15 October 2016

Desert Health Care candidate answers

The Desert Sun has provided questions and answers for candidates for the three positions on the Desert Health Care District commission. However, the format of the material does not conveniently allow comparison of the candidates' answers. So those published answers are presented here in tabular format.

First, let's explore what the function of Desert Health Care District is.  Their website provides succinct descriptions of the agency.

Our Mission

Promote good health for the District’s residents by providing community grants and by protecting and enhancing the assets of the District.

Our Vision

To be a leader in promoting a healthier community and higher quality of life for all District residents. To help meet health care needs in the District by continually enhancing our expertise, assessing the provision of health care services, reaching out to leading agencies to support their efforts, and advocating effective health care policy to key decision makers.

Our Values

We believe every resident in our District deserves:
  • Access to health education, disease prevention and comprehensive diagnostic and treatment services
  • The opportunity to participate in District matters through access and input to the board
We support positive health system change via:
  • Incorporating best-practice methodologies where possible
  • Encouraging accurate outcome measurement by benchmarking, monitoring and evaluation
  • Supporting innovative new practices and programs
  • Fostering collaboration and partnerships

Board of Directors

The five publicly elected officials bring a wealth of business experience and expertise, health care background, and community involvement to the board.

President - William J. Grimm, D.O.

  • Elected in November 2012

Kay Hazen - Vice-President

  • Appointed January 2001
  • Elected in November 2002
  • Appointed In Lieu of Election December 2010
  • Elected in November 2014

Mark Matthews - Treasurer

  • Appointed in Lieu of Election November 2000
  • Appointed In Lieu of Election December 2004
  • Elected in November 2008
  • Elected in November 2012

Michael Solomon, MD - Director

  • Elected in November 2008
  • Elected in November 2012

Carole Rogers, RN, MPH - Director

  • Elected in November 2014

Desert Health Care District Candidates Answer Questions

David Duffner Jerome C. Estes Lind Marie Levinson Donald Lorack Mark Matthews Jennifer Susan Wortham Les Zendle
What priorities do you have for the use of health care district grant money?
The best return on investment for grant money would be support for healthcare related educational programs. That would include nursing, nursing assistant, nurse practitioners, physician’s assistant, physical therapist and aides, x-ray technologist, lab techs, and any other related health care professional that I have forgotten to mention. There is a significant problem with the shortage of available workforce in the Coachella Valley. Many young people leave here to get training for a job in healthcare and then find a job where they get training. The district should act to reverse that trend, and support programs that encourage young people who aspire to healthcare vocations to get the training they need for the jobs we need to fill. Enhance mental health care awareness, particularly in our public schools and universities through education and anti-stigma campaigns. Support and develop early intervention and preventive health care services with special emphasis on mental health care which currently is at a crisis level in the Coachella Valley. Support specialized training regarding mental health issues in first responders and law enforcement. Identify and assist local not-for-profit organizations providing health care for our high-risk residents. I am on the grants committee and can speak to this question based on my experience. Currently there is one mental health clinic in our district in Desert Hot Springs for the geriatric population only. There are few programs, group homes or other long term treatment for this undeserved population, and nothing for the mentally ill who have a medical comorbidity. There are funds available to address this lack of resources and that is my priority. I would expand street medicine to include a mobile medical clinic to reach the undeserved unable to get medical care. Spending grant money for these programs will positively impact Desert Regional Medical Center’s Emergency Room and provide needed health care for all our residents. The current district organization has as a major mission statement “providing community grants”. My orientation as a former Desert Healthcare Administrator and career long Healthcare/Hospital Executive is that of the district mission being driven by its charge to provide an acute care hospital environment to a specific district community within its model. Recognizing the Desert Healthcare District has a modified model due to the change of control through the current lease, grants now appear to be the priority in an expanded community based agenda. I need to better understand where all the elements of the overall district strategy are in supporting the acute care model before setting any priorities for grants. The current list of grant activity appears to be impressive and I would like to know more about its sustainability against the daunting challenges facing the district. This column left blank because of blog format text. Each change in healthcare policy at the state and federal level will cause re-evaluation of where your finite grant funds go. The future decisions by the district and our neighbors east of the existing boundaries to address healthcare access and inequality will be paramount to both allocation and deployment of grant funding. This is why the outcome of the coming Desert Healthcare District election is so important. We have two directors who have chosen not to run for re-election. I am the only candidate on the ballot who has over 30 years of healthcare governance experience at Desert Hospital and 20 years at Desert Healthcare District. I played a role in negotiating the existing arrangement with Tenet Health which saved Desert Hospital from desperate financial straits while creating enormous value for the constituents of Desert Healthcare District. Our plan worked better than we imagined. I would invest a portion of the grant money in new technology and upgrade the hospital’s medical equipment. I would also invest in improving the outdated areas of the hospital. I would continue to fund health education programs; programs focused on the region’s youth; programs serving patients with HIV/AID’s, and those serving at-risk populations including victims of child, elder, and spousal abuse. I would continue to fund training for future health care providers and programs designed to bring quality health care providers to the area. The 2013 Coachella Valley Community Needs Assessment study reported that the Valley has a 13% higher rate of cancer deaths than the California average. I would like to see the district develop a program to provide cancer prevention and early detection services for our community. Finally, I would like to see funds spent on improving access to mental health care and substance abuse services. Improving access to primary care and especially mental health care (for people with and without insurance – including the under-insured). The District should help fund training programs for providers in these fields. Also, the District can use grants to help non-profits expand their counseling services (e.g., Jewish Family Service, LGBT Community Center of the Desert, etc.) Developing community-based programs in health education - both teaching people how to navigate our often non-integrated healthcare system (e.g., urgent care, emergency care, home health care, social services, etc.) and educating the community in wellness, disease prevention and self-treatment. Addressing issues of healthcare disparities and educating all providers in culturally competent care. The Coachella Valley’s Latino, Native American, African-American and the LGBTQ communities present unique challenges to those delivering high quality healthcare. As a community-wide organization, the District is in a unique position to address issues these challenges.
What role should the Desert Healthcare Foundation play in funding programs? What changes would you like to see in the foundation’s role or in its board of directors?
I am not clear about the relationship of the foundation board to the district board. My approach would be to subject this issue to analysis from the classic Business approach of identification of strengths, weaknesses, opportunities, and threats. In a transparent way the district board and the foundation must be in sync and the results should be cost effective. The structure must conform to the overall goals of the organization and ultimately to the benefit of the taxpayers/citizens. In 2012, the Foundation revised its bylaws to allow for support of health care and wellness services across the entire Coachella Valley. The roles of the foundation now include "fiscal sponsor and incubator of new collaborative projects.” I am in support of the current foundation bylaws. These rolls will become increasingly more urgent in the next 20 years as the Coachella Valley is the fastest growing population in Riverside County. Anticipating the health care needs of our growing population will require a visionary approach and commitment. The Foundation has come under criticism recently for spending district money for programs outside our district. The Foundation is also funded as a beneficiary of several trust funds. At this time, I don’t think there should be any funding from the District to be used outside the district boundary. The Foundation was originally founded to raise money when Desert was a nonprofit. Since then it funds health and welfare programs across the valley. The Foundation does not have a separate board. The District Board is responsible for the Foundations programs requests. I do think there should be a separate board. I would like to see much more community involvement by making sure through the paper and all other media sources to let our residents know when and where meetings will be held. I believe the district and the foundation are outstanding community assets that could and should play a very significant role in the future of health and healthcare support going forward to the entire C.V. Both entities are most relevant to today’s healthcare services environment, however, both would be benefitted from and benefit the entire community with a redirection of strategy and repositioning of purpose. This column left blank because of blog format text. In years past, the Foundation has developed important healthcare services to address local needs, including the Smile Factory dental program, breast cancer screening programs and Health Car transportation service. The Foundation created the Health Assessment Resource Center (HARC), developed the Wellness Park and worked with valley wide partners to educate and enroll residents during the introduction of the Affordable Care Act. The Foundation investment in Find Food Bank and the Desert Aids Project has dramatically improved the outcomes for food insecurity and Sexually Transmitted Disease. Going forward, however, I think it is possible that the Foundation may take on a less proactive role until we understand better what AB 2414 means when fully implemented. I have listened to ideas to support local business with insurance options for employers small and large that would have the dual benefit of insuring more people and supporting local employment. The foundation should continue playing a key role in identifying the healthcare needs in the community by supporting organizations such as HARC, and providing grants to community service organizations to fund health education and disease prevention programs. The Foundation could play a critical role in coordinating services, and building greater collaboration among government agencies, local healthcare providers, and community service organizations. A significate portion of the current funding for the foundation’s programs comes from the special tax imposed on the District’s property owners. I would like to see the foundation take a more active role in fundraising to support the needs of the District rather than relying on taxes. I would restructure the foundation’s board to include more physicians, healthcare providers and representatives of several community service organizations. It is somewhat confusing that there are two boards (Foundation and District), both of which have identical board members and make community grants. My understanding is that the Foundation Board essentially disappeared in 2004. It was resurrected in 2012 in order to make grants to programs that serve people across the entire Coachella Valley (including east of Cook Street). Hopefully, this will become a moot point if the voters approve the expansion of the district in 2018. Also, there are some theoretical benefits to having a separate Foundation because it can accept money from entities (other foundations and private bequests) reluctant to give money to a governmental agency like the DHCD. Regardless of which entity makes a community grant, the process needs to be transparent and accountable. Recipients of grants need to show that the money was used for the purpose intended and also be able to demonstrate positive outcomes from the funded program(s).
What are your feelings about the district’s expansion into the eastern Coachella Valley? How would you propose paying for new services there?
From a feeling standpoint I would like to see the district provide the maximum benefit over the broadest possible area. My concern would be that by stretching the district, the resources would also be stretched and therefore perhaps not as effective. I would definitely have an open mind on this question. The critical analysis would be based on the sources and uses of funds and the ultimate benefits to the taxpayer/citizens. The Desert Healthcare District voted to back a CV Expansion Bill AB2414 sponsored by Assemblyman Edwardo Garcia, which I support. The Bill could reach Governor Brown by the end of August 2016. Riverside County’s population is rapidly expanding, with the Coachella Valley’s population rising at a higher rate than the rest of the county. The population explosion will largely take place in the eastern Coachella Valley; for example, Indio is expected to increase from 73,000 in 2008 to 112,000 projected in 2030. The city of Coachella is expected to grow from 38,000 to 70,000 in 2020, per the Southern California Association of Governments. There will be an assessment/evaluation by Local Agency Formation Commission to determine the best way to pay for expansion. Also, the California Endowment is studying the issue with a report to be released soon. It appears property taxes and builder impact fees would pay for expansion of services. I support the district’s expansion. I think funding for this would be the same as for our district, through property taxes. There may be other funds through the state government available as well. The East Valley has a hospital, Oasis Mental Health and other programs in place. These programs could expand to accommodate the demand in the East Valley. Riverside Mental Health and Tenet would be good partners to further improve programs and patient care specific to the population in conjunction with the expansion. The expansion of the district into the East Valley is an outstanding idea and should be accomplished as soon as possible. The opportunity to have an all-inclusive valley collaborative strategy is something that is long overdue. An all-inclusive strategy utilizing the district and foundation entities supported by a valley wide coalition of providers and municipalities could very much create a model of best practices and support for Provider Delivery System Development, going forward into the challenge of National Healthcare Delivery Reform. This column left blank because of blog format text. A vote of the people in the East Valley will determine the expansion. The legislation does not allow for the voters of the Desert Healthcare District to have a voice on expansion. However, funding cannot be approved until a second vote takes place. Paying for these new services is a critical question. I welcome a broad public discussion to help develop a consensus on how to proceed. That sounds like good government to me. If and when East Valley voters approve the district expansion, I believe a funding and facilities plan should be on the same ballot in the future. The voters should demand a comprehensive plan for health service delivery for the near term of 10 years and the long term of 30 years. My concern is that the current bill (AB 2414), does not outline how the proposed expansion will enhance the overall health of our community. I am also very concerned that the proposed legislation fails to identify a funding mechanism for the expansion of services to the area, and that the residents in the current Desert Healthcare District will not have a voice in the decision. In the past few years, Desert Regional Medical Center generated nearly two hundred million dollars in profit. A good portion of the profit comes from serving patients from the eastern Coachella Valley. Most of the profit produced by the hospital currently leaves the region. I believe we should reinvest this money into our community, which would help the local economy by increasing employment and ensuring the healthcare needs of all of the people in the Coachella Valley are well served. I very much support the expansion of the Desert Healthcare District to the eastern Coachella Valley for two reasons. First, it is the most efficient way to offer residents of the eastern valley similar support in improving the health of that community — something they need and deserve. Second, dividing the Coachella Valley into two halves makes no sense from either a public health or an access to healthcare perspective. Residents cross Cook Street (in both directions) to work, shop, eat and seek medical care. Desert Regional Medical Center is home to the Coachella Valley’s only designated trauma center and the only neonatal intensive care unit. As to how to pay for the expansion, AB 2414 calls upon the Riverside County Local Agency Formation Commission (LAFCo) to do an “analysis of funding sources available to the district”. I would hope that such funding could come from the taxes residents already pay rather than new taxes.
What qualities would you like to see in the district’s next CEO?
The next CEO of the Desert Healthcare District must have excellent skills at organizational transformation and communication. The current district board and staff have been rocked by the turmoil of a lawsuit by a director against the district and the CEO with the predictable result of organizational dysfunction. Recalling my studies for an MBA in healthcare, the district board needs to refocus, and by that I mean the process of establishing vision, mission, goals, objectives, and then determining strategy and tactics to achieve those goals. Few people would disagree that the American healthcare system is in a state of flux. It is the job of the district board to organize and direct the organization and resources to achieve the maximum benefit for the taxpayers and citizens. The new CEO must be ready on day one to work under the direction of the board to get the job done. Track record of competence and caring; results-oriented Personal insight - one who isn’t as concerned with titles or power structures as they are about the welfare of the community One who seeks feedback from staff and others including community leaders. Courage - willingness to look at risk and act on what is the right thing to do, not just for today, for the long term. Tackle bad news head on. Foresight - someone who has a vision for the future; leadership as opposed to management. The next CEO qualities I would like to see are leadership, flexibility, task oriented and accountability to district residents for decisions made on their behalf. Improving community relations with community leaders and residents by more interaction and visibility. I would encourage through the press and all other media sources, residents to attend meetings and offer their concerns and comments on the health care of our district. Rather than the district telling us what we need, listening to residents that use health services fits more with our Mission Statement. The next CEO should be able to relate to a classic asset change of control model whereby the hospital has been partially monetized and its community mission somewhat replaced by the corpus associated with a new foundation, in this case, the district. Therefore, the individual should have some history and background associated with hospital operations and healthcare in general together with some but not overweighed experience in a public health environment. The ideal candidate because of the size and scope of the position should have an extensive background in finance with an aspiration in the pursuit of a CEO role of a marginally active district. To that end, an individual with hands-on experience in a California district environment would be very helpful. In addition, the usual and customary things that you would expect such as high professional character, honesty, loyalty, bravery, team leader should be warmly looked upon as values presented by an applicant. This column left blank because of blog format text. Running the Healthcare District of tomorrow requires someone who understands the role and rules of public agencies. I also expect them to have an understanding of our changing healthcare system as brought about by the Affordable Care Act and evolving market conditions. Healthcare is one of the largest and most important businesses in the Coachella Valley. A coalition and consensus builder will be important attributes for our next CEO. The Healthcare District CEO must be a strategic thinker who understands the connections and relationships among various stakeholders and how the District’s work fits into the big picture. The CEO must have a systems perspective, looking at the health of the community as a whole and must consider the past, present and possible future challenges and opportunities when making plans and decisions. I would seek a candidate with excellent results-oriented problem-solving skills and exceptional communications skills. The candidate must be an effective change agent, who drives for better and more innovative ways to improve the health of the community. The CEO must commit to sustained, effective change while consistently re-evaluating the status quo with a focus on value-added activities in a constantly changing environment. The role of the District CEO is to provide leadership and guidance in order to achieve the agency’s mission, strategy, and annual goals and objectives. It should also be noted that the new CEO will be the primary manager of both the possible expansion of the Desert District and the possible renegotiation/renewal of the hospital lease. My ideal candidate should have exceptional communication skills (listening and transmitting information), coupled with a passion for providing high quality healthcare in a collaborative effort — not only with the 5 elected officials of the District Board but with all the other key players in the district. To achieve this, he or she must understand the objectives of the District, be creative in assembling and synthesizing the varied recommendations, and work collaboratively to implement them in the most efficient and effective way possible.
Assess Tenet’s performance running Desert Regional Medical Center. Should Tenet be given approval to operate the hospital beyond 2027?
This extremely important question cannot be fully addressed in a brief response. According to reporting from the Desert Sun over the last couple of years, and the recent one star rating by Medicare, there should be intense scrutiny regarding the administration of Desert Regional Medical Center. After my 12 years of service here, it is obvious to me that Palm Springs and much of the Coachella Valley considers DRMC as “their community hospital.” As the only regional provider of trauma care, neonatal intensive care, and other vital services the hospital is incredibly important for providing healthcare to residents and also assuring that quality care is available to outsiders who choose to visit or become seasonal residents. I have no doubt whatsoever that DRMC can and should do better and I believe it is the duty of the Desert Healthcare District to provide oversight to ensure that high level quality is provided. Tenet has done a fair job in running Desert Regional Medical Center. The hospital has scored high in joint replacement surgery and gall bladder removal; The Comprehensive Community Cancer Program is excellent. The hospital received a gold+ award from the American Heart Association for treatment of congestive heart failure: and of course, the trauma Level II services are vital to our community. That said, there is room for improvement. Several agencies including the Federal Government have given the hospital a low overall rating. I believe it is too early to make a decision on the lease extension of 2027. We have time to measure and weigh our options. This should be accomplished with community partners involvement and the process should be as transparent as possible. The predictions for population growth over the next 11 years indicate tremendous population growth for the Coachella Valley and it will be essential that we be prepared to take on the needs of our growing communities. Tenets performance: I have given that a lot of thought and have talked to residents that have been there recently. My concerns are the long wait time in the emergency room, the reception area not being welcoming and helpful, elevators not working and the physical appearance and crowding of some floors and rooms. To my knowledge, Tenet has spent limited money compared to the income they receive from this facility doing any kind of upgrades or improvements. Particularly the East Wing, Lobby and Emergency Room. Their patient satisfaction is low compared to other county hospitals. I would like to see a Desert Hospital Urgent Care located by the hospital as an option for patients to alleviate the emergency room’s overcrowding and improving patient relations. A comprehensive Urgent Care to include Mental Health. I am not aware of any concrete proposals from Tenet at this time. It is in the District’s best interest to have in place a long-term agreement to deal with the very challenging strategic and operating matters it now faces with the hospital. The hospital needs to deal with significant strategic matters such as master planning for purposes of facility modernization, emergency room expansion, together with the resolution of any seismic issues. These fairly daunting matters cannot be dealt with in a vacuum nor within the context of a remaining 10-year lease alone. The healthcare environment is changing more today than ever before. The transformation of structure, operations and interests are all very time sensitive. For these reasons, again it is in the District’s best interest to move on and expeditiously deal with this situation. This column left blank because of blog format text. That will be determined by District Voters. The only way Tenet can be given approval to operate the hospital beyond 2027 is for a majority of voters in the Healthcare District to approve in a public vote. As it stands today, or as it will look if the voters approve expansion into the East Valley as AB 2414 proposes, we are going to need a tremendous amount of money for capital investment. The only way to do that is thru a compelling strategy created by healthcare leaders in the valley that is approved by a majority of voters in the Desert Healthcare District. If we eliminate a partnership with an entity such as Tenet we put the entire burden on the taxpayers of the district. We lose not just the capital investment made in hospital equipment and facilities, but also the property tax payments. The hospital reported better than average performance in the ED, and for procedures delivered to people who experienced a stroke. However, the hospital has one star out of five in the Hospital Compare Report. The Healthgrades report indicated that 68% of patients who received care at the hospital would definitely recommend the hospital, slightly below the national average. People who experienced a stroke, heart attack, respiratory failure, or sepsis had higher than expected mortality rates, which indicates an opportunity for improvement in the quality of care delivered at the hospital. There are 11 years left on the current lease. The new Board should take its time, and make an informed decision on the future of the hospital. Any future agreement must ensure that a percentage of profits generated by the hospital are reinvested into the hospital, and on services that will improve the health and wellbeing of our community. Although the District Board does not manage Desert Regional Medical Center (DRMC), it has a responsibility to ensure the hospital provides high quality affordable care to District residents. The current lease with Tenet Healthcare does not expire until 2027, however, the District Board can represent the community to help identify issues and to improve the quality of care and service at the DRMC. The low score from the Centers for Medicare and Medicaid Services is concerning, but it needs to be put in the context of other health scorecards such as those from the Leapfrog Group, Consumer Reports, Healthgrades, US News and World Reports, etc. Each of these scorecards gives us information about the quality of care and service at DRMC. Tenet should use this information, as well as its own assessment activities, to continually improve. Two services I think Tenet should add are inpatient psychiatry beds and more beds in the Emergency Department.

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