Ross always based his decisions on what was best for kids.”

Born in Coalinga, Gentry attended high school and West Hills Junior College in that town before going to the University of California, Berkley, where he majored in history and minored in English. He obtained a teaching credential from Sacramento State College, where he had taught students in a remedial history class as part of his teaching training and discovered he liked that.

When Gentry came to Tulare Union to teach, then-principal Bill Ny wanted him to assign him three periods of remedial history and two of college prep.

“But I asked for five remedial classes,” Gentry said. “I think I shocked Bill.”

He worked as a teacher in remedial and special education for 10 years, serving as chairman of what was called the Basic Education Department for most of that time.

“Teaching those kids, I became interested in what was becoming a new kind of special education,” Gentry said.

The old model he said viewed the students as “educable mentally retarded” and didn’t have very high educational expectations for students, he said.

The new model focused on addressing learning disabilities and  “many of the students prospered,” he said.

After eight years, he took a sabbatical and enrolled at Cal Poly, San Luis Obispo, where he earned a special education credential and a master’s degree in counseling. When he returned, he taught special education classes at Tulare Union, Tulare Western and Valley high schools for one year and then spent the next eight as a counselor at Union.

He then took a second sabbatical. He started out taking technology in education classes and following the suggestion of one of his Cal Poly professors, enrolled at the University of Southern California, where he obtained a doctorate in educational leadership in 1992.

In the meantime, he developed and taught the first computer applications laboratory in the school district for seven years and then served as director of the district’s technology department for five years. As assistant superintendent for curriculum the last seven years, he was in charge of the technology department which has grown to include seven people.

He is proud of his contributions and that of the technology department which, he said, includes “a whole lot of other people who have done terrific work.”

Building a district wide computer network empowers students, teachers and everybody else, he said.

“Although Ross went into administration and was able to have impact on students in a larger way, when you talked to him you could tell he always missed the one-to-one with kids,” Welch said. “If he was on campus visiting and kids were nearby, you could be sure that Ross would find some way to make a connection, usually with a little off-the-cuff comment in the gentle positive manner that is Ross. He likes kids and they like him back. As an administrator, he never forgot about kids.”

Gentry admits he always felt like “the reluctant administrator,” but with every job change his motivation was not to leave something but to go to something, he said. In the case of moving out of the classroom, the goal was to have an impact on more students.

Gentry is married to Cindy Neelands, a language arts teacher at Cherry Avenue Middle School, who is retiring from the Tulare City School District after 33 years of teaching.. Their daughter, Katya, is a kindergarten teacher in Monrovia.

While Gentry is officially retiring, he will continue to work on behalf of the district in trying to build a collaborative for agricultural programs with College of the Sequoias. He also will look at ways to expand the district’s health careers program and on other projects.

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Buena Vista “Family” To Celebrate 129 Years

Tulare - The 1952 Tehachapi earthquake destroyed the old brick building where they once attended classes, but it did little to diminish the memories Manuel Luis, Barton Smith and Richard Borges have of attending Buena Vista School.

The three are among the 500 alumni expected to attend the first Buena Vista School reunion in 20 years on Saturday, June 23 on the campus, 21660 Road 60.

Buena Vista was founded in 1878 with 15 students and continues today with an enrollment that fluctuates between 191 and 202 students.

The original school was a one-room wooden schoolhouse that stood where the Lorenzo ranch is now. The district constructed a larger, modern brick building in 1915, which was directly south of the current classroom buildings.

While Luis, 83, Smith, 74, and Borges, 70, began Buena Vista at different times, each recalls fondly Mrs. Carmel Monroe, their first grade teacher, who was loved even though she ran a tight ship in the classroom.

“She was a very lovely lady,” said Luis, who reported spending two years with her in first grade in the early 1930s so he could get a better handle on the English language. “Her whole heart was in teaching.”

Smith, who started school at Buena Vista in the mid-1930s, called Monroe “a phenomenal teacher” and Borges, who began classes there in the mid-1940s, reported she was “just top notch in phonics,” which meant children learned to read well.

Reunion coordinator David Gonzalez also studied with Monroe in the early 1950s and later became the school’s principal/superintendent.

“Teaching was everything for her,” Gonzalez said. “She lived for it.”

Monroe, who began teaching at Buena Vista in 1921, retired in xxxx.

In his early years at Buena Vista, Borges remembers riding a horse about three-quarters of a mile to school each day.

“My Dad built two little stalls there, where we parked our horses,” he said.

Later, his mother drove the school’s 60-passenger school bus.

Smith also rode a horse to school, although his apparently operated at two speeds.

“It could sure run fast going home,” he laughed.

Luis, Smith and Borges all sent their own children to Buena Vista, where later Luis coordinated the 4-H activity and Borges and Smith served on the three-person school board. (Smith’s son, Bruce, and Borges’ son, Rick, later served on the board as well.) Their wives were involved in what was then the Mothers’ Club, as were most mothers. Smith and Borges spoke with pride of the academic excellence the board has promoted for decades by the careful selection and hiring of teachers.

“The majority of the kids that came out of Buena Vista were on the honor roll their first semester of high school,” Borges said.

Gonzalez, who coincidentally was born in the town of Buena Vista in Jalisco, Mexico, not only can attest to the school’s standard of excellence as a former student—he went to school there for eight years in the 1950s—but he contributed to it when he returned in 1983 to teach for six years.

After a five-year interlude at Palo Verde School, he returned in 1993 as teacher, principal and superintendent, a position he held until he retired in 2005. He has served as a consultant to the school for the past two years.

“We’re a family here,” Gonzalez said, echoing the feelings of many who have attended the school.

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