The Coastal Post - August 2000

An Open Letter To Residents Of The Marin Healthcare District

By Linda Remy, Director

I was elected a Director of the Marin Healthcare District in November, 1996. In the last four years, I worked very hard to represent the public interest. My term ends this November. Serving Marin in this capacity has been a great honor, and I thank the voters for their confidence and trust.

August 1 is the last date for candidates to sign up for the District election this November. Since I am not seeking re-election, I am using this opportunity to let Marin residents know my thoughts as I begin my return to private life.

Marin General Hospital, owned by residents of the Marin Healthcare District, is among our county's most valuable public assets. In 1985, this important public asset was leased to the private Marin General Hospital Corporation. Today, MGH Corp. is a wholly-owned subsidiary of Sutter Health, one of the nation's largest healthcare conglomerates.

I remain convinced that the 1985 lease of MGH was executed improperly. An undisputed fact is that two of the District's key public employees -- Henry Buhrmann, the District's administrator, and Quentin Cook, the District's General Counsel -- negotiated and wrote the extremely tenant-friendly lease while also MGH Corp. employees. California law absolutely prohibits public employees from such conflicts of interest.

The flawed lease states in several places that its purpose is to promote the health and welfare of District residents. Yet this noble goal has not been met and, in fact, care at MGH has deteriorated. The following are some examples documented during the last six years at District Board meetings and in other settings

By January 2001, the California Appellate Court will rule on the District's case regarding the conflict of interest. My hope is that voters will elect Directors committed to continue the case through the California Supreme Court appeal. I believe the court will rule -- as it has many times before in many similar cases -- that the public is not time-barred from recovering its improperly transferred assets.

In my opinion, the Board must agree soon on a common vision, develop a coherent plan the public supports, and begin preliminary steps to make a smooth transition when the court declares the lease void. If the District plans now, it will be in a good position to reestablish local control of MGH when the opportunity arises.

Further, in the unlikely event the court fails to void the lease, the District still must have a plan in place. Without advance planning and a stringent savings plan, the District will lack the means to regain control of MGH should the lease run its full length.

Under either scenario, lacking a common vision and plan of action -- and lacking competent professionals to help the District develop these -- plays right into the hands of corporate interests who want the District to leave the hospital under Sutter control.

However, one thing I have learned in the last four years is that "local control" means different things to different people. Some would renegotiate the lease with Sutter/MGH despite our history and their arrogance. Others would re-lease MGH to another corporation, or enter into some kind of agreement with a management corporation that could be terminated on short notice. Yet others like things just as they are.

My view is that the public interest would be served best if MGH returned to the control of elected Directors accountable to the voters. As before the lease, Directors would set hospital policy and hire professional managers to carry out those policies. Those managers would report to the elected Board for their actions on behalf of the public well-being rather than to a private board for their actions on behalf of corporate profits.

Contrary to what some would have you believe, most district hospitals in California and nationally are managed this way. This is the only way to have public oversight and accountability for important issues like the availability and quality of healthcare, and for balancing these when economic issues intrude.

This also is the only way to end corporate manipulation of elections. You surely have noticed that the timing and frequency of corporation-friendly media -- Sutter/MGH publications, patient-of-the-day ads, and OpEd pieces written by friends of Sutter/MGH -- cynically ebbs and flows with each election cycle. Ask candidates for the District Board to voluntarily identify supporters with direct or indirect ties to Sutter/MGH and to the physician-owned Marin Independent Practice Association. The IPA is a Sutter/MGH business partner in many managed care health plans, and their profits depend on denying care and discharging patients early. Identify physicians in corporate partnerships with Sutter/MGH to operate lucrative stand-alone surgery centers that drain more profits from MGH and out of public view. Identify who contracts with Sutter/MGH to run the day surgery center, the emergency, lab, pharmacy, radiology, cardiology, oncology departments, and those who work as hospitalists and hold other positions. Remember those names when candidate ads start rolling off the printing presses and into your mailbox. Given the company they keep, whose side are they on?

Think about what has happened in the last few years at MGH. Decide if you believe corporate control of your publicly owned hospital meets the needs of your family and friends. Think about the kind of healthcare you want for yourself, your children, your grandchildren in ten years. Find out who supports what candidates and why. Be sure you understand and agree with the type of "local control", if any, candidates will seek to achieve if given the opportunity, and how they will plan for the return of the hospital to the District. Elect people this November to carry out your vision. After the election, hold them accountable to do what they said they would do.

Thank you for the trust you placed in me four years ago. Serving Marin as an elected official has been an extraordinary privilege. I learned that I am not suited for public office, and that I am better in the trenches than on the Board. I will continue to work for healthcare reform as a community activist and through my job as a health policy analyst at the University of California, San Francisco. In the meantime, everyone who knows me -- family, friend and foe alike -- looks forward to me getting a life.

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