League of Women Voters of California Education Fund
	Santa Clara County, CA November 6, 2012 Election
	Candidates Answer Questions on the Issues Director; El Camino Hospital District

The questions were prepared by the Leagues of Women Voters of Santa Clara County and asked of all candidates for this office.     See below for questions on Experience, Financial Situation, Collaboration Click on a name for candidate information.   See also more information about this contest. 1. What experience or training do you have which would help the District meet its goals? Answer from Wesley F. "Wes" Alles: Operating the District and Hospital is extremely complex with regard to applicable laws, certifications, mandates, and policies. Having ten years of leadership and governance experience I am knowledgeable about all aspects of both District and Hospital operations. I helped to create the strategic plan that will guide the hospital for the next three to five years. I am fully compliant with the fiduciary responsibilities of a Board member and fully compliant with the requirements of the Brown Act, HIPAA, Form 700 reporting, and with hospital and District policies and procedures. The District Board recently appointed more than twenty hospital Board committee members and three new hospital Board members. These individuals are extremely well qualified, however, they need mentoring as they become familiar with significant issues that impact the hospital. I have been the Board Chair as well as the Chair for four Board committees. In addition, the changes brought about by health care reform will require broad knowledge as the hospital seeks to respond intelligently to new regulations. Serving on the Board of a not-for-profit organization is complicated. Serving on the Board of a hospital is even more complicated. Serving on the Board of a Special District Hospital that seeks to retain its independence and community ownership is exceptionally complicated. In addition, health care is very competitive, and as with any business enterprise, informed decisions lead to greater success. I have served the Board for a decade and have a strong record of having made strategic and tactical decisions that enable El Camino Hospital to provide the highest quality of care for residents of our community. My educational background plus more than 35 years of experience in public health and health care are important aspects of my contributions to the community. I understand the competitive business environment, the regulatory requirements, and the financial elements that are required to govern a hospital. I want to continue to serve the community through stewardship of this brilliant community asset. Answer from John Zoglin: I have served for 5 years as a member of the El Camino Hospital District Board Member; currently I am Chairman of the Board. My major accomplishments over the past 4 years include: Increased Transparency by Adding 24 community members to 6 new oversight committees Doubled Community Benefit expenditures to $5.5M/yr Improved efficiency and accountability by establishing an Organizational Scorecard to keep administrators aligned with the Hospital strategy Expanded the Women's Hospital, Stroke Center, Heart and Vascular Institute, South Asian Heart Center and Chinese Health Initiative I have also been a major driver of El Camino Hospital migrating to Best Practices in our Strategic Process. Over the past two years the executive team and board have worked together to develop a consistent and rigorous approach to strategic analysis. This discipline is particularly important in this time of change within the healthcare industry. The Hospital must have a sophisticated understanding of its capabilities to effectively move forward in these uncertain times. With forthcoming expansion in available data, I have been encouraging administration to ensure we develop our ability to analyze the data - a need that requires not only analysts focused on the data, but evolving into a culture of analysis where everyone is trained to approach care in a data driven manner. This culture of analysis will allow us to reinvigorate our commitment to data driven decisions in support of Evidence Based Medicine. To improve our data collection we have been working with physicians, both independent and at major partners like PAMF and Stanford, to ensure that they use electronic health records and that they can easily share the data with the hospital. Improved efficiency. With the downturn in the economy the Hospital Administration found that we were losing millions of dollars per month. The Board worked to ensure that the hospital engaged in a rigorous re-engineering process that eliminated an estimated $70 million per year in annual costs. A new COO with deep expertise in Lean Management will lead our efforts in further cutting costs and improving healthcare affordability. Answer from Dennis W. Chiu: I believe that I am the most qualified candidate running to be a Director on the El Camino Hospital District Board based on the following work experience: - My experience as Vice President & General Counsel of a Santa Clara County healthcare nonprofit that provides many types of medical and community services, including general healthcare, mental healthcare, a senior center, and substance abuse treatment, provides me a firm foundation to understand the basic services of the Hospital. - My experience as a Chief Operating Officer & General Counsel of two for-profit companies gives me the experience to oversee the business of the Hospital. - My 12-years of ongoing experience on the Santa Clara County Planning Commission provides me the ability to represent the interests of taxpayers, and build coalitions with existing board members to implement good public policy. - My experience as a malpractice litigator and as a corporate transactional attorney will assist the Hospital Board to better assess the legal and financial risks of grand jury investigations, LAFCo audits, difficult labor negotiations, and the conflicts of interests when taxpayer's and the Hospital's interests conflict. Answer from Bill James: My academic and professional training have prepared me well to handle the technical and complex legal issues that come before the Board. I am a graduate of Stanford Law School (1994) and have an engineering degree from the U.S. Naval Academy (1986). Through my six years of service on the Board of Directors of the Community Services Agency of Mountain View, Los Altos, and Los Altos Hills, I have gained valuable non-profit board experience and a view into the needs of communities served by El Camino Hospital. Together with my partners I've built a thriving local business, our patent firm based in Cupertino, so I know what it takes to succeed as a service provider, and as an employer. I lived in Mexico City for nearly a year, as a Fulbright Scholar, and I speak Spanish reasonably well, which would enable me to provide a bridge to Spanish speaking members of our District. As the father of three young children, I understand well the healthcare needs of families with young children. I'm active in our community as a parent volunteer in my kids' schools and as an AYSO soccer coach, which has enabled me to establish relationships with many members of our community. Answer from Julia E. (Fox) Miller: I have served two terms on the Sunnyvale City Council and held Board positions on several regional boards: Bay Area Air Quality District, Association of Bay Area Governments Executive Board, the Bay Area Economic Forum and the San Francisco Bay Trail as an elected official. I am also a former board member of Sustainable Silicon Valley, Sunnyvale Historical Society, the San Francisco FBI Community Academy Alumni Board and Leadership Sunnyvale. 2. What is your evaluation of the financial condition of the District? Answer from John Zoglin: The hard work undertaken by the executive team, management and El Camino Hospital unions reduced annual costs by an estimated $70 million per year. This thoughtful effort has put the Hospital in a strong financial position -- for Now. However, the healthcare industry is evolving quickly and independent community hospitals such as El Camino Hospital -- that are committed to the healthcare of the local community -- are coming under increasing financial pressure. The consolidation of primary care physicians into more and more concentrated groups puts independent hospitals at significant risk over the upcoming years. In support of maintaining our award-winning, high quality of care, independent hospital I am committed to balancing the needs of all El Camino Hospital District stakeholders in support of El Camino Hospital's recently updated Strategy: "El Camino Hospital will be a locally controlled leader in optimizing the health and wellness of our communities in Silicon Valley, differentiated by innovative continuum of care developed in partnership with physicians, businesses, and payors." ...and Positioning Statement: El Camino Hospital will first be a value-based health care provider offering top decile, acute care quality at mid-level pricing, moving toward continuum partnerships that integrate care coordination and delivery strategies focused on the Triple Aim of quality, service, and affordability. We must have leadership from the Board to execute on this strategy and positioning or El Camino Hospital's financial condition will deteriorate quickly. Imbedded within these statements are four health care goals that indicate an evolution of El Camino Hospital's direction from its priorities over the first 50 years. These goals reflect the dynamic health care environment: 1. Focus on quality of care not just within the confines of the hospital campuses, but across the continuum of care. Research indicates that patients are often at most risk in transition between care givers; El Camino Hospital must take a leadership role in integrating and coordinating care with physicians and other care givers throughout episodes of care. 2. With healthcare costs becoming increasingly unaffordable, as an institution we can no longer be committed only to quality. El Camino Hospital must also do whatever we can to make health care as affordable as possible. 3. The delivery of healthcare is increasingly a partnership. Not just among health care service providers, but also between care givers and patients. Patients' and their families' needs and wishes deserve respect. 4. We must re-invigorate the spirit of innovation that delivered the first Medical Information System in the country here at El Camino Hospital. A cultural commitment to innovation across not only technologies but also processes can accelerate both the translation of research to patients and the adoption of processes based on evidence based medicine Answer from Bill James: We are fortunate that the financial condition of the District appears to be strong, but to maintain that financial strength while improving service I think we should consider ways to better use the resources we have available. The District and Hospital are quite properly considered a single entity for financial purposes, and the Hospital has a $400 million reserve that would allow it to fund operations for many months even if it had no revenue. I believe the Hospital should adopt a reserves policy that would enable us to know the level of reserves required to be prepared for realistic worst case scenarios. Reserves in excess of the required level should be used to retire Hospital and District debt or reinvested to improve the health of District residents. With a few notable exceptions, the Hospital has had on the order of $40 to $60 million in net operating income in recent years. We should consider whether the Hospital can afford to provide even greater levels of community benefits to District residents, and whether we should retire some of the debt incurred to build the new Hospital in Mountain View. I was opposed to the purchase of Los Gatos Community Hospital, and in general I don't believe the District should invest District resources, including money earned by the Hospital, to acquire healthcare facilities well outside the District. Answer from Dennis W. Chiu: If I take the question literally, since the Hospital District transfers all of the taxpayer funds, in one way or another, to the Hospital corporation, the financial condition of "the District" (as asked in the question) in terms of cash on hand can only be deemed poor, because it is nonexistent. However, "the District" owns the Hospital buildings and land, which is valuable real property in the heart of Mountain View. So, in terms of assets, "the District" has solid holdings. If the above question asks for an evaluation of the financial condition of the Hospital, the Hospital is doing well financially. Its bills are being paid, and it has significant financial reserves. Answer from Wesley F. "Wes" Alles: For more than 50 years El Camino Hospital has had a strong reputation for both quality of care and effective financial management. We live in affluent communities and our finances remain exceptionally strong. We have strong revenues and we continuously manage the costs so that our bottom line is healthy. When I first came onto the Board, El Camino Hospital was a nearly fifty year old building. In addition, California had mandated that all hospitals must be compliant with current seismic standards. This was an unfunded mandate, meaning that the nearly half billion dollars that would be necessary to build a new hospital would require that a bond measure be approved by voters of the District. Community residents DID approve this bond and the approval was with nearly 70% voting "yes". Because of the very strong financial rating of the hospital by the bond rating agencies, the interest rate on these funds was at a very favorable percent of interest. The community continues to support the hospital because it appreciates being able to receive the highest quality of health care possible while at the same time knowing that both the District and Hospital Boards demonstrate fiscal responsibility by consistently making good decisions. Over the past ten years that I have been a member of the Board of Directors, the hospital has had some of its best financial production. In addition, I was the Chair of the Finance Committee during the final stages of the completion of the new hospital. Because of strong financial management by the Board and the Executive team, the building was finished on-time and on budget. Our community now has a hospital that has been referred to as the "most technologically advanced hospital in the world." In addition to the building itself, the Board also supports quality of care through significant investments in medical equipment and information technology. El Camino Hospital has the finest medical, surgical, and information technology that is available, thereby enabling residents to receive the very best health care possible, right here in our community. Very few medical cases require a higher level of care than what is delivered by El Camino. Strong fiscal management enables the hospital to purchase top of the line diagnostic and treatment equipment. This kind of equipment attracts highly skilled physicians who want to work with state of the art tools. Your El Camino Hospital is well governed, well led, and well managed. It has a strategic plan that requires a significant amount of financial expenditures. It is the job of the Board to assure that these funds are available to achieve the goals of the strategic plan, as well as the vision and mission of the hospital. Answer from Julia E. (Fox) Miller: The hospital is very successful financially and therefore is able to distribute additional dollars to the communities they serve. They need to recover from the LAFCO and Grand Jury reports that list several areas that need improvement. My experience serving the CIty of Sunnyvale, that does 20 year budgeting gives me strength in this area. 3. In what ways would you collaborate with other governmental entities and community groups to achieve the District's goals? Answer from Wesley F. "Wes" Alles: I will continue to support collaboration because health care is expensive and we need to take advantage of the efficiencies that come from collaboration. During my tenure on the Board we have had to make many decisions related to cooperative agreements, business associate relationships, not-for-profit community benefit organizations, affiliations with health care organizations, and support for physicians and medical groups. We have sought to develop and sustain good relationships with all of our employees, those who are represented and those who are not. Over the past two years the Board has cooperated with the Civil Grand Jury and the Local Agency Formation Commission (LAFCo). When we built the new hospital our approvals were given by the Office of Statewide Health Planning and Development (OSHPD. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) conducts periodic on-site surveys to verify that "an accredited organization substantially complies with Joint Commission standards and continuously makes efforts to improve the care and services it provides." In a new health care paradigm, we will see new partnerships form- partnerships borne of economic and regulatory necessity. This is referred to as a Continuum of Care Organization where hospitals, wellness providers, skilled nursing facilities, outpatient surgery centers and dialysis services, as well as hospice will need to collaborate in order to remain in compliance with best practices, regulatory and statutory compliance, and financial accountability. The Board of Directors of both the District and the Hospital strongly support cooperation and collaboration. As an individual Board member I strongly support both of these principles. An excellent example of this principle is the community benefit program at El Camino Hospital. The Board has mandated that when the ad valorem tax dollars are received by the District, and after we satisfy the Gann requirement that money be put toward the maintenance of our hospital, that EVERY dollar of the remaining tax money be spent on community benefit. Not considering the tax money coming specifically to support the bonds, the El Camino Hospital District receives approximately $9 million dollars. Of this amount, every dollar is designated to be put into community benefit. In this regard, the Board asks the hospital administration and a community advisory committee composed of volunteers to create a request for proposals, to receive grant applications, to review and assign funds, to continuously monitor progress, and to review the evaluation metrics that are required of all community organizations that receive funds from the District. I also want to mention that individually, Board members are required to meet the standards of transparency described within the Brown Act and to assure appropriate policies such that HIPAA protections remain strong, thereby ensuring the privacy of our patients and their family. Answer from Dennis W. Chiu: I am committed to increasing hospital funding for community benefit programs and nonprofits to increase healthcare in the community. I would also ensure continued implementation of the Local Agency Formation Commission (LAFCo) findings and recommendations that require more hospital accountability and transparency to rebuild the trust and faith of the government agency overseeing the Hospital. Answer from Bill James: For years Santa Clara County has had to cut funding to county health-related programs due to funding constraints. Meanwhile, our District has earned tens of millions of dollars in net income year after year. We should partner with the County to restore and jointly fund County health programs that have been shown to be effective in improving the health of District residents. We should also partner with local school districts to educate and provide healthcare to our young residents, including by teaching them how to eat well, be active, and take care of their bodies and minds. We should work with local non-profits and municipalities to define and implement a coordinated and comprehensive approach to improving the health of District residents, including hard-to-reach residents such as the homeless and recent immigrants and their families. El Camino Hospital funds a highly successful Community Services Agency program to provide support to seniors after they have been discharged from the Hospital, which has proven to be very successful in reducing readmissions to the Hospital; many more programs like this one are possible. The Hospital can and should do more for the uninsured and families with limited resources. The Rotacare clinic provides access to many services, but too often our residents have to travel to Valley Medical Center or other County-run facilities to receive care that could be provided, for free or at reduced cost, much closer to home at our Hospital. Answer from Julia E. (Fox) Miller: My experience listed above gives me local, regional, state and federal connections to get things accomplished. Answer from John Zoglin: Over the past 4 years we have developed close relationships with all the major community groups in the District responsible for Healthcare -- 31 organizations in all. Together we have served almost 80,000 residents. We more than doubled the annual amount of tax money we spend on community care to the maximum allowed by law: $5.5 million. Even more important than the amount we spend is how we spend it. Our community care investments are characterized by: Aligning with tri-annual assessment of care gaps in Santa Clara County (the hospital spent more money to ensure a broader survey of the northern Santa Clara County citizens we serve) Working closely with the broad range of community organizations providing expertise not just money. We established a philosophy that we would: only contribute financially when we could also contribute our expertise, serve as a focal point, coordinating efforts among community organizations and work with organizations to improve their metrics, quality and accountability: o May 22, 2012 the Santa Clara County Board of Supervisors recognized the successful partnership between the El Camino Hospital (ECHD) and Santa Clara County Valley Medical Center (SCVMC) in providing medical and dental services for uninsured families at Valley Health Center (VHC) Over the past three years, El Camino Hospital District has donated a total of $3.8 million to underwrite otherwise un-funded services at Valley Health Center Sunnyvale to help nearly 14,000 patients receive cost-effective primary care and dental services. Chris Wilder, VMCF Executive Director said, "When we and El Camino Hospital District team up to provide care for patients, we are improving health outcomes, and reducing trips to the emergency room and return trips to doctors." o June 7, 2012 Sunnyvale School District passed a resolution recognizing El Camino Hospital District's ongoing commitment to addressing persistent unmet health needs for students in the District. Over three years, the District has provided more than $1.1 million in grants to fund a variety of programs that have helped more than 19,000 students. "The El Camino Hospital District is a true partner that ensures we have the resources we need to help our students cope with physical and emotional issues that often impact academic performance," said Dr. Ben Picard, superintendent, Sunnyvale School District. o In November 2011 El Camino Hospital was awarded the Outstanding Corporate Grant Maker Award at Silicon Valley Philanthropy Day by Association of Fundraising Professionals. We were recognized for the value we provide to our partners: "El Camino Hospital has taken a leadership role in facilitating close working relationships between its various community partners, to optimize their overall contributions to community health improvement." "El Camino Hospital has been at the forefront of corporate grant making, supporting innovative best practices models...The hospital takes an analytical and systematic approach to their Community Benefit efforts." More recently we have been reaching out to our city government partners to ensure we have an ongoing dialog about our joint commitment to community health. We have presented at Sunnyvale, Mountain View, Los Altos, Los Altos Hills and Cupertino City Councils in just the past 3 months. We also look forward to working closely with LAFCO, we have been leaders in working with other Santa Clara County Districts to take advantage of the opportunity to place to District representatives of Santa Clara County Districts on the LAFCO board. Responses to questions asked of each candidate are reproduced as submitted to the League.  Candidates' statements are presented as submitted. Please answer each question in no more than 400 words. Direct references to opponents are not permitted. The order of the candidates is random and changes daily. Candidates who did not respond are not listed on this page.