Builders Say New Air Board Fee On Land Use Unfair

San Joaquin Valley - Valley builders are forging a coalition to fight draft rules proposed by the Valley Air Board to tax certain land uses in the valley targeting new growth to fight smog.

Proponents argue it’s about time sprawl paid its fair share to improve the valley air noting how rapid growth here is making it harder to reach clean air goals.

But builders make a point. “We want to pay our fair share but we think it unfair that the new rules apply only to new growth,” says Tulare/Kings BIA executive director Bob Keenan.

Keenan addressed the Visalia Chamber of Commerce Board this past week and got approval from the board to join a growing list of groups opposing what is being called “The Air Board Tax that everyone will pay.”

Tulare Chamber, local Farm Bureau and area Realtors are also fighting the plan that could be adopted by the Air Board in November. Keenan has a busy speaking schedule to add cities and counties to his coalition list that could be quite impressive come November when this issue will be on the front burner.

The so-called indirect source rule is a way to target air emissions from new development that typically means more traffic. So the rule would target home subdivisions over 50 units, shopping centers and industrial projects that each - the logic goes -generate added air pollution for the valley.

Proponents suggest a look at recent history suggests valley growth will overwhelm our air shed considering the population could reach 7 million people by 2040. They note that even though cars are far cleaner than they were years ago, the number of vehicle miles traveled is growing faster than population growth meaning any gains we make to clean the air with new technology or all the investment made by farmers and central valley dairies will be threatened by new growth and traffic.

But the BIA’s Keenan suggests the added cost the Air Board will put on development will simply be passed on to consumers and in the meantime the Air Board has not even suggested how it would use up to $130 million in new fees it would receive each year to improve our air.

Target the New Guy

Air Board member and Tulare County Supervisor Steve Worthley says he has “major problem with indirect source rule.” He says “I don’t like that it just targets the new guy” rather than some fairer approach figuring we are all in this together.

He says a new development like a new Walmart in Dinuba doesn’t necessarily mean more traffic because of the project, because Dinuba area shoppers who frequent Walmart will now not have to travel to Tulare or Selma to shop at Walmart. There is now a store nearby and therefore might be expected to improve the air.

Worthley argues that rather than attacking the problems through taxing real estate - taking away the approval process from local jurisdictions, he suggests a tax on fuel. “We’re trying to get at reducing traffic anyway - why not tax fuel based on the fact if you use more fuel you will pay more to clean the air,” he notes. Such a suggestion would require new state legislation.

Consider however, how much screaming there would be over a new “gas tax” even as fuel reaches record levels in the state. Despite this fairer approach, is it politically possible?

The fee per house on new development - $1000 per home - would not seem to be too much to ask similar to a per home fee based on the number of vehicle miles traveled. That’s what the City of Visalia does with its transportation impact fees that help pay for roads.

The roads need to service the subdivisions and schools are needed to serve these subdivisions and builders pay fees for these necessary amenities. So why not clean air?

Arguing for some sort of fee is the fact that many of new subdivisions in valley cities are at the edge of town helping to build a sprawling city that requires use of vehicles to get around rather than promote infill for which a builder might get credits rather than pay a tax, some have suggested.

Others note that farmers have been asked to step up to the plate to help clean the air and are doing so but that development, including shopping centers and new home subdivisions haven’t met their obligation.

With the rapid growth in huge new subdivisions and coming of big national builders with high profit margins, it seems inevitable that new growth might be an easy target for regulators looking to meet future Clean Air standards.

But BIA’s Keenan says send the Air Board back to the drawing board” to come up with the fairer plan.

Consider that shopping centers and industrial space - each important job and revenue generators for valley cities - will be highly impacted by the fees and sometimes projects just won’t be built.

Economy Killer?

“We’re talking about an economy killer,” claims Keenan. The proposed fee for a regional shopping center would be $1.2 million in 2006 and $4.2 million by 2010. Just to build a mini mart with gas station the proposed fee would add $450,000 to the cost of the project by 2010.

The new rule would also target distribution centers - Visalia’s only expansion industry base for jobs that could be targeted if the fee is so high distribution companies choose to locate elsewhere instead of bringing jobs here. Here again, the target might be fuel - in this case diesel used by the trucking industry that is a problem for our air - perhaps a fee on this fuel could spur more use of cleaner burning diesel.

Worthley says if the indirect source rule proposal can’t be derailed completely, he hopes it can be substantially modified to apply say to just big home developments that can more easily absorb the cost of fees on new homes. New home subdivisions in Kern County have agreed to fund further air projects on a per unit basis.

Pushing in favor of some sort of fee is the Sierra Club and Environmental Defense has suggested the fee be used to help preserve farm land, revitalization of existing communities, reduce vehicle miles traveled and improve affordable housing.

Worthley says while he can support these goals, what he doesn’t want to see the Air Board grow into some kind of regional government that oversees the details including the everyday lives of citizens. He sees benefits however, in promoting infill in cities and air benefits that might bring.

The Air Board itself suggests what is their target - mobile emissions that now account for 69% of the NOx emissions in our Air District. But since they can’t target the cars they try to indirectly target land uses that attract or generate these motor trips.

If the proposed rules seem like overkill, the plain fact is that new growth does generate air pollution and that community infill and building standards that reward conservation would be good for everyone. So what’s fair?

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Some Grape Growers Face Uncertainty Over Crop

San Joaquin Valley - Hundreds of valley grape growers are in limbo this month over what to do with their Thompson seedless grape crop. The uncertainty comes because the valley’s largest buyer, Gallo Winery, Co. has yet to declare what they will pay for Thompsons used in wine blending.

“Growers are kind of gun shy” in complaining about Gallo, says Nat DiBuduo, president of Allied Grape Growers, because they still hold out hope they at Gallo will buy their grapes. But they are running out of time.

Last year Gallo declared they would pay $200 per ton in early July - up from just $90 a ton the year before. But this year there has been no announcement.

Farm trade group representative Manuel Cunha says the impact of Gallo’s decision not to commit to a price affects about 250,000 tons of Thompson seedless grapes forcing growers to either lay their grapes down for raisins or throw in the towel on the crop - let them rot on the vine, he says.

The tonnage represents about 25,000 acres in the central valley.

Extreme Labor Shortage

The problem with making raisins this year is an extreme labor shortage, says Cunha and much of the valley’s raisin crop is not yet been placed on the ground. Cunha says while there is a fraction of labor force needed to do raisin harvesting “Growers are saying they haven’t seen anything like it in the history of raisins here.” Instead the workforce has been siphoned off by the by the busy construction and landscape industry in the valley and elsewhere stimulated by low interest rates.

Cunha says the labor shortage is impacting other crops still being harvested, including tree fruit.

At the height of harvest about 450,000 farmworkers usually are needed to get California's crops in, but this year there are far fewer workers than that. How many fewer? There are no reliable statistics from government at any level to verify the immediate shortage in real time.

Farmers throughout the state, however, report extreme difficulty getting enough workers to fill out harvest crews, operate tractors and help with packing and shipping. They say the tight labor situation could quickly turn into a disaster with ruined crops if it starts to rain before the work is done.

Experts say a serious vulnerability for agriculture is that an estimated 70 percent of the state's seasonal farmworkers are falsely documented.

Growers fear the longer they wait the lower the price offering they will get when they get desperate.

“I wouldn’t be surprised to see Thompson seedless prices below $100 a ton again,” says one grower/middleman who asked not to be named.

Not a Good Thing

“It’s not a good thing when you have one company that dominates the industry,” he says. Gallo as the largest player in the Thompson seedless business calls the tune. Earlier this season several other wineries did announce they would pay $200 a ton for wine grapes, but Gallo didn’t follow. Now other wineries don’t want to commit because they don’t want to be at a competitive disadvantage if Gallo gets the grapes on the cheap.

“I had a grower come to me to ask me to help him move his grapes sitting on vines at 22 sugar,” meaning they need to be picked. “He doesn’t know what to do.”

He says the uncertainty over the future of their crops is causing health problems for some of the growers he knows.

To make matters worse growers have faced huge costs to fight mildew this year because of a wet spring.

USDA Says No

Cunha and others have been lobbying the USDA to extend raisin crop insurance until later in the month - a plan that would allow growers a few more days to lay down their grapes and still qualify for insurance against crop damage from rains. But this week USDA said they couldn’t extend the deadline meaning farmers are on their own after the insurance deadline this week when all raisins have to be on the ground to qualify.

California farmers say they're facing the very real prospect their crops won't be harvested or they will be ruined by rain if lack of workers delays things much longer.

Just this week some thunderstorms hit fields of raisins drying on tarps.

Jerald Rebensdorf is a farmer who manages Fresno Cooperative Raisin Growers. He says he hired 110 workers to harvest raisins last year. This year he has been able to hire only 50.

"Every crew is short," he said. "I don't know anybody who has enough workers."

He said he has converted some of his vineyards to mechanical harvesting and some to "dried on the vine." But he has also had to extend the harvest. He said the latest he has ever harvested raisins in the past was Sept. 10 or 12; this year, he said he expects harvest to extend until Sept. 16. That's a concern, because farmers always worry about having raisins exposed to rain or other inclement weather.

Fresno grape grower Alan Kasparian said that when it comes to getting an adequate workforce, it looks like everything that could go wrong has gone wrong.

"Usually in a given year there are one or two challenges you have to deal with, but this year it's almost everything," Kasparian said. "This is the tightest I've seen the labor situation in many years. We had a historically wet spring that delayed planting and crop development. This year harvest is at least two weeks late and, for raisins, that means the grapes are going down on trays when there's a real chance of rain damage.

"Raisins are the most labor intensive crop in this area," he said. "And we have more growers deciding to lay down their grapes because the wineries are indicating they don't need as many grapes for concentrate as we expected."

Late Crop

Kasparian said a late crop is a problem for field workers who normally move to other harvests in northern growing areas and to Washington state to harvest apples. Increasingly, workers are going into service jobs, such as in Las Vegas, which has seen a big job boom in recent years. And, because labor is tight, people are bidding up wages and pay, which some farmers can't afford, he said.

"I had someone enter our fields last week to try to take our crew by offering them more money. I had a small crew that was hijacked to go and pick someone else's fruit. Coupled with a paper shortage for laying down the grapes in the field, we've got a serious problem," Kasparian said.

If these small growers don’t make it this year, some believe we’re looking at more grapes being pulled in the valley.

Portions of this story are from the California Farm Bureau Federation.

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Some Embezzlement Case Victims May Be Unaware

By Miles Shuper

Visalia - An embezzlement case involving a prominent Visalia man likely has victims who are unaware they are victims and involve substantial amounts of money.

Louis Montion, 61, former president of the Visalia Unified School District Board of Trustees, is scheduled to be sentenced Oct.11 in Tulare County Superior Court. On Sept 13 Montion pleaded “no contest” to four felony counts of grand theft by embezzlement.

Montion owned a Visalia-based collection agency, “Receivables Solutions”. According to Visalia police investigators and prosecutors from the Tulare County District Attorney’s office various businesses send lists of clients who had not paid their debts to “Receivables Solutions” for collections. Montion collected money for the bad debts but did not give all the collected money to the creditors, it has been alleged. In some cases, no money was paid at all, authorities said.

Although no final accounting has been made as to how much money has embezzled, Deputy District Attorney Janet Wise said the total was likely more than $5,000. Visalia police investigator Rory Vadnais confirmed that the actual amount of money involved was in the thousands of dollars but could not say exactly how much.

But a source who talked to the Valley Voice, confidentially and who has seen some company reports, said the total in question “is in the hundreds of thousands of dollars.”

According to the charges, the thefts occurred during a period spanning from April 1, 2001 through Jan. 4, 2004. The case came attention of authorities when clients of “Receivables Solutions” failed to receive payments from the firm. Discovering that money had been collected from debtors but not sent to the creditors, clients contacted police.

One of the victims was Mill Creek Management, a property management company in Visalia.

Cathy Hutton, who along with husband Don, owns the company, cited a case in which a woman came in and told of having trouble renting a home or apartment due to a past debt which had been paid off but was still outstanding on a credit report.

Cathy Hutton said she is very concerned about those people who may not even know they are victims—people who paid their debts but money was never send to whom it was owed.

“It could be months or even years until they find out the debt they paid off was never cleared. It will have a long-time or even life-long effect on their credit, “ she said, adding that many of those whose debts were sent to collection “already are struggling” financially.

“They might be making $10 per week payments to get their debts paid and might not know until they went to buy or rent something that their payments weren’t recorded. Those are the real victims,” Hutton said.

Hutton says she knows of other companies or individuals who were never paid but did not report their losses to authorities. A number of them are in the medical field, she said.

One of the four listed victims in the criminal complaint is physical therapist Larry Nava and his wife Betty, who became concerned when no collection monies showed up for a considerable time.

Becky Nava agrees with Cathy Hutton that many people are still unaware their paid debts have not been cleared. Nava said she doesn’t know exactly how much more was lost altogether but believes it is considerable.

Montion’s case was filed out of custody. He was arraigned in Porterville and the plea taken by visiting Judge (Ret) David Allen. Montion was freed on his own recognizence. No bail was set.

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Olive Tree Sales Not ‘The Pits’

By Miles Shuper

Tulare County - For several years now olive acreage in Tulare County and most olive growing areas in California has been dwindling.

With offshore olives being grown, shipped and sold cheaper than U.S. growers can produce and market them, hundreds of trees have been uprooted. And new plantings, especially in the San Joaquin Valley are practically nonexistent.

But while the domestic market is fading, the market for olive trees themselves is strong and getting stronger.

Just ask Sandra Gallardo, president of La Raza Construction of Fresno whose curb and paving company has been transformed into the olive tree excavation and wholesale business. The demand for olive trees which she buys from growers is strong and getting stronger. She admits keeping up with the demand is challenging.

Olive trees have long been popular for landscaping and many a “backyard orchard” or frontyard landscape feature olive trees. The popularity of Mediterranean architecture both in commercial and residential construction has spawned even more interest in olive trees, which are green throughout the year and are a hardly stock.

Just ask Mac Roam who has been an olive rancher the western edge of Woodlake. His picturesque and handsomely landscaped ranch complete with large catfish pond, an island and lush grounds is surrounded by olive trees. The entwined olive tree winding driveway into his ranch is a local attraction. Those trees will remain but the trees surrounding the tunnel driveway are destined to be up-rooted, one by one and hauled away by Gallardo and her crews. Some already are gone but the harvest of trees will turn full-tilt as soon as this year's crop is harvesting, a task which may start any day now. With about five acres, about 500 trees total, the job could take up to a year. Gallardo said a customized tree spade which she is having built should speed the uprooting and shipping process.

Noting that early this week she had two new orders to fill, one for 80 trees and another for 40, Gallardo says she is working as fast a possible to full-fill the demand to wholesalers and tree brokers. Deliveries are made throughout the state. Many of them in Southern California. A quarantine in Northern California is adding to the demand for trees in the San Joaquin Valley, she explained.

Recently in Fresno she delivered 30 trees at the Big Fresno Fair. The trees are located in the bottom inner portion of the horse race track. Gary Kunkel, Tulare County Agriculture Commissioner noted a large dairy operation recently planted a large number of trees around entry into the operation.

Kunkel said Valley olive growers have been pulling out trees for several years. In 2004, Tulare County had 15,620 acres of olives. The total has been declining nearly every year. Ten years the county had 16,443 acres, a decrease of about 800 acres. Kunkel expects more and more orchards to be pulled out or bulldozed as off-shore olives continue to flood the American market. Sandwich shops and pizza makers are the biggest users of the off-shore olives, he explained. U.S. growers just can’t compete with the lower growing, picking processing and shipping costs and there is no indication that will change soon.

The going rate for olive trees is about $100, Gallardo said. La Raza Construction wholesales the trees, which eventually costs the ultimate buyer about $850. Generally La Raza fills orders as they arrive via the wholesalers and the brokers.

She explained that since olives are an alternate bearing crop and that this year, Roam’s five acres are on the heavy crop cycle, she will wait out the harvest. Other growers, those with a small number of trees, usually aren’t concerned about losing any crop.

Olives are relatively shallow rooted and can withstand transplanting quite easily. After they are uprooted, trees are placed either in four-foot boxes or root wrapped. Usually four tees are placed on a 48-foot deck trailer. Sandra says generally the trees are transported to where they will be replanted. It is rare to have them stored for any considerable time, but that doesn’t damage the trees, she said.

She said the biggest problem that buyers of trees encounter is over watering. “I tell them olive trees are hardy and should be watered on a regular basis and not ‘drowned’.

Some people think their trees have died but almost always they come back in about a year, despite the dead appearance,” she said. Some people will spray their new trees to stop bloom and fruit production but most want olives.

Backyard olive trees and other non-commercial growers have been a problem for commercial olive growers and agricultural officials fighting olive pests.

Kunkel said every year there is an on-going battle to get all olive trees treated for disease and pests, especially trees which are not in commercial production. He urges those using olive trees for decoration or back yard production to check their trees and to spray as often as required.

Kunkel said it is likely some growers will decide to pull out their trees after the current harvest.

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What's New

Ford dealer Tim Razzari is negotiating with the City of Visalia over a 6 acre piece of land at the southwest corner of Goshen and Ben Maddox. A notice of the closed door discussion was published for this week's city council meeting. The city has long wanted the dealer out of the heart of Downtown and now that developer Andy Mangano has purchased the current dealership building, Razzari needs to find a new home soon.

Downtrodden Sequoia Field owned by the county, may get new life helped by a plan to bring in small plane manufacturers, the Board of Supervisors heard this week. Renaissance Aircraft has expressed interest in a location at the field north of Visalia to use the current hangars to house a manufacturing line employing 50 to start with, said Carol Derden VP with the company. Supervisor Phil Cox has been leading the charge to upgrade the field with a plan to seek $5 million in federal funds.

The two sides squared off in court September 14 in the West 198 Auto Mall case. A three judge panel heard an appeal by Save Our Corridor group led by Greg Collins arguing that the city had not properly changed their elements of the general plan before they adopted the project. The city argued as a charter city they did not have to make all the changes the corridor group claimed were needed. The panel will likely hand down a ruling before the Visalia city council election in November.

The state has signed a lease with Westland Development to build a 31,000 sf office building for their Central Valley Regional Center on land it owns at Akers and 198. Developer Craig Mangano says the last piece of land they bought from the city four years ago is now in escrow to a hotel builder - Shangri La Development who plan a Hilton brand hotel at the site. That would be the second hotel in this quadrant with construction of La Quinta already underway.

Contract has been let to flatten the former Visalia Chamber building on Mineral King (used to be the Highway Patrol) along Mill Creek. The demolition of the building is necessary when the city found it unfit to be used. Creek supporters are hoping the land remains open space along the creek allowing the trail along the creek to continue but there may be new development plans.

Big Sports Complex Influx: Developer Johnny George says his Pinnacle Sports complex project is up in the air in part because of the high cost of the project. He says he is considering a location on Highway 99 in part because impact fees in Visalia would be so high. In addition, parking problems at the site on Tulare Ave. at Santa Fe may force him to downsize the huge sports playground by one-third. "We're not giving up" on the project, he says, but there remains plenty up in the air.

Although the city expects to open bids on the new Acequia parking garage in November, they will wait until after the Christmas rush to start the big project that will provide much of the parking for the hospital's North Expansion expected to begin around the same time. Kaweah Delta has competed clearing the site of the North Expansion.

Greater non-white population in Visalia schools according to the latest ethnic background supplied by VUSD. The district boasts 25,962 students this fall and about 54% are Hispanic at 14,078. That's up from about 53% last school year. Other minorities have increased at the district as well bringing the white student population to about 35% - down from 37% last school year. Asian school population from all counties is now nearly 1700 while the African American population is now 707.

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Exeter - The JG Boswell Co. is likely to get the green light to study an ambitious development plan for Yokohl Valley that includes the development of Tulare County's first "new town". Boswell - the farming giant on the west side of the valley - also is a major land holder on the east side including this 36,000 acre Yokohl property mostly used to run cattle just east of Exeter.

While the idea of a new town in Yokohl Valley has been discussed for several years a formal investigation by the company the past year resulted in an initial filing this week with the county - the first concrete step they are taking to initiate the formal approval process.

How big a project is Boswell talking about? Consider it on the scale of the company's San Diego East Lake project including a variety of new home products, its own services including schools and shopping, likely several golf courses, a resort lodge on the northeast part of the Yokohl area and its main village in the southwest portion of the land not far from the Yokohl Valley Rd. turn-off on 198. The company plans to leave at least 60% of the land in open space and continue to use the land for cattle raising.

Bill Ostream heads up the Boswell team studying the big project.

Ostream oversees East Lake in San Diego County as well. Ostream says the company plans to pay for all impacts a new development like this may bring offering company funds to pay for police and fire protection - likewise with schools like Exeter High School, for example, who might see an increase in high school students from the projects. The company plans road improvements to the area including likely access from Horse Creek Rd. on the upper part of the property not far from the proposed resort.

Ostream says while Boswell owns substantial water rights in the area, exact engineering plans on how water would be brought in haven't been determined noting that a full EIR lasting a year or more will be undertaken to detail impact issues before asking final county approval.

"All they are doing is asking permission to study the idea," says county planner Teresa Szymanis, suggesting the matter could come to the Board of Supervisors just before or after the holidays.

Ostream says one key argument the company will be making is that putting homes on sub prime grazing land helps keeps subdivision growth off our prime ag land to meet the growing need for housing.

He suggests the Yokohl Ranch project could be built out over a 20 year period with local builders invited to offer homes in the village to meet standards envisioned by Boswell. He says they plan to use local architectural styles and a Main St. village layout to meet the needs of "active adults" - a target population of the project - retirees - that Boswell has some years of experience with in both the East Lake and Sun City in Arizona where Boswell played a part.

But others will surely argue this pristine valley is a nature wonderland and laying down 10,000 homes in the fragile valley is the last thing Tulare County should do.

One issue likely to be brought up is the fact the valley is the home of over 30 important Native American sites identified in a 1975 Department of Interior study when the valley was being proposed as a reservoir site. Nearby Rocky Hill is a famous Indian rock painting site - a site that is seeking funds from the Department of Conservation to be preserved as a park.

Not to be forgotten is the fact that Yokohl is a key wildlife area for the condor and other endangered species. In fact there is strong preservation ethic in Tulare County foothills that may seek Boswell's help in furthering their goals if some or all of this project is going to move forward.

Boswell is already very familiar with another group that needs to be reckoned with, the Center for Race Poverty and the Environment who helped shut down the Boswell dairy plan in Kings County a few years ago and continue to insert themselves in other local issues including plans by Kaweah River Rock where they are parties to suit to stop the project. "We'll be talking to them," says Ostream.

There is another factor in the Boswell plan - next door neighbors, the Gills, have tentative plans of their own to do something similar although they haven't filed anything informal or formal on what plan they might be thinking about.

Supervisor Allen Ishida says unlike Boswell, the Gills water rights may or may not include surface water critical to a project like this.

Although he won't say he will give Boswell the green light to move forward on this study he implies. "I am very open" to it.

Supervisor Worthley told the Voice he too would allow the process to continue and would also approve this initiation. Connie Conway said "at first it seemed a well thought out plan" being the county's first fully master planned community. But Supervisor Phil Cox said they need more details before he would feel comfortable. "It's one thing to have water rights and another thing to deliver the water." In addition he wants to see some details on road improvement. "I worry about traffic impacts spilling out onto 198" of the project. If 198 is a major obstacle some might call for extending the freeway status from Exeter to Yokohl adding two lanes of through traffic as a cost to develop the project.

Cox says the brochure company handed out "had a lot of pretty pictures but no answers" to questions he is concerned about.

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Earlimart - On September 7 the Earlimart Development Group, made up of four land owners, requested the County of Tulare allow the initiation of general plan amendment for lands around Earlimart. The proposal would update the town community plan adding 7780 acres around the town for future development. The group, represented by land owners Greg Davis, Sid Afshar, Robert Pack and Vince Nguyen, say they represent nearly 1500 acres but they plan to recruit other land owners in the study area.

The initiation process will likely be heard by the Board of Supervisors in the next few months allowing the group to move forward with a more detailed study and EIR on the project. Sentiment at the board appear to favor it moving forward.

The group's study objectives include building a balance of affordable and other housing choices, adding commercial and industrial users for more jobs for the area and improvement of public services including infrastructure master plan for the area.

The group indicated it would move forward on the full EIR on the plan.

The 7680 acre plan boundary would run from Deer Creek on the north to White River on the south, Road 144 on the east and Road 120 as its western border.

One big fan is chair of the Board of Supervisors, Connie Conway, who expects the plan "will improve the quality of life of everyone in Earlimart" and likes the idea of bringing private monies to improve infrastructure when there is little public monies available. She says the project has gotten a good reception from Earlimart residents so far.

Conway represents the Earlimart area.

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Tulare County - The health-care system for Tulare County residents is balanced on the edge of a scalpel, and falling to either side represents a crisis for our area-one that will effect everyone. The problems must be addressed by the community, because we cannot afford the alternative.

Tulare County's population is increasing rapidly and approximately 50% of the people here have either no health insurance or coverage that pays very little for care-typically about twenty to twenty-five cents on the dollar. The uninsured patients are both undocumented people and the "working poor", who do not have employer-sponsored health insurance.

Health care for poor residents

Health care for these people-when it exists-typically comes in the form of the six county clinics or private, non-profit organizations such as Family Health Care Network (FHCN) and Exeter's San Juan Health Center. While these programs provide a great deal of care for many patients-FHCN alone had almost 300,000 patient visits in fiscal 2004-05-they are limited in the care provided. Typically, the patients do not receive treatment by non-primary care specialty physicians at these clinics, and private centers. Services normally covered include family medicine, internal medicine, obstetrics/gynecology, and pediatrics.

Access to non-primary care specialists in our community is even a greater problem for those patients requiring such services. Conditions requiring specialists may go partially treated or untreated for long periods of time, resulting in trips to the emergency room for very expensive medical care; many of these patients will make repeated ER visits because they do not have access to the specialists that they require. So-called "unassigned" patients-those without a primary-care physician-present a problem at the ER, because a specialty physician must be found who will agree to provide care. County specialists are very limited, in number and in where they practice. No County-contracted general surgeon or gastroenterologist has treated a patient at Kaweah Delta since I have been in practice here-and there is little chance of it happening, at least in the foreseeable future.

The physician angle-a no-win situation

Providing care for unassigned-often uninsured-patients is a problem for physicians in the community. Doctors are needed to care for patients in not only the primary ambulatory care setting, but also in the emergency room and in the hospital; in the case of the 50% of patients who are uninsured or underinsured, this care is often provided by the physicians with little hope of receiving any payment. Too often, a physician will work all night treating one or several patients admitted to the hospital after an emergency room visit, forcing the physician to cancel office hours the next day (would you want your doctor treating you when he or she had been up all night?). Thus, physicians lose a significant portion of their income while providing care for uninsured patients. This is a losing proposition for the physicians.

The burden has increased so much that many physicians have chosen not to provide care in the emergency room. There are many days and nights each month when one cannot get emergency care by a gastroenterologist, neurosurgeon, neurologist-even a general surgeon. Patients requiring these specialties must be transferred to another hospital-in Fresno, Bakersfield, even as far away as Los Angeles-or simply go without the needed care. And choosing not to provide ER care is not the only option. We have seen departures of many fine physicians in many specialties from this area in recent years-too often as a result of the strains of practice resulting from uncompensated care-and the lack of physicians places further strain on those remaining. A recent Times Delta article bade a fond farewell to Dr. Rafael Cuellar, indicating that he was retiring-in fact, he has chosen to practice in a friendlier market. As a direct result, the remaining gastroenterologists in the area are overbooked-having too many insured patients coming to their offices, they have no time to take on additional patient loads in the hospitals, insured or not. This scenario will be repeated in many specialties in the near future. The system cannot stand forever.

The hospital angle

Thirty percent of the patients admitted to Kaweah Delta Hospital through the emergency room have little or no insurance coverage, yet they receive the same high-quality care as there rest of us-CT scans, surgery, medicines, the works-because it's the right thing to do. But the hospital needs to make up that shortfall. We have all heard and read accounts of patients being charged ten dollars for an aspirin tablet, for example-the hospitals must charge more in order to pay for the care for those uninsured patients.

An unresponsive County government

Perhaps twenty-five years ago, the decision was made-some claim it was largely a political one, some claim financial-to close the county hospital in Tulare. Since then, County patients have been absorbed by the other district hospitals in the County-and four area hospitals have closed in the last ten years or so. The burden increases monthly, even weekly. What has been the County's response to this?

A letter from Lindsay Mann, CEO at Kaweah Delta Hospital, to Supervisor Connie Conway, requesting that the Supervisors discuss the situation with the Kaweah Delta administrators, went unanswered. So did calls requesting a response to the letter and initiation of a discussion of the matter. Finally, shortly after the announced retirement of long-time County Health and Human Services Director Ron Probasco, County Administrative Officer Brian Haddix told Mann that there was nothing to discuss. It is clear that the County intends not to address the problem. Nor have the Supervisors shown that they intend proper use of the so-called Millenium Fund, the money supplied by the federal tobacco settlement, that supplies two million dollars a year for the County-dollars intended to fund health care. This money is being spent on buildings and roads.

The future-bright or blight?

Where do we go from here, except down? One bright spot comes from Family Health Care Network. CEO Harry Foster recently announced his intention to employ a full-time general surgeon. If contract details can be worked out to comply with all applicable regulations, the new surgeon will work as part of a team with Dr. Victoria Gerken, Dr. Rebecca Zulim, and the soon-to-arrive Dr. Han Soo Kim. The four surgeons will form a cooperative to cover the needs of the Kaweah Delta Emergency Room, providing care for all patients in need, who are not attended to by another surgeon.

But the addition of one surgeon is only the first step. A 2004 study by the Coker Group indicated that Visalia will need at least 100 new physicians in a variety of specialties by 2008-that's just three years away. We will have a great deal of trouble attracting these physicians if we cannot show them a reasonable practice environment. Will the County Board of Supervisors fulfill their responsibility? Will they hire or contract with specialists to care for County patients? Will they take steps to ensure proper use of the Millenium Fund? Will they respond to the needs of the community? Will they even answer the phone?

David Hewitt, M.D. Pathologist with Visalia Pathology Medical Group and Medical Director of the Clinical Laboratory at Kaweah Delta Hospital, is Chief of Staff at KDH. Harry Foster of FHCN contributed information for this letter.

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