Sunday, February 26, 2006

The Political Season Begins Early For PPH & Escondido?

The reader comments added to the following NC Times article on PPH's ERTC decision are quite interesting and political. This years elections, particularly for the PPH Board, may be much more colorful than past elections!
http://www.nctimes.com/articles/2006/02/24/
news/inland/21_40_082_23_06.txt


Mike wrote on February 24, 2006 7:07 AM: "All good things comes to he who waits. This will have a significant impact on raising the quality of life in this area. All voters should not forget next election the three Escondido council members who caused delays and obstructed the hospital for more than a year for petty politics."

Sam wrote on February 24, 2006 2:19 PM: "Mike, Remember that the 3 council members have allowed PPH to build the hospital in Escondido. They should be thanked for their decision. The city did not delay the process 1 day. It took PPH 1 year to fullfil their promise to committ to build Citracado and upgrade Palomar downtown. Since BB passed, PPH has been doing environmental studies and negotiating purshase of land. They still need 18 more months to get the state approval. Stop your Propaganda about the city of Escondido and the council and be appreciative of the happy ending. The final agreement is good for the hospital district and the the city of Escondido. The Council will be remembered for their courage to protect the city's interest."

Disgusted wrote on February 24, 2006 2:46 PM: "Don't count your chickens, Mike. I'm still patiently waiting and closely watching. I agree that this will have a significant impact on the quality of life in this area, while we're paying through the nose for healthcare and taxes. All voters should not forget any future elections and the five Escondido council members who proved to us who really runs this city. I heartily thank you for making this so abundantly clear to the few of us who are actually paying attention. How sad and embarrassing for all of them. See you at the polls!"

The Order wrote on February 24, 2006 8:20 PM: "Up for grabs in this fall's election: 4 PPH board seats, the mayor's seat, and 2 city council seats. The seats at PPH are now held by Krider, Kleiter, Scofield and Larson. (Kleiter was the low voter get in 2002.) The city council seats are now held by Newman and Waldron. Disgusted will need to wait until 2008 to get at Rivera, Bassett and Greer at PPH, and Abed and Gallo at the city. We hear that J.K. wants a seat on the PPH board, T.D'A. wants the mayor's seat, and K.M. wants a seat on the city council."

Saturday, February 25, 2006

Foil The Future ERTC-PPH Health Care Monopoly

Friday, February 24, 2006

A Key To PPH's ERTC Site: PPH's Ability To Control The Land Surrounding The New Hospital

PPH has decided to exercise the option to acquire the ERTC property. The details of the shadowy Development Agreement between PPH and JRM-ERTC I are now available. Under the agreement, JRM must insert "use restrictions" in the grant deeds of the ERTC property not owned by PPH. The use restrictions requirements are in Section 8.5.2 of:
http://civics.robroy.cc/AC.pdf (JRM Agreement)

Now PPH has control over the use of all of the ERTC properties. PPH can control the property costs of competitive medical services near the new resort-style hospital. The other available properties in Escondido did not provide PPH with this control of the surrounding land. Now it is evident why the downtown location is so unacceptable to PPH. The downtown location failed to allow PPH the control it covets over the land surrounding the hospital.

A comment by a "Local MD" captures the problematic issues surrounding PPH's acquisition of the ERTC property:
Local MD wrote on February 24, 2006 7:54 PM: "So now PPH will control all aspects of the health care delivery system in North County...the real estate, the hospital beds, and the anciliary services. Physicians will be arm-twisted into leasing space from the hospital and to use their services. Has anyone from the PPH Board even mentioned the cost to the patient? Twenty years from now when our insurance premiums, co-pays and deductibles are through the roof we'll curse the fact that we created a monopoly with our own money. This PPH monopoly will have zero incentive to lower prices or improve services because they'll be the only game in town. That said, it will be a majestic structure...just like a Las Vegas casino, ready to pick our pockets."
The reader comment was added to the following NC Times article on the PPH ERTC decision:
http://www.nctimes.com/articles/2006/02/24/
news/inland/21_40_082_23_06.txt


Other reader comments added to the article are quite interesting. Mike, Sam, Disgusted, and The Order had some insightful political comments that will be investigated in a later blog post.

Tuesday, February 21, 2006

PPH Board Meeting Packet for Feb 23

The PPH Board Meeting Packet for the February 23, 2006 meeting is available at:
http://civics.robroy.cc/AgendaSummary.pdf Agenda & Summary
http://civics.robroy.cc/AA.pdf Addendum A (ERTC Devel Agmt)
http://civics.robroy.cc/AB.pdf Addendum B (MOU)
http://civics.robroy.cc/AC.pdf Addendum C (JRM Agreement)
http://civics.robroy.cc/AD.pdf Addendum D (ERTC CCR's)
http://civics.robroy.cc/AE.pdf Addendum E (SDG&E Agreement)
http://civics.robroy.cc/AF.pdf Addendum F (ERTC option close)
http://civics.robroy.cc/AG.pdf Addendum G (PDP Agmt)
http://civics.robroy.cc/AH.pdf Addendum H (Services Agmt)
http://civics.robroy.cc/AI.pdf Addendum I (Hospitalist Agmt)
http://civics.robroy.cc/AJ.pdf Addendum J (Jan. Fin. Report)

Take a look at sections 1.1 and 1.2 of the SDG&E Agreement (Addendum E). Now that is some Indemnification and Hold Harmless protection! Compare that with sections 3.6 and 3.7 of the ERTC Development Agreement with Escondido (Addendum A).

In Addendum C, a 50%/50% jointly owned PPH/JRM LLC gets to construct 300,000 square feet of medical office buildings (MOB) in two phases. Recall that the EIR Addendum showed 160,000 square feet of MOB which was projected to generate almost 50% of the traffic from ERTC Planning Area 4. Also, it appears that JRM can walk if the MOB projects are not feasible based on a financial calculation. The PPH/JRM Agreement also appears to lock other medical providers out the remaining land of the ERTC that is not owned by PPH.

Sunday, February 19, 2006

No Significant Environmental Impacts?

Ordinance No. 2006-09
"The City Council of the City of Escondido, California, DOES HEREBY ORDAIN as follows:
. . .
"SECTION 2. That the City Council has reviewed and considered the Addendum to the Final Environmental Impact Report for the Escondido Research and Technology Center (City Log No. ER-2001-12) and Mitigation Monitoring Report prepared for this project and has determined that all environmental issues associated with the project have been addressed and no significant environmental impacts will result from approving this project."

Has the City Council really reviewed the ERTC EIR Addendum? I quote from the ERTC EIR Addendum, Attachment 4, pages 7-8:

"3.2 Emergency Helicopter Operations Noise Impact
. . .
The maximum instantaneous noise levels would range from approximately 80 to 90 dB at the closest residences located west and northwest of the site. This maximum instantaneous noise level range is similar to a heavy truck at a distance of 50 feet. The maximum instantaneous noise level contours associated with helicopter landings or takeoffs are shown in Figure 5. The maximum instantaneous noise level inside the closest homes would vary depending if the windows are open or closed. If the windows are open, it is anticipated that th maximum sound level inside the closest homes could reach 75 dB. If the windows are closed, the maximum sound level could reach 70 dB. These noise levels could result in sleep disturbance for some of the occupants. Based on the recent helicopter records described in the previous paragraph, approximately four to five nighttime flights per month would be anticipated."
http://www.ci.escondido.ca.us/depts/cd/
planning/ertc/addendum.pdf


Is being subjected to sleep disturbances several times a month signficant?

The Escondido City Council has declared the following:
Escondido Municipal Code
"Sec. 17-226. General provisions.
(a) The city council of the City of Escondido finds and declares that:
(1) Inadequately controlled noise presents a growing danger to the health and welfare of the residents of the City of Escondido;
(2) The making and creating of disturbing, excessive, offensive or unusually loud noises within the jurisdictional limits of the City of Escondido is a condition which has persisted and the level and frequency of occurrence of such noises continue to increase;
(3) The making, creation or continuance of such excessive noises which are prolonged or unusual in their time, place and use effect and are a detriment to the public health, comfort, convenience, safety, welfare and prosperity of the residents of the City of Escondido;
(4) Every person is entitled to an environment in which the noise is not detrimental to his or her life, health and enjoyment of property; and
(5) The necessity in the public interest for the provisions and prohibitions hereinafter contained and enacted is declared to be a matter of legislative determination and public policy and it is further declared that the provisions and prohibitions hereinafter contained and enacted are in the pursuance of and for the purpose of securing and promoting the public health, comfort, convenience, safety, welfare, prosperity, peace and quiet of the City of Escondido and its inhabitants.
. . .
This decibel (dB) table compares some common sounds and shows how they rank in potential harm to hearing. Note that 70 dB is the point at which noise begins to harm hearing, that 60 dB is the threshold of stress response, and 45 dB disturbs sleep. To the ear, each 10 dB seems twice as loud."
http://ordlink.com/codes/escondid/
_DATA/TITLE17/
ARTICLE_12__NOISE_ABATEMENT_AND_CO/
Sec__17_226__General_provision.html

Friday, February 17, 2006

PPH Special Meeting For ERTC Approval - Feb. 23

[Agenda Abstract]
THURSDAY, FEBRUARY 23, 2006, 6:00 MEETING
PALOMAR MEDICAL CENTER
555 East Valley Parkway
Escondido, CA
Graybill Auditorium

PPH JOINT BOARD OF DIRECTORS AND FINANCE COMMITTEE MEETING
(SPECIAL BOARD MEETING AND REGULAR FINANCE COMMITTEE MEETING)
AGENDA POSTING ONLY
Detailed packet to be distributed Tuesday, February 21, 2006

CALL TO ORDER
- Public Comments
--ADJOURNMENT TO CLOSED SESSION
-pursuant to California Government Code §54956.8
Property: ERTC parcels 27-29 & 33-36
Agency Negotiator: Robert Hemker, CFO, PPH
Negotiating Parties: James McCann and Robert Hemker
Under Negotiation: Instruction to Negotiator regarding price, terms and conditions
Estimated date of public disclosure: February 2006
--ADJOURNMENT TO OPEN SESSION

-Action resulting from Closed Session, If Any
- Information Item(s)

1. Approval: Development Agreement Between PPH and the City of Escondido (Addendum A)
2. Approval: Memorandum of Understanding Between PPH and the City of Escondido Concerning the Preservation of Downtown Escondido and the Redevelopment of the Palomar Medical Center (Addendum B)
3. Approval: Development Agreement Between PPH and JRM-ERTC I, LLP (Addendum C)
4. Approval: Agreement as to the Form and Content of the CCR’s Governing the ERTC and the Association (Addendum D)
5. Approval: Ratification of SDG&E Indemnity Agreement for ERTC Properties (Addendum E)
6. Approval: Exercise of Purchase Option Agreement for ERTC Properties (Addendum F)
7. Approval: Operating Agreement with PDP Pomerado, LLC, a California Limited Liability Company (Addendum G)

- ADJOURNMENT TO FINANCE COMMITTEE MEETING

FINANCE COMMITTEE MEETING AGENDA

CALL TO ORDER

1. Review: Health Development Status Report
2. Approval: Administrative Services Agreements - POM (Addendum H)
Paul E. Tomembe, M.D. - Chief of Staff
Benjamin Kanter, M.D. - Chief of Staff Elect
Roger J. Achestal, M.D. - Chair, Quality Management Committee
3. Review: Hospitalist Programs at Palomar Medical Center and Pomerado Hospital (Addendum I)
4. Approval: January 2006 & YTD Financial Report (Addendum J)

- FINAL ADJOURNMENT

Tuesday, February 14, 2006

Will PPH Unite With Me To Save The Heart Of Downtown Escondido?

Last night , PPH called on community unity. I hope that PPH soon joins me in my efforts to Save The Heart Of Downtown Escondido, Palomar Medical Center, as a full-service hospital for the community.

Here is a summary of my comments made at the PPH board meeting last night::

1. Under the ERTC Development Agreement, the City of Escondido "shall diligently seek reimbursement from other developers who stand to benefit from the completion of the Citracado Parkway Improvements." I asked for clarification on that City obligation. Was the City obligated to seek reimbursement from developers in the west downtown area or as far away as Via Rancho Parkway?
2. I requested that the Valley Boulevard "crossover" be maintained or realigned no further west than the five "West Properties". I further argued against the total elimination of the crossover.
3. The "hold harmless" clause states that the clause "shall not apply to the extent such damage, liability, or claim is proximately caused by the intentional or negligent act or acts of the City", and the clause appears silent on the City's liability for acts by PPH or other parties.
4. My public records act request for the "Kaiser Agreement" was denied because it contained "trade secrets." PPH has discussed many parts of the Kaiser Agreement in public and those portions are not trade secrets. I requested that PPH redact any remaining trade secrets and make the agreement available for inspection and copy.
5. I noted that PPH is on the horns of a dilemma. I believe that Palomar Medical Center is a fine hospital with the newest emergency room in the area and that it should be saved as an acute care hospital. The emergency rooms at Fallbrook, Tri-City and Pomerado hospitals are all decades older. PPH keeps telling the public that PMC is an old and overcrowded facility. Yet, PMC is PPH's main source of revenue. PPH will continue to lose market share if it keeps making disparaging remarks about PMC. It must face this dilemma over the next 5 or 6 years. If PPH begins making positive and glowing remarks about PMC, they will be assisting me in my effort to "Save The Heart Of Downtown Escondido" as a full-service acute care hospital.

PPH Board Chair Dr. Rivera was so offended by my comments that he tried to cut me off before the allotted time, he told me I was wasting time, and he had his gavel at the ready a minute before the time limit. I ended my comments 30 seconds early.

Monday, February 13, 2006

Legal Liability Of The City Of Escondido - ERTC Hospital Location

I have reviewed these five documents:
1. ERTC EIR Addendum; 2. ERTC Specific Plan Amendment; 3. Finding of Fact and Statement of Overriding Considerations for the ERTC Specific Plan; 4. ERTC Development Agreement; 5. MOU

The MOU had some language regarding PPH's general liability insurance for the downtown PMC in section XVI (page 14), and Third Party Litigation in section XXIV (page 17). Nothing there appear to release the City of Liability.

The ERTC Development Agreement has several paragraphs relating to litigation: 3.6, 3.7, 3.8, 7.2, 7.7 and 7.8.

Paragraph 3.6 is the most relevant:
"3.6 Hold Harmless.
PPH agrees, to the extent permissible under the Local Health Care District Law, California Health and Safety Code, § 32000, et seq., to indemnify, hold harmless, and provide and pay all costs for a defense for the City, with legal counsel of the City’s choice at professionally reasonable rates, in any legal action filed in a court of competent jurisdiction by a third party challenging the validity of this Agreement. The provisions of this Section shall not apply to the extent such damage, liability, or claim is proximately caused by the intentional or negligent act or acts of the City, its officers, agents, employees, orrepresentatives."

My view is that the City will be indemnified for actions challenging the validity of the ERTC Development Agreement. However, the City is exposed to damages, liability and claims caused by acts of the City. The agreement appears to be silent on the City's exposure based on acts by PPH or other parties.

I did not find any language related to the City's Liability in the three remaining documents.

Sunday, February 12, 2006

Who Understood The Last Minute Concessions On Citracado Parkway Cost Reimbursement To PPH From Developer Fees

I have reviewed the video of the City Council meeting on February 8 with respect to the City's obligation to reimburse PPH with fees collected from other developers who stand to benefit from the completion of the Citracado Parkway Improvements. Based on my review of the comments made during the meeting, I place the probability of having understood the nature of the last minute reimbursement concession at the following percentages:

100% - Jeff Epp (at video time 03:47:34)
80% - Sam Abed (at video time 03:47:34)
50% - Jonathan Brindle (at video times 00:24:53; 00:25:50)
5% - Marie Waldron (at video time 04:04:40)
0% - Ed Gallo (at video time 03:23:48)

The other characters did not say enough to assign a probability of understanding.

The video of the Econdido City Council (6:30 meeting, video 4) is availabe at:
http://escondido.12milesout.com/Escondido/Default.aspx

Saturday, February 11, 2006

Last Minute Concessions To PPH On Their Share of Citracado Parkway Extension Costs

Last minute concessions by City negotiators to PPH included changes to the ERTC Development Agreement that shifted a significant portion of the costs for the Citracado Parkway extension from PPH to developers of future projects in the ERTC area. With what essentially amounts to a loan, PPH will advance $5 million to the City of Escondido for the costs of constructing Citracado Parkway. The PPH "loan" will be "reimbursed" to PPH over a period of 30 years from "developers who stand to benefit from the completion of Citracado Parkway" between Valley Parkway and Country Club Drive.

More specifically, the City of Escondido "shall diligently seek reimbursement from other developers who stand to benefit from the completion of the Citracado Parkway Improvements." And the "City shall report to PPH on an annual basis any Third-Source Funding it has sought, and any Third-Source funding it has received, and shall cooperate with PPH in accounting for the full cost of Citracado Parkway as constructed and total Third-Source funding to determine any such reimbursement."

The last minute concessions are set forth in the ERTC Development Agreement in paragraphs 3.1, 5.6.1 and 5.6.3:
http://civics.robroy.cc/rev-dev-agreement.pdf

With this diversion of future developer fees back to PPH, it is unlikely that Citracado Parkway will be completed between Valley Parkway and I-15 using developer fees from projects on the west side of Escondido during the term of the 30 year agreement.

It is most fascinating that there was no public discussion during the City Council meeting of this last minute concession by the City of Escondido to reimburse PPH with fees collected from future developers "who stand to benefit from the completion of Citracado Parkway" between Valley Parkway and Country Club Drive.

You can always trust that PPH will be consistent!

At the time of the City Council meeting, I wonder who understood the nature of this last minute concession to shift the costs of the Citracado Parkway extension from PPH to future developer fees.

Thursday, February 09, 2006

Escondido Decides To Trust PPH - Proposal Passes 5-0

After a last minute plea by PPH CEO, Michael Covert, requesting that the Escondido City Council not "legislate" PPH's future healthcare commitment at the downtown Palomar Medical Center after the hospital moves to the ERTC, the PPH proposal was passed by a vote of 5-0.

The meeting lasted almost until midnight. Spirited comments were presented for both sides of the issue, and it was clear that the crowd of 150+ persons included a large contingent of PPH employees.

Of curious note were representations related to supplemental environmental studies and modeling presented by Mr. Covert in his initial presentation.

The last minute plea was prompted by a request to insert language committing PPH to "24-hour Urgent Care if permitted by state law." During the discussion, it because apparent to another councilmember that the MOU did not even include a commitment to "23-hour Urgent Care" as presented and promised by Mr. Covert in previous public meeting in Escondido.

This writer looks forward to a March 1, 2006 (or soon thereafter) groundbreaking ceremony to kick off construction of the new hospital now that the zoning issue has been resolved. >;-)

The final drafts of the MOU and ERTC Development Agreement are available at:
http://civics.robroy.cc/rev-mou.pdf
http://civics.robroy.cc/rev-dev-agreement.pdf

Wednesday, February 08, 2006

Comments to the Escondido City Council Re: ERTC Approval

I want to acknowledge the goals, the vision, of PPH to be the health system of choice and to be recognized nationally for the highest quality of healthcare services. I understand their desire to build a new state-of-the-art hospital as part of that vision. I believe the Board when they say they represent the healthcare needs of an entire district, and not just the special interests of a particular community. I have listened to PPH’s assertions that the administrative cost of three acute-care hospitals would be too great. At its heart, the current Facilities Master Plan calls for two-acute care hospitals, one specialty hospital and four outpatient satellite facilities.

However, the current plan before you tonight has several flaws that seriously jeopardizes it successful implementation. First, no matter whether this proposal passes or fails, its pits the interests of one community against another. Further, it takes precious dollars away from healthcare and puts it into infrastructure. And it leaves a hole in the Heart of Downtown Escondido.

I call for a shift, not in the vision, but in the implementation. First, the current Pomerado Hospital site has about 30 buildable acres. The current expansion plans call for a modest addition of 160,000 square feet to that hospital. I suggest that PPH make more aggressive expansion plans for Pomerado Hospital, and make it a Hospital of the Future. Second, I suggest that PPH build its 72-bed specialty hospital in San Marcos. The specialty hospital could be tied with the outpatient satellite facility planned for San Marcos. Third, I urge that the Heart of Downtown Escondido be saved.

Palomar Medical Center is a fine acute-care hospital facility. Some have the mistaken belief that the buildings at Palomar Medical Center are over 50 years old. I am here to explain to you that none of the building are that old. In fact, half of the buildings are less than 20 years old, and the west parking structure is only 20 years old. Some claim that the site is too small. Last July, PPH presented a plan for the downtown site that included a modest hospital expansion building just east of the main tower. That building fits on the existing site with the removal of the old Adams Wing. At 10 stories, the hospital expansion building can replace the hospital functions now in the McLeod Tower when the Tower is eventually converted to medical and administrative office space. Some claim that the retrofit of Palomar Medical Center would be too expensive. An analysis in 1999 by structural engineers indicated a cost of $6.6 million to perform all needed seismic retrofit of Palomar Medical Center. Additionally, in its Facilities Master Plan, PPH failed to include about 100,000 square feet of hospital space that is in full compliance with the state’s structural seismic regulations. The 180,000 square feet of compliant space at Palomar Medical Center is larger that the current Pomerado Hospital, and the replacement cost of this space and the parking structures at Palomar Medical Center, in today’s dollars, is almost $200 million. What community can afford to dismantle a $200 million acute-care hospital facility. Palomar Medical Center, the Heart of Downtown Escondido, must be saved as a community hospital.

By more aggressively expanding Pomerado Hospital, by saving Palomar Medical Center, the Heart of Downtown Escondido, and by building a new 72-bed specialty hospital in San Marcos, PPH will be realizing its vision, PPH will be providing for the healthcare needs of the entire district, and PPH will have a plan that unites, rather than divides, our communities, and that will have a much higher chance of successful completion. Thank you for your time and patience.

Copies of Presentation Slides:
http://civics.robroy.cc/PMCexpansion.pdf
http://civics.robroy.cc/PMCevalLtr.pdf

Monday, February 06, 2006

Respecting The Integrity of the August Compromise

A letter to the Escondido Mayor and City Council Members:

The ERTC Specific Plan Amendment and the EIR Addendum presented by Palomar Pomerado Health fail to respect the integrity of the compromise reached by the parties last August. The compromise was for the City of Escondido to allow hospital uses on all of the acreage PPH was purchasing in the ERTC, and for PPH to partner with the City to make long-term improvement to infrastructure, including Citracado Parkway, and to enter into a development agreement for the downtown facility.

In addition to building a hospital in the ERTC, PPH now has ambitions to be a landlord for medical office buildings in the ERTC. PPH does not have title to most of the property on which it proposes building the hospital in the ERTC. The title resides in the hands of JRM-ERTC. To obtain title to the property, PPH must enter into a development agreement with JRM-ERTC to allow JRM-ERTC to develop up to 300,000 square feet of medical office building space and accompanying parking on the land to be acquired by PPH. These proposed private developer medical office buildings are an attack on the integrity of the August compromise.

In his letter dated August 18, 2005, the PPH Board Chairman wrote “[t]he new campus will feature an acute care hospital, trauma and emergency services in addition to oncology, cardiology and women’s centers of excellence. As the North County’s population continues to age, their health needs will become more acute and require highly specialized care as well. It is for these reasons that we cannot repeat mistakes made by other health systems. We must have the acreage needed to allow for necessary expansion.”

The Chairman’s letter had no hint of the need of acreage for private developer medical office buildings. And the attached “Master Plan” with a map of building and parking locations that was provided to the ad hoc Hospital Site Subcommittee failed to provide any hint of private developer medical office buildings on the ERTC site. The attached Tables 7-1 and 7-2 from the ERTC EIR Addendum indicates that all of the increased traffic for proposed Planning Area 4 will be generated by the private developer medical office buildings.
http://civics.robroy.cc/LtrEsco020206a.pdf

Further, all square footage limits have been removed for proposed Planning Area 4, as shown in attached pages 10 and 11 from the SPA. At the time of the compromise, the PPH’s Facility Master Plan showed 811,200 square feet of building space for the new facility, including support services, as shown on attached page 2-3. The unlimited building space proposal for Planning Area 4 is another attack on the integrity of the August compromise.

Regarding, Citracado Parkway, PPH proposes extension only to Valley Parkway. Valley Parkway at a location between Citracado and I-15 is only 2 lanes! Failure to complete Citracado Parkway to I-15 is another attack on the August compromise.

Finally, PPH promised the City of Escondido that it would undertake a redevelopment effort for the existing downtown site. The redevelopment effort included the construction of a large hospital expansion to the east of the current hospital buildings at PMC as shown in the attached Master Plan. Without completion of the redevelopment effort by PPH, it is likely that the move of the hospital, and associated medical offices and support businesses, will result in urban decay and blight in the downtown areas surrounding the existing hospital. The potential for urban decay is not address in the ERTC EIR addendum as required by the California Environmental Quality Act. (Citizens Assn. For Sensible Development of Bishop Area, and Bakersfield Citizens for Local Control)

PPH has indicated that it wants to sign a Memorandum of Understanding rather than a Development Agreement for the existing site redevelopment effort. Failure to enter into a binding Development Agreement for the redevelopment effort for the downtown site, or alternatively, failure to address the potential for urban decay and blight in the downtown areas surrounding the existing hospital, are additional attacks on the integrity of the August compromise.

In summary, PPH and the Escondido City Council should respect the integrity of the August compromise. If a hospital is allowed in the ERTC, only a hospital and hospital support buildings, on the order of 800,000 square feet, should be allowed in proposed Planning Area 4 of the ERTC. Citracado Parkway should be completed to I-15. And PPH should enter into a binding agreement requiring a redevelopment effort for the existing downtown site, or PPH should prepare an EIR, with ample public input, that addresses the potential for urban decay and blight in the downtown area resulting from the hospital move.

Thank you for consideration of my comments.

Saturday, February 04, 2006

Plan C - A Greater Role For Pomerado Hospital

Pomerado Hospital should be considered for a greater role in the Palomar Pomerado Health hospital facilities expansion plans.

Plan A, expansion in the ERTC, is now on life support and may expire in a few days. Plan B, expansion in San Marcos, is burdened with infrastructure and land acquisition cost issues. Another factor against Plan B is political. Also, PPH claims that administrative costs are a barrier to a three hospital solution.

"Plan C" is a suggestion to build more hospital space at Pomerado Hospital than is presently contemplated, to build a several hundred patient bed tower at Palomar Medical Center (PMC), and to convert the McLeod Tower to non-acute care uses.

The Pomerado Hospital site occupies about 30 buildable acres. A significant portion of the buildable land is occupied by a single story skilled nursing facility. The current proposal calls for the construction of 161,000 square feet of new hospital space at Pomerado Hospital, resulting in a total of 312,000 square feet of hospital space at the site. By sacrificing part of the skilled nursing facility, the hospital expansion could be greatly increased to about 350,000 square feet, resulting in a total of about 500,000 squre feet of hospital space at the Pomerado Hospital site. The increased expansion of Pomerado Hospital would relieve much of the expansion burden on the current PMC facility in Escondido.

A hospital expansion building of about 240,000 square feet, as shown the slides presented by PPH to Escondido at a Public Forum on July 28, 2005, could be built on the site of the current PMC. The 46-year old Adams Wing would need to be removed to make room for the new expansion building.


The hospital expansion building would fit nicely on the existing PMC site with the removal of the Adams Wing.

Further consideration of "Plan C" is warranted, particularly if the hurdles facing the ERTC site cannot be overcome.

Friday, February 03, 2006

Draft PPH/Escondido Agreements

The draft agreements between Palomar Pomerado Health and the City of Escondido are now available.

Ord. No. 2006-10 (ERTC Specific Plan Amendment)
http://civics.robroy.cc/I22a.pdf
Ord. No. 2006-09 (Infrastructure/Citracado Development Agreement)
http://civics.robroy.cc/I22b.pdf
Res. No. 2006-34 (Downtown PMC Memorandum of Understanding [MOU])
http://civics.robroy.cc/I22c.pdf
Staff Summary of Planning Commission Meeting of January 24, 2006
http://civics.robroy.cc/StaffSummaryCPr.pdf

The Story of Prop BB (Updated)

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 finding that it be more expensive to retrofit and upgrade the existing Palomar Medical Center than it would be to build a new medical center is interesing. According to a newspaper report in 2003:
"Palomar Pomerado board members decided in 2001 to spend more to completely redesign their hospitals instead of spending $56 million to simply install braces and supports to meet the 2008 standards. The $329 million project is essentially two jobs: In November, board members approved spending a maximum of $266 million to build a new patient-treatment tower ---- to replace the current tower that will be demolished ---- at the 319-bed Palomar Medical Center; and up to an additional $63 million to build a new patient tower, medical office building and increase the number of beds at the 119-bed Pomerado Hospital."
http://www.nctimes.com/articles/
2003/03/20/export6141.txt


According to PPH math, $56 million is "significantly more expensive" than $531 million (now up to $690 million).
Further, according to Proposition BB, PPH relied on reports prepared by outside experts. On September 28, an application was made to PPH to inspect and copy the following:
1. Compliance plan submitted to OSHPD for the Palomar Medical Center (PMC).
2. Request for Extension to Seismic Safety Deadlines submitted to OSHPD for PMC.
3. Seismic evaluation of the McLeod Tower at PMC.
4. Reports, documents, spreadsheets, calculations, analysis, and/or information used to determine a Structural Performance Category (SPC), for the McLeod Tower at PMC.
5. Reports, documents, spreadsheets, calculations, analysis, and/or information used to determine estimated cost of upgrading the McLeod Tower at PMC to a level above an SPC-1.
A copy of the application is available at the following link:
http://civics.robroy.cc/PPH-Request09-28-05.pdf

The reponse to the above request was a report prepared by an outside experts (structural engineers): "SB1953 Seismic Evaluation of Palomar Medical Center (Phase Report 1A), dated October 25, 1999"
http://civics.robroy.cc/PMC-SeismicEval10-25-99partial.pdf (2 MB)
http://civics.robroy.cc/PMC-SeismicEval10-25-99cont.pdf (10 MB)

The cost estimates for the seismic improvements to Palomar Medical Center were amazingly low. The structural engineers recommended that PPH "allocate a budget allowance totalling at least $6,670,000 for the direct construction costs of SB 1953 seismic retrofit measures" for Palomar Medical Center!

According to PPH math, $6.67 million is "significantly more expensive" than $531 million (now up to $690 million).

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://civics.robroy.cc/
PPHMasterFacilityPlan07-2004p300.pdf
(5.2 MB)
The lower resolution version (1.9 MB) is still available at:
http://members.cox.net/4robroy/escondido/
PPHMasterFacilityPlan07-2004p150PDF.pdf


Prop BB, an interesting story.

Thursday, February 02, 2006

Earthquakes, Natural Gas & The ERTC

The California Energy Commission, in approving the Palomar Energy Project in the ERTC, wrote the following:
"Failures of gas pipelines, according to data from the U.S. Department of Transportation (the National Transportation Safety Board) from the period 1984 - 1991, occur as a result of pipeline corrosion, pipeline construction or materials defects, rupture by heavy equipment excavating in the area such as bulldozers and backhoes, weather effects, and earthquakes. Given the gas line failures which occurred in the Marina District of San Francisco during the1989 Loma Prieta earthquake, the January 1994 Northridge earthquake in Southern California, and the January 1995 gas pipeline failures in Kobe, Japan, as well as the January 19, 1995 gas explosion in San Francisco, the safety of the gas pipeline is of paramount importance."
. . .
"Outside forces are the primary causes of incidents. Damage from outside forces includes damage caused by use of heavy mechanical equipment near pipelines (e.g., bulldozers and backhoes used in excavation activities), weather effects, vandalism, and earthquake-caused rupture as seen in the Marina District of San Francisco during the 1989 Loma Prieta Quake and in Kobe, Japan in January 1995. The fourth category, 'Other' includes equipment component failure, compressor station failures, operator errors and sabotage. The average annual service incident frequency for natural gas transmission systems varies with age, the diameter of the pipeline, and the amount of corrosion."
http://civics.robroy.cc/ERTCearthquake.pdf

A large natural gas pipeline runs under the northern end of Citracado Parkway in the ERTC to supply the 550 megawatt electric power plant located across the street from the PPH proposed hospital site.

Making sure that the inland north county's only Trauma Center is available in the event of any disaster (particularly an earthquake) is no longer a goal of PPH? During the campaign for Proposition BB to raise $496 million from property taxes, PPH had this to say:

"PPH operates the only Trauma Center in North County. As an ER nurse for the past 24 years, I have seen the dramatic increase in need for emergency services. We must ensure we can address any emergency situation, from an earthquake to a terrorist attack.”— Kim Colonnelli, R.N.Director of Emergency & Trauma Services
http://www.pph.org/documents/Community%20Advertisements/PPH%20Urgent%20Update.pdf

http://civics.robroy.cc/PPHearthquakeScareC.wmv