Tuesday, August 30, 2005

The Story of Prop BB

PPH authored quite a story when it drafted Resolution No. 08.04.04 (01), calling for an Election to Authorize the Issuance of Bonds, now known as Proposition BB. The Resolution can be found at:
http://www.pph.org/documents/
Board%20and%20Administration/
bod%20resolution%20080404.pdf


On page 2 of the Resolution is a story, quoted below:


FINDINGS
Palomar Pomerado Health (the "District") of North County San Diego provides accessible health care services, including trauma, emergency, and acute care services.

Over the next twenty years, North County San Diego communities are expected to grow to approximately 1.3 million residents, including a steadily increasing senior population.

Palomar Medical Center serves as the only Trauma Center in North County San Diego.

Palomar Medical Center is 50 years old. Over 70% of the hospital beds at Palomar Medical Center are located in buildings that do not meet state earthquake safety standards. Based on an evaluation of reports prepared by outside experts, the Board of Directors (the "Board") of the District has determined that it would be significantly more expensive to retrofit and upgrade the existing Palomar Medical Center than it would be to build a new medical center.


The expected growth to 1.3 million residents is a interesting aspect of the Prop BB story. According to the PPH Facilities Master Plan (page 1-7), the PPH district currently serves a population of about 452,738 people, and by 2020, it will serve about 592,825 people, a population increase of about 30%. 1,300,000 minus 592,825 equals 707,175 people. Where are these 707,175 future people? And why is PPH building a hospital of the future for them?




PMC's service as North County San Diego's only Trauma Center is another interesting aspect of the Prop BB story. San Diego County's Division of Emergency Medical Services (EMS) designed and oversees the Trauma System in San Diego County. See:
http://www2.sdcounty.ca.gov/hhsa/
ServiceDetails.asp?ServiceID=527

A map of the Trauma System catchment areas is located at:
http://www2.sdcounty.ca.gov/hhsa/
documents/EMS-CatchmentMap.pdf


Note that traumatic injury cases in the cities of Oceanside, Carlsbad, Encinitas, Solana Beach and Del Mar (all North County cities), pertain to the catchment area of Scripps Memorial Hospital in La Jolla. Further, traumatic injury cases in major segments of Rancho Penasquitos and Carmel Mountain Ranch, and in a small corner of Poway, pertain to the catchment area of Sharp Memorial Hospital in Kearny Mesa.

Finally, is PMC 50 years old? The buildings are not! See:
http://members.cox.net/4robroy/escondido/PMC-Blog.GIF
http://members.cox.net/4robroy/escondido/PMC-BlogD.pdf
The entire south half of PMC is less than 20 years old! The infamous McLeod Tower is about 36 years old. The lowly Adams wing is about 46 years old. The PPH Facilities Master Plan confirms that the buildings at PMC are not 50 years old! See:http://members.cox.net/4robroy/escondido/
PPHMasterFacilityPlan07-2004p150PDF.pdf


Prop BB, an interesting story.

Monday, August 29, 2005

Is PPH Going To San Marcos Anyway?

PPH has just posted another night of serial "Special" Board Meetings. No surprise. What is surprising is the topic!

Last week, PPH accepted the Escondido compromise. Right?

Hold on!

At 5 pm, Tuesday August 30, 2005, PPH will have a special meeting of its Board of Directors, in Room E at Pomerado Hospital:

"The meeting will be to discuss the San Marcos property; Options for the purchase of property at the ERTC (Escondido Research and Technology Center) site; and Potential Joint Development Agreement between the City of Escondido and Palomar Pomerado Health related to ERTC infrastructure, with a portion of the meeting being a full-board closed session pursuant to:

1. CONFERENCE WITH REAL PROPERTY NEGOTIATORS - 30 min
pursuant to Government Code Section 54956.8

Property: A certain portion of Blocks 63 and 67 Rancho Los Vallecitos Drive, San Marcos in the County of San Diego, Map #806 comprising approximately 86 gross acres.
Agency Negotiators: Bob Hemker, CFO, PPH
Negotiation Parties: Michael P. Neal, President and CEO, H.G. Fenton Company and PPH
Under Negotiation: Price and Terms

See Notice below:


The second Special Meeting of the Board of Directors for the evening is a joint Board/Finance Committee meeting. This meeting will be Open Session. See Notice below:

Tuesday, August 23, 2005

Escondido Goes All In

The City of Escondido has offered the entire 52 acres at the Escondido Research and Technology Center (ERTC) to the Palomar Pomerado Health (PPH) district so that PPH can build its cherished resort-style hospital there. The offer has two minor conditions.

1) PPH would need to sign agreements to help cover the costs of road and other infrastructure improvements around the ERTC.

2) PPH would need to sign a development agreement with a commitment to follow through with its renovation plan for the Palomar Medical Center (PMC) downtown.

Both of these restrictions appear reasonable. PPH has said that the new facility at the ERTC will provide 4000 jobs. By taking the main 52 acre pad of the ERTC, PPH will be the ERTC's main tenant and traffic generator, and must assume some of the infrastructure responsibilities that would have been placed on a private businesses that the city had hoped to site there. One core infrastructure responsibility is the long planned extension of Citracado Parkway to Valley Parkway.

The Citracado extension will save lives because emergency vehicles will be able to get to the hospital faster and avoid the railroad tracks and Nordahl freeway interchange. PPH has repeatedly claimed to place saving lives above everything else.

And after the elaborate PPH presentation last month, committing to the promised improvements for the downtown PMC should be a "no brainer".

See details in the North County Times at:
http://www.nctimes.com/articles/2005/08/24/
news/inland/21_02_208_23_05.txt

and in the Union Tribune at:
http://www.signonsandiego.com/news/northcounty/
20050823-9999-1m23ehosp.html

Saturday, August 20, 2005

A PPH Design For A Hospital In The ERTC

The Palomar Pomerado Health (PPH) district has commenced with hospital designs for the ERTC site. The latest featured design (Scheme J) is shown below:



The acute care hospital, conference center, and parking structure are shown on the North end of the site. Two medical office buildings and two parking structures are shown on the South end of the site. The Phase 2 Nursing Tower on the north side of the site is a future expansion of the acute care hospital

A closer look at the acute care hospital is shown here.
Notice the Phase 2 Nursing Tower is not shown in the design.

The total pad area for the site is 34.6 acreas. What is not shown is the 21.6 acres of slope surrounding the site, mainly on the north and west sides.

It appears that the parking structures and the medical office buildings could be reloated to the north slope areas facing Vineyard avenue. Then the south half of the site could be opened up for research and technology companies as desired by the City of Escondido.

Links to the photos are below:
http://civics.robroy.cc/HospERTC-J.JPG
http://civics.robroy.cc/HospERTC-J1.JPG

Friday, August 19, 2005

Hospital Contruction Costs Soar Over 20% In One Year

On July 26, 2005, the Palomar Pomerado Health (PPH) district held a meeting to listen to a presentation by Rudolph and Sletten, General and Engineering Contractors, regarding cost and market trends in California Hospital Construction.




Between 2004 and 2005, hospital construction costs have soared. The estimated construction cost for PPH to implement its Facilies Master Plan may have increased by over 20%. The original budget by PPH for implementing the nearly $800 million master facilities plan contemplated a yearly increase of only 5% per year.



Why is this important to Escondido?

Because PPH has promised to use over $70 million of Prop. BB money to upgrade Palomar Medical Center (PMC) AFTER the new hospital is built. In the timeline of the PPH Facilities Master Plan, PMC is the last project. If the other projects are over budget, will the shortfall be taken from the money for upgrading PMC?

With respect to Prop. BB, PMC may become the Highway 76 of the TransNet tax -- promised but never delivered!

Two days after this presentation on the soaring cost of hospital construction, PPH had a community forum in Escondido and presented an elaborate revitalization plan for the existing PMC site.

The PPH timeline from the Facilities Master Plan is below.


The slides for the hospital cost presentation at PPH can be found at:
http://civics.robroy.cc/HospitalCosts04-05h150.PDF

Tuesday, August 16, 2005

PPH Serial Special Meeting Update - August 16, 2005

Tuesday, August 16, 2005

6 pm - Joint Board of Directors (invited)/Strategic Planning Committee Meeting
Topics: All Facilities Update; Information Technology Update - Conference Room E

7:45 pm - Special Meeting of the Board of Directors
Topics: Reassessment of the Facilities Site Committee, Hospital Site Alternatives

9:30 pm - Special Meeting of the Board of Directors
Topic: Request that the Escondido City Council rescind its Resolution 2005-107 regarding the location of the new hospital (in Escondido, but not in the ERTC)

Monday, August 15, 2005

Late Night "Special" Meetings at PPH

Covert Operations are returning to high gear at the Palomar Pomerado Health (PPH) district.

Tonight's regularly scheduled PPH Board meeting was relatively uneventful. Until the end!

PPH has noticed a Joint Meeting of the Board of Directors & Strategic Planning Committee for tomorrow night (August 16, 2005) at Pomerado Hospital at 6 or 6:30 pm (I do not remember when). During Board Member comments it came out that after that joint meeting, the PPH Board will have a "special meeting" to consider alternative sites to the ERTC at 7:15 pm (?). Board Director Larson wanted to have an item added to the special meeting agenda for the PPH Board to formally request that the Escondido City Council rescind its Resolution 2005-107 regarding the location of the new hospital (in Escondido, but not in the ERTC) as a showing of good faith on the part of Escondido. This was at about 8:16 pm. Legal Counsel informed the Board that it was too late to re-notice the 7:15 pm meeting. So another special meeting will be noticed for 8:?? pm. As of 8:30 pm, Legal Counsel and the Board Assistant were still drafting the second special meeting's notice so no faxes had yet been sent to the newspapers.

These many meetings should prove to be interesting.

Funny, PPH did not offer to pass a Resolution recommitting it to locating the new facility in Escondido no matter what, i.e., regardless of what happens at the environmentally doomed ERTC.

Sunday, August 14, 2005

The Eminent Domain Façade of PPH

The following is taken from the Minutes of the Regular Meeting of the Board of Education for the Escondido Union School District on October 14, 2004 (less than 3 weeks before the election for Proposition BB). The Minutes are available at:
http://www.eusd4kids.org/board_agds.htm; the particular document is at:
http://www.eusd4kids.org/Board_min/
101404_Board_MN.pdf


Quick Quote from Minutes:
"Proposition BB for Palomar-Pomerado Health.
[Escondido Union School] Board members asked what assurance the hospital could give that the new hospital would stay in Escondido. [Lorie Shoemaker presenting on behalf of PPH] said the hospital board is committed to relocating within Escondido and may have to invoke eminent domain to find the 40 acres they will need."

Lorie Shoemaker is the Chief Nursing Officer for the Palomar Pomerado Health (PPH) District. See her name on the Executive Management Team list for PPH at:
http://www.pph.org/body.cfm?id=187

Longer Quote Version:
"Proposition BB for Palomar-Pomerado Health.
Dr. Caston introduced this presentation. He informed the audience that the Palomar-Pomerado Health Care system is a public entity and eligible to seek a general obligation bond. Laurie Shoemaker, a nurse administrator at Palomar Medical Center, made the presentation on behalf of Palomar-Pomerado Health and the Citizens for Better Health Care in support of Proposition BB. By 2008, all hospitals in California must be seismically compliant, and Palomar Hospital’s original building will be out of compliance. Retrofitting the existing facility is too expensive and would severely reduce patient capacity during the construction, making this an unacceptable option. In addition, this facility handles more than double the patients annually than it was built to accommodate. Pomerado Hospital has likewise outgrown its service area, which is 850 square miles being serviced by both hospital facilities.

Prop. BB is seeking $496 million, which would cost the taxpayer $17.75 per $100,000 assessed value or approximately $50 per year per household for the next 30 years. The money will be used to build a state-of-the-art hospital and trauma center in Escondido, health clinics in Valley Center and Ramona, modernization of existing facilities, and expansion of services.

Board members asked what assurance the hospital could give that the new hospital would stay in Escondido. Laurie said the hospital board is committed to relocating within Escondido and may have to invoke eminent domain to find the 40 acres they will need."

Friday, August 12, 2005

Are Three Acute Care Hospitals Too Many?

The Palomar Pomerado Health (PPH) district plans to dismantle the Palomar Medical Center (PMC) as an acute care hosital. PMC is the Heart of Downtown Escondido. PPH will take this unwise action because it believes that two acute care hospitals are better for Inland North San Diego County than three acute care hospitals.



1. Palomar Medical Center (Not Needed?)
(Palomar Pomerado Health)
Trauma Center – Level II
2. Pomerado Hospital
(Palomar Pomerado Health)
Not a Trauma Center
New. Palomar Medical Center West (Location Unknown)
((Palomar Pomerado Health)
Trauma Center – Level ?


Population by City (2002):
Escondido 162,131
Rancho Bernard. 65,581
San Marcos 62,599
Rancho Penasq. 52,781
Poway 49,331
Ramona 34,265
Valley Center 17,434
Julian, Pala, etc. 8,616
Total: 452,738
(Projection (by PPH) for 2020: 592,825)


By way of comparison, the San Bernardino Valley (about 80 miles north of Escondido) has seven (7) acute care hospitals! The seven hospital are within a few miles of each other.

1. Loma Linda University Medical Center
(Seventh Day Adventist)
Trauma Center – Level II
2. Arrowhead Regional Medical Center
(San Bernardino County)
Trauma Center – Level II
3. St. Bernardine Medical Center
(Catholic Healthcare West)
4. Community Hospital of San Bernardino
(Catholic Healthcare West)
5. Jerry L. Pettis Memorial Veterans Administration
(VA) Medical Center

6. Loma Linda UMC – East Campus Hospital
(Seventh Day Adventists)
7. Redlands Community Hospital
(Non-Profit Independent)

Population by City (2000):
San Bernardino 185,401
Rialto 91,873
Redlands 63,691
Colton 47,662
Highland 44,605
Loma Linda 18,681
Total: 451,913

The populations of the San Bernardino Valley and the Inland North San Diego County are about the same.

During the campaign for Proposition BB, PPH emphasized that the Emergency Room at PMC is crowded to beyond its capacity almost every morning. However, PPH has not adequately explained how merely moving the Emergency Room will address the overcrowding issue.

Three Emergency Rooms are better than two, and less than seven.

The Facilities Master Plan favored two acute care hospitals because the new hospital was to be in "the vicinity of Palomar Medical Center". See:
http://members.cox.net/4robroy/escondido/PPH-MFPp2-1l.PDF

Since the likely sites for the new hospital are not "in the vicinity of Palomar Medical Center", PPH should implement an alternate three (3) hospital plan, such as scheme D1 of its Facilities Master Plan, keeping PMC as a 120 bed acute care hospital. See the table on page 1-5:
http://civics.robroy.cc/PPH-MFPp1-5.PDF

Tuesday, August 09, 2005

PPH's ERTC Purchase Options & Agreements - $34.6 Million for ERTC Properties

The Escondido Research and Technology Center (ERTC) site will cost Palomar Pomerado Health (PPH) district exactly $1 million per net pad acre. The total price for the ERTC would be about $35 million dollars.

On February 11, 2005, PPH and JRM-ERTC entered into a purchase option agreement for 6.6 gross acres / 6.56 net acres (Parcels 30, 31 and 32) of the ERTC for a purchase price of $6.56 million. The option, which expired on March 16, 2005, was execised by PPH. For a copy of the option agreement, see:
http://civics.robroy.cc/ERTCopt1.PDF (1.5 MB)

On March 18, 2005, PPH and JRM-ERTC entered into an additional purchase option agreement for 49.65 gross acres / 28.08 net acres (Parcels 27-29 and 33-36) of the ERTC for a purchase price of $28.08 million. This additional purchase option expires at 5 pm PDT on August 31, 2005. For a copy of the additional option agreement, see:
http://civics.robroy.cc/ERTCopt2.PDF (1.4 MB)

(For some reason PPH redacted a couple of paragraphs in each agreement because "the public interest served by not disclosing those sections clearly outweighs the public interest served by disclosure of those sections". See:
http://civics.robroy.cc/PPHpreq1.PDF (294 KB)
http://civics.robroy.cc/PPHpreq2.PDF (108 KB)
Time will tell.)

If PPH exercises the additional purchase option, the total purchase price for the large pad area (about 35 acres) in the ERTC will be about $34.6 million. PPH is really excited about this location. It believes that it can purchase this large pad area for a lower price than other sites and can avoid the use of eminent domain.

But hold on.

A hospital is considered a "sensitive receptor" under the California Environmental Quality Act (CEQA). The Environment Impact Report (EIR) for the ERTC never considered placing a sensitive receptor in the ERTC. The ERTC's EIR is available in the Escondido Public Library. Further, the EIR for Sempra's Palomar Energy Project, the 546 Megawatt electric power plant in the ERTC, never considered having a hospital as a nearby neighbor. See:
http://www.energy.ca.gov/sitingcases/palomar/
Particularly, see:
http://www.energy.ca.gov/sitingcases/palomar/documents/
2003-08-08_FINAL_DECISION.PDF
(1.2 MB)

If PPH decides to locate in the ERTC, the City of Escondido would need to update the EIR for the ERTC and the California Energy Commission would need to reconsider its decision approving the Palomar Energy Project to include the environmental effects of the electric power plant on the PPH hospital.