Comes at Critical Time
Tulare - Tulare-area voters will go to the polls on Nov. 4 to elect three board members at a critical time in the history of the Tulare Local HealthCare District.
The 57-year-old hospital is preparing to build a four-story tower that will include a new emergency room and other improvements that officials hope will do two things: attract physicians interested in working in a state of the art hospital; and reassure district residents who now go elsewhere that they can receive excellent care at their local hospital.
District voters, convinced the expansion was critical to the hospital's long-term viability, overwhelmingly approved an $85 million bond measure in 2005 for the project. But since then, the scope of the expansion has broadened, costs have risen and the price tag has grown to $120 million –well beyond the initial $105 million estimate.
This has put the hospital board in the position of having to find $35 million at a time when Medi-Cal and other reimbursements are shrinking and costs continue to rise.
At the recommendation of new Chief Executive Officer Shawn Bolouki, the five-member board has hired a consulting firm that is doing a top-to-bottom operational analysis of the district with an eye toward both increasing efficiency and identifying cost-saving measures.
Recommendations are expected next week and no one is denying the board will have to make painful cuts if the hospital is to move its operational budget well into the black to save money for the expansion and build a healthy reserve.
Dr. Parmod Kumar, board chairman and a candidate for re-election, explained the decision that will face the board this way: “Do I put 700 jobs at risk [by doing nothing] or do I cut a few of the 700 jobs?”
Lawsuits
Against this financial backdrop, the hospital district is also involved in several lawsuits, including one it brought against Bob Montion, charging the former CEO, who retired in 2006 for medical reasons, with violating terms of his retirement settlement and launching a “vendetta” against the hospital.
That lawsuit remains unsettled as does another brought by a group of Latino voters who have charged the district with violating California's Voting Rights Act by conducting at-large, rather than neighborhood, elections. That matter is scheduled for trial in 2009.
A wrongful termination lawsuit filed by former Chief Financial Officer Lucy Reimche against the district was recently settled for $600,000.
These challenges have not discouraged people from running for the board. Five candidates, including two of the three incumbents whose seats are up for election, have filed in the race.
The candidates are, in alphabetical order:
• Skip Barwick, a 57-year-old real estate broker and owner of a soils amendment business. He also spent 14 years in the banking industry. He is a member of the board of directors for both the Tulare Noon Rotary Club and Happy Trails Therapeutic Riding Academy and a member of the committee in favor of the Measure J bond to build a College of the Sequoias campus in Tulare. He and his wife, Mary Jane Barwick, have five children and nine grandchildren between them.
• Sherrie Bell, a 48-year-old part-time realtor and fulltime mother. She is president of the Tulare Noon Rotary Club, served as AYSO soccer board treasurer for seven years and has been a volunteer in classrooms, for Boy Scouts and in her church. She is married to Robert Bell, an oral surgeon, and they have six children and two grandchildren.
• Incumbent Dr. Parmod Kumar, a gastroenterologist who has served 14 years on the board. He also has volunteered his services for the Tulare Athletic Boxing Club and offered his home for many charitable events in the community. He and his wife, Dr. Parul Gupta, an obstetrician and gynecologist, have one son.
• Incumbent Roger McPhetridge, a 51-year-old nurse with the California Department of Corrections. He is seeking a second term. His past community involvements have included Little League and other organizations and he has been on medical missions overseas to establish safety standards and protocols at hospitals in Kenya. He is married to Amber McPhetridge and they have four children and four grandchildren between them.
• Richard Torrez, 42, a history and science teacher in the alternative education program in the Tulare Joint Union High School District. He also is executive director of the Tulare Athletic Boxing Club, a position h e has held since 2000. He and his wife, Kimberly, have two children.
Skip Barwick
Barwick said his business background, especially the 14 years he spent in banking, and his ability to bring people together will serve him well if he is elected.
“I had a record of cleaning up bank branches with problems,”
he said. “At age 21, I was the youngest supervisor in Crocker Bank.”
He was also involved with personnel issues, audits, security, recording
keeping, marketing and other matters, he said.
After examining hospital financial reports, Barwick said the hospital needs
to not only cut expenses to address the decline in income but to find new
sources of revenue.
“Cutting alone won't do the job,” he said. “We need to recruit other services, other doctors, other medical practices that will tie into our hospital to increase our revenue stream.”
The hospital's move to offer bariatric services is a step
in the right direction, he said.
In other matters, Barwick said:
• The hospital's move to establish rural health clinics in Tulare and elsewhere in the district to ease the burden on the emergency room and increase revenues is a good idea, but he wishes the board would have tried to work something out with the Tulare Community Health Clinic.
• “I think the board has made some good sound changes and tried to do what, in its opinion, is best for the hospital, but the decisions they make will continue to be challenged by the perception of who ultimately benefits from them … It's not any more healthy having doctors in control of the hospital board than having teachers in control of the school board.”
•“The hospital has to operate on a profitable basis. Seeing the reserves depleted, it scares me.”
•“I think Shawn Bolouki is the guy to get this new hospital built. If it can be done, I think Shawn Bolouki can do it.”
Sherrie Bell
Bell comes to her interview with a copy of “Hardwiring Excellence,” a book by Quint Studer that Bolouki is asking members of his staff to read.
“If this is really his [Bolouki's] philosophy, it's a great philosophy,” Bell said, explaining the author calls upon hospitals to set high expectations for employees and recognize their good work, which in term will lead to excellent patient service.
“If the patient and employees are satisfied, the natural result is financial success,” she said.
Bell said she balked initially when asked to run for the hospital board but later decided it was important to become involved because of the expansion, the obvious discord and tension that had existed among board members until recently and the financial downturn of the district.
“I'm a peacemaker; I don't have a temper,” she said. “I have definite opinions. I like efficiency and waste bothers me. I believe the physical health of the community is essential to its overall health.”
In other matters, Bell said:
• “I have no agenda except to make the hospital better.” The hospital and board needs to move forward. “One of my concerns is there are a lot of people who want to go back to the past.”
• While a consultant may recommend a lot of cuts and changes later this month, it is important to give the people involved an opportunity to give their opinions.
• It is important to have a woman on the board, because “a majority of patients are women—obstetrics and gynecology is the hospital's largest department. If we [women] are not in the hospital, we're bringing patients to the hospital.” (Deanne Martin-Soares, the only woman on the board, is not seeking re-election.)
•“When I go to the board meetings, I'm liking what I see.” She especially liked a proposal from the hospital's health insurance broker that would cut insurance costs by $800,000 without affecting the level of benefits or unduly burdening employees.
Dr. Parmod Kumar
Kumar said he is running for the hospital board because he wants to help guide the hospital's expansion.
“I want to finish what I started,” he said. “I think as a doctor, I know what needs to go in there in terms of future care.”
He wants to complete the expansion in a timely manner and make the hospital “fiscally responsible,” he said, adding the board needs to respect the voters' support for the $85 million bond by “prudent management.”
He said he is proud the board hired Bolouki early this year for the permanent CEO job and Bob Kelley for the interim position before that.
He also described the new emergency room group the district
recently hired as “phenomenal” and reported patient complaints
have dropped as a result.
His board colleagues Drs. Prem Kamboj and Lonnie Smith were right about
their criticism of the emergency room when they ran for office two years
ago, Kumar said. “We had an issue with the emergency room.”
In other matters, Kumar said:
•“In this day in health care, this community is very blessed to have three doctors on the board. Are we physicians any greater members than the other two members, the answer is no.”
• He is optimistic the hospital can come up with the additional $35 million needed to build the four-story tower. “We have HFS Consulting and they are evaluating our institution from top to bottom. They will tell us which areas to cut. It's going to be difficult to cut jobs.”
• Bolouki has told board members they will either have to accept all the consultant's recommendations or none of them, so people perceive the process as fair. That's going to be necessary but hard, because “some of them [who will lose their jobs] are going to be my friends.”
• Neither he nor any other board member told Bob Kelley, interim CEO for a year, to fire the chief nursing officer or “go after this person or that person.”
• Rumors he orchestrated the hospital's recent decision to change its health insurance broker are false. He said no one lobbied him for a change and the decision came after a fair and methodical process in which he had no say. The new broker's plan to cut costs by $800,000 is indication the change was a good one, he added.
Roger McPhetridge
McPhetridge said he wants to see the hospital expansion completed and new rural health clinics established outside of Tulare, where the hospital now operates two.
“Tulare is certainly a start, but having them in Woodville, Tipton, PIxley and those areas are important so individuals who don't have medical care can access it,” McPhetridge said, adding this would also ease the load in the emergency room.
He is optimistic the district can raise the additional $35 million it needs for the new hospital tower by using cash reserves, getting the hospital foundation involved to a greater degree and encouraging donations from vendors and others in a position to help.
Even though his first term was not always pleasant as board
members bickered among themselves and he found himself a few times on the
losing end of a 3-2 vote, McPhetridge said he is seeking a second term because
of the hospital expansion.
“I feel fairly strongly that you need an old [returning] board member
so it will carry through,” he said in reference to the possibility
the board could seat three new directors after the election.
McPhetridge also said:
• “I like to think I've offered my experience and patience and neutrality to most issues — what I mean by that is being open-minded and not putting my thoughts all in one basket and saying, 'This is the only way.' Realizing I'm not the only one who has great ideas.”
• “I'm extremely happy with Shawn Bolouki, Victoria Myers [vice president for business development] and John Babedian, the new human resources director.”
• “We'll have at least one new board member with fresh ideas, which will be a good thing. Now there are three physicians and two nurses on the board. With Deanne [Martin-Soares] not running, we can put a fresh voice on the board so we can maintain an outside view. And I understand all three of them are fairly good candidates too.”
Richard Torrez
Torrez said he is running for the hospital board for several reasons, including his desire to be a “bridge” for people who don't know how to navigate the healthcare system and a voice for “at-risk” youths and their families.
“It's not a question of new programs; it's increasing awareness,” Torrez said, explaining he and his wife have often helped families that have health problems but don't know how to access the system.
“I have a rapport with a lot of people and I'll be able to bring in feedback and that will help with policies and procedures,” he said.
Another reason he is vying for a board seat is that the hospital has gone through “a lot of turmoil” and he “hopes to be a calming factor.”
Torrez said he would like to see more rural health clinics in places like Alpaugh and Pixley.
“If we can staff them…people will use them,” he said. “From what I've been reading, it would also help finances.”
Torrez also said:
• “I like to be part of things that are good and I see good things happening with the hospital.”
• Regarding raising the additional $35 million for the new hospital tower: “I'm always impressed with the citizens of Tulare and the surrounding communities. They'll do what is needed.” He said a combination of grants and community support will likely be needed. “I'm sure Mr. Bolouki is researching everything and he will bring it to the board.”
• The hospital expansion is very important. “Without the modern facility, we're one step behind. We're losing money with people going elsewhere to find care.”
Committee Hears All Sides
in Racetrack Controversy
Tulare - A fast-paced, well-run town hall meeting on the proposed Tulare Motor Sports Complex no doubt has given a citizens committee a lot to consider as it races to prepare a community impact report for city decision makers.
The final environmental impact report is due out within three to four weeks and the 36-member group will have to have its review done before Monday, Nov. 17, when the Planning Commission is now expected to hold the first formal public hearing on the 711-acre proposal. The project would include a speedway, drag strip, hotels, offices, retail shops, restaurants, recreational amenities, townhouses and other features.
After commissioners weigh in, the matter will go to the City Council on Tuesday, Dec. 2, for another public hearing and then to the Tulare County Local Agency Formation Commission, which would hold a third hearing to consider the request to annex county land into the city for the project.
“The earliest the land could be annexed would be the end of March,” city Planning Director Mark Kielty said.
The 2½ hour meeting last Thursday at the Claude Meitzenheimer Center drew about 150 people, who came to ask questions or voice opinions about the project proposed for 711-acres adjacent to the International Agri-Center and near the Sunrise Estates residential subdivision.
The advisory committee, which includes proponents and opponents of the project, brought in a panel that included developer Bud Long, Jerry Sinift, general manager of the Agri-Center, which plans to sell land to Long's group for the project, Kielty and two consultants who worked on the Environment Impact Report.
At the end of the meeting, moderator Tricia Stevers asked five high school students in the Tulare County Farm Bureau's Youth Leadership program what they thought about the project and got enthusiastic thumbs up from four of the youths and a “maybe” from a fifth.
“I obviously have my job cut out for me at the Farm Bureau,” said Stevers, who is co-chair of the citizens committee and executive director of the Farm Bureau, which opposes the project.
While the students favored the project, the rest of the audience appeared about evenly split when a straw vote was taken. A handful remained undecided.
“We've tried our best to bring all points of view together tonight,” Stevers told the audience before she began posing questions collected from the audience to the panel.
The questions covered a lot of territory, including:
· Traffic impacts on the Paige Avenue. Kielty said the road will become a six-lane arterial with signals at the Highway 99 off-ramp, Blackstone Avenue and Laspina Avenue.
· Financial backers of the project. Long said the Tulare Motor Sports Complex involves six limited partners and Bud Long Inc. is the general partner. The partnership has secured loan commitments “from various underwriters.”
· Loss of agricultural land. Kielty said for every acre taken out of agriculture, the developer will have to find one acre of “equally good” prime farm land to preserve.
· Elk Bayou Soccer Park. Whether the soccer park will remain or have to be re-located has not been decided yet, Kielty said.
· Impact on International Agri-Center. Sinift said the agricultural trade show industry has changed dramatically and investors and attendees are asking for a better return for their money and time. They want to stay closer to the show site and have places to eat and stay, which this project would provide. “This would complete the circle for us,” he said.
· Noise levels in residential areas. The environmental impact report identifies three instances in which noise levels “significantly” exceed 60 decibels, Kielty said. Those are at the proposed on-site townhouses and at two dairy sites. Housing to the north is “not significantly impacted.” He directed the questioner to a noise map included in the draft EIR.
· Noise levels at 100 yards from track. It will depend on what's going on, said Robert E. Brown, an acoustical consultant. “If there is top-fuel drag racing, “you would probably want to cover your ears.”
· Frequency of “substantial” traffic and noise. Top-fuel car drag races will be held at most twice a year and NASCAR- or Indy-type races will likely occur three times a year, Long said. “I don't think the rest of the events would be described as having significant noise or traffic.”
· Other types of racetrack events. Long said the track would probably have activities 250 days a year minimum, including such things as driving schools, pro and amateur racing, movie filming, clubs and car shows and “I assume some concerts,” although that is not the main purpose of the facility.
· Air quality. The impact regionally on ozone and particulate levels is “significant and unavoidable” up and down Highway 99, said David M. Mitchell, senior project manager for Michael Brandman Associates, which did the EIR.
The carbon monoxide, particulate matter and toxic emissions coming from the racetrack itself is “less than significant,” a determination that considers a worse-case scenario, which would be a heavy use day with poor atmospheric conditions, Mitchell said.
· Other projects on the site. Three major hotel operations have made offers to purchase and develop on the site, a 150-unit, four-star recreational vehicle park is planned, along with shopping opportunities and other activities, Long said.
· Cost to the city. The project requires a “significant amount of infrastructure,” which will be financed through a variety of sources, including development impact fees, community service facility district and Measure R sales tax revenues, Kielty said. The developer paid for the environmental impact report, although the city controlled the process.
· Community vote. The public can come to the City Council to express opinions and it also has the option of calling for a referendum, which would result in local voters deciding the matter, Kielty said.
· Impact on employment. The project will have a “significant impact” on the number of jobs available, reducing unemployment in the area to less than 5 percent, Long said, adding the “vast majority” of employees would be local people and pay would range from minimum wage to top executive salaries.
· Impact on water levels. The project will use less water than the current agricultural use does, Kielty said, adding the city and Tulare Irrigation District will continue its program to establish recharge basins to replenish the water supply in wet years. Mitchell said the city has enough water to cover the early development of the site, but would have to add another well later.
· NASCAR cup races? “I think every type of race available in the open market will be held at this facility,” Long said.
Second Half
After a break, local residents got a chance to share their
opinions.
Sandra Gist-Longiano said she was concerned about air and water quality.
“We have the highest rates of asthma in our country,” she said.
Pat Drilling shared that concern. “I do think we have
to be concerned about our children,” she said. “We have two
— soon-to-be three — schools in that area.”
Anthony Casteneda said he has talked to more than 1,000 people about the
project and has heard “not one negative comment.”
Don Brown said the situation is sad because “people who want to create jobs are destroying a priceless resource that is the San Joaquin Valley …The kind of things we grow in this Valley — you can't grow everywhere.”
Janet Heath said she had been “on the fence” regarding the project, but what she has learned has helped her make up her mind. “I'm definitely for this,” she said. “We have young people who don't have jobs.”
Lance Mouw worries the situation will end up “like the mortgage mess” if the city takes at face value the numbers regarding jobs and other matters offered by Long. “It's a great project if it flies,” he said. “If it doesn't fly, it's a disaster. What's the city going to do about that?”
Tom Drilling, a retired dentist, asked Long “when are
we going to see the money?”
The developer said his group already has paid nearly $900,000 for an EIR
and has funding in place for the project, which he estimates will cost about
$1 billion.
“We are not fools,” he told Drilling. “I'm not here to present a project that's smoke and mirrors.”
Tom Manning, a retired teacher and member of Tulare County Citizens for Responsible Growth, said “surely the ag folks see the irony” of favoring asphalt over farmland.
Rachel Dysart, who has spoken against the project on several occasions, said, “This is going to change the landscape of Tulare. This is going to change everything. I don't feel this is right for Tulare.
“We have a lot of really good artists in Tulare and I don't think we appreciate that,” said Wanda Cottengim, a club member who is in charge of this weekend's Art in the Park in Zumwalt Park in downtown Tulare.
Cottengim said Manuel Abad and Joe Vargas as two talented artists who are starting to come into their own on the local art scene.
Abad, who will display his work at the show, was raised in Tulare where he graduated from Tulare Western High School in 1979. After he was discharged from the military he moved to Texas and it was in 1985 that he took his one and only art class — a six-week course one night a week.
“I couldn't find the time to get back into it, so I just started doing it from the books,” he said. “I just liked the challenge of painting.”
He was also inspired by artists Bill Alexander and Bob Ross, who had programs on public television, and club member Wava Myers, an art teacher, who has critiqued his work.
“It helps being critiqued by people who know what they're talking about,” Abad said.
Abad's work is on display in the MGH Gallery in downtown Tulare, the International Agri-Center and The Oak Pit I Porterville.
Vargas took art classes in high school and metal sculptures became his passion after he was discharged from the Navy. He also customized automobiles and motorcycles and did air brushings.
“I liked to draw but I've always wanted to get into oil painting,” he said, explaining why, at the encouragement of his friend Jim Saenz, he became a student of Myers.
“He really has an eye for details in his paintings,” Cottengim said. “I think he's just a phenomenal talent to be just starting. I can't wait until Joe starts branching out and doing his own thing.”
Vargas said he has done landscapes and still life but is just starting to do portraits, focusing on family members. He is the oldest of the late Joe and Nina Vargas' nine children. “I also have a picture of the old Joe's Place [the restaurant his family operated] that I want to paint,” he added.
In addition to the more than 100 paintings that will be shown at Art in the Park, Cottengim said the event will feature jewelry, wood work, lawn items, log furniture, quilts, gourd art, wind chimes, floral arrangements and other crafts.
Tulare - Tulare businessman Gary Ribeiro intends to participate in the 2008 Relay for Life on Oct. 11, walking the survivor lap just as he did last year five months after receiving a diagnosis of stage four lung cancer.
“That's a very emotional walk,” said Ribeiro, who recalled he had just completed his first round of chemotherapy and wasn't feeling very well when he attended the 2007 event.
A lot has happened on the medical front since then. He has completed two more rounds of chemotherapy and has started a fourth. He participated in a trial program at University of California, Davis, Medical Center that “just wasn't very successful” and, of course, there's been those inevitable tests to see how the battle against his cancer is going.
But when one talks with Ribeiro, he gives the impression those medical details won't dominate his thoughts as he attends the event at Bob Mathias Stadium on the Tulare Union High School campus.
As a former American Cancer Society employee who spent a year helping communities, including Tulare, to organize their relays, he knows the event at its heart as much about celebrating life as it is about finding a cure for a dreaded disease.
“It's not a morbid event,” Ribeiro said. “Life is precious and we should celebrate it and fight for it.”
Ribeiro, 61, will tell you often how “blessed” he is, especially when he is talking about family and friends.
He and wife, Michelle, and their two children, Danielle, 16, and Jacob, 3, have a large support system of friends and family who “have gone out of their way to help us,” he said.
The families of cancer patients are often “the forgotten victims” and when people help with food, offers to provide transportation or to babysit, cards, phone calls and prayers, it makes a big difference, he said.
Ribeiro obviously takes great delight in his children.
Danielle, a high school junior, plays water polo and since he has been feeling “pretty good” lately, he's been able to watch her play, he said. “Jake puts a smile on his face every day. He's a fun, fun child.”
Then there's 28-year-old Tyson, who calls to tell him of his latest adventures on a nine-month journey that will take him through 20 countries, and 25-year-old Matt, who will marry in November.
Ribeiro encourages people to attend this year's Relay for Life, even if they are unable to walk.
“Go out just for the celebration,” 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 2 , 2008
