OCEANSIDE: Tri-City candidates weigh in on issues

Eight candidates seeking four seats on hospital board

By PAUL SISSON - Staff Writer | Monday, October 13, 2008 8:18 PM PDT ∞

OCEANSIDE ---- Patient care, the hospital's three failed bond attempts, and meeting seismic requirements are all issues on the minds of eight candidates seeking four seats on the Tri-City Healthcare District board of directors.

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Patient care has been called a top priority at the hospital, but some employees have said staffing cuts in recent years have undermined their efforts to provide that top-quality care. As a cost-control measure, Tri-City instituted changes in 2007 that put more responsibility on registered nurses to handle day-to-day chores, from checking vital signs to helping patients turn over.

The changes, which helped Tri-City end its fiscal year in the black, have been roundly criticized by some nursing aides, technicians and assistants who say they are spread too thin and are often sent home early.

Raising money to renovate the aging hospital has been another key challenge. On Aug. 26, Tri-City lost its third bond measure in two years when voters rejected a roughly $600 million proposal on a special mail-in ballot. (Two previous measures failed in regular elections.)

Each attempt to pass a bond ---- which would pay for upgrading the hospital so that all buildings comply with state earthquake codes ---- has earned support from more than 62 percent of district voters, but failed to clinch the two-thirds super-majority necessary to pass.

The seven-member hospital board must now determine how best to more forward without renovation and construction cash the bond would have generated.

Tri-City's slate of candidates includes:

Charlene Anderson

A registered nurse with 38 years in the health-care industry, Anderson, like many of the challengers in the Tri-City race, cited recent cuts to staffing levels for nursing assistants and technicians as her main motivator.

As a working nurse, she said she understands the role of assistants better than most. When registered nurses are checking vital signs and emptying bed pans, she said, there is less time for the more complicated tasks like giving discharge orders so that patients will know how to take care of themselves when they go home.

"It puts nurses at a greater risk of making mistakes, and it's frightening, to tell you the truth," Anderson said.

Anderson, 58, said she currently works as a nurse at Heritage Clinic in Escondido, but added that she has worked, as a member of the local nursing registry, and most hospitals in the region over the span of her career.

Though administrators, and some incumbent board members, have said patient care has not suffered at Tri-City, Anderson said they are relying on numbers and studies rather than eyes and ears.

"Studies don't predict what is actually being done," she said. "The staffing issue is not a new issue, it's just that Tri-City has cut it really low."

George Coulter

A clinical psychologist who has worked in Tri-City's psychology department for 26 years, Coulter cited concern over cuts to staffing levels at the hospital as the main reason he is running for a board seat.

"They just keep taking away from the actual care of the patients. The money is siphoned from the top, and there is nothing left," Coulter said.

Based on his daily work at the hospital, Coulter said he echoes union concerns that many workers, especially those who do the difficult work like emptying bed pans and taking patients to the bathroom, are spread too thin.

"They (the current leadership) just keep taking away from the actual care of the patients," he said.

Coulter said he has been told by hospital administrators that he will have to resign from his job at Tri-City if he is elected. Noting that other board members, like Dr. Madeline Rodriguez, continue to work at the hospital and serve on the board simultaneously, Coulter said he is not sure if he agrees with that assessment. But he said he will comply if elected.

"I might be looking for a job for the first time in a long time," he said.

Darlene Garrahy

As registered nurse and one of the board's longest-serving members, she's been a board member since 1992, Garrahy's association with Tri-City goes far beyond attending monthly meetings.

"(I) walked door-to-door in neighborhoods in Vista as a 12-year-old in 1957 to turn out the vote to create the hospital district," Garrahy said.

More recently she has traveled to Washington, D.C., and Sacramento to lobby state and federal legislators to "prevent reduction in Medicare and Medi Cal reimbursements."

Garrahy, 62, listed recruitment and retention of doctors and nurses, planning for new medical technology and expanded emergency services as priorities for a fifth term.

As chairwoman of Tri-City's Professional Affairs Committee, which reviews and investigates all reports of poor patient care, Garrahy said recently that she does not buy recent complaints about changes to staffing levels.

"We look at the data on falls, on bedsores, on every injury that happens in this hospital," Garrahy said. "Most of our scores (for patient care) are either better than the statewide average or (are) at the average."

Randy Horton

A financial analyst who manages bankruptcy cases for the federal government, Randy Horton, 55, has wished to regain his seat on the Tri-City board since he declined to run for a second term in 2002.

Though he was unable to regain his seat in 2004 and 2006, Horton said he thought he would try again this year, hoping that Tri-City would have just won its third bond attempt.

"I thought the last one would pass for sure, and I just thought it would be good to get on there and help make sure the money is spent responsibly," Horton said. "I definitely think the most important thing is to find out why the bond failed."

Though he said a formal voter survey should help answer that question, Horton said he has an idea of his own: "You don't float it into the perfect financial storm for instance."

Horton said he thinks Tri-City will need to try another bond, in two or for years, maybe for much less money than the previous three. With regard to the hospital's current labor strife, Horton said Tri-City should increase staffing for aides and technicians, given than it realized a profit last year.

"Now that we do have a bit of a pie, we can divvy it up slightly differently," he said.

Joseph T. Jewell III

A longtime Vista attorney who specializes in real estate law, Jewell, 63, said Tri-City's recent failure to pass three bond measures is reason enough to give him a shot.

"I have business experience, and I have common sense," Jewell said. "The current board has had at least four years and hasn't done it yet. How much more time can we give them?"

The longtime Vista resident, who is also asking voters to give him a four-year term on the Vista Irrigation District, said he is in the process of closing his law practice and is looking for volunteer activities to fill his time in retirement. He said he read the hospital's master facilities plan and was astounded that Tri-City's leadership would ask voters to pay for so much work all at once. He said the hospital would do better to take an incremental approach, perhaps starting with a simple retrofit of its buildings that need seismic upgrades.

"If they decided to eat this sandwich one bite at a time, I think they could get it done," Jewell said.

Hospital officials have not liked that idea in the past, stating that repairing the old buildings would cost as much as or more than building new.

RoseMarie Reno

With 24 years on Tri-City's board, and more than 50 years of experience as a nurse and teacher of nurses, Reno knows Tri-City Medical Center as well as she knows her own home.

Reno worked as a full- and part-time registered nurse at Tri-City from 1966 until 1975, earned a bachelor's degree in public health education, and taught nursing at MiraCosta College from 1979 to 2002.

With nearly a quarter century on the board, Reno could be forgiven if she wanted to step away from the dais. But she said recent events at the hospital, from a reduction in hours for nursing aides to three failed bond attempts, drive her to seek a seventh term.

"I am running to save this hospital district," Reno said. "It's the people's hospital and not Dr. Gonzalez's."

She said she is concerned with the possibility that Tri-City might be sold or leased to a larger hospital system. She said the fact that Tri-City is a district hospital, directly accountable to the people it serves through an elected board of directors, is preferable to being a nonprofit or for-profit hospital controlled by larger operators like Scripps or Sharp.

"Those people that don't like it should get off the board," she said.

Kathleen Sterling

If there is one point of continued contention for Sterling it is Tri-City Medical Center's management. Throughout her second term on the board, Sterling has taken every opportunity to take chief executive officer Art Gonzalez and his staff to task for having bloated salaries, hiring too many consultants and lately for failing to pass three bond measures.

Sterling, who lists her occupation as "consumer health analyst" has repeatedly called for the hospital to cut its budget at the top in recent months, saying many of the planning jobs that have been outsourced to consultants can be handled in-house.

"All excess revenue must be redirected into programs and services for patients, children, seniors, reconstruction and retrofitting the hospital," Sterling said.

Administrators have disagreed, stating that consultants are ultimately cheaper than hiring more full-time staff.

Sterling has also regularly pointed out that Tri-City has not yet applied for an extension to seismic retrofit requirements, which currently require the hospital to replace its two oldest buildings by 2013.

"Tri-City board must direct the CEO and his management team to get off their posterior(s) and do what they should have done nearly a year ago," Sterling said.

Administrators say they intend to request an extension, and are working on the necessary paperwork. The deadline to submit that paperwork, according to the office of state-wide health planning, is June 30, 2009.

David Tweedy

A Carlsbad psychologist with his own private practice, Tweedy is seeking a second term on the Tri-City board.

Tweedy said sustaining the Tri-City as a community hospital will be the board's biggest task in the coming four years. He hoped the state will grant an extension for Tri-City's South Tower building until 2020 so that the board will have more time to determine how it can be updated or replaced without the help of a public bond measure.

Noting that the hospital writes down more than $1 million a month in bad debt, Tweedy said he does not think it is likely that a hospital chain will purchase Tri-City anytime soon.

"Having some other hospital come in and save the day is not feasible as far as I can tell," Tweedy said.

He added that recent cutbacks and reorganization of the duties of assistant nurses, technicians and aides does not convince him that saving money on labor has hurt patient care. He noted that most complaints come from a relatively small set of union members.

"I'm sure there were isolated incidents. If there were patterns, we would see that in the data," he said.

Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com.

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