Font ResizeCorrespondence from the Garberville Sanitary District was the first item of import on the agenda. The district, along with all property owners in Garberville, had received a notice from the Sanitary District that rates for both sewer and water were going up by 20 percent. The hospital is currently paying a monthly fee of $264 for sewer, or recycled water, service. That rate will rise to $322.80, an increase of $58.80 a month, according to a rate schedule provided by the GSD. The cost to the district for water service was not discussed, but the rates are calculated by zone (Central, Lower Meadows and Upper Meadows) and by the diameter of the intake pipe and will receive the same 20 percent “across the board” increase.
Board chair Steve Bowen was concerned that the increase be proportional to use and board member Mike Thompson expressed a hope that the Sanitary District might give the Healthcare District a break. Thompson asked Operations Manager Kent Scown if the Garberville Fire District was getting any kind of break.
Scown said they weren't. He went on to say that, while he understood that the Sanitary District needed to increase rates, his brother had been trying to get the Sanitary District to adjust its rate structure, but without success. Mark Scown from Humboldt Redwoods Inn has attended several Sanitary District meetings in the past to make a case that the rate structure for water delivery is unjust and penalizes motels by charging per room rather than on actual usage. Thompson wondered if the healthcare district could address the hike from that perspective as well. Board member and Finance Committee Chair Corinne Stromstad suggested that there was no correlation between “what you use and what you get rid of.”
Board member and vice-chair Nancy Wilson noted that service districts like the GSD are being faced with more regulations and higher costs all the time. Wilson also wondered about the possibility of annually adjusted rates and said that she thought the GSD will need more money in the future. However, the board members were reluctant to get on board with the rate hike without further study. District Administrator Debbie Scaife suggested the board might want to select a member to attend the next GSD meeting. At that time they could raise their concerns and ask the GSD board for some idea as to “what the eventual rates will be.”
However, the communication from the Sanitary District included a ballot wherein the property owner was asked to vote yes or no on the rate hike, and when Thompson read the “fine print” accompanying the ballot, it was determined that they couldn't wait until the next GSD meeting to respond. Thompson moved that the healthcare district board vote “No” on the rate increase and this motion passed unanimously.
Under the District Administrator's report, Scaife said that she and Stromstad had attended a program in Ukiah called “Boards on Boards,” conducted by Dr. Bruce Spurlock, an authority on assessing patient care quality and safety. Stromstad said that Spurlock said that quality and safety should be a top priority for boards of directors and that CEOs and department managers should be held accountable in those areas.
”He said the board's big job is to push for quality,” Stromstad said. “It's not just to get better, but to be the best.”
Scaife said that “evidence-based medicine” can be applied to every hospital, even small ones like the Phelps Hospital. She said that she wanted to apply national standards to the hospital, and used standardized name tags as one example of that.
Board member Cherney objected to the suggestion that safety was the board's top job, saying it was only one of the board's responsibilities.
”Safety is not our only job,” he said.
The operation of a digitizer purchased to take over the second reading of x-rays after St. Joseph's Hospital stopped providing that service also came in for discussion during Scaife's Administrator's report. Cherney has alleged that instead of using the digitizer to send x-rays over the phone lines, x-rays were being driven to the contracted reader at great expense. Scaife clarified that the x-rays had been driven down once to establish a face-to-face relationship with Dr. Rankin, the Nighthawk contractor who will be giving the second reading.
Scown reported that the problem was with AT&T, that a final hurdle of existing firewalls was being resolved and that the system should be up and running soon.
Cherney charged also that patient treatment was being impacted by the delay. Dr. Batra, a new doctor working with the district, was present at the meeting and said that “all x-rays are over-read” and that, contrary to Cherney's assertion, it is not the radiologist who has the final say, that x-rays are read by the provider and the second reading is backup.
”Everyone, even radiologists, makes mistakes,” Dr. Batra said. The second reading, if different from the first, leads to a discussion, he said. He estimated that there was a 98 percent accuracy rate among the medical staff when it came to reading x-rays.
Cherney was not assuaged. He said that “at the end of the day” it had taken a few months, lots of donations, and too long a time.
”It just takes time,” Scaife said. “We wish it was faster as well.”
Cherney also raised the issue of policies affecting the campaign for healthcare district board seats. He has been talking to staff members and hearing them discuss the election and he was concerned about conflict erupting among staff members regarding the November healthcare district board election. He was concerned that it might affect patient care.
Human Resources Director Linda Feretto was asked what her research had shown regarding political activity in the work place. She said that the district had the right to limit political activity in the workplace, that posters were prohibited as was the use of district equipment to produce campaign material.
Thompson said he had done “extensive research” in this area and found that most regulations dealt with union activity and that he believed that they could prevent employees from wearing badges and buttons in the workplace. This directly contradicts an opinion from the district's attorney Doug Ingold delivered during the second district supervisor's race in June.
At this point someone noted that the item under discussion was not on the agenda. Wilson suggested that all questions about what was appropriate be referred to Feretto.
”I just want to make sure our employees don't get in fights,” Cherney said. He foresaw conflict from employees choosing sides in the election.
At this point, board candidate David Kirby spoke up. He referred to Cherney's charge that Scown and Wilson were responsible for the 1999 bankruptcy filing of the district.
”You don't want the staff choosing up sides,” he said, “when you're the one choosing up sides.”
”Of course I am,” Cherney responded. “It's my right.”
After this little dust-up, Cherney was asked to report on the OB/GYN search committee. He said that he and Brooke Phelps and Dr. Phelps had met and decided on a new strategy because looking for OB/GYNs required extra insurance and there were five other specialties that could provide a wider range of women's health care without the extra insurance.
Wilson commented that the other board members had spent quite a bit of time on the district's strategic plan and that it was better to work through the strategic plan. Cherney disparaged the ability of a strategic plan to accomplish much and charged that the district has developed several strategic plans over the years and he couldn't see any implementation or good coming of it. Scaife and Wilson suggested that planning was an ongoing process.
Dr. Mark Phelps reported that there have been changes in the clinic and that they are working through the lunch hour. Theoretically, he said, this means they get off earlier, but it hasn't worked out that way so far. He said the clinic had been busy and that the patient load was increasing. He also made note of the difficulty of finding specialists for referrals. He said that most referrals are going south out of county because they are having increasing problems with St. Joseph's system. St. Joe's is experiencing staff shortages, he said, and he characterized their system as “over-stretched.”
There was a long discussion initiated by Thompson about buying a CT scan machine for the hospital. Dr. Phelps said the machines are “hideously expensive” and would require hiring two certified technicians to the tune of $200,000 a year. There's a shortage of such technicians. Cherney suggested they could get by with one and simply take the machine off line when that person was off duty. Thompson observed that the “conversation might be wasting time” and the meeting moved on to the next item on the agenda.
In other business, Redwoods Rural Health Center Administrator Eric Fimbres was at the meeting and reported that there was a “better understanding” evolving between the two entities. He said he was glad to be allowed to participate in the district's strategic plan. Bowen noted that these efforts at cooperation had been made before and didn't work out, but he felt also that they were making progress.
Finance Chair Corinne Stromstad reported that the auditors had come and gone and it appears that the district will have a positive bottom line for the fourth year in a row. The un-audited amount was said to be around $218,000, but that will change some when the final figures for fiscal year 2007-2008 are presented. She said the auditors called it a “clean audit.” The audit is done by the firm of Matsom and Isom. Cherney said he had heard it was important to change auditors every so often. But, as in audits for special districts, the number of firms capable of doing a small healthcare district is limited. The district will also soon be audited by CPAs from Medicare and Medi-Cal.
Scaife reported that the state legislature didn't appear to be even close to passing a budget, that all votes are along party lines. She said that Medi-Cal had made a small payment to the district and that the 10 percent Medi-Cal cuts had been tossed out by a judge.
Wilson said that they are still working on the earthquake retrofit project, but she added, “like all these other mandates, we don't have the professionals to follow through.”
Scown said it all boiled down to what the district was willing to spend. Currently a new facility would cost about $600 a square foot. The previously discussed modular facility would cost $800 a square foot. “It's a very slow process,” he said.
When the topic of earthquake retrofit came up, Cherney took the position that the standards will never be enforced, while Wilson and Scaife said their contacts report there has been no discussion in Sacramento about rescinding the requirements.
Three applications have been received from individuals interested in taking over the Administrator's job. Scaife is willing to leave early if a suitable replacement is found. Cherney said he wanted to be on record that hiring a new administrator before the new board is seated was “a disastrous mistake.” Scaife said that for once she agreed with Cherney.
Cherney said that the names of winners in the Hospital Foundation's 300 Club raffle are not being made public, except for a broadcast at noon on Sundays. There was a lot of discussion as to whether the names of winners should be made public. The names may be printed in the newspaper at some point.
Cherney also urged everyone to read “Driving Fear Out of the Workplace” and wanted to know what was being done to implement the recommendations in the Bonser-Bishop report. Scaife said that a group of employees -- the Tuesday group -- has been meeting and that implementation is going forward. Most recently they had a discussion of what it means to be professional and employees are striving to become more professional in their behavior.
Near the end of the meeting Cherney found occasion to raise his favorite issue, suggesting that employee morale could be boosted by better reception when an employee makes a suggestion. He used himself as an example. He has repeatedly recommended that staff shortages could be solved by advertising in the Bay Area and other distant locations and that people were not following up on his idea.
Scaife responded that everyone had heard his idea and didn't think it was a good one. She said that it appeared that Cherney was going to keep making this suggestion until he got a yes.
”Why do we have to keep talking about this?” Wilson asked.
”Let's move on,” Bowen agreed.
Lastly, Scaife presented a schedule for catching up on the VALIC payments, depending on cash flow. She also said that there appears to be no standard for when VALIC payments are made and that they are consulting an attorney regarding this. Thompson, who has raised this issue repeatedly, agreed that there was some ambiguity in when the payments should be made, but he suggested that employees should be kept informed. There was another long discussion on the issue of VALIC versus Social Security. A former employee at the meeting said that she had discovered that her VALIC account negatively impacted the amount of Social Security she was awarded. She had not been aware of this in spite of meeting with the VALIC counselor. Cherney suggested that most people don't have the skills or education to discuss financial management with a counselor. Board candidate Ed Smith presented his views on investing.
