Hospitals chief sees need for cutbacks
Efton Hall says there are 'no sacred cows' when getting county medical center out of debt
By Rebecca Vesely, STAFF WRITER, The Oakland Tribune
Article Last Updated: Sunday, February 29, 2004 - 5:33:51 AM PST

The first thing Efton Hall Jr. -- the interim CEO of the Alameda County Medical Center -- did after he hired turnaround consulting firm Cambio Health Solutions for $3.2 million earlier this month was fill a shopping cart with reports from previous consultants.

"I wheeled that cart into Cambio's office down the hall," he said. "I told them, 'I don't want you to waste time reinventing the wheel.'"

It's a story Hall has told on several occasions to illustrate his key point since taking the helm at the medical center four months ago: Action is supplanting years of inaction.

"Our history is rich with lots of aim, aim, aim -- and you're waiting for the punch line -- there's no 'fire,'" Hall said in a recent two-hour interview.

That's all changing, he promises, first with Cambio's far-reaching and pricey contract to recommend and implement service cuts and even top-level management restructuring.

These decisions, Hall said, are being made outside the context of Measure A, a countywide half-cent sales tax initiative on the ballot in Tuesday's presidential primary election.

Measure A would raise an estimated $90 million -- three-fourths of which will go to themedical center. The medical center is composed of Highland and Fairmont hospitals, John George Psychiatric Pavilion and three outpatient clinics in Oakland, Newark and Hayward.

Hall was named interim CEO of the medical center in October after a drama-filled summer that concluded with the firing of CEO Kenneth Cohen, a mass exodus of members of the medical center's Board of Trustees and a ballooning budget deficit that is now at $71 million.

Since then, the medical center has been center-stage for more incredible trials.

A longtime physician at John George Psychiatric Pavilion in San Leandro, Dr. Erlinda Ursua, was killed in November, and a female patient has been charged with the crime. State and federal investigations have found multiple violations at the locked inpatient facility, including staff safety problems.

Management is under fire from multiple fronts. The medical center's chief nurse executive wrote a scathing letter in December criticizing leadership decisions and abruptly quit. And leaders of the three unions representing health care work-ers at the medical center in January held a "no confidence" vote in Hall and interim chief financial officer Robert Strawn, citing more than 10 major complaints.

For the affable Hall, who was born at Highland Hospital 51 years ago, the biggest tests are yet to come.

"We are right at the river's throat and we're getting ready to hit the toughest rapids yet," Hall said. "We're going to have to live with this tension for at least another 60 to 90 days. But there's a brighter day on the other side."

By brighter day, Hall doesn't mean the possible success of Measure A on Tuesday. He's talking about service and personnel cuts that Cambio will recommend in its first report, due in mid-March.

"If we were making a plan based on Measure A passing, we would all have to be fired," he said, pointing out that the medical center wouldn't likely begin seeing funds from the sales tax until at least November.

"We have to plan for the here and now -- we are $71 million under water."

To start, Hall and the five other members of the executive team on Friday took a 15 percent pay cut, which will save a total of $144,000 this year. Hall's annual salary will drop from $213,000 to $181,000. The previous CEO made$235,000 a year.

"Quite frankly, the types of changes this organization has to make includes wages and benefits -- it has to go downward," he said. "We're putting our money where our mouth is."

Hall has told Cambio that, for him, there are no "sacred cows" at the medical center -- everything is on the table to be cut.

This move is risky -- the last CEO lost his job in part because he made the unpopular and politically unthinkable decision to recommend closure of Highland Hospital's trauma center. The trauma center is the only one serving north county and treats anyone in a severe car accident coming off the Bay Bridge.

The recommendation to close the trauma center last summer brought swift action against Cohen by the county Board of Supervisors -- who ultimately are responsible for the medical center.

Still, Hall said, taking anything off the table "feels like spinning to me and not moving out."

This includes the latest flap -- over bottled water service.

For years, bottled water has flowed from water coolers at the medical center. Then, two weeks ago, director of human resources Sandra Osibin sent a memo to employees informing them that this service would be discontinued -- at a savings of $48,000 a year.

This riled the already outraged SEIU Local 250, representing about 800 health care workers at the medical center, who argue that working conditions are poor and that the tap water at the medical center is undrinkable.

Cutting the bottled water service was on the table in the past, but Hall said, "somewhere along the way it became a sacred cow. This is why I do not want any sacred cows."

Charlie Ridgell, a representative of Local 250, said the takeaway violates the medical center's union contract, which is up for negotiation at the end of April.

"This costs less than Efton Hall's benefits package," Ridgell said. "Now that we have Cambio, why do we need Efton Hall? If you really want to save money, whack some of these extraneous people who are playing solitaire all day."

Hall said the adversarial tone doesn't bother him. "I've certainly learned that having a thick skin is a tribute, not a deficit," he said. "Let's suck it up, get it on and get it over with."

Although every department could face severe cuts in the coming months, not all will. The murder of Dr. Ursua in November was a painful reminder of this.

Hall said he's not "a CEO trying to save his bacon," when explaining recent changes at John George -- including more security and plans to improve working conditions. Hall was chief operating officer for inpatient and acute care services at the medical center for nearly two years before becoming interim CEO -- meaning that John George was one of his responsibilities.

He said improvements rejected before last fall are now under consideration.

"We have changed our opinion of what's too expensive after Dr. Ursua's death," he said.

Hall remains focused on efficiencies and revenue-enhancements to lower the deficit.

Among the efficiencies is a countywide initiative called the Access to Care Collaborative to channel frequent users of Highland's emergency room to more appropriate social services, such as drug treatment programs, housing services and financial benefits assistance.

The medical center's Chief of Surgery, Dr. Alden Harkin, cites an astonishing figure: About 125 patients cost the medical center between $4 million and $6 million a year in uncompensated care.

These patients are almost all homeless, or living in squalor. They come to Highland often with acute medical conditions and stay weeks or months.

Harkin, who said Hall is doing an "outstanding job," explained that these 125 patients aren't abusing the system, it's just that they have nowhere else to go.

The collaborative on Friday announced that it plans to immediately connect these frequent users to case managers who can hook them up with appropriate services.

Hall said he is keeping focused on moving good ideas into action.

"Quite frankly, I don't think I'm the issue," he said. "I think I'm the instrument for change. And these aren't just words."

Contact Rebecca Vesely at rvesely@angnewspapers.com.