Sunday, August 27, 2006

SVHCC Agenda- August 28th, 2006

Sonoma Valley Health Care Coalition
MONDAY, August 28, 2006
7:00 PM – 9:00 PM Vintage House

Welcome and Opening Remarks – Co-Chairs (15 minutes)

· Options Committee Report
· Communications – KSVY/Blog/Coalition Page
· Volunteers – Community Outreach Program

1. A Doctor/Hospital Proposal – Bob Kowal

2. Future Agendas

· September 11 -- A Private Hospital Alternative – (Dr. Henry Grause and Michael Ross

Doctors Proposal to be Presented

At 7 PM on Monday, August 28, the Coalition will receive a presentation by Robert Kowal and a group of doctors at the Sonoma Hospital for a locally based public/private approach to a new hospital in the Sonoma Valley.

Note that the meeting will be at the Vintage House on Second Street East in Sonoma, not Ramekins.

There will be no Coalition meeting on Labor Day but on the following Monday, September 11
Dr. Henry Grause, architect Michael Ross, and a representative of the Cirrus Group will present their revised plan for a private hospital on Napa Road at 8th Street East.

Saturday, August 26, 2006

Heard It Through The Grapevine

This is the place to share your thoughts or ask questions and discuss the latest information, regarding the plan to build a new hospital in Sonoma.

What's on your mind?

Thursday, August 24, 2006

Five Seek Two Seats on Hospital Board

Sonoma Valley Sun

Following are ballot statements from candidates seeking two available hospital board seats. Lisa Hardy did not file a ballot statement, so The Sun interviewed her for this article.

Kathy (Whelan) Barnett
Age: 55
Occupation: Financial Consultant

I am running for a seat on the Sonoma Valley Health Care District Board because nothing is more important to our Valley than saving our hospital.If elected, I will be a voice of the community on the board.

As a financial consultant, the fiscal health and sustainability of our hospital will be my highest priority. I will continue to listen to every perspective and make commonsense decisions with the best interests of our community in mind.

As Treasurer of the No on C Committee, I worked hard to defeat a measure which was too expensive and which used eminent domain. I refused to listen to doomsday scenarios and knew there was another solution. Going forward, it is important for all of us to come together, regardless of where we stood on Measure C, and find a proposal our community can support.From the very beginning, a local hospital and the services it provides are important to me. I was born in a hospital which is now Bartholomew Park Winery.

Both my children were delivered at Sonoma Valley Hospital. Simply, our hospital is a vital part of our community’s fabric that must be preserved. With you vote, I’ll make sure that happens.


Dick Kirk
Age: 63
Occupation: Psychiatrist, pediatrician, family doctor, business consultant

I am a physician and member of the Health Care District Board, who grew up in Sonoma Valley valuing the land, people and beautiful environment. My education, from Dunbar School and Sonoma High, through becoming a Psychiatrist, Pediatrician, Family Physician, and a Master’s in Health Planning taught me to help heal.

I heal individuals, families and family businesses from illnesses and conflicts. The common sense I learned from our Valley combined with the technical sense of medical education helps me keep both in balance.I have focused on bringing the Board and community together, respecting all viewpoints and people.

The community is struggling to save our existing resources and build a new hospital. The hospital is a vital part of our community and must be preserved. I joined the “Plan B” process to develop alternatives to the hospital’s Measure C, and am now part of the new Coalition, working with integrity to find a quality solution, at reasonable cost, in an acceptable location.

I am working to increase community involvement to balance professional recommendations. I will bring the community together to heal this conflict. Please support me for another term on your District Board.

Michael A. Norton
Age: 57
Hospital Pharmacist

Healthcare in Sonoma Valley is at a crossroads. Timing is critical, if we are to preserve the services provided by our local hospital in a way that is sustainable. I am proud to have worked as a hospital pharmacist, both at a staff level and managerial capacity for 21 years. It’s been a pleasure to work with many dedicated hospital employees and I have enjoyed a collegial relationship with all our local physicians.

It is through the energies of devoted healthcare providers and support staff as well as the creativity of many different administrators and managers that the hospital has been able to survive and even thrive.

My wife and I moved to Sonoma in 1985. We are proud to be Sonomans and plan to live here long into retirement. Continuation of a local hospital is an important part of our vision for Sonoma’s future as it is for many longtime residents and recent arrivals. I hope to use my knowledge of hospital operations to help create a facility that is operationally efficient, capable of attracting quality physicians and other healthcare professionals, affordable and sustainable for years to come. If you share this vision, I would appreciate your vote.

Arnold J. “Arnie” Riebli
Age: 63
Occupation: Farmer-Businessman

I am running for the SVH Board. I am running for the good of my community, my neighbors and my grandchildren.I am a fourth generation, 52-year resident of Sonoma Valley, married to Joan, and I have four adult children, two of whom still reside in Sonoma with four of my grandchildren. I was formerly a volunteer fireman serving in the Valley for over 28 years.

I have worked in Agribusiness in Sonoma County for over 40 years. I reside on six boards. I feel my qualifications as a farmer, businessman and past public servant make me a solid candidate for the board. I am practical, possess integrity and I look forward to working with others to reach positive solutions. As a longstanding member of the community, I believe that I have a sound understanding of a major cross section of the local community.

If given the public confidence, I will represent the people with fiscal responsibility, compassion for my fellow neighbor and willingness to work toward compromise for the common good.With my experience, respect for community and your support, I feel that together, we can collectively make SVHCD the best that it can be.

Lisa Hardy
Occupation: Property Management

Glen Ellen resident Lisa Hardy didn’t file a campaign statement because, she explained Tuesday, doing so cost several hundred dollars and “I’m low-budget campaigning.”“I threw my hat into the the race because I felt like the hospital board has been dragging its feet, kind of in a rut,” said Hardy, who said she hopes to bring “new energy” and a “fresh voice” to the board.

Hardy feels it’s taking too long to get a new hospital built.“We should have been taking care of this sooner,” she said.Hardy said she was opposed to Measure C, the failed ballot proposal to build a new $148 million hospital on Fifth Street West because she was opposed to eminent domain required to take the Leveroni family’s hayfield there as a building site.

Hardy said she’s open-minded about a variety of sites for the hospital, but feels building a new facility on Eighth Street East and Napa Road might be too far away from Glen Ellen. Hardy worked for more than 18 years at Hanna Boys Center, starting as a child care worker and moving up to supervisor. Currently, she and her husband, Michael Hardy, run their own property management business.

Latinos Financial Impact

Sonoma Valley Sun

People complain, sometimes, to Sonoma Valley Hospital officials about non-citizens coming in as patients because they assume that non-citizens drain the hospital’s finances. That assumption is wrong, hospital officials say.

“We are better off with that community here than if we didn’t have them,” said Jim McSweeney, the hospital’s chief financial officer. If the Valley’s non-citizen population disappeared, “There’s no question in my mind that the hospital would be worse off, financially,” he said.

Hospital finance is a “confusing, arcane” subject, but McSweeney explained it this way:About half of the births that take place every year at the Sonoma Valley Hospital are paid for by Medi-Cal, a state and federal program for the poor that is often used in the Valley by Latina mothers.

“You can get on it if you’re a mother, even if you’re not a citizen,” McSweeney said.Medi-Cal accounts for about 10 percent of the hospital’s total income. Another 40 percent of the hospital’s income comes from Medicare, the federal program for those over age 65.

But Medicare kicks in more funding as the hospital serves more Medi-Cal patients.The Sonoma Valley Hospital gets an extra $500,000 a year from Medicare because of all the Medi-Cal patients that it serves.For comparison’s sake, that $500,000 is about one quarter of the $2 million in revenue that the hospital gets annually through the parcel tax paid by the Valley’s property owners.

Financially speaking, the more patients the hospital gets, the better off it is. Additional patients help offset the fixed costs that the hospital incurs by being open and staffed around the clock.“One, or two or 10 more births, aren’t going to add a dime to our costs,” McSweeney said.

Could Latino Vote Help Build Sonoma Hospital?

Only 7 percent of Latinos registered, but what about letting non-citizens vote?

Sonoma Valley Sun

Want a new hospital? Get the Latino community involved.Consultant Kathy Yarbrough offered that advice on Aug. 7 when she spoke to the Sonoma Valley Health Care Coalition, the ad hoc group that meets every Monday night to help craft a bond proposal for a new Sonoma Valley Hospital that will capture the required two-thirds voters’ support.

Yarbrough, the executive director for a coalition of rural hospitals, said that Tehachapi, a city east of Bakersfield, tried to get a hospital built only to have voters reject it by a 3-to-1 margin.But the second time around, Tehachapi voters approved a new, $21 million hospital — a success that Yarbrough attributed to Latino support.

“We really worked on getting with the Hispanic community,” she said. Tehachapi hospital supporters set up booths in front of Mexican restaurants, they included Latinos in focus groups and surveys, and they held meetings at the homes of Latino community leaders, Yarbrough said.Would such a campaign make a difference here?

One thing is obvious: Few, if any, Latinos have been involved at the Monday night hospital coalition meetings. Latinos also were noticeably absent at the three town hall meetings held prior to the hospital board’s decision to introduce Measure C, the failed proposal to build a $148 million hospital on Fifth Street West. And Latinos are underrepresented as voters in the Valley.

Latinos account for about 21 percent of Sonoma County’s population. Yet they only make up an estimated 7 percent of the registered voters in the Sonoma Valley Health Care District, according to the Sun’s analysis of computerized voter registration records. (Geographically, the hospital district includes all of Sonoma Valley up to Kenwood.)

The hospital district currently has 20,029 registered voters. The Sun estimated that 1,373 of those — or 7 percent — were Latino voters, based on their last names.Of course, many of the Sonoma Valley’s Latino residents aren’t citizens and can’t vote. The Valley was home to 3,985 non-citizens, according to year 2000 U.S. Census tract data.

If all those non-citizens were old enough to vote, they could boost voter participation by 20 percent in the hospital district.But non-citizens can’t vote, right?Wrong.It’s a little-known fact that the U.S. Constitution allows non-citizens to vote.

Non-citizen voting?“Philosophically, I’d have to say I’m opposed to it,” said hospital board member John MacConaghy, invoking a common sentiment. Although I’m very pro-immigration and pro-inclusion of our immigrant community, to me, my whole definition of a voter is a citizen.” But, surprising as it may sound, some communities have increased Latino participation by allowing non-citizens to vote in local elections.

For example, Chicago allows non-citizens to vote in school board elections. And in 2004, a referendum in San Francisco that would have let non-citizens vote for school board seats failed narrowly, by 51 percent to 49 percent.Hospital board member Mike Smith was intrigued by the idea.“It sounds like a good idea, if you could get people organized,” Smith said. “It certainly would change the dynamics of a lot of stuff.”

Non-citizen voting used to be widespread. For the first 150 years of U.S. history, from 1776 to 1926, 22 states and federal territories allowed non-citizens to vote in local, state and even federal elections. But the rights were gradually repealed, due to such things as anti-immigrant sentiment, southern states’ resentment of immigrants’ opposition to slavery, and the Red Scare after World War I.That’s according to Ron Hayduk, a political science professor at the Borough of Manhattan Community College, who’s written articles and a book about the subject titled “Democracy for All: Restoring Immigrant Voting Rights in the United States.”

Hayduk’s point is that the United States has an estimated 12 million legal permanent residents who may work, pay taxes, send their children to school and participate in the military — yet aren’t allowed to vote.He got interested in the subject while working for New York City’s Voter Assistance Commission, which encourages and helps people to register to vote.Hayduk looked at U.S. Census data and found there was a huge non-citizen population that wasn’t eligible to vote.

Around the same time, he heard news of an effort to register non-citizens in Tacoma Park, Md.His reaction to the Maryland campaign was, “Oh wow, really? You can do this? It’s legal?” Hayduk recalled.“I think it’s fascinating that this history has been effectively erased from our national (memory),” Hayduk told the Sun.

Most people know about poll taxes, literacy tests and other methods that the segregated South used to prevent blacks and poor whites from voting prior to the Voting Rights Act of 1965, Hayduk said, but few people realize non-citizens can vote.

Arguments pro and conThe most common objection to non-citizen voting is that immigrants should be citizens first, said an article co-written by Hayduk and Michele Wucker, of the World Policy Institute.But their argument against that is that the naturalization process has become cumbersome and slow and can take years, especially after Sept. 11, 2001.Their article said that opponents also question loyalty of immigrants.“Yet most immigrants are already members of their communities and assume all the other responsibilities of local citizenship.

They already have an inherent interest in safe, clean streets and services the community need to survive,” Hayduk and Wucker responded.They also note that non-citizens are not a homogenous group.“Some evidence from research on ... non-citizen voting in Europe suggests only modest shifts in the political balance of power, if any, would occur,” the article said.

Matt Gonzalez is the San Francisco city supervisor who introduced Proposition F, the 2004 ballot proposition that would have let non-citizens to vote in school board elections in the city.“There’s talk about doing it again, because we got so close,” Gonzales told the Sun.

Roughly one-third of San Francisco’s students have immigrant parents.Interestingly, Gonzales said voters turned down Proposition F in some of the traditionally more progressive neighborhoods, such as Haight-Ashbury, and approved it in more conservative – yet immigrant-heavy – neighborhoods, such as the Excelsior District.

Proposition F’s opponents said the measure would require an amendment to California’s constitution, but supporters believed that wasn’t necessary and that the measure could stave off any court challenges.

Monday, August 21, 2006

Meeting Summary (8-14-06)

Affiliation with St. Joseph Memorial Not in the Cards for SVH

Addressing the Sonoma Valley Health Care Coalition at its regular Monday meeting at Vintage House, George Perez, CEO of St. Joseph Memorial Hospital in Santa Rosa, extinguished any hope that Memorial would entertain a financial or operating affiliation with Sonoma Valley Hospital as a solution to the Valley’s need for a new viable hospital facility.

Perez, along with Mark Knight, St. Joseph’s Vice President of Strategic Services, was invited to address the Coalition, which is exploring a variety of options for a new healthcare system in the wake of the defeat of Measure C.

Bob Edwards, Co-Chair of the Coalition with Steve Pease, explained that numerous Coalition participants had asked whether taxpayer burden for a new facility might be reduced, and operating margins for the hospital improved, if the hospital entered into a joint relationship with Memorial, as has Petaluma Hospital and Queen of the Valley hospital in Napa. With interest in the subject high, the Coalition wanted to hear Perez discuss that possibility directly.

“I think we got the answer tonight,” said Edwards, who observed that “Though it wasn’t what we might have liked, at least we have laid that possibility to rest and the Coalition can focus on other Options. It’s part of what we are trying to do – working through information and options to see what will work best -- financially, operationally and for the voters. Part of learning what will work includes learning what will not.”

Perez distinguished Sonoma Valley’s situation from that of Petaluma and Napa hospitals, noting that the latter do not have the extensive seismic issues facing Sonoma Valley Hospital, with its implication of greater construction costs. He also said that the 80-bed Petaluma Hospital, like Napa’s and unlike Sonoma Valley, serves a far larger population (about 100,000 in its service area) and draws revenue from a greater pool of patients. Napa, he noted, also depends heavily on a very generous philanthropic income of some $12 million a year.

Pressed by several members of the audience seeking his opinion as to the threshold size of hospital which would be financially viable in Sonoma, Perez and Knight declined to speculate, noting there were many variables. Both said that in the current and anticipated health care environment, it will be difficult for small general hospitals to survive without taxpayer support of some kind. Small private for-profit hospitals are more likely to be successful, he noted, because they typically focus on high-margin or niche business and do not attempt to serve the medical needs of the general community.

Perez made it clear that constantly increasing costs and continually shrinking payor reimbursements, Memorial is not looking for additional relationships with other small hospitals, for financial reasons. “Though Sonoma has a high wealth base and is better off than many small hospitals, things are tough for small hospitals everywhere, and they have a very hard job,” he said. Noting that Petaluma lost $700,000 last month he said that small hospitals do not enjoy the benefits of high volume to stabilize ups and downs in patient load and revenue, and high fixed overheard costs can’t be reliably covered each month. He did not see that changing, given the on-going reductions in reimbursements from Medi-cal, Medicare and private insurers.

Like all speakers who have addressed the Coalition on a variety of topics since its inception on May, Perez and Knight devoted ample time to take numerous questions from the floor.

At the Coalitions August 21st meeting, attorney Mary McEachron will provide information and answer questions on eminent domain and restrictions pertaining to the use of the current hospital property. Also on the program will be an explanation of seismic code requirements by Michael Van Pelt, Principal, Van Pelt Construction Services, Suisun City, and Bill Dasher, S.E., Principal, DASSE Design, Oakland

On August 28, the Coalition will hear a presentation of a new hospital Option put together by the hospital and staff physicians. After a Labor Day break, Dr. Henry Grause and architect Michael Ross will return on September 11 to present the Coalition a two-pronged Option, including a newly developed proposal for a privately financed and operated hospital.

***

Sunday, August 20, 2006

SVHCC Meeting Double Header

REMEMBER -- AND PASS THE WORD.

The Sonoma Valley Health Care Coalition is meeting at Vintage House on Monday, Aug 21, and 28 at 7PM.

Tomorrows meeting, August 21, is a double header!

Two hot topics. Seismic Mandate in California and Eminent Domain.

Michael Van Pelt and Bill Dasher will talk to us about the California Seismic Mandate and its effect on us and other hospitals. They will also talk about our situation with the West Wing of our hospital, the Central Core and the East Wing, Skilled Nursing Facility.

Mary McEachron will then cover eminent domain. She will talk about how eminent domain works in California as well as the specific issues surrounding the Carnelli and Cuneo properties. So there are two key topics on tap for one session.

HOPE TO SEE YOU THERE -- AND PASS THE WORD.

Thursday, August 17, 2006

No Sugar Daddy

St. Joseph no ‘sugar daddy’ Owns area hospitals but no capital to build one in Sonoma, official says

Sonoma Valley Sun

Will a “sugar daddy” step forward and pay for a new Sonoma Valley Hospital so that taxpayers don’t have to?If that happens, the St. Joseph Health System, which operates hospitals in Santa Rosa, Napa and Petaluma, won’t be Mr. Moneybags.

At the Monday night meeting of the Sonoma Valley Healthcare Coalition, George Perez, the CEO of St. Joseph, said it doesn’t have the money to build a new facility here.“We just wouldn’t be able to do that,” said Perez. “We just don’t have the capital.“These are very expensive, very difficult times for people in healthcare right now.”

Perez went on to describe — with help from his vice president Mark Knight — how things work at St. Joseph as a crowd of about 60 people peppered him with questions at the Vintage House senior center.St. Joseph owns Queen of the Valley Hospital in Napa and Santa Rosa Memorial Hospital, and both of those are doing well, Perez said.

One thing that helps Queen of the Valley is the high level of donations that it receives, he said.“Napa’s consistently done much better than Santa Rosa” when it comes to philanthropy, he said, noting that about $11 million in donations have been made towards the heart institute there with $15 million expected by years’ end. But the real advantage that the two hospitals have over Petaluma’s publicly owned hospital (which St. Joseph’s operates) is size.“Economy of scale is a large part of it,” he said.

As an example, Perez said that a $450,000 piece of medical equipment costs as much for a small hospital as it does for a large one — but the large hospital will recover its expense sooner because the equipment gets more use.“It’s going to cost you $450,000 if you’re a 25-bed hospital or a 350-bed hospital,” Perez said.

All of St. Joseph’s hospitals, including some small ones along the California coast in the Eureka area, have to support themselves. The system’s big hospitals don’t subsidize the small ones, he said.Taxpayers in Petaluma will have to pass a bond to pay for facility improvements there; Petaluma’s hospital — though growing — doesn’t earn enough to make the improvements without taxpayers’ help, he said.A subsidy of some sort or donations generally are needed to keep a smaller hospital afloat, Knight said.“When you get below 100 beds, you’re in a tough situation no matter where you are,” he said.

• Want to stay abreast of the Sonoma Valley Healthcare Coalition’s doings? Check out the ad hoc committee’s blog at http://www.svhcc.blogspot.com

Monday, August 14, 2006

SVHCC Agenda - August 14th, 2006

Sonoma Valley Health Care Coalition
MONDAY, August 14, 2006
7:00 PM – 9:00 PM Vintage House




Welcome and Opening Remarks – Co-Chairs (15 minutes)

· Voter Survey Status Report

· Staff Survey Status Report

· Communications – KSVY/Blog/Coaltion Page

1. George Perez, CEO, Memorial Hospital, Santa Rosa, and Mark Knight, Vice President – Strategic Services, S. Joe/Memorial


2. Future Agendas

· August 21 – Eminent Domain & CC & R’s - Mary McEachron, Esq.; Seismic code requirements - Michael Van Pelt, Principal, Van Pelt Construction Services, Suisun City, & Bill Dasher, S.E., Principal, DASSE Design, Oakland

· August 28 -- ??

· September 11 -- ??

· September 18 -- ??

· September 25 -- ??



Adjourn: 9:00 PM

SVHCC Planned Meeting Speakers & Major Topics

Sonoma Valley Healthcare Coalition

Major Topics/Planned Meeting Speakers to Date

June 5, 2006: Review and Approval of The Statement of Purpose of the Coalition and Status Reports of Committees and Game Plan Going Forward

June 12, 2006: Drs. David Nidorf, Robert Cohen and Jim McSweeney – Emergency Rooms in California and the Sonoma Valley Hospital ER

June 19, 2006: Steve Marler – Sonoma Valley FireMed Ambulance Service

June 26, 2006: Preparation of Questions for the Plan B Experts[1]

July 3, 2006 – No meeting

July 6, 2006: Return of the Plan B Experts – Jim Diaz and Wanda Jones

July 10, 2006: Patricia Talbot – Sonoma Valley Community Health Center

July 17, 2006: David Hitchcock and David Yarborough – Outlook for Component (or Modular) Construction of California Hospital

July 24, 2006: Dr. Henry Grausz & Michael Ross – Another Option for Sonoma

July 31, 2006: J. Michael Watt – Future Market Demand for Sonoma Valley’s Hospital

August 7, 2006: Kathy Yarborough – The Outlook for Rural Hospitals in California

August 14, 2006: George Perez and Mark Knight – Memorial Hospital and its Relationship with Sonoma Valley Hospital

August 21, 2006: Mary McEachron – Eminent Domain and Mike Van Pelt, Van Pelt Construction Service & Bill Dasher, DASSE Design - Seismic Issues at Sonoma Valley Hospital

August 28, 2006: The Marin IPA/Doctors and Hospital Proposal
[1] On June 26th, the Options Committee meeting which preceded the Coalition Meeting had a presentation from representatives of Healdsburg Hospital to discuss their situation