Healthcare Industry Public Health 

Hospitals: crisis in leadership

Partner: 
North County Times
Summary: 

What impact does the quality of a board of directors, selected by voters, have on the quality of care at public hospitals? It turns out it matters a lot. An analysis of hospitals in North San Diego County shows how decisions made at the ballot box can have a huge effect on a hospital’s success or distress.

Impact Summary: 

What impact does the quality of a board of directors, selected by voters, have on the quality of care at public hospitals? It turns out it matters a lot. An analysis of hospitals in North San Diego County shows how decisions made at the ballot box can have a huge effect on a hospital’s success or distress.

Results
Tri-City cedes market share to Palomar
Deborah Schoch, Natalya Shulyakovskaya and Paul Sisson | May 28, 2009
North County's two flagship public hospitals are locked in a fierce business struggle, with Tri-City Medical Center losing money and patients to competitors while Palomar Medical Center surges ahead, a North County Times special report shows. Tri-City's plight is not the result of its rivals delivering measurably better medical care. To the contrary, the quality of care at Oceanside-based Tri-City is as good as, or in some categories, better than that offered at Escondido's Palomar Medical Center and at the county's 24 other general acute-care hospitals, two independent reviews show.
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Levies on property help fund districts
Paul Sisson | May 28, 2009
Though they do the same kind of work as other hospitals in the region, North County's two main medical centers sprouted from vastly different roots. Unlike most for-profit and nonprofit hospitals in San Diego County, Palomar Pomerado Health and Tri-City Medical Center are state-chartered public district hospitals, created decades ago by a majority vote of the communities they serve. Hospital districts are defined by specific boundaries. Property owners living or doing business inside the boundary have part of their property taxes allocated to the hospital. District taxpayers can also vote to tax themselves more, in the form of a general obligation bond, which can tack on an additional fee to their yearly property tax bill.
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Health care centers grew with region
Deborah Schoch, CHCF Center for Health Reporting | May 28, 2009
California's network of district hospitals is the product of a turbulent era, when troops returning from World War II needed acute care, especially in low-income rural areas where hospital beds were scarce. A state law passed in 1945 gave local governments the authority to raise taxes to build and manage hospitals and other health care facilities. Dozens of rural communities throughout California rushed to create districts and build hospitals. The first such district, Sequoia Hospital District in then-rural Redwood City in the Bay Area, was formed in 1946 and opened its hospital in 1950.
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Tracking the patients - what the data shows
Natalya Shulyakovskaya | May 28, 2009
As the feverish flow of news about major North County medical institutions rattled patients and doctors, the North County Times and the Center for California Health Care Journalism turned to the data to check how Tri-City Medical Center and Palomar and Pomerado hospitals served their communities.
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Results
Too public?
Deborah Schoch, CHCF Center for Health Reporting | May 30, 2009
The bed-bound patients at Tri-City Medical Center last Thursday afternoon could not have suspected the acrimony breaking out downstairs on floor L-L. More than 200 doctors, nurses, aides and local residents crammed into a basement assembly room of the Oceanside hospital, most of them there to issue a challenge to the public district hospital's troubled board of trustees. Their joint plea was a variation of the proverb, "Physician, heal thyself": Fix a failing governance system of elected board members, even it means merging with a rival hospital or going private. They begged the board to step back from its 1940s-style district hospital structure and launch a study of other ways to run a medical center.
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Results
Board member profiles
North County Times | May 30, 2009
Each of the two boards that set policy for their respective hospital districts has seven elected members. In each district, board members are elected to four-year terms. TRI-CITY HEALTH CARE DISTRICT Charlene Anderson: A registered nurse with 38 years of experience in healthcare, Anderson works as a nurse for Heritage Clinic in Escondido and lives in Oceanside. She won her first term on the board in 2008.
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Results
Tri-City medical staff chief unlikely revolutionary
Deborah Schoch, CHCF Center for Health Reporting | June 21, 2009
A Hollywood casting director in search of a revolutionary would not turn first to Dr. Richard Burruss, Jr. The earnest-faced Tri-City Medical Center emergency physician, with his soothing voice and Stanford degree, seems ready-made for the lead role in a modern-day "Dr. Kildare," not "Che." Yet amid leadership and financial tumult at the hospital this spring, Burruss, 53, the hospital's chief doctor, has emerged unexpectedly as the Tri-City staff's default leader, spearheading calls for a sweeping review of how the 397-bed Oceanside hospital is run. "It's not something I was out looking for," he said last week. "It just sort of evolved. The future of this hospital is important to me."
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Tri-City executive Anderson is alone at the top
Paul Sisson | September 12, 2009
OCEANSIDE -- Throughout several careers, and especially in his current role as chief executive officer of Tri-City Medical Center, Larry Anderson has relied on the contents of his rolodex to get things done. But he has also shown a willingness to scuttle diplomacy and simply attack. The hospital's elected governing board tapped Anderson to run the hospital temporarily early this year after abruptly placing Tri-City's former executive director, Arthur Gonzalez, and his administrative team, on paid leave for vague reasons. Today, Anderson is alone at the top. Eschewing a formal search for a new leader, four of seven hospital board members eliminated "interim" from Anderson's title in July. A $480,000-per-year, 18-month contract started on September 1.
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Results
PPH executive Covert 'A Type Triple-A personality'
David Garrick | September 12, 2009
ESCONDIDO -- Both supporters and critics say that insight into the personality and management style of Michael Covert, the charismatic chief executive of Palomar Pomerado Health, can be gleaned from the battle over where to locate the new Palomar Medical Center. During an extended and sometimes rancorous debate that spanned much of 2005 and 2006, the Escondido City Council tried to protect downtown by keeping the region's hospital there. But Covert preferred the new hospital a few miles away, on an empty promontory near the city's western border with San Marcos.
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Results
Local health care landscape changing rapidly
Deborah Schoch, CHCF Center for Health Reporting | September 17, 2009
When the towering new Palomar Medical Center opens in early 2012 on an Escondido hilltop, visitors to the top floor will be able to gaze 19 miles west past Vista, Carlsbad and Oceanside to the sea. That landscape is fast turning into a health care battleground as the region's three largest hospital systems fight for the hearts and pocketbooks of potential patients. At stake: the shape and quality of health care for North County's 860,000 residents. In the short term, the tug of war will bring more modern medical services and better patient care, making North County less dependent on the traditional hospital base in and around the city of San Diego to the south.
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Clinics help shoulder burden of uninsured
Deborah Schoch, CHCF Center for Health Reporting | September 17, 2009
While local hospitals compete to lure insured patients in well-off areas such as Carlsbad, the recession is leaving more and more residents without jobs or health insurance. A surge of uninsured and underinsured patients is severely straining the resources of hospital emergency departments. Many of those patients don't need emergency care but have nowhere else to turn for treatment of common problems such as high fevers, sinus infections and babies' earaches. And San Diego County's safety net is especially weak because, unlike many urban areas, it has neither a county public hospital nor county-run clinics due to decisions by county leaders decades ago.
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Medical buildings sprout amid quest for patients
Deborah Schoch, CHCF Center for Health Reporting | September 17, 2009
Anyone curious about local health care trends need only cruise along the boulevards of eastern Carlsbad to find some telling clues. This was one of three cities that banded together in the 1950s to found a public hospital district and create Tri-City Medical Center in nearby Oceanside. Today, the 100,000 residents of the well-off coastal community are still among the voters responsible for electing the hospital district's governing board. But when it comes to patient loyalty, all bets are off.
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OC treasurer opposes Tri-City's loan request
Paul Sisson | October 13, 2009
Orange County Treasurer Chriss Street, in a letter made public Tuesday, tells county supervisors he will not pursue a proposed loan to Tri-City Medical Center. Tri-City spokesman Jeff Segall said Tuesday that the hospital is not giving up its effort to obtain the loan, despite a sharply worded analysis written by Street's office that questions the Oceanside hospital's finances and prospects for the future. "There's the recommendation from the treasurer's office, but the supervisors make those decisions, as we understand it," Segall said. "We're having further discussions with (Orange) County officials." Keith Rodenhuis, a spokesman for Street, said Tuesday that the treasurer has received no direction from the supervisors so far.
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Results
Tri-City hospital board approves interest-only loan
Paul Sisson | January 20, 2010
After nearly one year of financial frustration, Tri-City Medical Center appears to have found a willing bank to help the public hospital refinance $53 million in long-term debt. At a special meeting Wednesday night, with thunder and lightening crashing in the heavens outside, hospital trustees unanimously gave Chief Executive Officer Larry Anderson the authority to finish a 15-month, interest-only bridge loan with Los Angeles based CapitalSource Bank.
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