Medical center needs Measure A, oversight
By Douglas Fischer - STAFF WRITER, The Oakland Tribune
Article Last Updated: Sunday, February 08, 2004 - 3:38:37 AM PST

IT IS NOT hard to support a sales tax that keeps the Alameda County Medical Center operating as a primary health care provider for people who need it and a safety net for the rest of us.

The role its three hospitals and clinics play for 125,000 patients a year, including 63,500 uninsured, is crucial to public health. And, the specialized service Highland Hospital's trauma center provides to save lives is the stuff on which medical legends are built.

Such services and the people who provide them make it necessary to support Measure A. The so-called "Essential Health Care Services Tax" would raise $90 million a year for 15 years, sunsetting in 2019. Yes, the half-cent sales tax increase pushes Alameda County's toll to 8.75 percent, the highest of any California county. It is an additional 50 cents per $100 spent.

Giving a vote of confidence to the way the center and its economics have been managed, however, is a tougher task. Especially when it comes to the removed role the Board of Supervisors has played in overseeing the center.

This is a county institution paid for by tax dollars -- a complex, multi-site operation with a $420 million budget. You can't simply farm it out.

The fact that the supervisors created a separate Board of Trustees for the medical center in 1998 does not insulate them from responsibility for its solvency and problems. The buck ultimately stops with supervisors Keith Carson, Gail Steele, Nate Miley, Scott Haggerty and Alice Lai-Bitker. They're responsible 24/7/52.

They can fire as many administrators as they wish, restructure the center board as many times as deemed necessary, but the supervisors bear ultimate responsibility for the center's management ills, its $71 million debt, and for taxpayers being asked to bail it out to the tune of $90 million a year.

That they weren't aware of -- or delayed response to -- the medical center's fiscal woes until they reached crisis proportions reflects diminished oversight. Supervisors cite "communication problems," but they didn't monitor, detect or intervene often or early enough to prevent problems from mushrooming into crises. That is a product of not being directly involved. Having at least one supervisor on the medical center's board would remind everyone where the buck stops, keep the "supes" informed and hopefully nip problems in the bud.

Now, public and employee confidence has eroded because of the huge deficit, questionable deaths and deficiencies found at the John George Psychiatric Pavilion and general turmoil. It can only be restored by supervisors getting and staying involved with Highland and Fairmont hospitals, the George facility in San Leandro, and ACMC's clinics, all of which in this era of out-of-control medical costs need a lot of TLC to cope -- let alone survive.

Seventy-five percent of the $90 million Measure A raises, $67.5 million a year, would go to the medical center. That's 16 percent of its budget. The other $22.5 million is to be distributed to private hospitals, community clinics and medical services.

ACMC's problems are not anomalous. More Americans lack health insurance, pointing them toward public hospitals and clinics for care. This growing patient load, cuts in public funding, skyrocketing health costs, etc., have severely cut funding for county hospitals. At least half of them are running deficits. Our medical safety net is unraveling. Without it, more poor, uninsured patients will end up in private emergency rooms, competing with the insured for medical resources.

Having closed two clinics, made $18 million in cuts and at least 65 layoffs in the past year, ACMC is considering more layoffs as well as co-pays and limiting nonemergency services to the indigent. And trustees, having been given a vote of "no confidence" by three unions, have hired a "turn-around" team to advise them on restructuring.

Frankly, the Board of Supervisors should have been more involved all along. One of its members should be a trustee. The board must assume a permanent, active role in ACMC governance. Making sure it runs properly is part of what we elected them to do.

Earning two-thirds voter approval for a tax increase is a formidable task in the best of times. We can't afford to let the medical center fail.

Failure of Measure A could be "dire beyond belief," says Steele. For, the medical center "really is about saving lives," Carson adds. We recommend approval of Measure A -- and more involvement by supervisors.