Hospitals, CEOs have rough past
County medical center has had eight chiefs
By Rebecca Vesely, STAFF WRITER, The Argus
Monday, September 22, 2003

The Alameda County Medical Center has a checkered past when it comes to leadership, having burned through eight CEOs in the past decade.

The latest chapter in the ongoing saga closed Wednesday when the medical center's Board of Trustees voted to remove CEO Kenneth Cohen, on the basis that he was unable to perform his job because of recent constraints placed on him by the county Board of Supervisors.

Cohen has served two years and three months, and will stay on for another 60 days to aid the search for his replacement.

While observers admit executive turnover is generally higher in health care than in other fields, the medical center's track record is particularly striking.

"To have eight leaders in a 10-year period is very unusual and it's not good," said Kerry Shannon, a health care consultant at PriceWaterhouseCoopers in Chicago who was part of a team that audited the medical center in July.

The county's medical center, which comprises Highland and Fairmont hospitals, John George Psychiatric Pavilion and three outpatient clinics, is the safety net for the uninsured and underinsured in the county.

This fiscal year, the medical center faces a budget deficit of upwards of $56 million -- revised from the original $45.7 million announced in July.

Cohen had begun making $11 million in "internal efficiency" cuts, which included layoffs and terminating consulting contracts. A policy of turning away non-emergency patients who cannot pay based on a sliding scale is scheduled to begin in October.

He also announced in July that the only way to close the deficit without an influx of cash was to shutter the three remaining outpatient clinics in Oakland, Hayward and Newark, as well as the trauma center at Highland Hospital.

Since then, the county supervisors have come up with the money to keep services open.

Dr. Jim Mittelberger, the center's president of the medical staff who served as interim CEO in 1999, said the operation is inherently difficult to run.

"It's fundamentally underfunded -- there's not enough money to invest and maintain operations," Mittelberger said.

Equally important, he said, true leadership on the county level has been lacking.

"You look at Santa Clara, San Francisco or Contra Costa counties, there's vision and goals in the leadership," he said. "Other places have recognized the special needs of the county hospital."

Dr. Roger Peeks, medical director at the center, who served as interim CEO from late 2000 to May 2001, said competing interests make the job demanding.

"It's an incredibly hard job," he said. "It's hard to please everyone."

Both former interim CEOs said executive turnover contributes to the myriad problems facing the county hospital. The medical staff as a whole supported Cohen, but also backed the trustees' decision to remove him.

"The turnover makes any long-term planning very difficult," Peeks said.

"You want anyone who comes in to have vision and it takes time to implement that vision."

Mittelberger said turnover leads to decisions that don't always benefit the overall health of the facilities.

"We end up doing the absolute minimum to get from year to year," he said. "The real problems are structural. They're not with any one person."

The reasons why previous CEOs didn't last long are as complex and varying as the medical center's problems.

The longest tenure in recent past was by Ophelia Long, a former nurse who served from 1990 to 1995. Long brought recognition and funds to the medical center, but resigned in 1995 citing health problems after an audit found at least $55,000 in dubious expenses and a county Grand Jury report questioned her hiring of consultants without bids or evaluation.

In one instance, Long hired an acquaintance to work two days a week in the hospital's medical records department, paying her $60,000 annually for the work. Nearly two years after she was hired, the hospital still had 2,500 incomplete or delinquent medical records.

More recently, Mike Smart, who served from 1995 to 1999, left the job, saying he wanted "to do something else without as much stress," according to an Oakland Tribune article published at the time.

Smart oversaw the medical center's transition in 1998 when the county spun it off into its own public authority. One of his most controversial decisions was to hire the firm Arthur Anderson for $1.1 million to help improve the operation.

"He was having trouble dealing with the new authority board," Peeks said.

The structure of the medical center today suggests that the CEO must answer to both his or her own Board of Trustees, as well as the county Board of Supervisors, which appoints the trustees. Indeed, this was the reason cited by the trustees in terminating Cohen -- that the supervisors and the trustees must both trust the leadership.

"In a job like that, you've got a complex set of issues and multiple boards you are beholden to," Shannon of PriceWaterhouseCoopers said.

Nancy Friedman, executive director of the advocacy group Vote Health, said this would be "enormously difficult."

"That task I wouldn't wish on my worst enemy right now," she said.

Mittelberger said without consensus between both boards, the CEO becomes caught in the middle.

"It's hard to be CEO without a cohesive vision by both boards," he said.

Contact Rebecca Vesely at rvesely@angnewspapers.com.