TDH to End Contract with ER Physicians

Tulare - Tulare District Hospital is ending its contract with the company that provides emergency room physicians, a move Chief Executive Officer Shawn Bolouki said was rooted in concern about patient safety and quality of care.

Representatives of Team Health West, the Pleasanton-based company that has provided ER physicians since 2005, have taken strong issue with Bolouki's assessment.

During the public comment portion of the Tulare Local HealthCare District board's June 25 meeting, Steve Myles, a Team Health vice president, said his company had received notice the hospital would terminate the company's contract.

“Our physicians and the leadership team have enjoyed working with Tulare and would like to continue working with Tulare,” Myles said, after presenting information indicating patient wait times, length of stay in the ER and the number of patients who leave without being seen had dropped significantly since November 2007.

Myles also said his company has conducted a service and operational assessment, used a “mystery patient” to assess service and provided ER nurses with additional training in the last seven months.

Bolouki told the board Myles “selectively omitted” the most serious issues he has with Team Health.

“I am not going to jeopardize the safety of patients and quality of care,” he said, reporting he had spent his first three months on the job observing Emergency Department operations at all hours of the day and night on weekdays and weekends, reviewing patient complaints about the ER, and meeting with community members.

Physician Released

Even after he raised concerns with Team Health, Bolouki said an incident occurred in which he had to release an emergency room physician who was in no condition to treat patients.

The nursing staff had alerted him to the situation and he agreed with their assessment and called board chairman, Dr. Parmod Kumar, who closed his practice and went to the emergency room to provide care for several hours until a Team Health physician could relieve him, Bolouki said.

Myles was not allowed to respond to Bolouki's comments during the meeting and later referred questions about the incident to Dr. Richard Carvolth the president of Team Health West.

“There was no evidence that physician was, in fact, impaired,” Carvolth said, adding his company had a replacement on the scene in less than an hour.

“We feel it was highly unfair for him to make that claim, especially in a public forum,” he said. He maintained there is a process for dealing with an impaired healthcare provider that Bolouki “clearly” did not follow.

He also said this was the first time the hospital had leveled such a charge about one of Team Health's physicians.

“All our indications prior to Mr. Bolouki arriving were that the hospital was very happy with our services and the direction in which emergency services were going and improving,” Carvolth said.

Myles said he attended an Emergency Department Action Committee meeting on Dec. 5, which included several hospital leaders and was chaired by Dr. Asit Shah, a Tulare pediatrician.

“It was reported patient satisfaction scores had exceeded their internal targets and that a cultural change had occurred and that the nursing and physician staffs were collaborating on many improvements,” Myles said, adding a decision was made to reduce the frequency of the Action Committee's meeting to once or twice a year, instead of every other month.

“I don't know anything about the past,” Bolouki said, adding he refuses to second-guess decisions made before his arrival because he is not familiar with the particulars of the issues or circumstances.

He makes his own observations, conducts his own assessments and then makes his decision accordingly, he said.

$100,000 Guarantee

In explaining his decision — which board Vice Chairman Prem Kamboj said had the full support of the hospital board — Bolouki also said he had to apologize to a fire captain who didn't get proper care and that in the prior week alone he had received eight complaints about the ER.

After the meeting, he said more than 50 percent of the complaints he has received about the ER involved “very specific complaints” about physicians.
He also said he had concerns about the rate of physician turnover and the high number of hours some physicians worked to which Carvolth replied: “We operate very much within very accepted standards within our industry.”

Team Health presented Bolouki with an action plan on May 15 in which the company identified ways in which it would, if given a chance, reduce “physician specific” complaints, assist the hospital in improving the image of the Emergency Department and improve the quality of care.

Bolouki said he wanted Team Health to put $100,000 “on the table” to guarantee those improvements would occur within 90 days or the company would forfeit the amount.

“If you don't deliver, there should be consequences,” he said.

Carvolth said Bolouki's proposal was “actually a unilateral penalty for goals that we would have had joint and mutual responsibilities for achieving with the hospital.”

While Bolouki said such penalty clauses are included in many contracts, Carvolth said he has been in business for more than 28 years and “we have never been asked by a hospital to agree to a unilateral penalty clause. I think that is unheard of in health care.”

Myles and Carvolth cited an article on the hospital Web site as evidence the physician group is providing “very good emergency services. The hospital reported it fared well in a comparison of area hospitals regarding treatment of heart attacks, heart failure and pneumonia, there conditions that often present themselves first in the emergency room, Carvolth said.

“The community should not be concerned that it has anything but safe, compassionate care,” he said.

Bolouki said he is talking with another company about providing emergency room physicians and that group is expected to be on-board by Sept. 1.

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Family Joins 'Beast' in Encore Show

Tulare - Mike Hamilton's first Encore Theatre experience was in 1983, when the then-bachelor played Earthquake Magoon in Lil'Abner. In his latest theatrical endeavor he is playing the beast in the company's production of “Beauty and the Beast,” but this time he is not the only Hamilton involved.

Hamilton, his wife, Vivian, and children, Stuart, 18, Jennifer, 16, and Taylor, 13, all have stage parts or are working behind the scenes of the musical extravaganza.
This is not the first time they have worked together.

“The very first time we all got involved here was the year Encore did “Big,” Hamilton said. “It was a blast.” Then came “The Wizard of Oz,” in which he played the Tin Man, Taylor and Jennifer were munchkins, Stuart guarded the gates of the Emerald City and Vivian worked behind the scenes.

What is life like in the Hamiltons’ busy household when the entire family gets involved in an Encore production?

“Messy,” answered Hamilton, who during the day works as a sales representative for Fastenal, an industrial supply company. “We live in Lindsay. We run home, go to bed, get up and come here. Laundry is an afterthought.”

After a show's run, the family takes time to “decompress” and then tackles the housework, he said.

A Vacation

The Hamilton children attend school in Tulare and mom Vivian is the business manager for the Tulare Joint Union High School District. She took last week off to devote full attention to Encore.

“This is my vacation,” she said with a laugh after nearing the end of a 15-hour day that included hoeing and weeding with Taylor around Encore's N Street property and working in the sound booth. “I'm working harder here than I do at work.”
The Hamiltons seem to enjoy their time together with Encore.

“It's nice just being together because we get so little of that,” Vivian said.
“It simplifies our schedules greatly,” said Stuart, who is the narrator and has other roles in the current production. “It's definitely a bonding thing.”

Added his father: “We're a pretty close bunch to begin with.”

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Twin Oaks Starts Work on New Facility

Tulare - Six years of wrangling with the California Office of Statewide Health and Planning Development (OSHPD) have finally come to an end for Magnolia Health Corporation and construction began this week on its 99-bed skilled nursing facility at Twin Oaks, at the corner of Merritt and M Street.

“We ought to be open by the middle of January,” said Ken Moyle, chief executive officer of Magnolia Health Corporation.

The company will hold no groundbreaking ceremony. “We want to get it built,” Moyle said. “We'll have the real party the day it opens.”

The new facility will compliment the Twin Oaks Assisted Living Facility that has been at that location for nearly a decade. The company plans to operate both its new facility and the existing Merritt Manor Skilled Nursing and Rehabilitation on Merritt Avenue across from Tulare District Hospital.

“It's going to be the next level of care. What we have now is assisting living – for someone who is retired and doesn't want to take care of themselves,” Moyle said. “They are self-functioning and physically fit people, but they just don't want to maintain a household anymore.” The new facility will offer health care and rehabilitation for patients who may stay just a couple of weeks or for several months.

Moyle said the nice thing is that spouses who live in Twin Oaks will not be as far away if one requires a skilled nursing facility. “If one spouse becomes sick they have to go to another facility. Now they can stay here.”

Also, residents of Twin Oaks who require skilled nursing will have their room kept for them, with the rent waived for a certain period of time, while they are in the care facility.

While the two facilities will not be physically connected (law will not allow that), they will be next door and connected by a walkway.

The Twin Oaks nursing facility will be similar to Merritt Manor, but larger with a complete rehabilitation unit that will be about four times the size of the one at Merritt.

He said the Twin Oaks Rehabilitation and Nursing Center will accommodate both long term and short term care needs.

About 30 to 40 percent of the patients at Merritt Manor are classified as short-term stays – from two to six weeks. While the average length of stay has come down significantly, he said “we do have some long-term custodial patients – maybe staying a year or two.”

Moyle said the facility will employ 110 to 120 people, from registered nurses to housekeepers.

“We're thrilled. It's going to be wonderful,” Moyle said.
The experience with the state was a nightmare with the continual delays, he said.
“It (the project) has been in Sacramento at OSHPD – back and forth,” Marlene Luis, chief operations officer, said of the six-year-long process.

Residents should see the 35,000-square foot building taking shape in the next 60 days, Moyle said, adding the design will be very similar to what the company has in Porterville.

The facility – with both assisted living and nursing care on the same campus - will be the only one of its kind between Bakersfield and Fresno, he said. .

He said they hope to complete construction of the one-story structure in six to eight months. Cost of the project will be in excess of $6 million, he added.
Twin Oaks Assisted Living is licensed for 85 beds in 48 rooms. Moyle said the occupancy averages about 80 percent.

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Market Bazaar is Step into Another World

Tulare - AMarket Bazaar can feel like a step into the past or a visit to an exotic country, depending on where your tastes lead you as you wander through this unique new business at 245 South K St.

Owner-operator Mercedes Dorado has filled 1,600-square-feet of space with imports, antiques, vintage and cottage furniture, china, jewelry and other interesting, and often fascinating, vintage and imported items.

Friends of Dorado, who admired what she had done with 120-square-feet of space at The Paris Flee Market in downtown Visalia, were urging her to do more with her talent when she and husband, Dion, discovered the vacant downtown Tulare building that she is leasing from the owner of Olie's Fashions.

“The theme is a bazaar, where you find all kind of stuff,” Dorado said as she noted she even carries “new stuff” such as purses and wallets.

Many people have an eclectic taste in furnishings and they might, for example, have a vintage sideboard they want to keep but they also want an exotic touch to their surroundings and that's where her store comes into play, Dorado said.

One recent day, her collection included such diverse items as a shabby chic dresser, French country buffet, imported Bali plantation sleigh bed, a hand stitched Iraqi rug, ironwork big clocks, a five-legged circa 1900 table that she carefully restored, Turkish teapots, a Princess Elizabeth chase lounge, bamboo trunks from India, a 1980s bedroom set and a collection of finely detailed knick knacks.

Many of Dorado's items come from estate sales or import companies and she's constantly looking for new offerings to replace what she's sold.

“A lot of my stuff has been flying out the door,” she said. “All of my carnival class is gone.”

She considers her prices moderate and notes she will mark down items rather than have them sit too long in the store. “I want to keep the store fresh; I find that attracts customers,” she said.

Marine Veteran

Dorado's background is as interesting as her store. She was born and raised in the Sacramento area, but her father traveled a lot and she also lived in such exotic countries as Turkey and Saudi Arabia.

She later spent 18 years with the Marine Corps, retiring three years ago after serving most of those years in logistics management in North Carolina. Her husband is also a Marine and served during the Kuwait invasion and in Iraq for two years. He has returned to Iraq as a reservist with security forces.

After her military discharge, Dorado worked as a financial analyst with the city of Visalia for about three years, but was bored.

“There was no need for me to shoot for a second retirement and not do what I wanted,” she said. In the meantime, her husband was employed as a Dinuba police officer.

It was on one of their trips from Visalia to the Uniform Shoppe in downtown Tulare that they noticed the vacant South K building and decided it would be a good location for her business.

“The downtown is small and clean and I like the people,” Dorado said. “The store owners are very nice.”

As for the future, Dorado said she has applied for a liquor license so she can either sell wine or offer refreshments to her customers while they shop.

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$600,000 Awarded to TDH, Clinic

Tulare - Tulare Community Health Clinic and Tulare District Hospital will get $600,000 in tobacco tax grant money to help the clinic buy land and the hospital design its expansion.

The First 5 Tulare County Commission, which oversees Proposition 10 tobacco tax money, has awarded the clinic $250,000 in one-time grant money to help it purchase land at Prosperity Avenue and Hillman Street where it wants to build a permanent home.

“This grant has come at a good time and I'm very excited about it,” said Steven Holdridge, president of the Tulare Community Health Clinic board. “We are in desperate need of a new home for our patients. The new pediatrics clinic [which is renting space on Leland Avenue] is only a temporary fix.”

The clinic is in escrow to purchase the Prosperity/Hillman land and the grant amount was based on the percentage of the clinic's patients who are 0 to 5 years of age. Grant writer Dawn Wells said these young patients comprise about 25 percent of the clinic's approximately 20,000 patient visits per year.

News of the grant award comes as the clinic marks this month its 10th anniversary since becoming independent of Tulare District. The past decade has brought significant growth to the clinic, which is headquartered in The Village shopping center on Prosperity Avenue at Cherry Street. Escrow on the Prosperity/Hillman property is expected to close in November.

Hospital Expansion

The commission awarded Tulare District $350,000 to help design and take through the state approval process the birthing center portion of its $120 million expansion.
Holdridge was equally as excited to hear about the hospital's grant.

“That's great,” he said. “We're constantly working with Tulare District …the majority of our babies are born there. This is really exciting news.”

Chief Executive Officer Shawn Bolouki said the hospital is grateful for the First 5 money and is continuing to look for other opportunities to help fund the expansion.
Voters passed an $85 million construction bond in 2005, but the cost of the project has skyrocketed to $120 million and the hospital is looking for ways to raise the balance of the funds needed. The hospital, he said for example, has hired a company to develop a strategic fund raising plan for the Tulare Hospital Foundation.

“Tulare is doing well in our grant programs,” said Janet Hogan, executive director of First 5 Tulare County. She also reported Tulare District, after skipping a year, is once again getting an additional $320,000 from a different pot of tobacco money for its breast-feeding awareness program.

Hogan explained tobacco grant money is earmarked to help early children development programs for ages 0 to 5 years. “Our commission has placed a strong emphasis on the health needs of young children,” she said.

Other one-time projects funded by First 5, includes four awards to the Kaweah Delta Foundation: $71,789 for equipment in the hospital's neo-natal intensive care unit; $60,470 for newborn hearing screening equipment; $50,000 to plan for a dental program at the hospital's San Juan Clinic in Exeter and $19,832 for ear, nose and throat equipment for the San Juan Clinic.

Lindsay Unified School District received a $176,868 grant to set up a classroom for its infant-toddler program.

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