"Expert Advisory Panel" To Review Patient Room Plans

A Special Meeting of the Board of Directors of Palomar Pomerado Health has been called for an "Expert Advisory Panel" regarding the future focus and perspectives of Palomar Pomerado Health's design process. "The group will be asked to review and comment on the district's plans for patient rooms and other details of a hospital that Palomar Pomerado plans to build in the ERTC" said a PPH spokesman.

I have several concerns about PPH's latest plans for patient rooms. On December 20, 2005, the PPH Board was presented with the patient room layout shown below:


First, the patient "hygiene zone" appears to have a major defect! The toilet appears to be too close to the shower. If the patient does not trip over the shower basin getting to the toilet, then the patient's knees may be overhanging the shower basin when seated on the toilet.

Second, the patient "hygiene zone" is blocking half of the window area and cuts into the "family zone."

The original "healing environment" patient room plans, detailed in the Facilities Master Plan (July 2004) on page 1-18, showed a large window area to allow ample use of natural light and a wide and narrow "family zone" closer to the head of the patient's bed to encourage extended family visits. The latest plans for the patient rooms have the "family zone" placed quite a distance (8 to 10 feet) from the head of the patient's bed. Also, the original patient room plans had ample clearances in the patient hygiene zone.

I hope that PPH has a different patient room design to present to the "Expert Advisory Panel" because the latest design appears to have significant defects. For an estimated cost of $690 million, the residents of the district deserve the best "patient room" design.

The "Expert Advisory Panel" appears to be an encore of a expert review meeting last July reported in the North County Times:
http://www.nctimes.com/articles/2005/07/09/
news/inland/23_07_027_8_05.txt
That meeting featured: Keith Argenbright (physician); Garth Ballantyne (physician); Ron Riner (physician); Richard Satava (physician); John Reiling (Pres & CEO of St. Joseph's Hospital in Wisconsin); and Donald Jones (VP Qualcomm).

This time PPH will have "representatives from IBM, Qualcomm and companies that have built hospitals." Why do I get the feeling that PPH is expecting some good coverage in the media touting their "design process" after this meeting and in advance of the upcoming meeting of the Escondido City Council?

Very recently PPH told the Escondido Design Review Board and the Planning Commission that PPH did not have detailed plans for the new hospital. Much design activity must have taken place over the last few days if the review of the "Expert Advisory Panel" is to have any real merit!

The complete handout presented to the PPH Board on December 20, 2005, is available at this link:
http://civics.robroy.cc/PPHBdSupport122005.pdf
The Facilities Master Plan (July 2004) is available at this link:
http://civics.robroy.cc/
PPHMasterFacilityPlan07-2004p300.pdf
The Special Meeting Notice is available at this link:
http://civics.robroy.cc/PPHBdAgenda013006.pdf
The Special Meeting time (Monday, January 30, 2006, from 10 am to 3 pm) and location was reported in the North County Times:
http://www.nctimes.com/articles/2006/01/28/
news/inland/23_55_461_27_06.txt

SDG&E Powerline Easement Under Proposed Emergency Room

During the Escondido Planning Commission meeting held on January 24th, 2006, one of the Commissioners asked a PPH representative if there were any powerline easements on the ERTC property being acquired by PPH. The representative responded that he did not have "any evidence" of an easement.

County land records show an easement (X) across the middle of PPH proposed Specific Plan Area 4. A copy of the recorded map is available at:
http://civics.robroy.cc/ERTCMapS15.pdf

Further investigation is warranted.

PPH MOU = IOU?

At tonight's meeting of the PPH Board of Directors and Finance Committee, PPH staff reported that PPH is negotiating a development agreement with the City of Escondido for infrastructure improvements near the ERTC site, and a memorandum of understanding (MOU) for the downtown PMC redevelopment.

My understanding is that a MOU would not be legally binding on PPH or the City unless it clearly states that it is legally binding.

While we await disclosure of the MOU, it now appears that PPH is not willing to make a binding commitment to the promised redevelopment of the downtown PMC facility.

From Wikipedia, the free encyclopedia:
A memorandum of understanding (MOU) is a legal document describing an agreement between parties. It is a more formal alternative to a gentlemen's agreement, but less formal than a contract.

The Much Awaited PPH Finance Committee Meeting

The Finance Committee of the Palomar Pomerado Health (PPH) district will have a joint meeting with the Board of Directors on January 26, 2006. The agenda is attached.
http://civics.robroy.cc/PPHBdAgenda012606.pdf

The first item on the agenda is instructions to the PPH negotiator regarding the terms of payment for lots 27-36 of the ERTC. (Estimated date of public disclosure is February 28, 2006.)

This is curious!

First, PPH already owns ERTC lots 30-32. The purchase contract for lots 30-32 and the land records from the SD County Recorder's Office are available at the following links!
http://civics.robroy.cc/ERTCopt1.PDF
http://civics.robroy.cc/2005-0226220GrantDeed.pdf
http://civics.robroy.cc/2005-0226221relocation.pdf

What "terms of payment" needs to be negotiated with JRM-ERTC for lots 30-32? PPH has already paid JRM-ERTC $6.56 million for lots 30-32! This must be another "mistake"!? These "mistakes" appear to be the trademark of the Covert administration.

Second, regarding the "terms of payment" for lots 27-29 and 33-36, this was negotiated last winter and memorialized in a written option contract. Article 2 and Paragraph 5.1.1 of the option contract dated March 18, 2005, appear to define the "terms of payment" for lots 27-29 and 33-36! $28.08 million in cash must be delivered to the Escrow Agent. Pretty simple.
http://civics.robroy.cc/ERTCopt2.PDF

Perhaps PPH wants to discuss the Development Agreement they need to provide to JRM-ERTC in order to close escrow on lots 27-29 and 33-36 as required by paragraphs 4.2.6 and 5.1.2. PPH must provide a mutually acceptable Development Agreement to JRM-ERTC for the "joint development of up to 300,000 square feet of medical office building space and associated parking . . ." If PPH wants to instruct their negotiator regarding the JRM-ERTC Development Agreement for medical office building space, they should clearly indicate that on the agenda.

The third item on the agenda is interesting: "Report on Negotiations with City of Escondido Regarding Development Agreement"

Most interesting is what is not on the agenda. Missing from the agenda is discussion regarding the recently disclosed $230 million funding shortfall in the PPH plan for hospital seismic retrofit and expansion. Maybe the massive funding problem is not of sufficient importance at this time to warrant inclusion on the agenda.

A massive $230 million funding shortfall is not an urgent matter for PPH?

"Other Streets To Get Around The Hospital" - Respect For The Spirit Of Sunshine II

Once again, the Escondido City Council is having a closed session conference with its real property negotiators on the price and terms of payment for two small streets segments around Palomar Medical Center. This item (II.b.) is on today's agenda:

CONFERENCE WITH REAL PROPERTY NEGOTIATOR (Gov. Code §54956.8)
Property: Valley Boulevard between Grand Avenue and Valley Parkway and certain portions of Pennsylvania Avenue between Valley Parkway and Elm
Agency Negotiator: Clay Phillips and Jeffrey Epp
Negotiating parties: City of Escondido and the Palomar Health District
Under negotiation: Price and terms of payment
http://www.ci.escondido.ca.us/government/
docs/index.html
(Someday someone at the City will realize that they are negotiating with the Palomar Pomerado Health district!)

This same item was on the agendas of January 11, 2006, December 21, 2005, December 14, 2005, December 7, 2005, November 16, 2005, and September 14, 2005. This item has now been on the agenda for seven (7) meetings!

I have noted that during this time, the following important topic has not been on the agenda for Council discussion: Traffic effects of closing Valley Boulevard between Grand Avenue and Valley Parkway. It now appears that public discussion of the traffic effects was unnecessary!

As reported in the North County Times: [City Manager] Clay "Phillips said that city officials do not see the loss of Valley Boulevard as a potential problem because drivers can use other streets to get around the hospital."
http://www.nctimes.com/articles/2006/01/12/
news/inland/21_15_011_11_06.txt

A traffic hint: After Valley Bouldvard is closed, as you are sitting in a two-block traffic backup on Grand heading east to the light at Ash on your way to Valley Center, try this! Turn right on Cedar. Turn left on 4th. Turn right on Ash. Turn left on Oak Hill. Turn left on Bear Valley. Follow Bear Valley until it merges with East Valley Parkway. Cool! You just saved two (2) minutes. These "other streets to get around the hospital" are pretty cool!

No public discussion on the traffic effects resulting from the loss of Valley Boulevard is needed?

PPH Finance Committee Cancels Regular Meeting

The Finance Committee of the Board of Directors of Palomar Pomerado Health (PPH) has cancelled its regular monthly meeting scheduled for January 24th. The cancellation notice is attached.
http://civics.robroy.cc/PPHFinCancel012406.pdf

I believe the meeting cancellation is significant for at least the following reason. During the Board's special joint meeting on December 20th, significant project cost increases (+$230 million) were disclosed. Concerned board member Bruce Krider requested that the Finance Committee study and suggest strategies for containing the cost increases. Mr. Krider requested that the Finance Committee do this "real quick."

Finance Committee is not addressing the $230 million funding shortfall issue "real quick" by cancelling its meeting!

PPH has ignored the concerns of the public. Now, PPH is ignoring a request by a member of its own board! Maybe the Finance Committee has found something else more important than the issue of the $230 million funding shortfall.

Who Are The "PPH Advocates"?

This bright yellow sign was near the PPH meeting notice display case at Palomar Medical Center (PMC). Hard to miss. A search of the web for "PPH Advocates" resulted in the following link:
http://www.pph.org/body.cfm?id=260

The link is to a "Palomar Pomerado Health Community Advocate Council Form." It appears that members of the community can sign up for various levels of involvement including:
"Leadership
I am interested in a leadership role within the Advocate League or Council. The Advocates League Chairperson oversees all activities of the different Community Leagues. The Advocate Council members provide oversight for the entire Advocate program."
and
"Community Events
I would like to represent Palomar Pomerado Health at local functions and events, as a Community Advocate. Periodic training will be provided so all volunteers are well versed in issues effecting the health system."

During the Prop BB campaign, these advocates helped get out the message:
"Kay Stuckhart, a volunteer and advocate for Palomar-Pomerado Health, asked that the [Escondido Union School] district staff be advocates for the passage of this proposition and that the board formally endorse Proposition BB."
http://www.eusd4kids.org/Board_min/101404_Board_MN.pdf

What Happened To David Fried At The North County Times?

I have not seen an article by David Fried at the North County Times in over a week. David Fried is the reporter that broke the story on December 29, 2005, about the concerns SDG&E has with PPH locating a hospital in the ERTC:
http://www.nctimes.com/articles/2005/12/29/
news/inland/20_36_1212_28_05.txt

The NCT editor immediately wrote an editorial the next day to rehabilitate the position of PPH:
http://www.nctimes.com/articles/2005/12/30/
opinion/editorials/19_12_2112_29_05.txt

That same day I wrote here that the editorial appeared to reveal a division between the news staff and the editorial staff at NCT regarding coverage of the Palomar Pomerado Health (PPH) hospital expansion, and that the editorial staff appeared to be very unhappy.

A call to David Fried's number at NCT (760 740-5416) yields a message by David Fried saying that he will be out until January 30th. Is it a coincidence that he is out during the time period that the Escondido Planning Commission and the Escondido City Council are to consider the zoning change for the ERTC that would allow PPH to build the new hospital there?

PPH Officially Rejects The San Marcos Site

Last month, PPH officially rejected the San Marcos site from consideration for the new hospital. The following is copied from the ERTC Environmental Impact Report (EIR) Addendum:
"Site 6 (San Marcos site). This site is located in the City of San Marcos near SR-78 and Twin Oaks Valley Road. This site is approximately 184 acres. PPH considered this site; however, there were issues with infrastructure and land acquisition. The site was ultimately rejected because PPH would prefer to keep the hospital in Escondido. The City of San Marcos is currently pursuing other development plans for the site."
From page 4 of the draft ERTC EIR Addendum dated December 2, 2005:
http://civics.robroy.cc/ERTC-EIR2.pdf

The ERTC EIR Addendum was adopted by the PPH Board of Directors on December 6, 2005.

So how much did the City of San Marcos want in infrastructure improvements? More than $30 million? More than $40 million?

The following is a reminder of PPH's actions last August after Escondido's Hospital Site Ad-Hoc Subcommittee offered to allow PPH to build the new hospital in the ERTC:
1. (Very First Action): PPH wrote a letter dated August 24, 2005, stating, "we cannot state with certainty that the two parties will reach accord on all the terms and conditions of such an agreement." (Referring to a development agreement for the downtown facility - PMC)
http://civics.robroy.cc/ERTCagmtLtrs.PDF
2. : PPH posted a Notice on August 29, 2005, of a Special Meeting that was held on August 30, 2005, for a closed session Conference with Real Property Negotiators to discuss "Price and terms" of the San Marcos site.
http://civics.robroy.cc/PPHBdAgenda083005.pdf
3. : PPH held another Special Meeting on August 30, 2005. Regarding the City of Escondido's request for PPH to contribute to roadway infrastructure improvements, including Citracado Parkway, as part of the issues to address in the City's approval of the zoning change, the PPH Board gave "specific direction that PPH Staff make every effort to limit those contributions to PPH's fair share and to items that are directly related to the potential hospital on the ERTC site."
http://civics.robroy.cc/PPHBdMinutes083005.pdf

Watchdog Training - "Follow The Money" - Lesson 2

"Contribution: A payment, including a loan, a forgiveness of a loan, a third party payment on a loan, or an enforceable promise to make a payment except to the extent that full and adequate consideration is received and it is clear from surrounding circumstances that it is not made for political purposes." Page 33, Definitions, Campaign Disclosure Manual E, prepared by the California Fair Political Practices Commission. Available at:
http://civics.robroy.cc/fp.html

Watchdog Training - "Follow The Money" - Lesson 1 was posted on January 1, 2006.

10News: Winners Of The Lazy News Team Award

Earlier today, the Design Review Board for the City of Escondido held a meeting that included a case review of proposed changes to the design guidelines and amendment to the specific plan for the ERTC to incorporate hospital uses. The applicant for the proposed changes was the Palomar Pomerado Health district.

As a part of its 6:30 pm news broadcast, 10News ran a report on the Design Review Board meeting.

Similarities between the actual Design Review Board meeting and the contents of the 10News report were few. A significant segment of report was focused on a scale model of the hospital. The scale hospital model shown on the 10News report was not shown at the meeting.

Another significant segment of the 10News report covered another hospital having a "healing environment." Apparently 10News has decided to act as the propaganda arm of the public relations department of PPH (a local government agency) in its effort to"persuade" the Escondido City Council to enact a zoning change to permit construction of an expensive resort-style "healing environment" hospital across the street from a 550 Megawatt electric power plant.

For being too lazy to attend the meeting and become informed on the issues, I am expressing my disappointment with the 10News Team. Particular mention is given of Hal Clement, Carol LaBeau, and Michael Chen.

Maybe the next time the 10News Team comes to Escondido, they can exhibit a better work ethic.

Respect For The Spirit Of Sunshine

The Escondido City Councils enjoys having closed session conferences with its real property negotiators on the price and terms of payment for two small streets segments around Palomar Medical Center. This item is on today's agenda:

CONFERENCE WITH REAL PROPERTY NEGOTIATOR (Gov. Code §54956.8)
Property: Valley Boulevard between Grand Avenue and Valley Parkway and certain portions of Pennsylvania Avenue between Valley Parkway and Elm
Agency Negotiator: Clay Phillips and Jeffrey Epp
Negotiating parties: City of Escondido and the Palomar Health District
Under negotiation: Price and terms of payment
http://www.ci.escondido.ca.us/government/docs/index.html

(Someday someone at the City will realize that they are negotiating with the Palomar Pomerado Health district!)

This same item was on the agendas of December 21, 2005, December 14, 2005, December 7, 2005, November 16, 2005, and September 14, 2005. This item has now been on the agenda for six (6) meetings!

During this time, the following important topics have not been on the agenda for Council discussion:
1. Traffic effects of closing Valley Boulevard between Grand Avenue and Valley Parkway.
2. Infrastructure improvements by PPH for the ERTC (including Citracado Parkway).
3. Development agreement between PPH and Escondido for the downtown site.
4. JRM (private developer) agreement with PPH to build medical office buildings (not part of the hospital) on PPH land in the ERTC.
5. EIR for ERTC zoning change to accommodate a hospital.

Are these topics not important enough for discussion by the Escondido City Council? Or has the Escondido City Council found a "loophole" in the Brown Act, allowing discussion of a wide range of topics, if the discussion is in some manner tied to negotiations on the price and terms of real property? Is the Escondido City Council respecting the spirit of California's sunshine laws?

These may prove to be interesting questions during the upcoming political season.

PPH Believes There Is A Significant Exposure To Litigation By An Adjacent Landowner In The ERTC

The Palomar Pomerado Health (PPH) district has scheduled a special meeting of its Board of Directors, pursuant to California Government Code Section 54956.9, Subdivision (b), to conference with legal counsel regarding potential litigation. According to the meeting agenda, "there are facts and circumstances surrounding the location of the hospital at the ERTC site which might result in litigation by adjacent landowners."

The agenda for the special meeting on January 9, 2006, is available at:
http://civics.robroy.cc/ph.html

California Government Code Section 54956.9 is part of the Brown Act, which is available at:
http://www.leginfo.ca.gov/cgi-bin/displaycode?
section=gov&group=54001-55000&file=54950-54963

Under subdivision (b), "facts and circumstances" shall consist only of:
(A) facts and circumstances not yet known to potential plaintiffs (facts need not be disclosed)
(B) facts and circumstances known to potential plantiffs (facts shall be publicly stated on the agenda or announced)
(C) a claim or written communication threatening litigation (claim or communication shall be available for public inspection)
(D) a statement in an open or public meeting threatening litigation
(E) a statement threatening litigation made to an official or employee with a record made of the statement prior to the meeting (record shall be available for public inspection)

$230 Million+ Funding Shortfall at PPH

The Palomar Pomerado Health district now predicts a funding shortfall of $230 million for its planned facilities expansion. The funding shortfall is on top of $50 million that PPH needs to raise from charitable donations to the PPH Foundation.
Because of the funding shortfall, PPH is considering a two-phase plan of building two-thirds of a resort-style “healing-environment” hospital in the ERTC, and leaving the women and children's services center in the existing downtown Palomar Medical Center until 2013. The first phase would exhaust all of the funds earmarked for the facilities expansion. The second phase, which would include building a new women and children's services center in the ERTC, would require new funding sources.
PPH has not calculated how much this two-phase plan would cost over the one-phase plan having the $230 million funding shortfall. It is very likely that the two-phase plan will cost substantially more than the one-phase plan because the several-year delay in constructing the women and children's services building in the ERTC will increase its cost. Building two-thirds of a resort-style hospital in the ERTC with a promise to build the remaining third at some future date is a recipe for an expensive disaster.

Is The Watchdog Asleep Again?

The following extract is from an article about lessons to be learned from the Cunningham case in today's North County Times (Jan. 1, 2006):

The media
It was a Copley News Service report in June that started the unraveling of Randy Cunningham's web of deceit.
Marcus Stern, in the news service's Washington office, detailed how Mitchell Wade, founder of the defense firm MZM Inc., paid $700,000 more for Cunningham's Del Mar Heights home that (sic) he would sell it for less than a year later. That purchase provided the cash for Cunningham to buy the gated mansion in exclusive Rancho Santa Fe.
Until then, rarely was there a negative word about Cunningham, who had won regular endorsement for re-election from this newspaper.
At the Poynter Institute, a Florida-based journalism think tank and center for continuing education, vice president and senior scholar Dr. Roy Peter Clark suggested that until Stern's report, the media may have lost sight of its role as a government watchdog.
Newsroom budget cuts over the years that have reporters covering multiple beats and lack of money to fund bureaus in Washington are one part of the problem, Clark said.
"Communities should hold their news organizations accountable," he said last week. "Not necessarily for some sort of ideological bias, but in terms of performance and level of public service."
But the greater failing may have been in forgetting the watchdog role.
"Every news organization has to walk the line between skepticism and cynicism, and it appears there may not have been enough skepticism directed at this individual ---- anyone who looks at politics through rose-colored glasses is just a fool."
The adage "follow the money" wasn't done until Stern's report, something Roberta Baskin at the Center for Public Integrity said may have been the media's biggest sin.
"It's always about following the money," said Baskin, executive director of the nonprofit and nonpartisan center in Washington, which conducts investigative research and reports on public policy issues.
"You always need to look beyond what people say and what they do to see where the money is coming from and where it's going," she said.
Stern's story did just that. Until then, no media outlet in San Diego or in Washington had really taken a hard look at Cunningham and where he was getting his money and where it was being spent.
North County Times editor Kent Davy said that when Cunningham was running for re-election in 2004, the newspaper failed to look below the surface.
"If we had been much more aggressive about trying to understand his finances and his lifestyle, we might have stumbled onto the key to the story," Davy said. "The recommendations about following the money are dead-on, and that implies that we need to be doing routine record checks of people in the news so that things like the house transaction don't surprise us."
While not first with the initial story about the home sale, Davy said the newspaper "responded in a very credible manner which has significantly pushed the story along."
http://www.nctimes.com/articles/2006/01/01/
news/top_stories/123105192840.txt

Has the North County Times really learned anything about its role as a government watchdog? This check was uncovered last month in response to a public records request made to the Palomar Pomerado Health (PPH) district:

By contributing $375,000, the PPH Foundation was the largest campaign contributor to the "Citizens for Better Health Care - Yes on BB" campaign committee. However, the PPH Foundation has yet to complete a Major Donor report (Form 461) as required of a contributor of over $10,000 to the campaign, or a Recipient Committee report (Form 460) for detailing the source of any campaign contributions as required when that source is $100 or more for a person or organization that receives contributions that total $1,000 or more. More details are available at:
http://civics.robroy.cc/fp.html
Also, see the blog entry below titled "Somber Issues in Escondido", dated December 7, 2005.

Until the disclosure forms (required under California's Political Reform Act) are completed, the public cannot see where the money is coming from and going to in the PPH hospital expansion matter.

Perhaps the North County Times is again waiting for the Copley News Service to take the lead in investigating this matter.