Tulare - The consulting firm hired to do a thorough operational and financial assessment of Tulare District Hospital and its affiliates has made recommendations that, if fully implemented, could potentially save $12.9 million in the first year.
Chief Executive Office Shawn Bolouki already had identified other possible cost savings outside the scope of the assessment by HFS Consultants that could boost the savings to between $14.2 million and $14.6 million.
While at first blush it might appear the report is saying the hospital can easily save the $35 million it needs over the next four years for the district's share of a planned $120 million expansion, Bolouki cautioned that is not the case.
A more reasonable expectation is the hospital can save between $4.3 million and $5.4 million a year, he said. HFS potential totals reflect 100 percent implementation of the recommendations, while Bolouki's estimates assume that 60 to 75 percent can be achieved.
The HFS report identifies what needs to be done, but not in all cases how to do it. Figuring out how to make the savings a reality is going to take a lot of “honest open dialogue” and will involve staff cutbacks and other difficult changes, Bolouki said.
“No pain. No gain,” he said.
The $12.9 million HFS projected savings also included a one-time benefit of $5.7 million that would not improve cash flow, but would affect the hospital's balance sheet and income statements.
Bolouki said that would still be a very good thing because it would put the hospital in a position to get better interest rates when it sells the remainder of the $85 million in voter-approved bonds ($70 million worth) for the expansion.
The largest potential savings will likely come from staff cutbacks to bring staffing levels in line with national hospital standards.
The hospital currently employs the equivalent of 5.5 full time employees per occupied bed, which Richard Parsons, an HFS principal, said is above the national average of 4.5.
Consultants also found the hospital needs to improve length-of-stay figures which also are out of compliance with the national average.
The national average length of stay for patients with chronic obstructive pulmonary disease ranges from 3.4 days to 5.1 days, depending on severity, but Tulare District's average runs between 4.2 and 7.2 days. Medicare won't pay for the extra days, which means the hospital loses money.
In an executive summary presented Oct. 8 to the hospital board, HFS representatives said they reviewed the operations of key departments and compared them to national hospital standards.
In addition to staffing levels that are “out of date with national hospital standards,” the consultants found:
· Outdate and/or very deficient policies and procedures for many departments.
· A lack of a strategic plan in many departments.
· A lack of formal review processes, controls and/or measurement procedures.
· Staff behaviors that varied from efficient to less than efficient.
· A staff that provides good care and generally promotes a positive working environment.
A bright light in the assessment was a survey that found 91.5 percent of patients are satisfied with the care they receive at the hospital.
The final 300-page assessment is expected in a few weeks. The cost of the study is about $320,000, Bolouki said.
The hospital already has $20 million in reserve but Bolouki said to use all that money for construction would leave little or no cash left to operate the new facility.
Tulare - Tulare-based Res-Com Pest Control has purchased the Hydrex Pest Control franchise in Visalia, which serves 1,420 customers in Tulare, Kings and Fresno counties.
“We're now the number one pest control company in Tulare County,” said Tony Taylor, who owns the business with his brother Mark Taylor. “We're right at 8,000 customers right now.”
Because Res-Com already serves customers in Tulare, Kings, Fresno and Madera counties, the purchase of Hydrex from Troy and Carol Tenhet means the company can give “prompter service, because everything is so consolidated” and service technicians will not have to drive more than 15 miles a day, Tony Taylor said.
“If you don't have travel time, you have more time for
customers,” Taylor said.
The purchase also brings Taylor closer to his long-term plan to focus the
business within a 35-mile radius from his office.
“At this time it's a little scary to do something like that, but it [the purchase] fits into my mental business plan to have that 35-mile radius,” he said.
Three years ago Res-Com sold off its Bakersfield accounts to consolidate efforts. “A lot of times you start branching out and you have to have a manager and more overhead,” he said. “We do have a Fresno warehouse and we run four trucks out of there.”
The Taylors purchased Strike Pest Control in Porterville in April 2007, gaining 810 customers in the move.
Res-Com is keeping all six of Hydrex Pest Control's service technicians and one of its three office workers, Taylor said, adding the purchase brings the number of Res-Com employees to 51, including 33 pest control technicians and six termite control technicians. “For being a downtown business, we're becoming one of the biggest ones downtown,” he said.
23 Years Old
The Taylor brothers started Res-Com in December 1985.
“We both use to work for another pest control — I was fired and my brother was laid-off,” Tony Taylor said.
Their father, Wayne, who will be 78 years old in December, continues to help his sons in the business, serving as chief financial officer, and their mother, Ellen, 74, works in the pest control department.
Res-Com has been a strong supporter of numerous community projects and organizations. Each year the company holds a Christmas Party for its employees and invites the community to the luncheon at which thousands of dollars are raised for the Salvation Army.
The company is a past Tulare Chamber of Commerce Business of the Year and Tony Taylor is a past Man of the Year. He is currently president of the Tulare Public Library Foundation, which is expected to launch soon a campaign to raise $1 million for the library.
The Taylor brothers are very proud of their business and thankful for the community support it has.
“We're really blessed,” Tony Taylor said. “The community supports us and it's a win-win situation.”
Reopen with New Owners
Tulare - The Emerton Club in downtown Tulare was scheduled to close this week for renovation and is expected to re-open in two to three weeks under new ownership.
Carol Rinn-Elkin, the managing partner for the Tulare Avenue and K Street restaurant, said she cannot announce who the new owners are yet, but said she is “delighted” with their commitment to purchase and operate the up-scale downtown eatery.
“There are some well-know, influential folks in this town who believe in this restaurant and they believe in Tulare,” Rinn-Elkin said. “They're getting together for the long haul.”
Even while the restaurant is closed, The Emerton Club will continue to honor its commitments to service clubs and others who have contracts for special events, she said.
Her staff was told about the change about three weeks ago and she also told regular customers, she said.
Rinn-Elkins said she and six others in a limited partnership have operated the business for 61/2 years and it was the combination of tough economic times and the fact she is 66 years old that prompted the decision to retire.
Paul and Vicki Daley opened V's, the first restaurant in the building, in October 1995, and Rinn-Elkin said they continue to own the structure and are making the improvements for the new owners.
“We just continue to support Tulare and we think Tulare deserves a nice restaurant,” Paul Daley said.
“I think it is important for our community to have that kind of restaurant here, because obviously that's the only one of that type—except for La Piazza,” said Jennifer McCoun, chief executive officer of the Tulare Chamber of Commerce. “We really don't have a lot of upper- end restaurants.”
McCoun said she hopes the new owners will be able to make changes that will allow the eatery to become more profitable.
The Emerton Club stopped serving lunches earlier this year and Rinn-Elkin — who frequently complained the parking situation in the adjacent city-owned lot made it difficult to build up a strong lunch crowd — said the new owners have not decided yet whether they will open for lunch.
The Emerton Club is built on an historic downtown site, where
the Hotel Tulare stood from 1922 until May 23, 1983, when it was destroyed
by an arson fire.
The hotel was built by Los Angeles broker Emery M. Whilton — hence
the name Emerton Club.
California Gov. William D. Stephens and Tulare Elks Lodge members were the first guests when the hotel opened its dining room on July 11, 1922, according to a brief history of the hotel written by Ellen Gorelick, director and curator emeritus of the Tulare Historical Museum.
Other notables, such as President Herbert Hoover, John Wayne, Bing Crosby, Bob Hope, Clark Gable and Jimmy Durante visited the hotel.
Whilton, a big game hunter, filled the hotel lobby and dining room with “the world's greatest private collection of California wild animals, birds and fish specimens,” Gorelick wrote.
After Whilton died in 1945, the hotel was sold to a national company. It closed in 1966, but several businesses continued to operate on the ground floor until the fire.
Tulare - Three women and two men are seeking to replace veteran trustees Karen Hill and Joe Cardoza, who are not seeking re-election to the Tulare Joint Union High School board Nov. 4.
The two new board members will join Craig Hamilton, a dairy
nutritionists, Adrian Holguin, real estate manager, and Steven Lessley,
an optometrist, on the board.
The candidates, in alphabetical order, are:
• Samantha Cushing, 37, a trading assistant with J.D. Heiskell and Company. She is an alumnus of Leadership Tulare, a member of the College of the Sequoias Foundation Board, a participant and honoree in the Leukemia and Lymphoma Society's Team in Training, team recruitment co-chair for the 2008 Relay for Life and a member of Catholic Daughters of the Americas' Tulare chapter. She is also a motivational speaker. She and husband, Wil, have three children, ages 2, 6 and 9 years, who attend Sundale School.
• Frank Fernandes, 37, a dairy farmer. He is a Sundale School parent volunteer, president of the Growers GPS Network and a member of St. Aloysius Church, the Tule River Cooperative Cotton Gin board of directors and the Holstein Association. He and his wife, Diane, have three children, ages 4, 6, and 9.
• Cathy Mederos, 54, a parent/homemaker. She serves on the board of Tulare Youth Services Bureau and is past president of the Tulare City Historical Society and its current membership chair, a member of the Tulare Relay for Life Committee, financial secretary for Sons of Italy Roma Lodge, director for the Tulare County Cabrillo Civic Club and a member of St. Aloysius Catholic Church. She and husband, Dennis, have three adult children.
• Elva Jean Strawn, 60, retired community health technician. She has served seven years as a Tulare Hospital Foundation trustee, four years as a member of the Tulare Police Citizens Complaint Review Board and is a past Girl Scout leader. She also was a volunteer for two ballot bond measures to help build Mission Oak High School. She and her husband, Thomas, have two grown children.
• Derek Thomas, 43, an employee with the California Department of Corrections. Thomas, who ran for City Council in 2004 and 2006, serves on the board for the Boys and Girls Club and has coached high school and AAU basketball and Junior NBA. He is married with two children, ages 13 and 24.
Samantha Cushing
Her educational, work and volunteer experience in the community
have prepared her to serve on the high school board, Cushing said.
She has a bachelor's degree in organizational leadership and development
and in her current position with J.D. Heiskell she works with other employees
to maintain internal accounting measures for the California Business Unit
and helps management implement change, she said.
Cushing said her three top priorities are:
• Maintaining the standard and expectation of excellence among students and staff by engaging in conversation and district-related activities “Knowing the pulse of your organization and understanding the issues it faces allows for open and honest communication.”
• Developing additional resources for technical and vocational education. “Our agricultural and vocational courses must continue to be at the forefront of our agenda.” She said the board should consider hiring a full-time grant writer to find funds for additional programs.
• Maintaining a professional and mutually beneficial relationship with College of the Sequoias, which plans to build a Tulare campus. “The opportunities that will become available to the district and the surrounding communities of the South County through the construction of this facility are endless.”
Frank Fernandes
His vested interest in the community and the quality of education of his children, “first and foremost” qualify him to serve on the school board, Fernandes said.
“My Bachelor of Science degree in business along with my involvement and background in agriculture are also important characteristics needed in this office,” he said, adding that his six years of board experience with the Tule River Cooperative Gin “helps in transitioning a new member such as me.”
Fernandes said his three top priorities are:
• Managing the growth of the district by making sure phase two of Mission Oak High School is completed and encouraging “the growth of a fourth site before we reach capacity.”
• Ensuring high academic standards and opportunities for all students by promoting and backing policies that support that. “As an educational policy-maker, I need to have a moral commitment to provide the very best learning experience, as well as meeting the unique needs of the individual.”
• Maintaining fiscal preparedness. “As a trustee I need to hold the administration accountable for meeting all state requirements so we do not lose any funding.”
Cathy Mederos
Her volunteer experiences with schools have well-qualified her to serve on the high school board, Mederos said.
She was president of the Tulare Western High School Parent/Teacher Organization for six years, co-chaired the district's Sober Grad Party on three occasions and served on site councils and parent advisory committees - all activities that led to her receiving the 2000 Mustang of the Year Award at Tulare Western High School and the 2005 Golden Apple Award from the Tulare County Chapter of California School Administrators, she said. She was also named the Tulare Chamber of commerce's 2007 Woman of the Year.
Mederos said her three top priorities are:
• To make sure all students — whether they plan to enter the workforce after graduation or go to college — have the opportunity to meet their academic potential. “A way to achieve this goal is to continue to offer college prep courses and advanced placement classes, as well as expand our vocational education opportunities.”
• Plan for future growth in the district by starting to look for land for a fourth high school. “Communication with the Tulare City School District, other feeder school districts and the city of Tulare are important in making the decision as to where the fourth high school will be built.”
• Maintain a high quality of educators by continuing to attract the best teachers and develop future administrators. “Continuing to be fiscally responsible and maintaining a positive work environment will assure success in that regard.”
Elva Jean Strawn
Her work and volunteer experiences have prepared her to serve as a high school trustee, Strawn said.
She worked on two bond measure to fund construction of Mission Oak High School, counseled teenagers for nine years, taught parenting classes for six years and worked with budgets, she said.
Strawn said her three top priorities are:
• Safety. “I would like to focus on receiving more categorical and block grants for new [police] officers so that we can eliminate the current gaps at the school sites so that every school has a [full-time] officer protecting our students.” The officers now rotate among the schools.
• Transportation. She wants to find funding for new buses to accommodate the increasing number of students. “This will help with overcrowding issues and give our students the safety they need as well.”
• Infrastructure. She said Tulare Union, Tulare Western and the school farm need facility upgrades and new structures to accommodate the numbers of students they serve.
Derek Thomas
Thomas said the most important qualifications he would bring to the school board is his desire and willingness to serve the district.
“I'm a man of honesty and integrity,” he said. “I possess leadership ability and great communication skills. I know how to get along with people and will keep confidential matters confidential.”
Thomas said his three top priorities are:
• School safety. “As a board member I will ensure there is adequate security on our high school campus.”
• The budget. Expressing concern about state budget cuts that took $3 billion from education, he called for “a conservative and responsible approach to spending” that would include appropriating funds to establish a healthy reserve.
• “The third priority is to be supportive of the dedicated professionals who manage the day-to-day operations of our schools, while providing the necessary resources for our students to achieve their highest potential.”
Tulare - The plot in the on-going saga of Tulare Local HealthCare District versus former Chief Executive Officer Robert Montion has thickened with Montion filing a cross-complaint targeting two physician board members and a third doctor.
The cross-complaint was filed in Tulare County Superior Court in September in connection with a hospital district lawsuit filed last November that alleges Montion violated terms of his severance agreement and was conducting a “vendetta” against the district and interfering with its business.
Montion retired as the district's CEO on March 28, 2007, for health reasons. The lawsuit against him alleges the hospital district suffered damages in excess of $75,000.
Montion's cross-complaint alleges, among other things, that Drs. Parmod Kumar and Prem Kamboj, hospital board members, and Dr. Vinod Gupta, Kumar's brother, told people that Montion was:
• “Brain-damaged and incapable of rational thought or action.”
• A “dead man” in reference to his physical condition.
• “Mentally unbalanced.”
• “So mentally unstable and unbalanced that he would take actions to physically harm the children of Dr. Kumar.”
The action alleges the comments were libelous and slanderous and were made to individuals and companies as part of a “scheme” to damage his present and prospective business relationships.
The lawsuit also alleges Kumar and Gupta — who at one time were Montion's physicians — “deliberately, intentionally and maliciously” disclosed confidential medical information to unauthorized individuals in an attempt to destroy his reputation. If true, such disclosures would violate the state Civil Code regarding patient confidentiality.
“We're not saying their comments were accurate, but that he [Montion] did have physical conditions that were disclosed … and that they suggested that maybe because of those physical conditions he was …mentally unstable,” said Fresno attorney Russell Ryan, who is representing Montion.
Leonard Herr, attorney for both the hospital district and Gupta, denied the allegations and called the cross-complaint “frivolous.”
Settlement Attempts
Asked recently about the money it is costing the district to sue Montion and defend itself in a Voting Rights Lawsuit that local residents have filed against the hospital district, Kumar said recently he would like to settle both cases. (A lawsuit former Chief Financial Officer Lucy Reimche brought against the district recently was settled for $600,000.)
“I would love to go beyond these lawsuits, but people have to be willing to come to the table,” Kumar said.
He said Chief Executive Officer Shawn Bolouki, as well as Herr, have tried to forge agreements, but “it takes two parties to settle.”
Ryan said he was surprised by Kumar's comments and said he and Herr occasionally discussed the possibility of a settlement in Montion's case but the hospital district never put any concrete proposals on the table.
“Mr. Montion — both through me and on his own — tried and he seemed to be rebuffed on every attempt,” Ryan said. “It's kind of frustrating because we'd like to do it…you would think the district would like to get this behind them, but their actions say otherwise.”
Herr said the district has been involved in three mediation sessions involving Montion and the plaintiffs in the Voters Rights Case, but to no avail.
He said Joaquin Avila, attorney for the plaintiffs in the Voters Rights Case, initially wanted to settle that lawsuit for more than $300,000, but “the price tag is now over $1 million.” Herr added the hospital district will be filing a motion “to have the whole case thrown out.”
Avila said Monday he generally does not discuss what goes on in settlement hearings.
“We've explored different avenues and so far they haven't been successful,” he said. “I can tell you these are very expensive cases and if we do win, we will go for attorney fees against the hospital district.”
He and the hospital have one more attempt at mediation before trial and that will take place in December, he said.
Herr called Montion's contention he wants to settle his case “baloney,” especially in light of his cross-complaint against the doctors.
“The hospital paid him money to go away and leave people alone,” but he didn't,” Herr said.
In a response filed in September to the hospital district's lawsuit, Montion denied the district's allegation he violated the settlement agreement. In an earlier motion, he alleged the lawsuit was an attempt to deprive him of his constitutional rights and bankrupt him and asked the court to dismiss the hospital's action against him. The motion was denied.
Kamboj Residency
Montion has remained deeply involved with the hospital district despite his retirement.
In August he filed papers to run for the hospital board, but later withdrew them, explaining he had learned Reimche had filed a second lawsuit against him and the district and he needed to spend time addressing that.
[That lawsuit has not been made public and is believed to be a federal “qui tam” or whistleblower action. Reimche had made reference to such a case in filings related to her Tulare County Superior Court lawsuit.]
At the hospital board's Sept. 24 meeting, Montion read a prepared statement with the intention of asking to Kamboj to resign from the board for a number of reasons, alleging, among other things, that he was not living within the hospital district as required by laws.
But hospital attorney Kris Pedersen would not allow him to finish his statement because she said he had spoken for more than seven minutes, using up his allotted time.
Pedersen had used up his allotted time by interrupting him
several times, Montion insisted. “I'd like the record to read my first
amendment rights have been violated.”
A few hours after the meeting Kamboj issued a prepared statement, contending
the former CEO was “bitter about the binding legal ruling that was
handed down by the District Attorney relative to the matter of my legal
residence.” He also said a judge had reviewed a matter and referred
further questions to his attorney Joe Altschule.
Altschule said the matter was not reviewed by a judge but investigated by
the District Attorney's Office in 2006. That was when Kamboj, a long-time
Tulare pediatrician, bought a $200,000, 100-square-foot condominium in Tulare
and declared it his domicile so he could run for the Tulare hospital board.
In a verbal communication from Assistant District Attorney Don Gallian, Altschule said he was told two years ago the district attorney's office had investigated and the “matter was finished for now.” He also said if Kamboj were elected and moved back to Visalia, the office might look at the matter again.
Montion alleges Kamboj continues to live in an 8,000-square-foot, $900,000 home on 10 acres in Visalia and not in Tulare. He cited a July contract the doctor and his wife signed with the county that gives the address of his Visalia home. Kamboj said he did not provide the county with that address.
Kamboj has said he also owns homes in Los Angeles and Bakersfield and also spends time in them as well as in his Visalia home.
“Ask any lawyer,” Altschule said. “The residence of your domicile is where you intend it to be … he has complied with the laws.”
Montion disagreed with that comment and has sent Altschule opinions by the state Attorney General and other that he said does not support that notion.
“Domicile” in the state Health and Safety Code is defined as “a place of physical presence coupled with an intention to make that place one's permanent home; a person may only have one domicile at any given time,” according to one of the Attorney General's opinions he cited.
Montion also hand-delivered a copy of his complaints about Kamboj to the Secretary of State's Office, which county officials say is the appropriate investigative agency.
The reply he received indicated the Election Fraud Investigation
Unit was aware of the 2006 investigation conducted by the District Attorney
and recently contacted that office to see if it was going to re-open the
matter in light of Montion's complaint.
“Their office informed us that they stand by their original determination,”
the letter from the state reads. The letter further thanks Montion for “bringing
this matter to our attention,” but does indicate whether it will conduct
its own investigation.
Montion said the only remaining step for him is to initiate a special type of lawsuit called a “quo warranto” action which would require him to get permission from the Attorney General to file a lawsuit, which would require substantial financial resources.
“I think I've done all I'm going to do,” he said.
The above stories are the property of The Valley Voice Newspaper and may not be reprinted without explicit permission in writing from the publisher.
October 16, 2008
