League of Women Voters - Part 2 Meeting

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[0] SPEAKER_20: sponsored by the League of Women Voters. My name is Mary Miller. I am a member of the League of Women Voters of Fremont, Newark, and Union City, and am the moderator for this evening's forum. The purpose of the League of Women Voters is to promote political responsibility through informed and active participation of citizens in government. The League is nonpartisan. support or oppose any political party or candidate. The league is, however, political in that it reaches positions on selected governmental issues after member study and agreement and takes action for positive change on those positions. Here are the ground rules for this forum. Questions have been collected from the audience and have been sent to us. We sort them by our question sorters here to ensure that a variety of issues are covered. Due to time constraints, we may not be able to ask every question submitted. Each candidate will have a minute and a half to answer the questions, and then we'll conclude with a minute and a half closing statement. Our timekeepers are seated up front, and we'll raise a 15-second card, letting the speaker know there are only 15 seconds remaining, and a stop card when time is up. Candidates, if you would like me to repeat a question, just ask. And also, do not feel you need to use the entire minute and a half, unless you want to. Let's see, we expect the audience to give each speaker the opportunity to be heard, and please hold your applause until the end. So now that you know the format, please meet our candidates, Dr. Jacob Epen, Mr. Bernard Stewart, and Mr. Michael Wallace. We'll start the questioning. I'll change the format so you're not always following the same person. Everybody gets to be first. Everybody gets to be last. And therefore, everybody gets to be in the middle. So first question, we'll start with Dr. Eapon. What do you see as the biggest challenges before the hospital in the next five to ten years?

[144] SPEAKER_08: so fast, and the cost of health care has risen so much. It's on an average about 2.5% of the GDP, which is larger than the economic growth. We spend about 20% of the GDP for health care in this country, which is the highest. The closest second, I think, is only about 11%. On an average, that's about $10,000 per capita per person. So I think the rising cost in health care, I think, is one of the biggest challenges that the health care industry in this country would face. It's already facing, but I think it's going to get worse. And for the same reason, many of the hospitals and the hospital industry have closed, even in this state. In 2018, I think about eight hospitals in this country have closed down, mostly because filing bankruptcy just cannot afford to keep the doors open. That includes about two hospitals in California. So I think the biggest challenge is that, and the second would be to keep up with the technology. The technology is changing so much, and we've got to catch up with the technology, which again is directly related to the cost increase.

[236] SPEAKER_20: Thank you. And Dr. Stewart, the same question?

[240] SPEAKER_10: Happy to be here tonight. The hospital faces... Is your mic on? I hope so.

[247] SPEAKER_20: Can you hear? Okay, sorry.

[249] SPEAKER_10: I'll speak louder. Okay. Hospitals face tremendous challenges right now. I believe there are several very, very serious challenges to the hospital at the moment. A thing that a lot of people don't understand is that the Medi-Cal and Medicare systems do not pay the cost of care. In fact, they pay about 40 percent of the cost of care. And so every Medicare patient, every Medi-Cal patient that enters the hospital, enters the hospital and causes a loss of revenue. 70 percent of the hospital's business is Medicare and Medi-Cal. So, you can see the difficulties of maintaining a bottom line. Tremendous challenges. We've been very fortunate to have a system where we've been able to stay on top of those things, but it is a challenge. As Dr. Epen mentioned, some hospitals are closing. A second concern that I have is we have a need to build a new hospital. There is a state mandate to build new hospitals to bring them up to earthquake standards.

[334] SPEAKER_20: Thank you. And finally, Mr. Wallace, the same question.

[338] SPEAKER_32: Good evening, everyone. Dr. Eapon noted the impact of the cost increases, and I think Dr. Stewart has indicated the impact of revenue declines. When I got on the hospital board 28 years ago, the hospital collected roughly 70 cents on every dollar bill. And in the recent months, we collect 30 cents on the dollar bill. So you can see this humongous shift in revenue that the hospital is getting from insurance companies. Nonetheless, the hospital has been able to manage a tremendous bottom line through great management. And over the last year, for instance, the hospital generated well over $20 million in profits, which is plowed back into the hospital. So even with these forces, the hospital is doing quite well. I agree with Dr. Stewart that the biggest challenge is building the tower that has to be built by 2030 in order to comply with the mandated seismic standards. So that probably is the biggest challenge. We look forward to another bond issue in the coming years to raise the money to build that new tower.

[430] SPEAKER_20: Thank you. The second question is What impact will it have on the services you provide if the Affordable Care Act is repealed? And we'll start with Dr. Stewart this time.

[444] SPEAKER_10: That is really an interesting subject. When the Affordable Care Act was first instituted, we complained about that. We thought it would be very difficult and cause troubles, and yes, it was very difficult and caused troubles, but we were able to adjust to that in some ways and begin to function with that in some ways, now we have a new administration that is gradually tearing that apart and taking it apart piece by piece. And so you can see our position that we got used to it, we adapted to it, we worked around it, and now It's being changed again where we have to adapt to it again. This is just an indication of how difficult it is to maintain a bottom line in a hospital at the moment. That's why Alta Bates is being closed up in Berkeley. The impact of the ACA is a tremendous impact and it is changing almost daily. which is a challenge that we're anxious to meet, we're anxious to stay in business, we're anxious to provide the community with the health care that we're originally set up to do. And so far, we've been able to do that.

[526] SPEAKER_20: Thank you. And Mr. Wallace, the same question.

[529] SPEAKER_32: Well, I think that the hospital weathered the storm before the ACA, during the ACA, And if it is repealed, the hospital will respond and continue to provide the services the community needs. So I do not see the impact on the hospital's business in a way that will cause the hospital to fail or to stop delivering the quality of services that it presently provides.

[572] SPEAKER_20: Thank you. And Dr. Ethan.

[575] SPEAKER_08: I think the Affordable Care Act actually was brought into because we had about 40 million people in this country who had no insurance at all. And most of them didn't have any primary care physicians. They didn't have any preventive care. And most of them landed up in the ER. which again, like I was saying, increased the cost of hospital care. And this was at least a solution to reduce the number, but even I should note that the ACA, the Affordable Care Act, didn't do justice to all the 40 million. I mean, after the ACA was introduced, I think about 27 million people were insured. And there was still quite a bit of uninsured population in the country, I think about 4 people in California were still uninsured. I can speak for that because I work for a safety net clinic. I work for the Alameda health system. My clinic is just two blocks from here. I have seen the effects of it. Unfortunately, although it is not repelled, exchange where people go to get this, it is called exchange in California, a lot of insurances have withdrawn from the exchange. So giving clients a limited choice to get the ACA even if they can afford to get it. So it's a shame something has to be done.

[675] SPEAKER_20: Thank you. Okay, this next question will start with you Dr. Eaton. So there are two questions here that are essentially the same.

[686] SPEAKER_10: Excuse me. I think you meant to say Dr. Wallace. He's up next.

[690] SPEAKER_20: Oh, I'm sorry. I didn't let you finish.

[692] SPEAKER_32: I'm not a doctor.

[696] SPEAKER_10: He's a doctor of finance. Well, on TV I'm a doctor.

[702] SPEAKER_20: I am so sorry. I'm very embarrassed. Please.

[710] SPEAKER_32: Go ahead. I didn't hear the question.

[712] SPEAKER_20: Oh, no. No, this question. No, we're going in a different order for the third question. I thought you meant I didn't let you talk.

[717] Penny DeLeon: Oh, no.

[718] SPEAKER_20: OK, so the question is, many elected boards and commissions have term limits. What is your opinion of term limits? And then related, there was a 2014 grand jury recommended term limits for the board. So do you agree or not? We'll start with Mr. Wallace, then Dr. Eapon, and then, I'm sorry, Dr. Eapon, Mr. Wallace, Dr. Stewart. Yeah. I don't want you all following each other. Get a chance to speak first.

[749] SPEAKER_32: Who would you like to go first?

[751] SPEAKER_20: I'd like you to go first. Oh, OK. I'm sorry. I'd like Dr. Eaton to go first. OK. We're shuffling right here. Yeah. Dr. Eaton? Dr. Eaton, yeah. I know you just spoke. Please speak again.

[763] Jodi Croce: Can you speak into the microphone a little closer, please?

[769] SPEAKER_08: You know, I have no problems in limiting the term. But there are some pros and cons in this. And especially in an industry like ours, in hospital, anyone who comes into the board, it takes a few years for them to learn the ropes and get used to what's happening in the hospital setting. I think one of the positive things that has happened in our board is we have had a board for about 14 years. That hasn't changed. I don't know if it's in the history of the hospital, the last 60 years, this probably may be the longest standing board. But in this 14 years, a lot of positive things have happened too. The hospital has been now rated in the top 100 hospitals in the country by health grades and by US News and World Report. Our orthopedic surgery unit has been ranked in the top 100 departments in the country. And health grades have consistently ranked quite a few of our departments in the top, given five-star rating. So I think all this possibly achieved because, you know, some of the, that the board was able to understand each other. and strategize things for a long term.

[866] SPEAKER_20: Thank you. And now Mr. Wallace.

[872] SPEAKER_32: I think that that's something that the people would have to decide. In terms of my own opinion, there are some agencies which I think would make some sense. In our particular instance, I don't think that it would. The worst thing I think that would happen is a potential for partisan politics, and I don't think that has any place in the hospital healthcare arena. And as Dr. Eapon mentioned, it does take a certain amount of experience to understand the nuances of managing the management team of the hospital takes a fairly good educational cycle to do that. So I wouldn't be for it in the hospital setting. Certain city councils, I'm all for it. But no, I'm just kidding there. But certain places I think it's appropriate. I don't know that it's done a lot of good in the state. or in places where term limits are in effect, but certainly not in the healthcare district.

[959] SPEAKER_20: Thank you. And Dr. Stewart, the same question.

[964] SPEAKER_10: When I decided to run originally to be on the board of directors, I thought that I had a lot of preparation and I thought that I was really prepared to do that. I had attended every board meeting for a year prior to running for the office. I'm a dentist. I had practiced dentistry for over 40 years. And I thought I understood insurance and billing for insurance and patients' needs and serving and building a business and so on. And honestly, I was shocked at what faced me when I first got on the board. It is a tremendous, difficult thing to understand and to follow and to keep it on an even keel. And I would be opposed to term limits in the hospital setting. The other great disadvantage that I see in term limits are, you know, particularly right now at the election time, there are elected officials that are out there campaigning because they have a term limit and they need to campaign every two years. What that means is you're campaigning all the time, and that instills partisanship, it instills all kinds of difficulties when you've got someone that's interested in being elected rather than serving.

[1057] SPEAKER_20: Thank you. Okay, let's see, we're on the fourth question. How does the board reach out to the public to get input on important policy issues? Okay, and we'll start this question with Mr. Wallace.

[1083] SPEAKER_32: That is a really good question. The amount of time I spend trying to just make the public aware that they own the hospital is one of the biggest challenges that I face when I run campaigns, either for myself or for different bond measures. Awareness of the hospital's existence and the fact that the residents own the hospital is the paramount challenge that I face. We circulate periodicals. on a quarterly basis to the public. We have Channel 78 that we have on the Comcast to show our board meetings and various types of seminars, health care seminars that we have. We conduct a lot of different seminars for the public that are free and open to the public at our facilities. It's an ongoing outreach, and it's a challenge.

[1167] SPEAKER_20: Thank you. And Dr. Stewart, same question.

[1172] SPEAKER_10: The hospital regularly does a community needs assessment. Where we go into a community, the hospital encompasses all of Fremont, all of Newark, all of Union City, part of Hayward, and part of Sunol. That's the hospital district. That's a very, very large area. But regularly we do a community needs assessment where we go into those communities and find what exactly is needed health-wise and to some degree also what is wanted by the public for the hospital. And that's a good way to get an understanding. Just an aside on that, we found this last survey that 40 percent of the tuberculosis in Alameda County is centered in Newark. And that's a little bit of a shock. I said 30 percent, I'm sorry, 30 percent. And so those are all ways we reach out. The other way that I think is very important to reach out is our public television, our Channel 78, as Mr. Wallace has mentioned. We have open board meetings that are televised. We have open board meetings that the public is invited to. We always have a section on the agenda where the public is invited to speak. We are a public community hospital. The hospital is owned by this community and we're anxious to serve this community.

[1266] SPEAKER_20: Thank you. Dr. Ipan.

[1272] SPEAKER_08: What both my colleagues have said is pretty much the same. I mean, like Bonnie was saying, we have this open door board meeting where public is invited to come and give their input. I really wish there would be more participation, more than what we see these days. Our InHealth channel pretty much gives a lot of topics on health education. We have live lectures. But is there a room to increase the transparency? Is there a space for that? I think there is. But I think any input from the public, I think, as far as I'm concerned, will be most welcome.

[1320] SPEAKER_20: Thank you. This next question, let's see. We'll start with Dr. Stewart and then Mr. Wallace. than Dr. Eban. DEVCO is part of the board's responsibility that is not transparent to the public. The board appoints its members. Please explain DEVCO's function as you understand it and discuss why its operations are conducted in closed sessions. How can the taxpayers better understand and participate in this public entity? So this is about DEVCO.

[1362] SPEAKER_10: Devco is a result of SB 1225, a law passed in California that allows district hospitals to form a non-profit corporation to transact business that benefits the district. It's not correct to say that that agency is not open to the public. First of all, the members of that board are public citizens. They are drawn from the public, and we're anxious to appoint people that are in the public and separate from the hospital. They have open board meetings where you can attend and understand the workings of the Devco board. It's not a secret organization. It's not something that we're trying to hide our business from. that a public entity, the hospital, a publicly owned entity can form a non-profit corporation to run business entities that support the hospital and the district.

[1436] SPEAKER_20: Thank you. And Mr. Wallace?

[1438] SPEAKER_32: Yes, and adding to what Dr. Stewart has said, and those entities provide services that are very important to the district residents that would be not easily, or if at all, provided for in the hospital proper. The radiology is an example. The services that that department, so to speak, provides is essential to the district residents. And I think the legislature in their wisdom saw that public hospitals, and California is kind of unique in that there are district hospitals throughout the state that must compete with other hospital entities such as Kaiser or Sutter. And in order to compete with those entities for the benefit of the district residents, they sought in their wisdom to create this type of non-profit organization, which the hospital totally controls.

[1512] SPEAKER_20: Okay. Dr. Eban.

[1514] SPEAKER_08: Yeah, just for a second, like Michael was just mentioning, it is just one form of conducting business. If we don't do that, we just cannot compete with other hospitals around the town. In the same way, we have set up this foundation. Hospitals are not in California are not allowed to employ doctors. That's one of the reasons why a foundation was created. And we have doctors, physicians working in the foundation. We have about 100 doctors. And that's the same like Kaiser model. I mean, Kaiser Foundation is the one that employs the doctors. Kaiser Permanente itself cannot employ doctors. So this is just one way of doing business in the community. And like Bernie was saying, Yeah, I think the depot board meetings are open, open to public.

[1568] SPEAKER_20: Okay, thank you. And one last. Last question before our closing statements. Most board members are medical professionals, which gives the appearance of a lack of community representation. Explain how you will be a trustee who represents the interests of our diverse community. Oh, I'm sorry, Anne, starting with Mr. Wallace.

[1599] SPEAKER_32: Well, I guess I have the good fortune of saying I'm not a physician. And in my 45 years of doing business in Fremont in the leadership of Fremont Bank, and presently I'm the chairman of the board of Fremont Bank, I have had the honor and the privilege of serving the residents of our community in various financial needs. And so I find that I don't know that as much as healthcare issues as Dr. Eaton or Dr. Stewart. And I think I bring that sort of balance to the board.

[1646] SPEAKER_20: Okay, thank you. And Dr. Eaton?

[1649] SPEAKER_08: Well, I think there's nothing around a physician being on the board of a hospital. But beyond that, I've been in Fremont for about 34 years. And I worked and served this community for that long. I worked in the community health clinics here in Union City. I was a medical director 25 years ago. And since then, I've been working for the Alameda Health System. I'm one of the medical directors for them, making decisions for most of this population. So I think it's good to have a representation from that population and the public health. Because mostly now we are all changing into population health, which is basically public health. So I think I think I'm a strong board member in the hospital.

[1717] SPEAKER_20: Thank you. Dr. Stewart.

[1720] SPEAKER_10: First of all, I think we have to understand that as we sit here tonight, this is an elected position. The hospital really doesn't have a choice as to who's on the board. And we do have two physicians on the board, Dr. Epen and Dr. Nicholson. We have a dentist on the board. And we have two other folks. Michael Wallace gives us a wonderful perspective on financial things. I think it's important to have that perspective, that physician's perspective on the board. I think it's also important to make clear that of all the board members, Dr. Nicholson is the only one that has privileges at the hospital. that it's fairly diverse. It's fairly diverse. We have a good representation of the community, I think. But I think it is a danger in the hospital, district hospital. It's a danger that anybody could be elected to us. And it could be someone who would be detrimental to the board even. I think it's very, very important for the right people to be on that board, and I'm not too worried about the overabundance of physicians or medical people on the board. I respect and I'm anxious to have their input.

[1815] SPEAKER_20: Thank you. Okay, so now we'll have a minute and a half closing statements, and we'll start with Mr. Wallace, Dr. Stewart, and Dr. Eaton in that order.

[1829] SPEAKER_32: This is celebrating our 60th birthday at the hospital. It's been a busy time. Just for your information, annually we take care of 12,000 inpatients, 80,000 outpatients. We perform 4,500 surgeries and 1,700 deliveries, 52,000 ER visits, there are 1,800 folks working at the hospital, and 600 physicians. And the budget for the hospital is half a billion dollars, $500 million. It's a major, major undertaking. We just recently opened the Morris-Hyman Critical Care Pavilion, which costs $376 million to build. It's a 224,000 square foot building. And recently, or since the bond measures were passed for our new campus, we built a power, a central plant to power the new campus. We built a parking garage and a joint replacement center. So we've accomplished much and all during this time we've had positive bottom lines. But we have a lot more to do. Presently we have to get our hospital designated as a trauma center so we can treat trauma patients locally and not have them travel to Eden for their care. This is an act the Board of Supervisors must do. And then we have to raise money to build a new tower, which we'll be doing in the next two years.

[1928] SPEAKER_20: Thank you.

[1930] SPEAKER_10: I was born and raised in this area. This area is very, very special to me. I have three children living in this area, 10 grandchildren. It's very, very important to me that this be an uplifting, good, solid community. And I believe a good, solid, performing hospital is an integral part of a community and the power that will make a community a good, solid place to live. I think we've been very, very successful on the hospital board I'm very proud of what the hospital is. I see the hospital as a shining light in this area. It's a hospital that's responsive to the public, it's responsive to the needs of each one of us, and we hope very, very soon that that hospital will be a designated trauma center, as Mr. Wallace has said. I think it's terribly important that we have a hospital that is responsible to the people and not to the whims of a corporate manager or even an insurance company. Our health is probably one of the most important things any one of us have. And I'm glad that I can serve on that board. I'm anxious to serve and continue to make Washington Hospital the wonderful place that it is.

[2024] SPEAKER_08: Thank you. And Dr. Egan. Well, like I said, I lived in this area for over 34 years, but before that I served pretty much all around the world. I have seen the burden of infectious disease and illnesses, having worked in sub-Sahara for five years in Africa, in India, and also in the Philippines when I worked for the United Nations. So I pretty much know what health care is pretty much around the world. And the Tri-Cities are melting pot. We have people from all different nations around the world. So I'm really proud to be representing all of them, and still hospital being an independent hospital. You know, we have, like I said, we have gotten to the top 100 hospitals in the country. We have a lot of departments which have graded five-star grading by health grades. We have started alliance with UC San Francisco, UCSF, for certain specialties, like prenatology, that is prenatal care, high risk, cancer treatment. So we are making progress. And most of the dreams that I had when I got to the board have come true. Now, like you say, I have a dream. And the dream is to have a new teller.

[2120] SPEAKER_20: Thank you. I want to thank you candidates for your willingness to run for this important office and for your participation in our forum tonight. Thank the audience for coming and remind you to vote by November 6th. Also, please visit our website, www.votersedge.org, which has been developed through our league partnership with MapLight. to provide another avenue for you to, for candidates to post information and the public to see it free of charge. And on that note, I want to thank you and be sure to vote by November 6th.

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