While a healthcare district board divided in an apparent 3-2 split wrangles over whether to revoke two leadership posts the previous board approved in November, the future direction of the district itself appears to be at stake.
The district’s own attorney has advised trustees not to take that step, which he said would be potentially divisive and very unusual.
At issue is whether the board should focus its efforts on what the Cambria Community Healthcare District has specialized in for the past 64 years — transporting ill people, accident victims and others to the hospital for emergency treatment. Or should the district branch out by encouraging more doctors to practice on the North Coast and/or running or contracting for an emergency facility or mini-hospital, which could cost ratepayers more money?
All the trustees say they want the district to provide more healthcare opportunities and education, but the debate appears to center on the degree to which that would be done, and how. Discussions in the past also have included whether the district should continue to run the ambulance service, or have a separate provider elsewhere contract to do it.
The decision on removing President Mike McLaughlin and Vice President Barbara Bronson Gray from their posts could be made Tuesday, July 28, during the trustees’ monthly meeting, which starts at 6 p.m. at Rabobank, 1070 Main St.
A large crowd is expected at Tuesday’s meeting, which could cap a period of tension on the board characterized by strongly worded exchanges that led observers at June's meeting to label the board "dysfunctional."
Some trustees have said Bronson Gray didn’t have board approval to expand an examination of district services as far as she did and that her management style has damaged the board’s relationship with staff.
Director Bob Putney said Bronson Gray has “made it clear she wants to move ahead to have an expanded healthcare facility, and the board hasn’t considered that yet. A majority of taxpayers may not support that, because it may cost them more money.”
Director Mary Ann Meyer agreed, saying Bronson Gray’s agenda is to “open an urgent-care facility. She brings it up two, three, four times a meeting. Morro Bay has an urgent-care facility, and they’re barely surviving,” with a larger population base in town and Los Osos nearby.
If the board’s leadership rotation follows a customary pattern, Bronson Gray would be president next year.
She said her goal is bringing information to the public and requiring quality service to patients, and that she has never insulted staff or her fellow board members in public, as some have accused her of doing.
Bronson Gray also said, “Mike and I are focused on the issues, positioning the CCHD to provide a continuum of services, including our current ambulance service, to meet the expressed needs of the community.
“Despite our clear statement of this objective, you’ve heard the rumors that people are spreading that we want to get rid of our ambulance service, which is absolutely false.”
The board majority — directors Putney, Meyer and Kristi Jenkins — have disagreed occasionally with how McLaughlin votes, runs meetings and oversees board operations. Meanwhile, much of the vocal criticism has focused on Bronson Gray, including her work with the nurses committee.
McLaughlin said the board will “have differences of opinion, but I’m not sure what’s driving this. … I’m not guilty of any high crimes and misdemeanors.” He said the board majority’s goal “is not clear to me, especially with only three months to go (in the term) and so much good work to do.”
Both said that, before the board makes any decisions on changes to the district’s operations, trustees would have to host focus groups and public forums, as Bronson Gray said, “to better define those needs as we talk with potential providers and health systems.”
The district operates an advanced-support ambulance service, maintains a volunteer crisis intervention team, owns a professional medical building and provides community healthcare education. CCHD is supported by taxes, fees and the public.
The district has negotiated off and on for years with the Cambria Community Services District about combining services, management, staff and/or locations. A recent San Luis Obispo County grand jury report about North Coast emergency services recommended that the two districts re-energize those talks to see whether agreements can be finalized.
McLaughlin and Bronson Gray served on an ad hoc committee that met in response to the grand jury report.
If Putney, Jenkins and Meyer (the newcomer to the board) do strip McLaughlin and Bronson Gray of their titles and responsibilities Tuesday, a subsequent election likely would return Putney and Jenkins to the posts they’ve shared for the past five years. That’s a bone of contention for the current officers, who maintain that rotation of leadership responsibilities is included in the district’s bylaws.
District counsel Raymond Biering said in June that clause “vaguely addresses” the practice “where officers rotate through succession.”
Changing president and vice president in mid-year, with another election of officers due in November, is legal, Biering said, but it’s not a step he recommends. In 35 years of legal practice, including representing many agencies and boards, including a board of supervisors and many state agencies, he said, “this is the first time I’ve seen something like this. … Removing an officer can be a very disruptive kind of process,” and divisive.
Biering explained, “When I look at removal of an officer, I think of it in terms of malfeasance in office, or some action that’s causing significant detriment to the district. I think, in good conscience, there really needs to be” such a cause before removing an officer, “but I don’t know that there’s a legal requirement” for that cause to be there.
Later in the meeting, he said, “As your counsel, giving my heartfelt advice, you’ve got an organizational election in November that’s only a few months off” and a strategic planning workshop on June 29 “that would be a really good time for the board to engage in that kind of robust discussion.”
At that strategic-planning meeting, the trustees discussed a need for civil discussion and public discourse, but there was disagreement about what those terms meant.
Biering decried attacks by one board member on another, and said that “our job is to help you provide health care, especially ambulance, for the community, and I think you do it very well. Unless there’s a strong position to move on” with removing McLaughlin and Bronson Gray from their leadership roles, “I’d urge you to avoid it.”
No matter what the board decides about its leadership, McLaughlin and Bronson Gray would remain on the board, but the degree of their influence likely would change.
Both have been active in pushing for and researching about the emergency-care facility, saying the district should be more active in all phases of health care, as is allowed in their bylaws.
The current ambulance function could remain as it is or be contracted for with an outside agency, an option that’s been discussed for years, especially during budget negotiations that focus on salaries and benefits.
There is precedent for the district handling more than ambulance services. According to the district website at www.cambria-healthcare.org, in 1957, CCHD bought two Main Street lots for $3,500, and began building the current clinic building to provide medical offices to be leased to a physician. The district also began buying medical equipment for the physicians to use.
In recent years, the district has been battling to balance its budget, especially given falling reimbursement rates from Medicare in a community that has a high percentage of seniors and the elderly. Also, according to Jenkins, the state is pushing health care districts to expand their services.
Normally, such questions about the district’s future focus would be asked first of the community’s population and the voters who might have to pay more per year for the added facilities, such as an emergency-treatment clinic. Studies would be done to see whether North Coast population and demographics could support such a facility.
That hasn’t happened yet, although Bronson Gray got board approval in December to hold one meeting with a group of nurses, to learn what they’ve experienced in the field on the North Coast.
She then expanded that effort, holding multiple meetings with the group and having participants ask some on the North Coast to fill out a small survey on the area’s health care needs.
After a couple of outsiders received the survey and passed it on to others online, the document went locally viral.
A report on the subsequent nurses’ meetings is also expected to be part of Tuesday’s meeting, along with a report on a July 14 meeting that Shirley Bianchi, Bronson Gray and McLaughlin had with Alan Iftiniuk, president/CEO of French Medical Center of Dignity Health. Bianchi is a former county supervisor and planning commissioner who also served on the CCHD board in the early 1980s and who was integrally involved with the county’s negotiations about General Hospital and Catholic Healthcare West’s purchase of what was then French Hospital.
Bianchi said that Iftiniuk seemed quite interested in the prospect of establishing a clinic in Cambria, and that district representatives also will meet further with representatives of Community Health Centers of the Central Coast, which already operates a regular clinic in Cambria, to see whether it’s feasible for that nonprofit to expand into providing 24/7 emergency care.