Election 2014: Tahoe Forest Hospital candidates sound off
October 6, 2014
TRUCKEE, Calif. — Health care costs, public trust and the CEO's contract were among topics discussed by seven candidates running for the Tahoe Forest Hospital District board at a political forum Wednesday at Truckee Town Hall.
Dale Chamblin (incumbent), John Falk, Mark Spohr, Charles Zipkin, Greg Jellinek, Ned Hughes and Ronda Brooks are vying for three, four-year seats in the Nov. 4 election.
Below is a sampling of some of their comments given at the forum in front of roughly 100 people, presented in random order:
Regarding Health care costs in Tahoe Forest Hospital District…
Hughes: As far as administrative cost, there's been some criticism about the high salaries. I can't address that. I think you get what you pay for, and as far as I am concerned, the management has delivered an excellent hospital. You just have to walk down a corridor or be a patient to realize the quality of care you are going to get here … As far as our cost compared to other hospitals in the community, we've already seen and I have printouts that show that we have cheaper rates as far as inpatient care, emergency room visits, X-ray and labs, and the only thing that we actually charge more for is MRIs.
Chamblin: Tahoe Forest Hospital in order to keep its doors open has to generate about $115 million a year in addition to the $5 million they get from taxes. It is a large and complex business. It's got over 750 employees, and it takes very talented and experienced people to run that business. Claims of outrageous salaries are false …. We are paying median wages for top level quality service, so rather than listen to the unsubstantiated, please get the facts … High prices, no. Tahoe Forest Hospital isn't charging high prices. It's comparable … We are very competitive not only with California hospitals but with Reno hospitals, as well.
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Jellinek: Director Chamblin if there is no problem with the finances in the hospital district, why is the district projecting a $2.5 million operating loss for this next fiscal year? Something's got to change, and … it can either come from administrative costs, the cost of delivering health care or from facility fees, so those are (the) three areas that have to be looked at with a critical, independent eye.
Zipkin: I reviewed this question with the people in finance at the hospital, I've also spoken with board members separately, and I agree with director Chamblin that we are paying our CEO about the median. You have to remember that the search for a CEO (of) a $110 million budgeted company with over 700 employees is a national search … You're competing with all the hospitals in the country, not just small little rural hospitals, but with all of them … In terms of how much we charge, Mr. Chamblin is again correct. Our charges for MRIs and the 20 most popular used services at the hospital are actually comparable with other hospitals. In fact, a little lower than some. When you compare us to free standing centers such as Reno Diagnostic for X-ray or GI Consultants in Reno, it's true, you can't compete with a free standing center and an attempt to do so results in financial disaster and closure of services.
Brooks: … I think administrative costs are too high. Facility costs, I don't know how you can drive down Donner Pass Road and see that fancy, schmancy building and not think there's a lot of money there … As far as health care costs, I'm still on the fence about that. I've heard conflicting data. I've tried to do my homework and find more data on the hospital website, but you know what, that data is not available. … (Until then) I really can't comment.
Spohr: I believe administrative costs are too high. Every time I investigate or look into different areas I find administrative waste and overcompensation. This adds up. It's a few million here and a few million there, and pretty soon you're talking about real money … In terms of prices, according to reports filed with the state, the cost of inpatient care over the last eight years has increased by 50 percent and the cost of outpatient care has almost doubled, this is unacceptable.
Falk: When we speak of health care costs and the various components of health care costs, there is a recurring theme of talking about the comparison of Tahoe Forest Hospital or Tahoe Forest Hospital employees or whomever, or the cost of a given service against other. I challenge that. I challenge that because we don't want to be comparable to others, we want to be better. We want to do it better, and so I suggest that we aren't striving to be in the middle of the bell curve — that we shouldn't even use that as our tool. Our tool should be the simple question of: How low can we drive cost down without damaging the quality of service and care provided? And it shouldn't be based on a benchmark of others in the region or beyond. It should be what we can do, and how best we can do it.
Regarding Bob Schapper's existing CEOs contract/conflict of interest policies…
Zipkin: It's a serious question. I have reviewed the due diligence that the board did in cooperation with the human resources department at the hospital in terms of deciding what the CEO's salary should be, and I really have to concur with Mr. Chamblin that the CEO's salary — it sounds outrageous for some in the community where the average income is maybe $40,000 a year, for the CEO to be paid this much — but the truth is once again you're competing with national hospitals and very large hospitals, so I really think the compensation package should really be off the table … I think our present CEO has done a spectacular job. I think there are some issues maybe with some of the way he has dealt with some of the physicians and that can easily be dealt with.
Brooks: My opinion is how could there not have been a conflict of interest, and I think we're not done yet. I think the DA needs to speak about it and may even go down to Sacramento, but in my opinion, Mr. Schapper should not continue as the CEO, and I look forward to the board's discussion on his contract in open session.
Spohr: I agree there's a clear appearance of a conflict of interest. The board has voted to keep a report secret, and the report said there might be the appearance of some but not enough evidence. Well, what's the evidence? We need to know. The board needs to be less secretive, more open, more transparent; we need to publish the report, and I think the district attorney should be involved.
Falk: I really think that comes down to answering the question: What's best for the district in total (for) the people it serves? And I don't think given 45 seconds or whatever I have left it's possible to adequately address that, but I can say that it would be imprudent for me to cast judgement at this juncture with the limited knowledge that I've had access to and weigh in one way or the other. I need more information before I can make an informed decision … Regarding conflict of interest … I think this is an important issue to get out in front of, which is to say, you need a conflict of interest policy before you get a situation in front of you that may or may not be a conflict of interest that way you can apply it to a diverse set of situations, and you're not actually dealing any particular issue or relationship. So it needs to be done early and it needs to be done by the board of directors proactively.
Hughes: I would renew the CEO's contract if I had the right material to appraise what's going on, and if I was a board member, it would part of a decision I would make with a flexible opinion and looking at the facts … Everything is seamless and efficient. One of the new general surgeons that we hired has told me that it's the best hospital she ever worked in, with the best nursing care, the best staff cooperation and she really looks forward to staying here, and I hope that losing the CEO won't change the rest of the hospital, which would be lowering all of the qualities that we have now with our specialists and the contracts.
Chamblin: I was not a member of the board when Marsha Schapper was hired, and I had to rely on the short period of time I've been on the board on the investigators who investigated this whole issue. My decision on the issue was based on the facts like I make all of my decisions based on fact … My responsibility, my fiduciary responsibility is to the public; it's not to Bob, and I want to do whatever is best for the hospital. If I can use this metaphor — this airplane is flying along at 30,000 feet. I don't think it's in the best interest just because there's a red light flashing on the cockpit dashboard to open the door and throw the pilot out. It's got to be done in a thoughtful and careful manner.
Jellinek: We've all gotten a lot of information from a lot of different sources, and I for one am going to reserve judgement until I can drill down a little bit. You have director Chamblin on one hand supporting the CEO and you have Brooks on the other hand saying he's got to go, and quite frankly, I'm confused, and if I'm elected to the board, hopefully, I'll be less confused, but right now, I'm reserving judgment … As to the conflict of interest charge, I've thought from the very beginning that this needs to be addressed by an independent trier fact. For the board to in close session come to a conclusion, it's like having the fox guarding the hen house.
Regarding the public's trust and communication…
Chamblin: If I am elected to the board that would be one of my very first priorities. I want to see more public input, and I want to see an improvement in transparency … I have been working with staff for the last six months to get our board meetings televised, and I can tell you as of January, if the new board will allow it, those meetings will be televised. I think that's going to go a long ways toward improving our transparency, but public input and transparency are (on) the top of my priority list for my participation on the board.
Jellinek: … We came up with affordability, accountability and transparency. Affordability to local citizenry … The reason why I got started with this was when my own patients started asking me if I could take them to Reno for surgery. It has to be affordable to the folks that live in town. Accountability of the board to our bosses, and that is you guys, the public. That's who the board works for. Transparency. I'll echo what director Chamblin said, the board needs to be transparent in all of its actions, so that you, the public, can understand what's going on with your money.
Zipkin: I think a lot of the problems that we've read about in the press result(ed) from a lack of communication. I think if the public knew what the hospital was doing or what the board was doing, there would be a lot less distrust. Obviously, they go hand in hand, and one way to do that is to have an information officer who's responsible to the community. I think that's really critical. We have excellent marketing now, but the outreach to the community has been less than stellar, and I think that needs to be improved … I would also move the board's meetings to different venues. I think it's a mistake to have them only on campus in Truckee every time. I think it's important for people on the board (to) promise critical review of all programs and contracts on a regular basis and let the public know what they are doing.
Brooks: Many a hospital employee has told me that communication at the hospital is one of the biggest problems, and I think that is because it starts at the top. A couple of ideas I have are that the minutes for the hospital board meetings should be more open. They should not only be on a website, but they should be in our public library. Everyone should be able to go in and sit down and open a book or a binder and read those meeting minutes … The other thing I think we need is more spontaneous dialogue with the board. It's not good enough for the public to come to a meeting and be limited to two minutes. I think … the public should be allowed to speak more, they should have more opportunities at the beginning of the meeting, (and) they also should have opportunities at the end of the meeting.
Spohr: I'm glad to see that Dale is now touting transparency. Unfortunately, the board is one of the most closed boards that I have ever experienced. Most of the board's business has been conducted in closed session, with very little information released. It's been going into closed session even when it doesn't need to be in closed session … We need more transparency to build trust. Also, in terms of pricing, it's impossible to find out what the price of anything is at the hospital. We need to publish the prices of everything, so when you come to the hospital, you know how much it is going to cost you.
Falk: I think that we do need to meet not just at the main campus, but throughout the district. I think it makes sense to go out and meet on the North Shore on occasion and other venues that would help increase the likelihood that people from that area of the community will attend and engage. The main point … regarding trust is to do the public's business in public. That means that you don't go into closed session by default because you can, but you stay in open session every time you can and only go into closed session when it's absolutely prudent to do so, when you must. That way the public doesn't feel that there are things being hidden whether or not they are being hidden.
Hughes: I think … meetings that are televised … would be very helpful. I have only been in this race for over six weeks, so I'm not too familiar with how transparent the board has been. The hospital, to me, while we've been getting oriented with this whole process, has been very transparent and very helpful in getting use oriented for the job … I think we need to talk more about the great things that are happening with the hospital such as the hospice and weight reduction plans that are going on in Kings Beach for adolescents, I don't think people know about that. I think the cancer center needs bragging rights; they need to say and get out to the community and tell people how good they are.
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