League of Women Voters of California
Santa Clara County, CA November 5, 2002 Election
	Bill James Answers Questions Candidate for Director; El Camino Hospital District

The questions were prepared by the League of Women Voters of Los Altos/Mtn. View Area and asked of all candidates for this office.

Read the answers from all candidates.

Questions & Answers

1. Discuss how the Master Plan for El Camino Hospital meets the future health care needs in our community.

I have reviewed the Draft Master Plan and I believe it provides a good starting point for further discussion on what the Hospital must do to be prepared to meet the future health care needs of our community. The Draft Master Plan clearly reflects a careful and extensive effort on the part of many individuals to anticipate the needs of the community and to guide the Hospital rebuilding effort to meet those needs. I commend those involved for the hard work they have done to date. In particular, I appreciate the attention that has been given to providing flexible and expandable space, including room for further building if needed in the future to meet unanticipated needs.

That said, I believe there is more work to be done. First, I think the time has come to take a step back and do a sanity check of the Draft Master Plan as it has evolved. I would convene an ad hoc committee of physicians, nurses, patients, patient care advocates, and other stakeholders to take a fresh look at the Draft Master Plan, with an eye toward ensuring that the proposed structure and layout makes sense. For example, surgical personnel should be asked if it makes sense to have the CCU on a separate floor from surgery. Dialysis service providers and patients should be asked how the proposal to move dialysis services off the main hospital campus would affect them.

In addition, as I understand it the proposed facility would provide 310 beds, as opposed to the current 426. Before we build, we should be sure that this significant cut in capacity is warranted.

For example, the Draft Master Plan does not appear to focus on the likely extensive need in the coming decades for geriatric care for Baby Boomers and other older residents, who in this community will be numerous and may tend to live to a very advanced age due to factors such as relative affluence and healthy/active lifestyles. How is our Community Hospital going to ensure they have the health care services they need to support a rich, independent life in their later years? Such patients may require more frequent hospitalization and longer hospital stays, and our community hospital should be prepared to serve their needs.

Also, it seems a shame that our Hospital is a leader locally in deliveries of newborn babies and has an excellent neo-natal intensive care unit (NICU), but many area pediatricians reportedly steer their pediatric patients to other hospitals, such as Stanford, for care, apparently as a result of a perception that unlike other area hospitals El Camino does not pay particular attention to providing pediatric care. The Draft Master Plan lumps pediatrics beds with other beds, and makes no other mention of meeting the community's needs for pediatric services, apart from existing OB/GYN (e.g., deliveries) and NICU services. With younger families moving into the area in droves, either to participate in the technology economy or as immigrants, it is unfortunate that the Draft Master Plan does not include a more comprehensive plan to provide better for our kids' healthcare needs.

2. Please discuss the financial condition of El Camino Hospital and how this affects its bond rating.

The financial condition of the Hospital appears to be strong. The financial information available publicly shows the Hospital meeting or on track to meet the industry medians for an A+ bond rating. I commend the Board and senior management for achieving this result, which will put the Hospital in a strong position should it have to borrow funds to rebuild.

I think it is important, however, to keep in mind that the Hospital District does not exist primarily to achieve good financial results. It exists to meet the health care needs of our community. I feel the Board should ensure that the Hospital's senior managers are evaluated and rewarded not only on the basis of financial performance, but also based on the Board's assessment of how well they have succeeded in ensuring that our Community Hospital continues in its fine tradition of offering the highest quality of care in a manner consistent with our values as a community.

In addition to traditional measures such as patient satisfaction, the Board should look to the caregivers at the Hospital, including both nurses and other caregivers employed by the Hospital and also the physicians who practice there, as an important source of feedback regarding the extent to which key managers are meeting their needs and the needs of patients.

Finally, as a community-owned and community-operated entity, I feel strongly that the Hospital should make full disclosure of its finances to the same extent as other "district" hospitals. It is my understanding that at least certain financial information is not disclosed in detail due to the non-profit structure that was retained by the Hospital after it was returned to District ownership and control a number of years ago. In addition, the Hospital obtained from the Internal Revenue Service some time after fiscal year 2000 an exemption from the limited financial disclosure that nonprofits are required to make, further restricting access to financial information.

To the extent that this vestige of the disastrous privatization experiment of the 1990's remains, I feel strongly that the District should either revert to the structure that was in place prior to the privatization, or at a minimum the Board should direct the Hospital to report voluntarily to the public the same information, at the same level of detail, as it was required to disclose before the non-profit structure was adopted. Existing law permits a public entity such as the District to limit disclosure of certain sensitive information; the rest should be available for public scrutiny and oversight.

3. Is El Camino Hospital current in its standards of medical staffing; e.g. the ration of RNs to patients? Is housekeeping staffing adequate as back up for nursing and admissions from ER? What do you recommend to improve the staffing situation, if needed?

I believe El Camino Hospital should ensure that staffing levels are adequate to provide the extremely high quality and personalized care for which the Hospital is known and loved in the community.

I am troubled by the apparent trends. Not so many years ago, El Camino was a "primary nursing" hospital, in which a registered nurse was assigned to each patient to ensure continuity and quality of care. Now, in addition to no longer having an assigned caregiver, it is my understanding that in many cases patients receive from less skilled caregivers services formerly provided by, or at least supervised by, a registered nurse.

In this era of managed care and declining Medicare reimbursements, I am concerned that the "industry" or "community" standard for such matters may not be sufficient to ensure that patients receive the highest quality of care, in a manner consistent with our values as a community.

I am particularly troubled by reports that patient care has been suffering as a result of inadequate staffing. Housekeeping staff, emergency room nurses, and other caregivers have reported that cuts in the night housekeeping staff have resulted in inadequate cleanliness in the inpatient tower and delays in making beds available to receive patients. In at least some cases, these delays have caused the Emergency Room (ER) to close for periods because patients cannot be transferred out of the ER to the main hospital tower. It is my understanding that inadequate nursing staff levels in the inpatient tower have led to similar problems on occasion. Such failures to be available to meet the emergency medical needs of the community are entirely unacceptable.

To address these problems, I would (1) make it clear that providing quality patient care, and meeting the community's health care needs, is the number one priority; (2) focus less on the financial bottom line, while ensuring that we pay enough attention to finances to keep the Hospital on solid financial ground; and (3) if adequate staffing cannot be achieved or maintained otherwise, I would analyze the budget and organization to determine if the Hospital can do a better job of controlling expenses associated with the management and administration of the Hospital. With regard to this latter point, it is my understanding that the costs of management and administration as a percentage of total expenses have risen considerably in recent years, which I am concerned may reflect an insufficient focus on the primacy of patient care.