What could be on the KVHD agenda for September first?

What could possibly top the last few meetings of the Kern Valley Healthcare District board of director's meetings?

After two months of forcing the issue that there is no other answer available to human kind as to how to financially manage and upgrade the KVHD hospital without the help of the residents of this community surrounding Lake Isabella, putting up tax dollars for a general OBLIGATION bond.
(the obligation part, of course, is ours to carry)

Well, what if there were other options and the hospital knew of them, and rather than go that route, insists upon putting a very large amount of money on the ballot to maybe just see if they can get it. Tie a string on a stick and call it a fishing pole.

Let's take a walk down agenda lane and see what we find here...

PUBLIC NOTICE


KERN VALLEY HEALTHCARE DISTRICT
AGENDA FOR BOARD OF DIRECTORS
REGULAR MEETING

Wednesday, September 1, 2010 – 5:30 p.m.
Location: Hospital Cafeteria

A. PUBLIC COMMENT
This portion of the meeting is reserved for persons to address the Board on any matter not on this agenda but under the jurisdiction of the Board. They may ask a question for clarification, make a referral to staff for factual information or request staff to report back to the Board at a later meeting. Also, the Board may take action to direct the staff to place a matter of business on a future agenda. The Board cannot take action on items not listed on the agenda for action.
Speakers are limited to three minutes.
Please state your name before making your comment.

(I'm proud to say that I was the one who created the three minute rule. Yes, after I, as a reporter supporter was allowed more than 20 minutes to criticize certain board members during the "Bonnie and Clyde era", when I realized I had made a critical error in who was lying and who was not, they created the three minute rule to keep me off their record. You see as an audience member of a "public healthcare district" you do have the right to question and receive answers in a timely fashion. And I learned from board member Bob Jamison not to forget to ask that my comments are added to the record, "verbatim" meaning "word for word" baby. So, if you have comments and you would like them to be added to the hospital's records, you will need to tell them that. Go to the KVHD website and look at the minutes from the meetings. It's being edited for readership...)

B. CONSENT AGENDA
The following items are considered routine and non-controversial by Hospital Staff. Consent items are listed as ACTION items and may be approved by one motion if no member of the Board or audience wishes to comment or ask questions. If comment or discussion is desired, the item will be removed from the Consent Agenda and will be considered separately.

(Here's a touchy subject, it's called a consent agenda, where the board puts on many items and can vote on all at once. The consent agenda is a way of saving time, but it also reduces explanation of what contracts are up, new contractors, general hospital business, and contains the "minutes" for the record for approval. In the past few years only one or two board members pulled items for explanatory purposes, and certainly no public citizen ever pulled it...until last month's board meeting. I had finally had it with the editing of my comments and had asked that they be considered verbatim, so I asked to have the minutes pulled from a very special meeting we will be addressing soon. Well, the board I guess didn't read their monthly agenda too carefully, as you see above it's right on the first page. When I requested the minutes be pulled at first I was told I couldn't do it, next I was questioned as to why I was doing it, as it had to be approved before I could pull it. A few years ago, I wish I had listened when an insider told me "watch the consent agenda." He is right.)

· Board of Directors Meeting – Minutes August 4, 2010
· Special Board of Directors Meeting – Minutes July 28, 2010
· Finance Committee Meeting – Minutes August 25, 2010
· Unaudited Financial Statements
· Supplemental Finance Reports
· Variance Analysis for July 2010
· Product Line Summary
· Contract Renewals
A. Beckman Coulter Corporation – ACL 8000 Coag System
B. Sparkle Contract – Mats
C. Boehmer, Misty – Riverside Property Management – 6429 Park B
D. Siemens Medical Solutions – iSeries Maintenance
E. Valley Healthcare Systems – Staffing RN/LVN
· Board Personnel and Policy Committee Minutes – August 23, 2010
· Human Resources Report – July 2010
· Policy/Procedures:
Human Resources:
Paid Time Off (PTO)
Business Office – Patient Accounting
Appeals Process for Insurance
Safety Management:
Security Education
Plant Operations:
Hazardous Materials Handling/Storage
Safety Policy
· Manuals:
Administration
Nursing (Acute Care)
· Job Descriptions: None
· Medical Appointment: None
· Medical Reappointment:
Sonia Sawal, MD – Active Staff
Kent Skogerson, MD – Active Staff
· Professional Services Agreement – Hans Yu, DO
· Professional Services Agreement – Tony Hoang, MD
· Capital Expenditure Request – Kirby Lester KL15i Pill Counter

(the next parts of the agenda are just a listing of reports from the CEO, CFO, CNO, etc., so I've deleted them...but there's more)

F. OLD BUSINESS:
Strategic Planning
Tim McGlew, Chief Executive Officer Information

G. NEW BUSINESS:

1. Agreement – Healthcare Consulting Services
Chet Beedle, Chief Financial Officer Action

2. General Obligation Bond Ad Hoc Committee
Victoria Alwin, Board Chair Action

(What in the world could this be another committee for board members to sit on or is this an action committee to get the bond going and get that 22.7 million straight to these people. I guess we will have to wait and see, as I still haven't recieved any information I asked regarding the committee, board member, Bob Jamison, created and chaired and was paid for, but the hospital doesn't seem to have any records available. Is this going to be another committee like that?)

1. Resolution Amending Conflict of Interest Code
Brad Armstrong, Board Secretary Action


H. DIRECTORS COMMENTS ON ITEMS NOT APPEARING ON THE AGENDA


I. CLOSED SESSION:
Existing Litigation – People v. Hughes, et. al.
Existing Litigation – Zaiko v. KHVD
Potential Litigation – 4 Cases

(This is a serious situation, we will not be able to get any information on as it is in closed session. But if the cases go to court they are easily located on the Kern County Superior court website. Go to Civil cases and enter in Kern Valley Healthcare District and you will see a listing of cases, some new, some in progress, some are just an interesting history. But the issue that the hospital could be sued as I'm sure they have a cap on their liability insurance, and as we have said, if the community offers up it's property taxes, it is possible that money could go to the victims if they are successful in their respective court cases. Aside from just the bond, the weakening of the hospital's ability to stay alive financially has been it's own undoing.)

J. CLOSED SESSION REPORT
Scott Nave, General Counsel


K. ADJOURNMENT

Enjoy the meeting, and make sure that if you were promised responses to your questions, that you follow up and get those answers. As I've been watching video, I've seen questions addressed and promises of action or answers, but no one on either side, the hospital or community is following up. You have every right, you're dealing with a public, government hospital...not only that your property taxes are collateral for the district. You pay property taxes already, and you have the burden of the debt they created 24 years ago and still have not paid off.

(LOOK AGAIN) Cal Mtg. doesn't want to see this

Cal Mtg wanted Measure M too, not just this new GOB

Premature accusation from March of 2009 as I saw the financial collapse last year. This post has been on the blog for more than a year, but I put it there in anticipation of what is happening at the hospital now, default and deception. This is an interview I did when I was that popular reporter who wrote what the hospital wanted me to, as I recieved free healthcare and other benefits for my support.

Much like you see with the local newspaper the Kern Valley Sun, I too, wrote advertisement like articles which were totally bias to help the paper or the coporate owners make money. I'm as stupid as the current writers for the Sun, but then I woke up.

FLASH to 2006 when we were (me included) pushing the general obligation bond to the community.
Remember, Predatory lending is defined by a pattern of who benefits.

Dejavu, four years later we are back not with the excuse we have to seismically upgrade the building or close down: now they want us to pay off a 24 year old debt that should never have gone that far.

I'm tired, and I will try to get time tomorrow to reveal the rest of the interview and if necessary explain the obvious implications.

READ ON:

Interview with Gary Evans, Cal Mtg., regarding the Cal Mtg. program and what sort of help and relief the community can expect. Mr. Evans said this was "his opinion." This interview took place in November of 2006, right after the general obligation bond to build a new wing on the hospital, Measure M, failed.
This is a transcript from a digital recording.

Me: What is Cal Mtg.?

Gary Evans of Cal Mtg. : We are a division of OSHPD, but we are funded entirely from insurance premiums.

Why was this program created?
GE: There is a need throughout California for healthcare, private, non-profit, excuse me. Non-profit health facilities in California are unable to raise monies on their own, their own credit worthiness to build facilities so this was created to try to assist organizations to borrow money to build health facilities in needed areas.
(Aside: I can tell you that this "explanation" of what Cal Mtg. is NOT or does not even begin to describe the powers that be here. At the time of this interview I could only hear clicks, while now I'm immersed in the double talk, a translator of lies. They are a sinister presence building their portfolio and their record for not allowing bankruptcy against their almost unpenetrable facade.These people are big time, they are not afraid of some reporter type, your average gal about town. They tolerate me and probably poison my water. Oh that's right that's already being done.)

Is there any possibility they (KVHD) could go through you to do upgrading, the seismic retrofitting; or are they pretty much out of the game with the debt what it is?

GE: Their debt is, umm, significant for a hospital their size. And to add additional debt to be paid by revenues from the hospital would probably weaken the hospital. So, we would probably not be in a position to do that. I think the GOB (general obligation bond) is the only reasonable way that could happen.
(Of course a GOB would be great for everyone involved except the community. A community who has no say, gets no answers, is repeatedly lied to, thrown out of their jobs at the hospital for traveling staff, and is expected to pay the bill for all the mistakes? If the mistakes were gone, along with the mistake makers who are still here, then this community might step up and help with a bond. Until then, there's no amount of Public relations fluff that can bring back trust. Only truth elicits trust.)

Regarding, bankruptcy: 
 
GE: Well, any organization can petition a court to approve a reorganizational plan and in that plan it would be possible for the court to say , umm, its reasonable that you shouldn't have to pay this debt; you aren't able to pay this debt and it could be erased.
That's highly theoretical and the fact, the facts of the situation would be reviewed by the judge: is there organization paying the bills? Can they survive without going into that kind of reorganization? 

And my guess is that the attorney general's office of the state of California would fight pretty vigorously to oppose any type of reorganization at this point. 
(That was 2006 and this is now. KVHD is in trouble and it won't get better but worse. How would a judge look at the situation now? And how does it look to Cal Mtg now? KVHD currently enjoys some sort of pay off with Cal Mtg. with another recent loan transaction, probably costing the mental midget of math, Chet Beedle, CFO, a bundle but like the DOJ and the Dr. Pormir plead out to drugging people, calling it a legal "first"--of course making it all better fro the rest of us. We the people are so duped by this slick outfit, I can only appreciate their incredibly insignificant presence, yet oh so powerful. A great job putting this organized crime group together. Seriously. Kudos to the excellent deception. No bankruptcies would probably never occur as they might allow for "SCRUTINY.:" And we don't have any scrutiny.)
 Re: Legistlative relief such as was discussed with Senator Roy Ashburn.
 GE: It seems to be more of a hope than a reality. Its never been done before that I'm aware of and, um, I would guess, I guess the Senator's office would be a better place to answer that question.
I would be surprised if anything could be done that way.
(Everyone would be surprised. We have yet to see a politician really stand up for their promises, platforms and principles. It's the system called the popularity contest, not who is best qualified for the job, or who will stand up for what is right.)

Re: Payments on bond and management


GE: We are, we have insured their bond issue, so if they can't make payments on the bond issue, we then have to make the payments.
We are interested in maintaining appropriate management at the hospital. So, if they terminated management and hired somebody we felt was not qualified to run the hospital; we do have the authority to say no in that situation.

(Well, what kind of oversight was it on the part of Cal Mortgage when they allowed a CEO to come in with some phony credentials? Did they, like Dave Green, from Brim Management, actually see those credentials? So, then I see that there is culpability on the part of this government, insurance, monster. Since they hire people, and that person may not be qualified, and then that person does very bad things; I'd say it goes back to Cal Mtg.)

It's a hot potato, here you take it...Ott, I wonder if she is rehirable? Her resume.

Oh, it started in 2006, the trouble.
The state, Department of Health Services, tagged KVHD pretty hard early in the year.

They call them tags and these tags refer to certain codes which the hospital would have to comply with.

Documents starting in Feb. 2006 lead us right down the road to August, when a new Director of Nursing would be hired, and the practices at the facility changed dramatically.

But DHS also made an interesting note, asking then CEO, Pam Ott, if she had a Nursing Home Administrator's license.

If you look on the second page of the document, you see that Ott responds to this claim after referring it to the board counsel. Because the skilled nursing facility is not distinct from the hospital, a hospital administrator can run both.

But Ott puts the burden on the Cheif nursing officer, which was Sharon Brucker at the time, (still with the hospital in some other capacity, unknown) as to who is responsible.

The second tag calls for the hospital to have a full time Director of Nursing. In March Ott tells the state it has complied. However, the DON, Lucy Miller, was there in that position for only 3 weeks or so. Then in Aug., Gwen Hughes took over the position of DON. Less then two weeks later employees were running to Ott, Brucker, alerting of impending trouble.

Ott then said in this letter, "I do have many years of experience as an Administrator of a distinct part long term care facility as a division of healthcare district healthcare systems."

All right, I do have to put up the rest of Ott's resume, escpecially since I just read it again, and realized it wasn't the resume she necessarily came to the job with here, as it was updated with KVHD on it. (I wonder if human resources or any of the sticky three board members gave her a "letter of recommendation?" Or even a personal reference? Put a good word in for her? I'd like to know.)

Well, here's a letter, not of recommendation, but the famous, "cry for help" from the SNF employees letter, given over to a board member they hoped would help, in the first week of January, 2007.

The letter which included staffing records indicating shortages, and the names of three medicines, was passed along, but the board member took much heat, as the CEO knew this meant the trouble was leaking out of her control.

Maybe this should have been the letter our former CEO took with her. The employees were acting like hostages when this was written.

And why didn't the state look a little closer at Ott when they tried to tag them with the license issue? You see it could have been anyone who may have saved the day, by looking closer, and listening. And the state is no less culpable if they are to be oversight, then there should be some over them too.

Here's the whole resume, excluding the excerpt in the post below:
PAMELA OTT, RN, MHA
Bakersfield, CA 93312
e-mail:: @netscape.net

PROFESSIONAL EXPERIENCE

Kern Valley Healthcare District – Lake Isabella, CA January 2003-Present
Chief Executive Officer

Areas of Responsibility:
Administer, organize, and guide all activities of the Acute Care Hospital (a Critical Access Hospital), 74 Bed Skilled Nursing Center, Retail Pharmacy, and Rural Health & Specialty Clinics. Assure strength in the fiscal viability of the organization and provide vision for the continuation and enhancement of quality healthcare services for the Kern Valley Community.
Areas of Accomplishment:
· Successfully prepared staff and organization for a Critical Access Hospital Certification which was obtained November, 2003; (who hasn't taken credit for this raise your hand?)
· Improved financial performance of the organization. Budget has grown from $34 million to $55 million over the past four years:
· Restructuring the Utilization Review process reducing contractual write off by 12% (currently at 56%) and reduced length of stay of inpatients by 1.5 patient days;
· Enhanced the utilization of Swing Bed admissions by 50%;
· Reducing utilization of contracted Registry Nursing by 75% (Reducing staff who disagreed with you, or knew what you were up to, by 100%)
· Implementing a flex staffing program throughout the organization;
· Negotiated new physician contracts for services reducing costs by 40%;
· Enhancing community perception of hospital and clinic services (Yeah, we sure got some good press and public relations out of you)increasing the utilization of Rural Health Clinic by 100% and increased inpatient admissions by 25%.
· Developing new outpatient services such as cardiology, respiratory therapy/pulmonary testing, and specialty clinics.
· Improved employee retention rate from 10% to 2% for the past 3 years. (Okay, now that's as funny as it gets. I have several blank pages which were supposed to be the recruitment and retention committee. The employees quit. I guess that doesn't sound quite as good on a resume.)
· Recruited three physicians and one mid-level provider for the Rural Health Clinic;
· Developed an effective Hospitalist program for unassigned hospital admissions;
· Recruited specialty Physicians including General Surgeon, Gynecologist, and Opthamology.

(Aren't resumes fun to read? Escpecially, when you know her education credentials were never checked, you know the rest of her claims will be accepted as nonfiction too.)
Delano Regional Medical Center – Delano, CA November 2001-December 2002
Director of Acute Care Services
Areas of Responsibility:
Provide leadership and mentoring for a staff of 240 RN’s, LVN’s, Unit Representatives and CNA’s. The areas of responsibility that I directed were Surgery, Obstetrics, Outpatient Surgery, GI Laboratory, Critical Care, Telemetry Step-down, Medical/Surgical, Barriatric Surgical, and Emergency Departments. Job responsibilities included hiring, discipline, and discharge of staff. Also included was full responsibility for staffing, budget, policy setting, meeting and exceeding all JCAHO standards, staff development, assuring continuous quality improvement, and maintaining effective multidisciplinary relationships. During my employment at DRMC, I accomplished the following:
· Reduced the RN vacancy rate from 61% to 28% through recruitment efforts; (or as you called it at KVHD, "placating the pack of wolves.")
· Designed and implemented a preceptorship program for new graduate and re-entry RN’s;
· Brought standards up to and at times exceeded JCAHO standards including, with the assistance of a multidisciplinary team, developed a Medication Error Reduction program, Pain Management program, Reduction of Restraint Utilization Program, and updated EMTALA standards for the Emergency Department;
Worked with the Directors of the entire healthcare team to create a seamless caring environment.
Ocean Beach Healthcare District – Ilwaco, Washington April 1993-April 2001
Chief Executive Officer/Superintendent of Public Health Care Services District #3 of Pacific county
Chief Executive/Superintendent for an acute care hospital, outpatient surgical services, cardiac rehabilitation, 2 rural health care clinics, urgent care clinic, assisted living center, and trauma certified emergency medical system. During tenure, accomplishments include:
· Enhanced fiscal stability of the Health Care District by over 2 million dollars;
· Successfully guided the organization in the award of a 9.75million dollar tax levy for the purpose of hospital expansion;
(oh, you mean you measure M'd them?)
· Implementation and maintenance of an effective Continuous Quality Improvement Program;
· Recruited and retained 15 multi-specialty medical staff members into the community;
· Developed a solid partnership between the Health Care Services District and the local health care providers;
· Implemented a new information management system in order to accommodate the new HIPPA regulations;
· Implemented and maintain an effective customer relations program; and· Prepared the organization and community for Critical Access Hospital Designation.
Chief Operations Officer/DNS April 1993- August 1996
Began working for Ocean Beach Hospital in the capacity of COO/DNS. The responsibilities during the three year period included overall management of Critical Care, Surgery, Medical/Surgical Acute Care, Emergency Services, Pharmacy, Laboratory, Respiratory Therapy, Medical Records, Infection Control, Inservice Education, Discharge Planning, Utilization Review, Risk Management, Diagnostic Imaging, Dietary, Housekeeping, Purchasing and Central Services. During the time of assuming the COO responsibilities, The following objectives were accomplished:
· Developed a Surgical Services Department;
· Designed and implemented a Critical Care Unit, including teaching a critical care core curriculum for nursing staff;
· Initiated an acuity system throughout the organization with the result of enhancing efficiencies and reducing FTE’s;
· Obtained a Level IV trauma Certification;
· Coordinated an inter-community healthcare provider consortium; and Maintained a balanced budget.
Rideout Memorial Hospital, Marysville, California October 1989-April 1993
Department Director, Critical Care Services
Provided leadership to 84 employees in the Critical Care Services Department. Responsibilities included Budgeting, education, internship, policy & procedure development and implementation, staffing, performance appraisal and quality improvement. Maintained JACHO compliance at all times. (Wow stud. Why not at KVHD?)
Evergreen Cardiac Rehabilitation, Grass Valley, California August 1987-October 1989
Partner/Owner/Cardiac Rehabilitation Coordinator
Maintained a very successful Medicare Certified Cardiac Rehabilitation Center.
Sierra Nevada Memorial Hospital, Grass Valley, California February 1981-August 1987
Specialty Care Units Coordinator
Established, developed, and provided leadership to Cardiac and Intensive Care Units, Telemeter Step-down Unit, Pediatrics Department and the Surgical Intensive Care Unit. Established policies and procedures, Quality Assurance Programs. Provided critical care education and internship programs, and maintained the departmental budgets. Maintained JACHO compliance without deficiencies. (No Deficiencies, I'd hire you, I'm sold. I'm sure the KVHD hospital, unlike some of the employees you fired who are now deemed not rehirable, never put a blemish on your record.)
Escondido Cardiology, Escondido, California June 1978-December 1980
Cardiac Specialist
Worked with cardiology group providing Cardiac Rehabilitation, Holter Monitoring, Stress Testing, Pacemaker Clinic and Echocardiography.
Palomar Memorial Hospital, Escondido, California March, 1974-June 1978
Charge Nurse for Medical, Surgical and Cardiac Intensive Care Units
Provided leadership and mentoring for all aspects of critical care for the organization. Designed new Cardiac Program including Cardiac Catheterization Lab. Taught all aspects of critical care specialties to nursing staff.
Los Robles Hospital, Thousand Oaks, California July, 1972-February 1974
Charge Nurse for a Cardiac Surgical Intensive Care Unit
Managerial accountability for all aspects of patient care within the CSCU.

(I wonder what her taxes look like?)

You know the story, I've been repeating myself, turning it over and over, for you to look at, and it doesn't change. But when you look at the details it makes much sense.

But here's the question of the day: If Pam Ott left the hospital KVHD in May 2007, avoiding the civil lawsuit onslaught, why didn't things get better in the SNF or overall?

And the answer is:

(Look again) The Chet Beedle interview:CFO part of problem? Part one.

UPDATE: Cal Mtg. here's your man, Beedle, attacking any employees in 2006 who weren't backing Measure M, the bond, that was to be used to build an extension onto the hospital, and the depreciation monies were to be paid to the debt. The plans were faulty and now again, here we are after another GOB. Funny, from what I understand we didn't go after a GOB until KVHD got into the HIGH RISK revenue bond deal which has been in default for 24 years and now they have a management company trying to cut costs so we don't have to keep getting lines of credit from Cal Mtg. to move to operations where we pay off our bonds.)

"They push me, I push back harder." Chet Beedle, CFO, KVHD (regarding the employees, not Cal Mtg.)

It was June of 2006, the year KVHD was making its move to decide whether to put a general obligation bond, Measure M, on the ballot for November. It was also the year the skilled nursing facility struggled under short staffing and mismanagement, being tucked away while elections were being decided.

Chet Beedle recently announced at last week's finance meeting, that the reserve for the bond debt has been depleted and likely, come this August, more or the rest of the reserve will be used to pay the state, Cal Mtg., putting us, the district, at risk of being in default. Which could cause this state agency to come in and force a management company in to solve our problems for us.
Well, Cal Mtg. sent BRIM, never really left, they left Chet Beedle behind who came on as an official employee in 2003.

Here's a partial transcript from an interview in June of 2006, when the CFO, Beedle, was explaining the bond, the debt, the general obligation bond needed for Measure M.

The hospital had two months to get paperwork ready to put the measure on the ballot. And it would be hiring a new Director of Nursing for the Skilled Nursing facility, named Gwen Hughes, so the hospital could concentrate on its efforts to land this bond the community would pay for in property taxes.

The Revenue Bond is borrowed on future revenues

Laura: any idea whether retrofit versus expanding?
Chet: we don't know yet, its got to be taken into consideration, a new roof, or get into asbestos or those kinds of things.

(Beedle went on to explain the debt.)
Chet: If you just put it on the market (the hospital), you would have got six or seven million for the whole hospital. So, when you borrow 21 million dollars the basis for what you're going to do just isn't there and actaully after that they relatively lost money almost every year and up into the late 90's. Four million in one year. (he said it was caused by a capitated contract with BFMC but the story changed many times much like Ott's did.)

...so the hospital was very close in 1999 to actually make the board think they had to take bankruptcy because they couldn't pay the bills.

(Is that what we might be thinking right now, again, because of the nursing center, Sycamore management contract, legal matters, penalties, traveling nursing expenses, etc.? Are we back to that time. Is Cal Mtg. here yet? Are we ready to tackle our own investigations and not fall aside to outside state and local agencies who have not helped at all in the past?)

Chet: When you take out a 21 million dollar bond, a 21 million, one part of that bond is one years worth of pricinple and interest, you're supposed to borrow that money but put it in reserve just in case anything should happen...they didn't pay their bond payments in 1999 at all. So, all this revenue was used up and the state guarantees these bonds, and the state was relatively speaking, gonna, could have, taken the facility because they have the rights to the assets when they do this, this insurance guarantee. So, what the state did was make them hire a management company for a period of time.
(Chet said the original company the state recommended was "too expensive" so they sought out another. Hence, BRIM, management, and consultant Chet Beedle.)
Chet: So, they didn't specify what firm they needed to hire, so they decided to look at other firms and one of the firms was BRIM, and they decided on BRIM.
Laura: What did BRIM do to help the hospital. what exactly did you guys do?
Chet: Again, we put in the policies and procedures that BRIM had on the finance side, I basically got them working in productivity, I actually negotiated an agreement with BFMC, a long term pay out, or actually a reduction of half a million and then a payment of the amount that they owed. then I kind of worked on the long term debt of plan where we would make a lot of long term debt payments and satisfy the state that this was going to be okay.

Laura: what changed the debt?
Chet: What changed is actually the hospital in 2003,, actually for almost a year what happened, when the CEO that was here who decided to go elsewhere, Dave Green, Pam applied for the job. She was interim about, I want to say, four months or so and then the board decided to hire her as permanent CEO, she actually worked on the side of revenue, I was here day to day on the expense side or the cash purchases and recievables side, and just tried to do a better job of collections and a better job of how we paid our bills and how we managed our cash and a little bit at at time, it takes a long time.
(Chet said the hospital began to get better and he came on as CFO in 2003. And BRIM left in 2004. He left out the part about having to acquire these loans he said we don't qualify for, to pay costs)
Chet: The board agreed, BRIM left, we went forward and actually from about July 2004 and on we made money every month.

MEASURE M: THE GOB BOND ON THE FAST TRACK

Laura: You have to declare the amount right for the ballot prior to the measure going on the ballot?
Chet: You have to to know what percent, the amount that goes on the ballot has to be based upon what you're going to recieve, the answer is yes.
Laura: But you'd have to have this all in by August, which would mean July willl be a very long month.
Chet: Very definitely. I'm not sure that the declaration on the 6th of August I think it is has to state all of the specifics, you have just have to tell them that you're to go on the November ballot, the specifics maybe able to come later if you know what I'm saying.
Laura: And you'll need the specifics right away, you've worked with an architect so far?
Chet: We have an architect we have been using, for, we haven't done a lot with them, but yes, uhhu.
Laura: Is that the one with the Rural Health Design Network, with the Yarboroughs?
Chet: uhu, that's the one we've been using. However, when we get ready to go for the bid on the architectural drawings, for let's say we're going to do a new building, or partial building, okay? Because it's greater than 25 thousand we actually have to go out for a bid, that's by statute, we will go out to bid with various architects out there. You have to get bids in after going over 25 thousand dollars.
(Well, amazingly, the contract went to the same architect firm associated with RHDN. They did drag in two other bidders, but Mr. Jamison, Mr. Armstrong, and Barbara Casas all saw that they should stick with Aspen Street Architects. Sticky board members and sticky organizations. Considering the final product, the plans, were of no use, except to have the hospital pay to have them drawn, it was a waste.)

Why do we need a general obligation bond?

Chet: The hospital could not really go out and borrow more money, we've just been through this long story that they probably borrowed three times more than the hospital is worth and that they paid for, so the situation is, no one at this point would lend the hospital more money on the hospital, even though our financials are good, we still have that big amount of debt already out there and so the simple fact is the hospital cannot go and borrow any money on its own. the only alternative is if it's going to do something as far as a construction project, I, any, whether its retrofit, whether it's new, whether, it doesn't make any difference it has to go through a tax obligation because that's the only vehicle that creates new money into the organization, you can't borrow that money okay?Yeah, there's enough money to pay that outstanding debt even though its extra high from before, and there's enough money for us to make a profit and pay our bills, but there's not enough money to do construction. So, that's the only way it could happen.
Laura: So, as of right now, you're able to make those yearly payments on this revenue bond?
Chet: Oh, yeah, we've done it all along, actually ever since 1991 they've been making all those payments except for one year. (According the contract the monies paid are supposed to be made from the earnings from the project. Paying from loans, shorting staff, trying to build a building quickly so he can use the depreciation to pay Cal Mtg. is not something he was sharing back then)
Laura: As far as the SNF goes they started out with 150 beds and I'm sure they made projections on filling up 150 beds...
Chet: you bet.
Laura: So, when they got into trouble and couldn't build that many beds, that's where the real trouble started for the hospital?
Chet: That plus the fact, that even the structure itself that they did build they probably paid twice what they should have paid, because all of the changes, because of the resizing, so they really spent 21 million on a 13 million dollar building if you really want to hear what I'm saying.
Laura: Yeah, I do. (Where the hell were you OSHPD and CAL MTG.?)

(Beedle speculated that they would have been able to utilize the money from the new building for expenses, and retrieve monies from Medicare for the depreciation. There was a lot of hope that this bond would go through.)

(However, the hastily thrown together 12.5 million dollar figure that was supposedly with a two million dollar buffer, was admitted to having been too little money anyway. The hospital would have been forced to come back to the community on it's original plans for another bond. But in the end the whole conception was incorrect. The plans were unusable. Former KVHD Chairman, Brad Armstrong, vehemently denies any wrongdoing on the part of his board quorum to this day.)

Forcing the Issue

August 2006, the board proceeds to move forward on the bond, which has a tentative price tag, and faulty plans. At the same time, things are not going well in the SNF, staffing was cut, nurses worked while sick and burn out, but the bond was going to the community.

And when the employees complained that there were internal problems, the CFO, CEO, CNO, and human resources set out to show down with their own staff by supplying quotes and human resources documents.

In a separate audio interview coming up, Chet Beedle said, "They push me, I push back harder." (employees)

Next up: going for measure M, employee intimidation, the loss, internal investigation

Tracking down the troubles: some KVHD history

Thanks Dave.

Here is a portentous piece of Public relations fluff that has many interesting facts for certain people to look at and for the community to see how a management company hired an unqualified individual for two top priority jobs: First as the Clinical Nursing officer and then CEO.


And they brought on our current numbers man, Chet Beedle, CFO, who is still with us. (or against us)

I will make comments to direct your attention to certain issues and items that are still biting us right now. I will highlight some statements to look at as well.
It was a long article, Dolly, so I have just taken the most pertinent excerpts.

Popular hospital CEO rakes new assignment
By Dolly Ogawa

Published on Wednesday, July 2, 2003 10:00 PM PDT

CEO David Green had been at Kern Valley Hospital for exactly 3 years on June 25, the day he left for his new position in the city of El Centro in the San Joaquin Valley.

In those three years he accomplished a lot."When I came here the hospital had a lot of turmoil regarding financial issues. I think we've settled a lot of that and have a direction we're going in and we have solidified the nursing staff, especially with Pam (Pamela Ott, former Director of Nursing), coming on board. Now with the board appointing Pam as the interim CEO at this point it helps further solidify this team."

Green feels that the whole staff and management team, which he describes as a tremendous pool of talent and experience, is the best the hospital has ever had and possibly the best anywhere.We have many nurses that have transferred here from LA and Orange County. "Whatever brought them here we've got the cream of the crop and the people from here are very good at what they do because they've been doing it for a long time."

(Then we fired the cream of the crop? We probably should have fired the mold on top of the crop.)

"I believe the skilled nursing center we have here is second to none in the state. You walk down the hall you don't smell anything, here you have a significant number of not just nurses but CNAs that care about the people. We don't sacrifice quality up here because we have people who know what they 're doing."

(We sacrificed quality and management then made scapegoats out of some quality personnel)


The hospital's main challenge has been a tremendous debt burden. "Although we've been able to make a go of it, it's been up and down. They tried to deal with managed care in the late 90s and lost a significant amount of money. Managed care doesn't work out for any rural health care service. The hospital was struggling when Cal Mortgage who guarantees funding for hospitals insisted they needed more support. BRIM Healthcare was hired in 2000. BRIM is a company that has backup regional support for the CEO.
Carol Bradshaw was the chief nursing officer. When she left they found someone from Paradise and she left last winter. Then they were lucky enough to find Pamela Ott, when she moved to this area to be close to her grandchildren. "Lucky us," Green said. "She had been in this type of environment before."

Ott said, "We have competent people taking care of you here, whereas in large hospitals down below they have registry nurses and you can't always trust their abilities."

(Ouch, that comes back to bite us right now. Oh, there are traveling nurses looking for a place to stay. Mr. Jamison, do you have any open rooms?)

In a small community it was so easy for rumors to spread. There have been a lot of misunderstandings.
(Rumors became more like fact and finally evolved into urban legend; see post below)

Green's replacement, Pamela Ott, was found by "Divine Destiny." It was a miracle to find just the right person so easily and so quickly. Her daughter told her how beautiful it was up here.When Green had to replace the chief nursing officer, he put a small ad in the Bakersfield paper. In all his 28 years in this business he'd never seen this happen. It is so hard to replace the chief nursing officer, he insisted. It takes months. From the ad he received two responses. One was from Pamela Ott. He couldn't believe it as he read her credentials.

(Actually I couldn’t believe it when I read her credentials either. They are posted on the blog.)

Something had to be wrong (and it certainly was) and then he talked to her on the phone. She was so nice! It was unbelievable. He thought that once she came up here and saw what the job entailed he'd lose her on that round. No. It was divine destiny, as she said. She was perfect for the job.

When Green scheduled an interview with all of the management staff she was taken with the people. "I love rural health care because you can make a difference in the community. You can help people stay in their beautiful environment without having to leave to get health care. So it's pretty special for me.

(It's all been so special. The SNF disaster, the fired employees, the lawsuits, the collusion with some board members, the finger pointing, the measure M fiasco, the conflict of interest, the scapegoating; Gosh, rural healthcare really is so much fun)

I thought this is great after so many years working of being an administrator, to have the opportunity to work as a chief nursing officer and work with --someone who has the same vision for rural health care."Green said during her interview, "You could do my job." Little did she know that he would be leaving and that she would be doing his job. It is an interim position.

The Board of Directors will be making the final decision and they are taking their time. Pamela also wants to have some time to see the scope of the job by doing it.

Thanks Dave, the board, Brim, and Cal Mtg. and Goldman Sachs?

What do Cal Water and the Kern Valley Healthcare District have in common: your money

Cal Water and KVHD

I was just perusing the comments and published one that had a very good point regarding the rate increases obtained by Cal Water over the last five years.

The point of the comment was that the state, Public Utilities Commission, or PUC, after much public input decided that we, meaning the public, had to absorb the costs to make our water "safe."

The writer of the comment made the point that after several increases, the water is not any better than it was before. This person, and most of us who have to use this water, think it tastes like a "sewer."

But over the last four years, we have put out more money to use this water, but it's quality did not increase, just the cost. Maybe there is less uranium, fluoride, arsenic and chlorine, though I think that is speculation, however, it tastes and feels like the same water that makes my hair look like I sprayed it with AuqaNet hairspray, sticky and brittle.

I not only don't drink it, I don't give it to my animals either. www.krvpetcorner.blogspot.com/

As a citizen of the valley, I attended two of the meetings regarding this issue. Most people did not want to talk they wanted to yell.

One point I made was the fire hazard situation. People cannot afford to pay for the extra water costs and continue to try and grow fruit trees, lawns, vegetable gardens without shorting themselves.

So, much like when gas prices rose and put a grip on us all, people curtailed their out of town trips.

Water goes up and the plants get thirsty. Thirsty plants and trees are dry and fire prone, more likely to quickly spread to a structure.

This community is a fire area, but nobody took that into consideration when they allowed Cal Water to up the price of it's mediocre product

Cal Water representatives said at the first meeting when they announced their company stocks were up but they need us to pay the extra because the government lowered the levels of arsenic allowed in drinking water, and it was going to cost a lot of money to create a better filtration system.

How sad. Well, we're now paying, and it's the same old water.

The Kern Valley Healthcare District is now in cahoots with the state trying to drag more money out of us here in "high price, no service" valley, to save them from...themselves probably.

They have been in trouble for years, and now with emails proving the situation to be both a problem with our hospital finances and the state, they want the community to bail them out.

But, like Cal Water, they made sure their stockholders were secure, much like we made sure our hospital CEO, got a raise, and then promised raises for the employees "sometime" this year.

If they can barely make payroll, are being sued by many, quickly threw together architectural plans, then how can they say they can give a raise? So many people have complained to me about the raise and the survey, that the bond measure is lost in the other issues.

Unfortunately, the reasoning given at the last KVHD board meeting by the chairwoman of the
board for this raise, was quite odd. She basically told us all that since the finance manager, Chet Beedle, had overpaid companies such as Sycamore and Tracy Brown, as well as the massive amount of registry nurses, that our new CEO should get the same...

Same what? Overpayment?

Now, at least the state office came up with an idea to help seniors and low income residents by creating a crafty plan to pass along the cost to other Cal Water customers outside the valley, thereby allowing for a reduction of $20 to those hit the hardest by the increases.

The hospital wants to raise property taxes (next we will be discussing the cost of these taxes, as Exhibit A, notes what I tried to get an answer to at the last meeting, that these are ESTIMATES, yes, that's right they didn't want to answer) but it has not allowed enough time and input to consider the ramifications.

There is no hardship relief on the KVHD (Measure "G" for "Gee, we forgot to plan this out") ballot and the state cut a program last year that allowed senior and disabled homeowners to get help paying property taxes.

So, seniors and disabled will have no alternatives if this hastily planned GOB comes through.

But you need to know this too, this is only the first bond. Oh, did they forget to tell you, well, I'll be talking about it soon, as it is on video.

22.7 million dollars also could potentially build a "new hospital" maybe in Lake Isabella. That doesn't mean we would have to get rid of the old one. Keep the nursing center open and use the rest of the space for administration or other things. Then take your 22 million and build a structure with a brand new ER, small acute care, out patient surgery center, specialist offices, or any of the various items NEEDED to be licensed as a hospital.

These are just some of the ideas that were not considered as the hospital has apparently all the information it needs. We the people of the valley have been treated like interlopers rather than voters whose taxes already go to support the hospital.

Point: Will throwing money at the hospital make it taste any better? Or will you still be going to Bakersfield and Ridgecrest to get the healthcare that doesn't cloud up when you pour it in a glass?

KVHD generated timeline shows 20 year default cycle

In 1986, the Kern Valley Healthcare District began a business relationship with the Office of Statewide Healthcare Planning and Development, which included a business plan to build to a nursing center, surgery suites, cafeteria, physical therapy, and other not really necessarily pie in the sky ideas.

It should have worked. We were to build 140 or so beds in the nursing center, we finished with 74.

The story goes we had no collateral to build these things, but a program called CAl Mtg. was created to get money to hospitals to build, expand and upgrade. The hitch to the Cal Mtg. plan was that the idea was not to lose but to make money. In it's own mission statement, the program must protect "the fund." So, no bankruptcy or other silly ideas of getting away, once it was signed, it was over.

As the hospital tried to finish it's project, by 1989 contractors were unhappy, materials missing, money unaccounted for, and then the Loma Prieta earthquake.

The board back in 89' could not protect the money, could not make the payments on the bonds without taking it from the loan they got to use for construction.

They borrowed money to make payments on borrowed money, paid interest with principal. Then borrowed time became a factor as in 1991 the first management company would come to the hospital and begin, Oh, I don't know...making money for themselves, supposedly helping the broke hospital continue on.

This pattern would stay with us as just two weeks ago, rather than calling it "technical default" anymore which the hospital has been in since the project began in 1986, Cal mtg. is using the contract or covenant to force an audit on the hospital, with HFS financial consultants.

According to their contract they are supposed to be inspecting and coming to meetings, helping the hospital survive, but not survive just to pay them.

We are surviving to pay them, but I've got news for you, if the hospital closed today, this community would still owe that debt. It would come straight out of our property taxes for the next however many years it would take.

When KVHD contracted with them, they used us, the community as chattel. And now in emails, CFO, Beedle has offered us up to banks for lines of credit and to who else, Cal Mtg.

Now you know this is your debt Kern River Valley.

Cal Mtg. has had it rough recently as information that they may have been hearing about the current goals of the board and the community may not be quite accurate. The finance manager turned over the employee benefit report to controller Barbara Figueroa, and that only means one thing, there's a glitch somewhere.

Nobody bankrupts on Cal Mtg. the thought is blasphemous, because Cal Mtg. will provide the hospital with reoccurring loans or lines of credit to pay the debt so "the fund" doesn't have to pay. It creates loans for the hospital as it did a month ago, a million dollar line of operating credit, which is completely gone.

$833,000 went to Cal Mtg. to pay the bondholders. Another $75,000 went to pay for the services of the auditors HFS, which Cal mtg. foisted upon the hospital. The remainder went to the employees benefit fund which was lacking.

So, 90% of this loan directly benefited Cal Mtg. Though it kept the hospital from having to have Cal Mtg. pay off the bondholders and then we owe the balance of our debt immediately.

The hospital board, as far as I know, has been given little knowledge of how this situation works and has worked since the hospital began the default cycle in 1991. I think if they knew they would try to take action to put a stop to it. I'm sure there's a communication problem somewhere.

Questions that should be asked are left floating in the air at meetings. Follow up is after I get home at night.

GOB [sic] helps those who help themselves

With the hospital being audited, and things like original documents and receipts will be expected to be shown, there is still the problem with HFS coming in on behalf of Cal Mtg. and the debt to the bondholders.

I'd almost think a trustee should be appointed in this case and will again, ask the hospital board to consider talking to Cal Mtg. themselves, rather than hearing the news through their administrators who apparently are running their own GOB campaign.

Correspondence between Cal Mtg. financial officer Mabel Chan and KVHD Cheif Financial officer, Chet Beedle reveal that Cal Mtg. is being told that the hospital is "officially" going for the general obligation which would have the community pay off the 15 million bonds with property taxes.

Who would that benefit once again? Cal Mtg. Yes, KVHD would too, but the community would have to benefit in some way too and considering this history, this timeline of terror below, they may want to pull out the people who have been covering the loan history.

Here's something to consider, as I've been adding up just some of the numbers, I am up to 6.5 million which we have paid out to, because of, or in fees, surrounding this whole insurance credit relationship we had with Cal Mtg.

(Update July 2010: the numbers and fees are difficult to pinpoint, as payments for services are vague, but I do have new information I will be sharing which includes the latest report as to why the hospital didn't obtain a loan rather than risk bonds which cannot be bankrupted on. The originator of this high risk package which could end healthcare in the KRV for good, is none other than Goldman Sachs, as was reported by the bond insurer, Cal Mtg.)

I cannot even imagine, as you will see in the documents in 2003 the refinance which should benefit the hospital, actually raised the total (rounding figures) amount from 16 million to 17 million.

What happened is we were in our default position of weakness for 24 years. We were never ahead of this revenue "bondage" deal.

Cal Mtg. again benefited from the 2003 refinance in that they were paid with a line of credit.

How could a company survive paying interest twice on the same monies? They are not and now, HFS arrives today June 6 to fulfill their contract to "forensically audit" this hospital for the next three months.

Who will this benefit in the long run? Paying HFS now as you can see in the documents brings us to 1.5 million dollars in management expenses due to the default cycle and Cal Mtg.'s refusal to pay off the bonds as they have collected more than enough from us for 24 years.

That 1.5 million which I think is a general number and there is likely much more money involved, could have been a payment to Cal Mtg. to cover the debt.

If you had a car wreck, still owed 75% of your car loan and lost your job on the same day, and your insurance company said instead of paying off your car, fixing it or totalling it, that they would back a loan so you could pay for the car yourself and pay a years worth of premiums to them: what would you say?






These documents actually help form a timeline that can aide in getting to the truth. We are beginning to hear more truth as the situation becomes more, what? Transparent maybe.




Predatory lending is defined by "who benefits from the transaction." But if the lender never comes on site and takes the word of a business in trouble, they deserve no pity, they did that themselves. Board minutes can be altered if that is what they are basing there decisions to provide more credit to a sinking ship.

And with Cal Mtg. allowing the hospital to survive on life support just because they can't handle the thought of losing them (the money) it's again not in this businesses best interest, at all. They have been allowing the CFO, Beedle to take money from a "debt reserve fund" designed to be a savings account in the event profits aren't up to par.

That savings account has to be one and half times the amount of the principle and interest payment. They use "ratios" to keep a barometer, but the ratios have been changed as Cal Mtg. once again lowered their standards so the hospital could make a payment out of savings.

It's like teaching the dog it's okay to eat at the table. And inevitably they take advantage.

Is there more? I'm afraid there is...absorb this while I work on "the" ultimate KVHD timeline (I'm calling it that because it is like seeing footprints in deep snow, obvious.) which will be my final efforts to correct something that has existed here for far too long.

I recently read and agree that white collar crime indeed diminishes public trust and some estimates say it costs billions and billions of dollars each year. And because of the complexity of these cases they are the most difficult to win in court. But depending on the evidence, it may be tough, but it's not impossible.

Now, would short staffing a nursing center because you had to pay Cal Mtg. in 2006 with another line of credit be considered a crime? I guess we will find out as I'm not letting that question go.

What there's more? Part two of KVHD Rocktoberfest!!!

"We're going to come together as a board," Dr. Robert Gross, DO, and first vice chair of the Kern Valley healthcare District board of directors, said regarding the passing of the motion to review the pharmacy financials before making a decision to close.

Measure twice, cut once

As was already reported, the KVHD board of directors denied a motion by board member, Bob Jamison, to begin wrapping up the business with the pharmacy, with a second motion being made by Dr. Gross to have the board carefully review the situation before closing the retail outlet.

Gross said the board needs to do some teamwork and make sure that this is the correct decision, as many questions were asked as how this will effect not only the community, but employees as well.

Jamison and Chairwoman, Kay Knight, exchanged their views regarding the decision.

"We've just had a very rough financial report for the district that says we're losing money. If you want to look at it on an emotional side, or belittle the messenger, keep in mind all you're probably doing is drawing out the inevitable and making matters worse," Jamison told Knight.

Jamison went on to say the pharmacy has been losing money for the last four years, and now with complaints and inability to service the customers properly, he said he sees no reason to delay.

"But it used to serve the public well," Knight replied.

She went on to say, "Our surgical services loses over a million dollars a year."

"We're not talking about surgical services we're talking about a pharmacy," Jamison retorted.

"We're talking about losing money and what we are going to do to prevent losing money," the chairwoman specified her concerns.

CEO, Tim McGlew, who, with help from Chet Beedle, (they're practically finishing each others sentences now) recommended to the board that the pharmacy be closed based partially on some interesting data obtained in an old consultant report.

"If we cannot do the service right than maybe we should not being doing this," McGlew explained. (Same logic would then apply to all other departments?)

"The bottom line is we've been losing money for the last, you know, four or five years, in the pharmacy, as Chet brought up last time, most of this came up as a result of the advent of Medicare Part D," McGlew reiterating what Chief Financial Officer, Chet Beedle, had been saying.

Beedle explained that the prices charged for medications were dropped down at that point, starting a cycle of losses for the pharmacy. (Well, I guess we will have a chance to look at this up close and find out if indeed that is the problem)

We need our pharmacy, says the Chairwoman

Not quite ready to give up on the Mt. Mesa Clinical Pharmacy, Knight reads off her reasons for wanting to hold off on closing the outlet.

Her concerns included the lack of availability of services on the "West Side Story" side of the lake, and employees who have put in years of work at the small facility.

(Yes, as I said in the Sept. Finance blog, there was an excuse given that the reason "The Drug Store," pharmacy in Kernville was able to remain profitable was due to the money people with power and influence living on that side of the lake. This was later disputed and laughed at by the owner of that pharmacy, who said it was just the opposite as all the medical providers are on this side.)

"I would hate to see our pharmacy close," she said was her opinion, "over the last few years the retail pharmacy has had very profitable months, I believe the allocated overhead expenses associated with the retail pharmacy are high."

She went on to say that the accounting system might be a place to start looking for answers."The losses we're experiencing are not from any mismanagement of the pharmacy or any wrongdoing within the pharmacy, but the losses as I see it are associated in the whole method of allotting overhead expenses from other departments to the retail pharmacy."

(I guess we can find that out now, as a team.)

Knight told the audience that the money to pay the long term debt impacted the finances of the pharmacy. "To service that debt we had to scrape pennies from anywhere we could."

Beedle said earlier in the year the debt was going to be a problem, he warned us. Then, however, he retracted that at the first finance commit me meeting with our then brand spanking new CEO, Tim McGlew. He then shocked me by saying it was already paid and it wasn't a big deal.

At that meeting Beedle said rather offhandedly that the 1.1 million was paid without dipping into reserve account required by the insurer Cal Mtg. We found out later that 150K was taken from reserves to make the payment.

Beedle and I ended up in a heated exchange that day as I told him that he said this all on video. Again, he said that he didn't say that. (We're cutting the videos this week and will probably fill up our Youtube site with some really fun stuff.)

Now that Beedle is becoming more open about the financial problems, as he has projected a serious problem paying next year's August bond payment. He even intimated that we could potentially have to use our insurance to make the bond payments. Our insurance is Cal Mtg. and once we do that we may as well give them the rest of the hospital. (Well, they pretty much have it now)

Our CEO, has experience with Cal Mtg. as, if I remember correctly, his last employer had more than 115 million in loans insured by the OSHPD offspring. (Office of Statewide Healthcare Planning and Development: see blogs regarding Cal Mtg. and its relationship to OSHPD)

I'll be interested to get his views on the long term debt situation.

You can't just close it, there is a process

Robert Knight, continuing his service to the healthcare district, this time from a seat in the audience where he is seen at every meeting supporting his wife who is the chairwoman.

Knight raised his hand and made a comment.

"This is a district hospital and it is tax supported by people who live here and actually earn their living here, not somewhere else. And I believe there's a section of the law that requires that you cannot just lop off a department, there's a process you have to go through which includes, I believe three different months, weeks, public notices."

The CEO responded that Mr. Knight was "right," saying that this is his first job with a public healthcare district and he deferred to Knight's experience. He said he will confer with counsel as to the process.

Knight went on to say, "It won't hurt to look at these numbers, there's a lot of, when you look at Mr. Beedle's numbers, there's a lot of stuff in there that doesn't make a lot of sense."

The options

Keep the pharmacy open and lose money, Beedle's report suggests. Cut back on staff, keep a minimum inventory with mostly generic medications, move skilled nursing facility pharmacy services into hospital, hours remain same except for being closed an hour for lunch with only one pharmacist on duty.

(That just gave me the warm fuzzies, what's the second option?)

Set a date to close the pharmacy to the public. Inventory liquidated or moved into hospital pharmacy. Employees and covered board members can use the internal pharmacy.

Okay, what did you think of that analysis?

Even more impressive is the data used to create these two top notch options.

When I looked and saw "The Casey Report" being used as a tool for justifying these two skimpy scenarios, I knew instantly the board was correct to hold off any action on this issue so this could be properly analyzed.

What is the Casey report?

The Casey report was done in 2000 by a firm suggested by Cal Mtg who was getting really worried about the lack of funds provided on the debt, but even more so, about the talk of bankruptcy.

Casey made some strong claims in the report, but unfortunately some of the data was not completely accurate, which caused the KVHD board to dismiss it as a source of advice.

Though some suggestions contained in the report, I believe, but I'll have to recheck, led to the closing of the Kernville clinic along with a cardiac rehab type of business. (Gee, a cardiac rehab in a senior community, that couldn't make money, could it?)

I have this report, and since we are now using it as viable data, I'll go ahead and tell you why it was given to me.

Former CEO, and currently a defendant in our felony elder abuse case, Pam Ott, and Bob Jamison gave it to me to impugn Robert Knight as the cause of all the financial problems at the hospital.

There is a reference in the report that the CEO, Knight, needed to be fired.

But the consultant was never hired and there was some question as to the accuracy of the report itself. Now, suddenly it resurfaces and is being taken into account as to the decision with the pharmacy???

We have an obscure report which was a one time deal, as the former KVHD board members chose not to hire on this company. And yet, here it is, an outdated, antiquated, analysis being used, I guess seriously which is hard to believe, to make a decision on the pharmacy which services a good portion of the community. (I'll say no more and just keep rolling my eyes)

As we begin to make decisions as to the future of the hospital and its potential services, business opportunities, there is the specter of that debt which makes it tough to believe much can be done without addressing this issue.

Like I said, I made a proposal to Cal Mtg. back in February I think, and both chairwoman Kay Knight, and Assemblywoman Fuller, were interested in trying to negotiate with the pseudo government agency which is actually allowed to make a profit. (That is the problem, the state is not going to fight about a profitable endeavour such as Cal Mtg. But it's the way they have become profitable which I have addressed and will revisit.)

However, CFO Beedle, talked Mrs. Knight out of trying to cut a deal for some financial breathing room, and the whole effort was stopped short.

Now, at this recent meeting, Beedle announced we could actually be using the insurance if we can't pay.

What about the pharmacy employees? What about the customers?

Chief Clinical Officer, Cynthia Burciaga, addressed Chairwoman Knight's concerns about the employees at the pharmacy.

"Miss Chair, as far as the comment regarding losing employees or having them lay off employees in the retail pharmacy, our open position report is available on line as well as posted in other areas, and there are many positions in the hospital where we can absorb the employees," Burciaga told Knight.

"So you're going to take care of them," I asked her.

Burciaga said she didn't want to lose any of the "valuable" employees and that they could apply for other positions at the hospital or be cross trained into something else. She thanked them for their service as they have had to deal complaints from the public and uncertain hours.

"They've been so good about cutting back their hours to help out, but still maintaining their benefits," she said.

(I'm sure if others a little higher up would pitch in their hours or cut some of their money, it would help much more than taking it from the little guys. You just don't hear the top administrators talking about taking cuts or even cutting their hours at this hospital. How about a furlough program?)

How to pump up the volume

Marge Swendleson, who could be called a community advocate, stood up and addressed the issue of insurance companies sending patients down to Bakersfield or elsewhere when they can have the same services available here.

She said a phone call to the HMO or insurance company by the patient explaining that the services are available close to home can get results.
"They can have the procedure done here and it takes is a phone call because I've experienced it and had nothing but good results."

McGlew agreed with her, but said that the hospital can't do that for the patients.

He explained, the hospital has contracts with these organizations, but they just refuse to let the district do the volume here.
"It's gotten to the point now that just a simple chest x-ray, they will require them to go to Bakersfield to get that. Clearly, the time down and back is exorbitant for a simple procedure like that."

Swendleson said people just need to make a stand, make phone calls, write letters and things can change. She said she wrote a letter to some editor about it.

McGlew said he has contacted the department of managed care to review the situation as well as sending requests for help from two other state agencies.

The CEO said its a difficult situation, "but we will rattle some swords."


Dr. Gross responded, "it shouldn't end with the letter to the newspaper, which I think is a really good idea, but there's a law on the books that basically states that these insurance companies have to provide all services within thirty miles from where they are insuring you at. So, I suggest you write a letter to your representatives as well...letters like that help, they can help an awful lot."

Is this story over with yet? No.

McGlew reported that he attended the annual California Hospital Association meeting recently and that some good news came out of the event.

"The primary purpose of that was to begin putting the network together of the critical access hospitals throughout the state of California."

He said getting this group of similar small districts together will help as far as advocating for the special needs of these critical access hospitals.

As McGlew has talked about getting more specialists up here to create more services and more volume, he said he found out at the CHA meeting, that the telecommunications or telemedicine, will be available soon by way of money from a stimulis package.

"They announced at the meeting that they had already proceeded with the purchase of that equipment for every one of the hospitals. So, that will be coming shortly, that was very good news."

McGlew also made mention of the fact that all the CEO's in the new network, have no retail pharmacies. So, we are all alone in this?

Where's my flu shot?

I guess we're all asking how we can get flu shots this year as the hospital has not recieved it's shipment as of yet. And the only shipment they are expecting will cover patients, staff, and residents of the nursing center.

What happened to the drive by flu shot clinic? I don't know, but I will find out. I need to speak to Public health and find out what has happened.

It's only speculation, but could there have been a problem paying for these vaccinations? Let's find out together.

I need a flu shot, but I will wait until I know our elderly residents and children are taken care of first. And if I or anyone else have to go to Bakersfield to get a flu shot, then we have sunk to our nadir of service.

Odds and then the end...

In his CEO report, McGlew said that they will be going to all the department heads and do a departmental review. Beedle said they haven't done that, but they always kept in touch via reports and records.

Out of the blue, McGlew mentioned a skilled nursing facility policy which prohibits hiring anyone convicted of elder abuse or neglect type issues. He said it is only a SNF policy now, but would like to see it district wide.

Second vice chair, Brad Armstrong, who has been on the board for more than 20 years, through many a disaster including the construction project and the SNF elder abuse disaster, voted with the other three board members to take a look at the pharmacy one more time.

"I most certainly don't want to make the wrong decision." And I concur.

Two new Obgyn's will be arriving in the valley at the end of October as part of the push for specialists.

And "The Drug Store," in Kernville should be keeping a close watch on the pharmacy situation here as it will impact there business as well: they're going to be making some good money if our pharmacy goes down. And they can even expand their delivery business to make it a convenience.

LOOK AGAIN May 2009 KVHD meeting: can they govern themselves?

Let's look at these meetings again: repeat...sounds familiar

Power to the people

Board members entered the cafeteria tonight, obviously giddy and drained from a day of CEO recruiting. The afternoon special meeting ran all the way up until the regular board meeting at 5:30 pm.
They closed the first session with a statement from board chairwoman, Kathryn Knight, that the search for the CEO goes on. They interviewed three candidates, she reported.

A public speaker said he had information that former CEO's were given much money in expenses and if the board was looking for a local administrator.

Knight was momentarily chastised by board counsel, Scott Nave, for saying they were hoping to find a CEO who would live in the valley. Nave corrected that the CEO doesn't have to live here to qualify, by law.

Obviously, that doesn't exclude anyone locally either.

The closed session agenda was adjusted for the evening, as Nave directed the chairwoman that there would be an extra case of litigation needed to be addressed. "This arose subsequent to the posting of the agenda on Monday and requires immediate attention," he said.

Immediate attention is probably going to be the key word in the next few months for the district, as debt reserves have already been utilized to pay earlier installments on the revenue bonds, which will require a 1.1 million payment in August.

Oh, but that's a long way off. Oops, that's right, it's around the corner. And our CFEO, Chet Beedle, had happy news that they have reduced costs on traveling staff converting them from the religion of making good money, to KVHD style of payment. I'm sure we can squeeze some contributions for the August balloon payment, a cake sale or something.

The auxillary seems to be making all kinds of money, and they are the true benefactors of the hospital, recently allocating money for equipment for the hospital. The members have logged long hours of volunteer work, and remain major contributors to the infrastructure of the district. (Where would the hospital be without them?)

The skilled nursing facility began its annual Center for Medicaid Services survey this week, reported, SNF consultant, Tracy Brown. She said they expect the inspectors to be at the hospital through the week, and will then have an exit survey.

Board member, Victoria Alwin, asked if the board could be there at the exit survey with the inspectors. Brown said she believed it would be no problem.

Bradley Armstrong, always acting like the expert of the board, nodded to Alwin, that yes, she could attend. (Armstrong may have wanted to attend more of those exit surveys if he had wanted to know what was going on in the SNF. Or did he? )

(Exit survey 2007: now I remember that Mr. Armstrong, Mr. Jamison, and former board member, Barbara Casas did attend the exit meeting excluding the Knights. They actually played a shell game to keep the Knights from knowing what was going on. They changed rooms and times. But those three did indeed attend what would have been a ghastly report. So, they knew and they colluded to keep others from knowing, including board members. This is why an investigation is totally necessary. We need the horsepower of honesty to clear out the past.)

Armstrong, the autocrat, trying to hide his past transgressions, permitted the board to go to the skilled nursing facility for the exit survey at the end of the week. He didn't try to strong arm anyone this time or keep them from their duty as a board member. He would've looked bad and the rest of the board, sans Jamison, would not have stood for it.

Kay Knight gave her report about the Association of California Healthcare Districts where she and her husband, former board member, Robert Knight attended legislative day in Sacramento two weeks ago.

Knight, who said she has been attending these events for 20 years, pointed out that health care districts are at the mercy of the legislature, therefore, making it important to take action.

"The only way to ensure that healthcare districts are advanced within the legislature is for our district to become actively involved in the legislative process. Now is the time for us to organize in an organized grass roots programs. The more registered voters we can get involved in a given legislative district, the more political influence healthcare will weild in Sacramento. There are strength in numbers," Knight said.

She also said she would like to see the whole board attend these meetings, possibly next year. (Armstrong, who protested going to the ACHD event at the April 1, 2009 board meeting, grabbed Knight's laminated ACHD information flyer like he found his missing piece of toast next to his fried egg. He then called for it to be distributed. Twenty years to notice? Read your mail.)

The comedy event of the night was that of Bob Jamison who finally found something to say, though, it was mumbled and incoherent, we appreciate him trying. He was razzed up about the by-laws of the district, which had just been reorganized and nicely mimeographed, but needed to be discussed by him. Everyone agreed; another time. He huffed and puffed and never did say what the problem was that he would actually pull an item off of the consent agenda. (he doesn't like to see anyone else do it, especially for trivial things like questions.)

Ironically enough, Jamison, had a question about the Teen 2000 pregnancy program. I braced for him to ask for personal advice, but he just wanted to make sure the program was going to still be around after budget cuts. (I'm sure it's personal)

Turn it around and investigate

I'm sure that the board of directors wants to make sure that it runs the district in a manner that reflects care and dedication. But until this small sampling of government steps up, how can we expect big, bloated government agencies to do their jobs. If small doesn't work, big is always worse.

I have submitted a request for an investigation into the knowledge and actions of board members, Robert Jamison and Bradley Armstrong, regarding the skilled nursing facility and the conflict of interest with Rural Health Design Network and Aspen Street Architects. This is first on my list, there are more issues naturally. And we will be hearing about them in the coming week.

The request read at the meeting lead to some confusion. Kay Knight said she was surprised and would refer it to the board counsel and the board for further discussion.

Board counsel, Scott Nave, responded to an earlier request from me regarding the ability of the board to do its own investigating of itself. Nave explained the board's ability in an email.
1. As long as it doesn’t violate the law, the Board can do anything within its scope of authority under its enabling legislation. The Board can order investigations. However, the Board doesn’t have any authority to take action against former employees.

After reading my request, I explained my reasons for the investigation which should be done by independent, objective, firms; outsiders. Way outside!

"The point is that it's time for accountability; time for transparency; it's been time for crying out loud...You have the power as the board to do what you need to do to look into what happened here and bring it to the community. I say if you're waiting for something to happen, which it continually does here, it will happen."

"Step up and do what is necessary. Clear yourselves; make yourselves look good, this is an opportunity to do something good."

Mrs. Knight reassured me that she would refer the matter out.

"Refer it out to whomever you want to, just get it started," I said.

Mrs. Knight, looked surprised, but I reassured her. "I trust that you will, I trust that you will, take this and take care of what needs to be done. I'm not going to worry about it from this moment. I made the request."

To the Kern Valley Healthcare District Board of Directors:
May 6th 2009
Regular monthly board meeting
Request for investigation
Submitted by Laura Hart
I am requesting that the KVHD district, unlike it has at any other time in its existence, take responsibility and investigate with the help of independent investigators and auditors the truth of what has happened to this hospital so that it may be noted that the district takes its own responsibility as administrators seriously and utilize their own powers for the best interests of the community it serves.
There has been no real success in finding the problems with this district which are true or satisfactory especially via the course of government types of inquiries: its time to step up and actually make government work.

As the local healthcare government, I am requesting the board investigate this matter, and anything else the board sees as pertinent at its own discretion (I will submit other suggestions):
First, investigate the knowledge of current board members, Robert Jamison and Bradley Armstrong in the knowledge and denial of the skilled nursing facility. Their respective roles in blocking help to the situation.
And the two board members influence in using Aspen Street Architects for the Measure M general obligation bond. And conflict of interest involved with the two Rural Health Design Network and Aspen Street Architects, Kathy and David Yarborough.
Please calendar a special meeting and prepare to go forward with discussion and a vote at the next board meeting in June 2009.
My request is based on my own investigations and all information is available to board members and outside contractors at any time. The parties involved could be cleared or must be held accountable.

Can they step up? We will find out soon.

In other KVHD news the district has hired a new CCO, who is expected to arrive later this month.

Closed session report coming soon.

Next up: Brad Armstrong and Chet Beedle. The leftovers nobody wants to eat.