The questions were prepared by the the League of Women Voters of the Los Altos-Mtn. View Area and asked of all candidates for this office.

See below for questions on Master Plan, Financial condition, Staffing

Click on a name for other candidate information.   See also more information about this contest.

Answer from Laura E. Ferrer:

I requested a copy of the hospital's Master Plan during my orientation visit this month with hospital administration. I was informed that the Master Plan has not been completed, and is still confidential as a work in progress. Therefore, I cannot respond to this question with any degree of certainty. If the Master Plan is still in development after the election, I will work to ensure that it addresses the public's increasing interest in sensible alternative treatments and medicine. I believe, based on my research, that the hospital has recovered from its troubles during '93 through '96, and is headed in the right direction. I will be diligent to ensure that it remains strong and responsive to its citizen-owners.

Answer from David W Reeder:

The El Camino Hospital Board has developed a Strategic Plan and Vision of where the hospital should be over the next 20 years to meet the needs of District residents. With the support of a community committee, we conducted research and obtained community input which has led to a Master Plan which allows for flexibility to respond to changing health care needs. Specific inputs were provided by the Campus Facilities Steering Committee including the needs of nurses, physicians, the Emergency Room and outpatient services.

Answer from Mark J. O'Connor:

The hospital has served the communities of Mountain View, Sunnyvale, Los Altos, Los Altos Hills, Palo Alto and Cupertino since 1960. With the upcoming rebuild of the hospital tower to meet State mandated earthquake standards much time has been spent determining the community health needs of the District over the next 50 years. Studies have shown our strengths and weaknesses and how best to improve and meet the communitis health needs of the future. Centers for cardiac care, cancer, women's health and orthopedics will be implemented. Outreach to the community as a preventitive health resource will be seen as an ongoing commitment in civic centers, workplaces and schools.

Answer from Bill James:

I have reviewed the Draft Master Plan and I believe it provides a good starting point for further discussion on what the Hospital must do to be prepared to meet the future health care needs of our community. The Draft Master Plan clearly reflects a careful and extensive effort on the part of many individuals to anticipate the needs of the community and to guide the Hospital rebuilding effort to meet those needs. I commend those involved for the hard work they have done to date. In particular, I appreciate the attention that has been given to providing flexible and expandable space, including room for further building if needed in the future to meet unanticipated needs.

That said, I believe there is more work to be done. First, I think the time has come to take a step back and do a sanity check of the Draft Master Plan as it has evolved. I would convene an ad hoc committee of physicians, nurses, patients, patient care advocates, and other stakeholders to take a fresh look at the Draft Master Plan, with an eye toward ensuring that the proposed structure and layout makes sense. For example, surgical personnel should be asked if it makes sense to have the CCU on a separate floor from surgery. Dialysis service providers and patients should be asked how the proposal to move dialysis services off the main hospital campus would affect them.

In addition, as I understand it the proposed facility would provide 310 beds, as opposed to the current 426. Before we build, we should be sure that this significant cut in capacity is warranted.

For example, the Draft Master Plan does not appear to focus on the likely extensive need in the coming decades for geriatric care for Baby Boomers and other older residents, who in this community will be numerous and may tend to live to a very advanced age due to factors such as relative affluence and healthy/active lifestyles. How is our Community Hospital going to ensure they have the health care services they need to support a rich, independent life in their later years? Such patients may require more frequent hospitalization and longer hospital stays, and our community hospital should be prepared to serve their needs.

Also, it seems a shame that our Hospital is a leader locally in deliveries of newborn babies and has an excellent neo-natal intensive care unit (NICU), but many area pediatricians reportedly steer their pediatric patients to other hospitals, such as Stanford, for care, apparently as a result of a perception that unlike other area hospitals El Camino does not pay particular attention to providing pediatric care. The Draft Master Plan lumps pediatrics beds with other beds, and makes no other mention of meeting the community's needs for pediatric services, apart from existing OB/GYN (e.g., deliveries) and NICU services. With younger families moving into the area in droves, either to participate in the technology economy or as immigrants, it is unfortunate that the Draft Master Plan does not include a more comprehensive plan to provide better for our kids' healthcare needs.

Answer from Bill James:

The financial condition of the Hospital appears to be strong. The financial information available publicly shows the Hospital meeting or on track to meet the industry medians for an A+ bond rating. I commend the Board and senior management for achieving this result, which will put the Hospital in a strong position should it have to borrow funds to rebuild.

I think it is important, however, to keep in mind that the Hospital District does not exist primarily to achieve good financial results. It exists to meet the health care needs of our community. I feel the Board should ensure that the Hospital's senior managers are evaluated and rewarded not only on the basis of financial performance, but also based on the Board's assessment of how well they have succeeded in ensuring that our Community Hospital continues in its fine tradition of offering the highest quality of care in a manner consistent with our values as a community.

In addition to traditional measures such as patient satisfaction, the Board should look to the caregivers at the Hospital, including both nurses and other caregivers employed by the Hospital and also the physicians who practice there, as an important source of feedback regarding the extent to which key managers are meeting their needs and the needs of patients.

Finally, as a community-owned and community-operated entity, I feel strongly that the Hospital should make full disclosure of its finances to the same extent as other "district" hospitals. It is my understanding that at least certain financial information is not disclosed in detail due to the non-profit structure that was retained by the Hospital after it was returned to District ownership and control a number of years ago. In addition, the Hospital obtained from the Internal Revenue Service some time after fiscal year 2000 an exemption from the limited financial disclosure that nonprofits are required to make, further restricting access to financial information.

To the extent that this vestige of the disastrous privatization experiment of the 1990's remains, I feel strongly that the District should either revert to the structure that was in place prior to the privatization, or at a minimum the Board should direct the Hospital to report voluntarily to the public the same information, at the same level of detail, as it was required to disclose before the non-profit structure was adopted. Existing law permits a public entity such as the District to limit disclosure of certain sensitive information; the rest should be available for public scrutiny and oversight.

Answer from Laura E. Ferrer:

The hospital's current financial condition supports a top bond rating. This is important to protect because the upcoming reconstruction of the tower to meet newer, more stringent earthquake safety standards will require financing above and beyond the available cash reserves that are currently on hand for that purpose. While there is probably no way to avoid needing extra money beyond cash reserves and donations or contributions from the private sector, I believe that the hospital has demonstrated a strong enough financial foundation that a properly done bond issue, adequate to cover the deficit, is the sensible path. Such a bond issue, properly structured, should be retirable out of operating revenue surpluses as the bond payments come due. I will be vigilant toward avoiding seeking any tax-sourced funding.

Answer from David W Reeder:

El Camino Hospital experienced a financial setback in the late '90s primarily as a result of drastically lowered Medicare reimbursements dictated by the Balanced Budget Act. A successful effort has been undertaken over the last two years to improve the hospital's financial condition to levels that warrent an A+ bond rating if needed to finace the hospital rebuild program. It is important to understand that our improved financial position wass the result of poductivity improvements rather than cutbacks in the quality of health care and our excellent nursing staff.

Answer from Mark J. O'Connor:

The financial condition of the hospital is strong. We have no debt, unique compared to all other hospitals in California. We have over 400 days of cash on hand; Industry standards state a financially healthy hospital have at least 150 days cash on hand. Currently we have a strong financial rating, and if we need to borrow monies in part for the hospital rebuild our interest rate will be favorable. These current strengths and continued growth and containment of costs will give us a very favorable bond rating.

Answer from David W Reeder:

The Board carefully reviews benchmark standards for non-profit hospitals to ensure that our medical, nursing and houskeeping staffing levels are adequate to allow for health care service levels well above the median for comparable hospitals. We recently gave our nurses an unsolicited salary increase to make sure we retain our highly qualified nursing staff. We have also increased our diatary staff when we fell below benchmark standares. We have recently reviewed our housekeeping staffing levels and determined that they are adequate.

Answer from Laura E. Ferrer:

I understand that the hospital meets or exceeds commonly-accepted staffing standards. There remain unfilled positions to which we need to apply intelligent and creative recruiting and retention methods. I will focus on finding qualified people both statewide and nationally from among US citizens, and I will resist any attempt to resort to H1B-visa hiring in the absence of convincing proof that there are no qualified, hirable American citizens available. I believe that the hospital, like any good employer, needs to be competitive in its compensation and appreciation of its existing and future indispensable talent. Dedicated people who will properly serve the health care needs of the district, and in the process contribute favorably to the hospital's financial success, must be adequately rewarded so they can live comfortably in the community they serve.

Answer from Bill James:

I believe El Camino Hospital should ensure that staffing levels are adequate to provide the extremely high quality and personalized care for which the Hospital is known and loved in the community.

I am troubled by the apparent trends. Not so many years ago, El Camino was a "primary nursing" hospital, in which a registered nurse was assigned to each patient to ensure continuity and quality of care. Now, in addition to no longer having an assigned caregiver, it is my understanding that in many cases patients receive from less skilled caregivers services formerly provided by, or at least supervised by, a registered nurse.

In this era of managed care and declining Medicare reimbursements, I am concerned that the "industry" or "community" standard for such matters may not be sufficient to ensure that patients receive the highest quality of care, in a manner consistent with our values as a community.

I am particularly troubled by reports that patient care has been suffering as a result of inadequate staffing. Housekeeping staff, emergency room nurses, and other caregivers have reported that cuts in the night housekeeping staff have resulted in inadequate cleanliness in the inpatient tower and delays in making beds available to receive patients. In at least some cases, these delays have caused the Emergency Room (ER) to close for periods because patients cannot be transferred out of the ER to the main hospital tower. It is my understanding that inadequate nursing staff levels in the inpatient tower have led to similar problems on occasion. Such failures to be available to meet the emergency medical needs of the community are entirely unacceptable.

To address these problems, I would (1) make it clear that providing quality patient care, and meeting the community's health care needs, is the number one priority; (2) focus less on the financial bottom line, while ensuring that we pay enough attention to finances to keep the Hospital on solid financial ground; and (3) if adequate staffing cannot be achieved or maintained otherwise, I would analyze the budget and organization to determine if the Hospital can do a better job of controlling expenses associated with the management and administration of the Hospital. With regard to this latter point, it is my understanding that the costs of management and administration as a percentage of total expenses have risen considerably in recent years, which I am concerned may reflect an insufficient focus on the primacy of patient care.

Answer from Mark J. O'Connor:

Our current nurse staffing ratio exceeds State guidelines and industry standards. Our nurses are a great source of quality of care and pride to the community and have been recognized nationally for their superior and compassionate care. Currently, housekeeeping staffing ratios during days and evenings are adequate. There is ongoing evaluations to make sure night housekeeping ratios are adequate and if found not to be will be changed.

The order of the candidates is random and changes daily.