Tri-City Medical Center directors have 60 days to decide how to replace board member Dr. Madeline Rodriguez, who abruptly left a heated board meeting Wednesday night and said later she was quitting the panel.

Hospital attorney Greg Moser said at 5 p.m. Thursday that he had received a voice mail from Rodriguez late Wednesday night notifying him that she intended to resign, but that neither he nor the hospital’s administrative office had yet received written notice from her.

Rodriguez could not be reached for comment.

Board member Ron Mitchell said Thursday evening that he hadn’t spoken to Rodriguez, but hoped she would change her mind and remain on the panel.

“She’s a great person,” Mitchell said. “She has a calming effect on the board, she has a real concern for patients and she is a wonderful doctor.”

Rodriguez told reporters Wednesday that she was stepping down, shortly after she walked out of a public meeting in which several speakers criticized the hospital board for its 4-3 decision Monday to fire Tri-City’s chief executive officer Larry Anderson.

The board suspended that decision in a 5-0 vote Wednesday, after Rodriguez left the meeting. Board member Charlene Anderson, no relation to Larry Anderson, was also absent.

Mitchell, who voted Monday to fire the hospital’s chief executive, said Wednesday that he supported the reprieve but declined to say why.

Regarding Rodriguez’s departure, Moser said statutes governing a board member’s resignation do not require a written notice, though one is usually given.

“The statute says that the resignation has to be given to the board. I think that there is sufficient evidence to say that she has resigned,” Moser said.

The 56-year-old Rodriguez is an obstetrician who was elected to Tri-City’s board in November 2006. In her campaign for a board seat, Rodriguez said she had delivered more than 3,000 babies at Tri-City in more than 18 years.

In a telephone interview Wednesday night, Rodriguez said she had simply had enough with hospital district politics. She was one of four board members who voted Monday to fire Anderson, saying that his “management and business development philosophy were not in alignment.” That vote was superseded by Wednesday’s vote allowing Anderson to remain at his post.

Moser said Thursday that under the hospital board’s policy on filling board vacancies, the remaining six directors can either appoint a new member or choose to hold a special election to fill out Rodriguez’s term, which ends in November.

If the board decides to appoint a new member, it would have to solicit applications from the community by advertising the vacancy for two consecutive weeks.

All potential appointees must live inside Tri-City’s hospital district boundary, which includes most of Oceanside, Vista and Carlsbad. Applicants must also be legal U.S. citizens, age 18 or older, eligible to vote, and never convicted of a felony.

If board members decide not to appoint a new member —- or can’t agree on a candidate —- the board would have to call for a special election within that same 60-day period. Such an election would be held on the next regularly scheduled election date that is 130 or more days after the vote.

Moser said the board has not yet decided when it will decide on an appointment or election, but noted that the board’s next regular meeting is scheduled for Thursday, April 29.

Call staff writer Paul Sisson at 760-901-4087.

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In an action unrelated to her role as a Tri-City hospital board member, registered nurse Charlene Anderson faces losing her nursing license over allegations that she inappropriately accessed prescription medication when she worked for Scripps Memorial Hospital Encinitas from 2002 to 2006.

Anderson, who was elected to the Tri-City board in November 2008, did not return telephone calls seeking comment Wednesday. She is not related to Larry Anderson, Tri-City’s chief executive officer.

A complaint against Charlene Anderson, filed by the California Board of Registered Nursing, accuses her of removing 23 Percocet, six hydrocodone and three Tylenol With Codeine tablets from Scripps Encinitas’ electronic dispensing machine between May 4, 2006, and Aug. 20, 2006.

The complaint states that Anderson wrote “no medication record, nursing notes nor wastage” notes indicating what happened to the narcotic pain relievers.

Russ Heimerich, a spokesman for the California Department of Consumer Affairs, said Tuesday that Anderson will have an opportunity to rebut the accusations during a formal hearing at 9 a.m. May 27 in the agency’s downtown San Diego office at 1350 Front St.

Heimerich said the complaint was filed after an initial round of investigation by the state attorney general’s office. The complaint was amended in January but there is no date stamp to show when it was initially filed.

The agency does not release the name of the person or persons who filed the complaint, he said.

“We’ve already done our investigation; the attorneys have looked at it; they’ve decided there is enough evidence to move forward,” Heimerich said.

The complaint against Anderson requests suspension or revocation of her registered nursing license, and for her to have to pay for the costs of the investigation against her.

It was unclear Wednesday who reported the missing medication and why so much time has passed between the alleged incidents and the date of the hearing.

Anderson, 59, has been a registered nurse for about 40 years. In the November 2008 hospital board election, she got the second highest number of votes and was backed by Tri-City’s two employee unions.

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By PAUL SISSON -

psisson@nctimes.com |
Saturday, July 25, 2009 10:09 PM PDT

∞

Tri-City Medical Center faces $129,500 in fines for failing to promptly
report four “adverse events” at the hospital, including a patient death, in 2008
and early 2009, according to state records.

Such reporting problems aren’t unusual —- almost all of North County’s
hospitals have been fined at least once in the past two years for failing to
report such incidents within five days of becoming aware of them, as state law
mandates.

However, Tri-City’s fines are significantly larger because its delays in
reporting were much longer. The fines grow by $100 a day.

In two instances, it took Tri-City more than 400 days to file a report with the
California Department of Public Health, the agency that collects the data. Among
other North County hospitals, the next-longest delay was at Scripps Encinitas,
which incurred a $6,600 fine for reporting an incident 66 days late.

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OCEANSIDE —- Earlier projections that Tri-City Medical Center could face a $4 million to $6 million loss in the coming budget year have turned around, with executives saying Thursday that they believe the public hospital can turn a very modest profit by June 30, 2010.

Tri-City’s governing board held a collegial, relaxed budget session Thursday and received a much less dire calculation of the hospital’s immediate financial future.

In a public board meeting May 28, Tri-City’s interim chief Larry Anderson estimated that the hospital could lose millions of dollars during the next 12 months as it struggles to refinance debt with an unfavorable interest rate and tries regain business recently lost to neighboring Scripps Health Inc.

On Thursday, he said things had improved slightly.

“We have produced a budget that we think is challenging but doable,” Anderson said.

Next year’s draft budget forecasts $330 million in revenue and $330.8 million in expenditures, leaving a $793,865 loss for the year.

But the hospital also expects to make $1.2 million in interest on its investments, making the bottom line black by $406,135.

Anderson said the big change in expected financial health comes largely from rosier guesses at how many patients will pass through Tri-City’s doors next year.

The hospital had been seeing significantly fewer than 200 patients per day for several months after the Sharp Mission Park Medical Group was bought by Scripps Health and the group’s 64 doctors began using Scripps hospitals instead of Tri-City.

However, last month, the number of patients ticked upward and Anderson said the hospital expects to keep above 200 patients per day in the next fiscal year.

Reid Hollyfield, the hospital’s vice president of finance, said recently negotiated contract increases with insurance companies, and an 8 percent increase in prices the hospital charges for procedures also helped deliver a much more optimistic financial picture.

Hollyfield projects that Tri-City will still end the current budget year with a $5.6 million operating loss.

The hospital also stands to spend an additional $2.4 million on bank fees to refinance its existing debt, pushing the total loss for the year closer to $8 million, according to an e-mail Hollyfield wrote on May 21.

L SISSON – psisson@nctimes.com

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A team of Tri-City executives, led by interim chief executive officer Larry Anderson, made several trips to Sacramento in recent months to lobby for a bill that would exempt the public district hospital from a state law that requires all hospital buildings to be in compliance with new earthquake standards by 2013.

When it was first introduced by Assembly members Martin Garrick and Diane Harkey, the bill listed a series of potential exemptions that could get government-owned hospitals out of the deadline. But the version passed by the Assembly on Wednesday is much more narrowly tailored to hospital districts that have tried to pass bond measures and failed.

Tri-City previously stated, in three public bond campaigns, that its buildings would need to be repaired or replaced at a hefty cost in order to comply with the law.

The state classifies hospital buildings according to their probability of sustaining damage in an earthquake. Two of Tri-City’s oldest buildings were in the worst possible category, meaning that they must be replaced, or taken out of use, by 2013. However, the state has a new computer program that is more precise in determining a building’s true earthquake risk. If a building can be shown to have less risk of collapse, it can be reclassified into a less severe category with a mandate for replacement in 2030 instead.

However, in early 2009 the hospital convinced state regulators to reclassify one of its two remaining noncompliant buildings, and has now made significant progress on reclassifying the second, Tri-City’s central tower which opened in 1961.

The hospital is simultaneously working with regulators to get the building shifted into a category of less severe earthquake risk. A consultant hired by the hospital recently drilled concrete samples from the building and sent them to engineers for structural testing. That testing will determine the building’s true earthquake strength.

The current version of the bill also calls for the Legislature to wait and see if regulators grant Tri-City’s pending request for reclassification.

“This is a much more watered-down version, and I think it will get through the Senate just fine,” said Mike Zimmerman, Garrick’s chief of staff.

He noted that the current bill can be modified if regulators determine the hospital’s central tower really does need to be replaced.

“If that turns out to be the case, we can bring everybody back to the table and do an amendment,” Zimmerman said.

Larry Schallock, a hospital board member who traveled to Sacramento to lobby for the bill, said the legislation gives him comfort.

“This is our backup if the other part does not make it,” Schallock said. “We won’t be left stranded.”

Call staff writer Paul Sisson at 760-901-4087 or psisson@nctimes.com.

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The report concluded, in part, that Tri-City’s “current model of governance by elected board members may not be a productive model for … meeting the kinds of complex problems faced by modern health care organizations.”

The report prepared by the civil grand jury was released five days after a hospital board majority — made up of directors Kathleen Sterling, RoseMarie Reno, George Coulter and Charlene Anderson — rejected a proposal by Tri-City doctors to form a task force to study whether the public hospital district should change its governance structure.

Hospital board members received a copy of the report days before they considered the doctors’ proposal, officials said.

Tri-City board member Charlene Anderson declined to comment Tuesday on the document. Board chairwoman Madeline Rodriguez, who supported the doctors’ request, said she didn’t expect the report to change the minds of opposing board members.

Meanwhile, the hospital’s chief of staff, Dr. Richard Burruss, said he was shocked to learn the board knew of the findings before nixing the task-force idea.

“I cannot believe that they would be so arrogant as to disregard a grand jury like that,” he said.

The report recommends that the hospital board form a panel of qualified “stakeholders” in the healthcare district to conduct the outside review.

The grand jury investigates citizen complaints about government agencies in San Diego County and looks into issues that jurors raise about local governing bodies. The panel prepares written reports about its investigations and recommends changes for the agencies.

State law requires the agencies involved to file responses to grand jury reports, but the grand jury has no formal power to enforce its recommendations.

The investigation into Tri-City was launched after the panel received a citizen complaint, the report stated.

Tri-City chief executive officer Larry Anderson said Tuesday that an attorney retained by the district said the grand jury has no jurisdiction over the health-care district. Anderson said he did not know whether the board would respond to the panel’s demand for a response.

The report reflected what North County residents have known for years —- that the seven board members who run the public hospital district are often at odds, and that changes in hospital policy can be made when power swings after publicly-held elections.

The latest board majority, put in place by voters on Nov. 20, has made a series of controversial decisions, including abruptly sidelining the hospital’s top administrators in a Dec. 18 special meeting.

That meeting and the turmoil that followed is referenced in the grand jury report, though the panel took no position on whether the board majority violated the Brown Act, as critics have alleged.

In conducting its investigation, the grand jury interviewed several current and former board members, though three current board members declined to be interviewed, the report stated. It did not name the board members.

Grand jury foreman L.D. Martin said Tuesday that the refusal of some board members to speak to the panel underscored that hospital’s governing body lacks unity.

“I think it shows the dysfunctionality of that group as a whole,” Martin said.

Martin said that if Tri-City does not respond to the grand jury’s report within 90 days, a judge can compel them to do so. However, the court cannot force the hospital board to do much more than simply agree or disagree with the report’s findings and list supporting reasons why.

Martin said he believes the report, even though it carries no legal weight, will help push for a look at alternate ways to run the hospital district because the grand jury is made up of citizens.

“We speak on behalf of the public and the community,” he said. “We believe the public will see this and push to make some changes.”

Panel says hospital should seek outside review
By PAUL SISSON and MELANIE MARSHALL

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The suit, which seeks a restraining order, also names Sharp Mission Park Medical Group, a North County medical provider whose doctors previously practiced at Tri-City. In 2008, Scripps purchased the medical group and the 64 doctors who worked there agreed to start using Scripps hospitals.

Attorney Daniel Callahan, an Orange County trial attorney who is representing Tri-City in the lawsuit, said Tuesday the case is about what’s best for patients who live in the health-care district.

“This is not about money,” Callahan said. “This is about the residents of the Tri-City area being denied good reliable prompt medical care.”

Scripps officials took immediate offense to the 16-page lawsuit filed in Vista Superior Court. Dr. Brent Eastman, Scripps’ chief medical officer, called Tri-City’s allegations “outrageous.”

“I think it’s an unprecedented attack of one hospital system on another,” Eastman said.

Since the Sharp Mission Park deal took effect in January, the number of surgeries at Tri-City has dropped 30 percent, according hospital reports, Tri-City is on pace to finish the fiscal year with an $8 million deficit, in part because of the loss of patients, officials have said.

In the lawsuit, Tri-City accuses Scripps of forcing nonemergency patients to have surgeries and other medical procedures at Scripps facilities and says Scripps has made “false representations to patients and members of the public, that they must receive care and treatment from Scripps and no other medical facility, including Tri-City.”�

It also accuses Scripps of unlawful restraint of trade.

The lawsuit asks the court to bar Scripps from directing patients who live within the Tri-City district to Scripps hospitals. The Scripps hospital closest to Tri-City is Scripps Encinitas, about 20 miles south.

Eastman said that, while Scripps doctors do state their preference to refer patients to a Scripps hospital, they do not insist.

“I’m aware of multiple cases where that is the case, where patients have chosen to go to Tri-City,” Eastman said. “Scripps does not require, nor can they require, ultimately where those patients go.”

The lawsuit alleges that some Scripps patients who pass through the doors of the Tri-City Emergency Department are inappropriately transferred to Scripps hospitals in Encinitas or La Jolla after they are stabilized. The lawsuit cites one case in which an unnamed patient allegedly died after arriving at Scripps from Tri-City.

Callahan, Tri-City’s attorney, said the patient might have survived had he or she not been transferred. He declined to say how the hospital learned of the patient’s death, given that federal privacy law prohibits sharing identifiable details of medical records.

“This is a situation that has gone grossly out of control and it is because Scripps is trying to increase market share and thus profitability,” Callahan said.

Eastman, Scripps’ medical director, said his organization was approached by doctors in the Sharp medical group about joining Scripps. He noted that the normal emergency medical system automatically directs patients with severe problems to the nearest hospital for treatment.

Sharp Mission Park, now called Scripps Coastal Medical Center, is in a large office building just east of Tri-City that contains an urgent care facility. Eastman said that since Jan. 1, 20 to 30 percent of patients seen there were sent to Tri-City because their conditions required immediate treatment.

“I think those physicians are absolutely adhering to the Hippocratic oath and doing what’s in the best interests of their patients,” Eastman said.

Call staff writer Paul Sisson at 760-901-4087 or psisson@nctimes.com.

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Led by Chief of Staff Dr. Richard Burruss, the physicians said they’ll make a public presentation to the board Thursday calling for the formation of an advisory panel that could potentially steer the hospital toward a partnership with a private health-care company.

Burruss said Tri-City’s Medical Executive Committee, which oversees all doctors who work at the hospital, reached a consensus after four Tri-City board members ousted the hospital’s entire management team during a closed meeting Dec. 18.

Doctors made a previous presentation to the board behind closed doors. On Monday, they met with the press to provide a peek at the script for Thursday’s formal meeting with the board.

Burruss said when the board put hospital CEO Arthur Gonzalez and his management team on unexplained paid leave, it “crystallized” long-simmering frustration among hospital staff over the public board’s regular infighting. In recent months, board members have publicly yelled at each other from the dais on issues ranging from finances to doctor discipline.

Burruss said the drama has hurt Tri-City’s image and could soon send more doctors and patients to other, more peaceful hospitals if it is not resolved.

“We felt that was disruptive to the medical center and disruptive to the care that is being provided to our community,” Burruss said.

The doctors are asking for a special panel made up of board members, doctors, nurses, health-care workers and members of the public who would look into other governance models for Tri-City. The doctors’ proposal also calls for the panel to examine all possible “partnership opportunities” in and out of San Diego County.

Burruss did not specify which health care systems the doctors think ought to be on Tri-City’s short list.

“I think the physicians have been, in some ways, disenfranchised from the decision-making process,” he said.

Other public hospital districts, including Grossmont Health Care District in East San Diego County, have leased their facilities to private nonprofit operators over the past few decades. That idea does not appear to have much traction with many Tri-City board members, such as former board chairwoman RoseMarie Reno.

At a recent hospital board meeting, Reno said Tri-City would resist any opportunities to move governance to a private board.

“This hospital will be the people’s hospital, and not the doctors’ hospital,” Reno said.

It was Reno — selected as the board’s chair last year but recently demoted— and three other board members who put Gonzalez, and eight other hospital administrators, on paid administrative leave during a special closed-door meeting Dec. 18.

The board took action without informing Tri-City’s medical staff first. The nine employees remain on leave, and the results of an investigation into hospital finances still have not been released.

At Monday’s press conference, several doctors said they believe constant arguments among board members at public board meetings have created a false perception of poor quality care among patients.

Dr. Andrew Heinle, an anesthesiologist, said the sometimes political nature of board meetings drags the entire hospital down.

“You don’t want to have to defend your hospital to your patients,” Heinle said. “We provide very good care here. I’ve worked at many other hospitals —- Cedars (Cedars-Sinai in Los Angeles), UCLA hospital, and the quality of the care here is excellent. To have the circus happening detracts from our ability to take care of patients.”

Several doctors said a government-maintained Web site, hospitalcompare.org, shows that Tri-City’s quality is top-notch. The Web site ranks Tri-City’s care as good as or better than care offered by neighboring hospitals.

However, the hospital has recently been twice stung by mortality reports that suggested the hospital had higher-than-average death rates among stroke patients, and some heart patients, in 2006. Strangely, the hospitalcompare.org site, which is run by the U.S. Department of Health Services, finds that Tri-City’s death rates are no different from the national average.

Burruss said Monday it is time for the board to work in partnership with hospital staff to correct Tri-City’s image problem. He said many hospital employees are embarrassed to tell friends where they work.

“That is an attitude that we need to change,” he said. “That attitude is the result of the actions of the board. It is not the result of the care that we provide.”

Thursday’s meeting begins at 3 p.m. in the hospital’s lower-level Assembly Room 3.

Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com.

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