Marin's longest running opera, starring the Marin Health Care District and Sutter/CHS which leases Marin General Hospital (MGH) through a subsidiary corporation, continues to be the best show in town. With standing-room-only, spilling out into the hallway audiences for the District's January and February meetings, the hospital corporation refused to schedule the large conference rooms even though they were not in use.
The corporation did not provide the usual audio equipment setup for the District to record its meetings. Instead, it has been sending people to videotape meetings, even though a team of volunteer videographers from Channel 31 have been taping District meetings for more than a year.
The corporation boycotted the January meeting. Medical Director Mary McDevitt told Director Diana Parnell she would only attend quarterly meetings and Attorney Al Bianchi declined to attend. Agenda items which corporate representatives would have presented were not heard. Highlights from the January meeting included the report from the District's auditors, a demand that the corporation provide public reports to the district as required under the lease, and an attempt to form a committee of elected officials to focus on Novato Community Hospital (NCH).
Prior to this year, the District and the hospital corporation used the same auditing firm. In early 1996, the District voted to hire a different firm to conduct its annual audit. The District's new auditors presented their report for the year ended June 30, 1996, which for the first time included a note of reportable conditions. The note indicates that, for at least two years, the corporation leasing the District hospital may have disposed of District assets with an original book value of over $1 million without adequate accounting to the District. Although these items had little remaining depreciation value, the equipment may sell on the market for more than the depreciated value. The District Board is following up on this.
The Office of Statewide Health Planning and Development (OSHPD) requires every hospital in the state to submit Summary Financial and Utilization Reports quarterly, and the Annual Report of Hospitals once a year. The 1987 amendment to the hospital lease requires the corporation to provide the District with these reports. Director Diana Parnell said the Board had asked for the reports in the past, but that the corporation had refused to provide them. Director Remy said these reports are public information and are crucial for the District and consumers to verify patient census, staffing patterns, and other service characteristics. Director Remy made a motion that the OSHPD reports be provided in full and that all back reports be brought up to date. The motion was seconded by Director Siegel. Directors Remy, Siegel, Bergman, and Parnell voted yes. Director Coxhead voted no.
Director Remy had viewed a tape of the Novato Town Council meeting where Sutter/CHS presented its plans for NCH which includes closing the delivery unit. Most Novato residents receive their care in other facilities, i.e., MGH or Kaiser, and the corporation has moved NCH administrative staff to MGH. Even though Novato does not belong to the District, it is among the communities served by the District. Ray Seets, a physician on the NCH staff, said the Sutter/CHS Memo of Understanding with the Town of Novato requires that the delivery unit be maintained, and that the community opposed Sutter/CHS plans to close it. A moment of levity occurred when Director Siegel said she could hardly imagine driving down Highway 101 during commute hours "just about to pop." A member of the audience responded that if the baby arrived, she would be able to drive to MGH in the commuter lane, at which point the audience roared with laughter. An effort by Director Siegel to establish a committee of elected officials from the District, Novato Town Council, and the Board of Supervisors to study issues of common concern failed. Directors Siegel and Remy voted yes, Directors Bergman and Coxhead voted no, and Director Parnell abstained.
February Meeting. Director Parnell began the February meeting by introducing Teri Burnett, the District's new Administrative Assistant, who is replacing Joe Echelberry. She also introduced Steve Mayne as interim general counsel to the Board, replacing Steve Lipton. Echelberry and Lipton had worked for the Board for many years and resigned at the December meeting. Director Parnell stated that there had been some progress with respect to obtaining an office, but that no progress had been made with the files or other outstanding issues. Highlights from the February meeting included the stormy return of the corporation, concerns about the impact of the upcoming Kaiser strike, and a presentation by the Marin Safe Healthcare Coalition about its report to the state Attorney General on false advertising.
The corporation returned for the January meeting with its video crew, but refused to answer specific questions posed by the District Board. For example, Medical Director Mary McDevitt provided a lengthy description of emergency preparedness, but refused to answer specific questions about how the corporation would increase bed availability in the event of a major catastrophe, given that it has converted most rooms from single to double occupancy. The corporation also refused to provide the OSHPD reports requested in January, or to answer other specific questions posed on items outstanding since December and January. Instead, Dr. McDevitt attempted to force the Board to listen to a presentation that was not on the agenda. Director Parnell stopped Dr. McDevitt, noting that the Board would be in violation of the Brown Act if issues not on the agenda were presented.
CEO Henry Buhrmann sent a letter to staff notifying them that MGH had granted temporary hospital privileges to Kaiser physicians. The timing coincides with the pending strike of Kaiser registered nurses. Kaiser patients will be sent to MGH if the RNs strike. The California Nurses Association (CNA) represents RNs at MGH and Kaiser. The audience was concerned that MGH nurses would be used as scabs to break the strike involving their Kaiser colleagues. Many impassioned speakers -- physicians, nurses, patients -- spoke on both sides of the issue. Dr. McDevitt was evasive on questions relating to the hospital's ability to respond to the impending strike. Representatives from CNA, the Marin Safe Healthcare Coalition, the Social Justice Center of Marin, and concerned Kaiser members have begun informational picketing and leafleting.
Dr. William Rothman, spokesperson for the Marin Safe Healthcare Coalition, presented findings of an investigation the Coalition conducted about corporate advertisements on quality of care at MGH. The corporation repeatedly ran an ad in every daily and weekly newspaper in the area which made the following claim: "We received the highest possible quality ratings from the California Medical Association and State and Federal Agencies." The Coalition found that (1) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited MGH somewhere in the third tier and well below the highest possible ratings; (2) the California Medical Association does not rate hospitals; and (3) from 1994 to 1996, 17 complaints had been filed at the California State Department of Health which violated more than 50 Federal or State Regulations, and 4 of 5 complaints filed since August 30, 1995 have been substantiated. The JCAHO report will be available for public review in March. Based on their findings, the Coalition has filed a false advertising complaint with the California Attorney General and the Federal Security Exchange Commission.
DISTRICT MAKES DEMAND
The Marin Health Care District Board met on February 26, 1997 in closed session and voted unanimously 5-0 to take the following action: The Marin Health Care District Board has determined that the 1985 lease and the 1994 agreement with Marin General Hospital corporation has been breached in certain material respects. The District has instructed its legal counsel to make demands upon the corporation with respect to the items under dispute, with a request that the corporation respond in writing by March 10, 1997.
District Chair Diana Parnell, MD, was out of town and unavailable for comment. According to Director Linda Remy, the motion was made by Sylvia Siegel and seconded by Suzanna Coxhead. She noted that the Board had several closed meetings on the issue since the discovery two days after the November election that the corporation was moving the District files without authorization.
Remy said the Board determined the material breaches included (1) failing to maintain District records, putting the District in violation of the Public Records Act; (2) locating the district office in a largish closet next to the restroom in the restricted area of the hospital delivery unit, thereby violating the Public Records Act, the Health and Safety Code, and the Uniform Building Code; and (3) failing to provide secretarial services as required under the lease. She said attorney Cora Lancelle found the records in significant disarray last November. Since then, Lancelle has established there are time gaps where no records are available including the entire first volume of the District's records, and that numerous documents are missing. The District is asking the hospital corporation, former District directors and former legal counsel to provide any materials they may have to help the District reconstruct its records.
Remy reported some progress has been made on the District office. The corporation has agreed to provide 375 square feet of office space at 1100 South Eliseo in Greenbrae. This space needs remodeling to make it work for the District's purposes, and it will be some time before the District can move its files out of the delivery unit. There is the outstanding issue of equipping, furnishing, and supplying the office for the remainder of the lease.
From 1985 when the District leased the hospital until 1993, the corporation provided secretarial and related services for the District Board, pursuant to the lease. In 1994, the prior Board entered into a Management and Administrative Services agreement which charges the District for secretarial services it was entitled to receive for free under the lease. The current Board unanimously determined the 1994 agreement was unnecessary, and the District will attempt to recover funds paid under it. Given the corporation's performance history, the Board is demanding that a District staff person provide ongoing support services and that the person be paid by the corporation as required under the lease.
Meanwhile, the District has been able to obtain a telephone in time to be listed in the new telephone book. The number is (415) 461-5700. Obtaining the telephone was complicated, according to Remy, because of problems with the District records. Pacific Telephone did not believe the District existed, and no records acceptable to PacBell could be found despite concerted efforts by Lancelle to locate them. Director Sylvia Siegel had to intervene, using her considerable clout from years fighting PacBell as a consumer advocate.