Community sounds off on Tahoe Forest Health System | TahoeDailyTribune.com

Community sounds off on Tahoe Forest Health System

TAHOE/TRUCKEE, Calif. — As an internal investigation into Tahoe Forest Health System's conflict of interest policies continues, the district is facing greater public scrutiny on how it operates. "I think part of the problem that I'm experiencing is there's a huge lack of trust, and I think the community is feeling a huge lack of trust," said Truckee resident Lynne Larson at the July 22 board of directors meeting. "When we have this open-ended kind of thing, that whole trust issue comes back into play." Her comment came during board discussion of OK'ing an information systems expense item, at a time when the district's finances and cost of care have recently come into question. Crystal Betts, chief financial officer for the hospital district, said a 2013 audit reported an operating loss of $5.8 million, which includes depreciation as an operating expense. However, considering the district treats depreciation as a non-operating expense, Tahoe Forest saw an operating income of $1.6 million last year, she said. "What's most important for the community to understand is that our depreciation expense is the largest single contributor to the change in our net earnings," Betts said. As for fiscal year 2014, due to deprecation, the district projected a $1 million net loss, but final numbers are expected to be more positive, she said. In a July 23 statement, the hospital board said the district's cash reserves are "very strong." "We are expected to exceed earnings budget for fiscal year ending June 30, 2014, with earnings of about 2 percent despite a weak winter season, as operating expenses were successfully reduced to meet diminished needs," the board wrote. COST VS. QUALITY In connection with district finances, some community members have characterized Tahoe Forest's costs as "outrageous." "I brought (someone) in last year who drank too much, over drank, and she ended up for one night in the emergency room, and the bill was so outrageous; it was unbelievable," said Truckee resident Ruth Cross at the July 22 meeting. "At some point, costs have to be brought under control, and it doesn't mean at the sake of employees or the sake of the people in this district." Cross chose not to add to her meeting comments when the Sierra Sun reached out for a follow-up interview. The idea of lowering hospital bills would likely come at a cost, said Tahoe Vista resident Randy Hill, who's a hospital volunteer and former chair of the $98.5 million Measure C bond campaign. "What is being missed in this public debate is the fact that making our local health care 'affordable' — affordable to whom and by what standards — would necessitate reducing or eliminating any number of services to which we have all become accustomed," he said. "Imagine a public agency, in this case a hospital, decides it will no longer offer something that is important to you. … The drama and vitriol currently taking place in our community would pale in comparison." Further, Tahoe Forest is highly regarded by community members for its quality of care, with the district earning distinctions such as it being named a Rural Center of Excellence by UC Davis, and its recognition in 2011 by the National Rural Health Association as a Top 100 Critical Care Access Hospital. "Tahoe Forest Hospital has an exceptional medical staff and support staff," said Jamie Cole, a Truckee resident and former TFH employee. "The staff is wonderful. They are caring, dedicated and professional. Our community is also fortunate to have exceptional physicians." GOING OUT OF AREA However, Cole also takes issue with cost of care, specifically with cancer treatment. "Patients should not expect treatment to be free nor should they be financially bankrupt," Cole said. "It is morally wrong, in my opinion, of the hospital to price drugs so far above the actual cost." In an attempt to provide context of cost through one small example, the Sun pulled a hospital bill of a newspaper staff member. In 2011, the staff member visited the emergency room at Incline Village Community Hospital, which is part of Tahoe Forest Hospital District. Doctors performed tests and determined the person had contracted Influenza A, was prescribed medication and released. The staff member eventually received a bill for $897.50 for the roughly hour-and-a-half long visit. Line items included a $457 emergency room charge, $151 for a respiratory lab culture and $15.50 for one 800-milligram Motrin tablet. Various web searches show one can purchase 500 tablets of 800mg ibuprofen for as low as $39.95; or, one could purchase a bottle of 100 tablets of 200mg Motrin ibuprofen for $5.99. Cost concerns like those from Cole can drive locals to seek other treatment facilities, said John Falk, a legislative advocate in Truckee. "The cost differential between our local facility and those in Reno and the Sacramento area can, and have, driven me to seek services out-of-area on occasion," he said. "Call it 'out-migration' or 'customer leakage,' it speaks to a larger issue — the cost of service has a chilling effect on local resident usage of the facilities they contribute to (pay for), via property taxes and special assessments (such as Measure C)." 'ASSESSING THE VALUE' In a July 15 open letter, District CEO Bob Schapper said the public needs to weigh cost against quality of care. "TFHS is well below the median pricing compared to other hospitals in our regional 'cohort,'" he wrote. "… When you consider what a very high-quality hospital TFHS is, evidenced by very low to non-existent infection rates, high patient satisfaction, robust surgical care improvement program, low pneumonia rates and excellence and innovation awards, TFHS is perhaps the highest value health care provider in the region. "Frankly, these indicators should be the highest priority when assessing the value of any health care system." When asked for details on median pricing, Betts said the district did a study using information on the California Office of Statewide Health Planning and Development website, which shows the 25 most common outpatient procedures performed in a hospital, and compared pricing for those procedures to eight other hospitals that would be considered comparable or within our region. "In most cases the district's pricing was at or below those we were compared against," Betts said. "We take the pricing issue very seriously and are working to improve price transparency." Schapper added in his letter: "Hospitals must, without exception, care for everyone who comes through our doors, regardless of their ability to pay. Everyone must be served, yet no one is 'forced' to pay. No other business in the world is required by law to operate in this fashion. "Hospitals have no reliable revenue sources, are expected to employ highly skilled workers and care for thousands of patients with less and less resources. These are national issues. There is no denying the cost of health care is high." CONFLICT OF INTEREST? Schapper's comments came after Moonshine Ink published a July 11 report, raising examples of a potential conflict of interest with him, and the hospital's involvement with Medical Practice Solutions Inc., a company operated by his wife, Marsha Schapper. When asked to address his connection with MPS, Schapper stated the following in an email to the Sun: "As has been disclosed many times over the years, I have been a participant in name only in Medical Practice Solutions. I am not an active participant in the corporation. … "The accounting and tax terminology for this is 'substance over form' meaning that I was listed on paper, but factually had no involvement." Despite that, the board reportedly began an internal investigation in connection with the district's conflict of interest policies in May, and a report of any findings or conclusions is expected soon. Falk said he is "disappointed" that the issue has gotten to this point. "The mere appearance of impropriety is worthy of early and decisive action, whether it be to clearly articulated that the issue was considered and deemed legitimate, or to reject or rescind the inappropriate contractual arrangement, cleanly disassociating our hospital district from any such charges," he said. That sentiment is echoed by Truckee resident Gaylan Larson, husband to Lynne. "The governing board, including the CEO, should always back away from the gray areas where conflict of interest is even possible," he said. "The governing board must earn trust from their public and any suggestion of impropriety erodes that trust."

Board: Insufficient evidence that Tahoe hospital CEO broke law (updated)

The Tahoe Forest Hospital District board of directors will take no further action regarding an alleged conflict of interest with CEO Bob Schapper. The board's 4-1 decision Thursday afternoon after meeting for roughly five hours in closed session caps a multi-month internal investigation. The decision was based on a conclusion from an independent investigator that found insufficient evidence that Schapper violated California's conflict of interest code 1090. Greg Moser, a partner with San Diego-based law firm Procopio, Cory, Hargreaves & Savitch LLP, a firm hired by the board, conducted the probe. "The CEO had no role in influencing the decision to contract with the firm (Medical Practice Solutions Inc., a company operated by Schapper's wife, Marsha), to direct the work, and toward that end, any decisions to renew that contract were brought back on an annual basis, and the board has always approved those contracts," said Steven Gross, general counsel for TFHD. Board chair John Mohun voted against Thursday's motion. He was not available for immediate comment. When asked Friday for a statement from Bob Schapper on the board's ruling, Paige Nebeker-Thomason, TFHD director of marketing and communications, said he will not be making any statements. "We are pleased to know that after a full and complete independent review of our conflict of interest policy and the facts and circumstances surrounding the engagement of Marsha over the years, the facts show the CEO had no role in hiring or influencing compensation for Marsha," Crystal Betts, chief financial officer for Tahoe Forest Health System, said in a statement. "We're very committed to continuing to improve transparency of our actions." Medical Practice Solutions contracted with the hospital in February 2003 and was paid $915,000 over the course of more than seven years for its services, according to previous reports. California Secretary of State documents show Bob Schapper was listed as the company's chief financial officer in 2003 and 2013. Code 1090 states: "Members of the legislature, state, county, district, judicial district, and city officers or employees shall not be financially interested in any contract made by them in their official capacity, or by any body or board of which they are members." In a previous statement to the Sun, Schapper addressed his connection with MPS by saying: "As has been disclosed many times over the years, I have been a participant in name only in Medical Practice Solutions. I am not an active participant in the corporation." In October 2010, Marsha Schapper was hired as a full-time district employee, serving as executive director of multi-specialty clinics until May 14, 2014, when her position was eliminated for consolidation purposes. "It's important to note that during her tenure as an employee … Mr. Schapper had absolutely no role in the decision to hire her, or to set her compensation or determine eligibility for amounts of any bonuses," Gross said. "She was constantly under the direction of the CFO, and then later the CFO and the COO of the organization, and it's really based on those sets of facts that the board has determined the action it's taken today." The investigation's findings were supported by Randy Riddle, whose focus is ethics laws, including conflict of interest matters. Riddle, who previously told the Sun his legal opinion was Schapper broke no laws, was hired in July by Schapper's personal attorney. The hospital board reportedly began conducting the internal investigation in May. "I want to thank you all for your patience, not just today, but over the last three, four months as this issue percolated through the community," Karen Sessler, a TFHD director, said at Thursday's meeting. "… It was very important for the board to take its time to work through this important issues, to not rush into it, to get expert, outside counsel and investigators involved." On Tuesday, Glenn Jennings, Nevada County deputy district attorney who is assigned to the Truckee office, said: "We have no information yet concerning these allegations." A spokesperson for the state attorney general's office said it has no comment at this point. The district has paid approximately $47,000 through July 2014 for Moser and the law firm's services, Gross said. "I'm glad we're at the end," TFHD director Roger Kahn said in a follow-up interview. "We're happy to finally put it behind us and will continue to run the hospital in the best possible way for our community."

Obama health plan draws mixed reactions

SOUTH LAKE TAHOE – South Lake Tahoe resident Kelly Brosch is watching the health care debate in Washington D.C. from a unique point of view. Brosch, who lived in Europe for five years under its public system, has seen the best of both worlds when it comes to health care. Brosch, who was working Thursday at Gaialicious clothing store, said her insurance carries a high deductable, but has adequate coverage. When she lived in Europe, she said she saw similar quality of service to America’s system, with one small detail: “When it’s all done, you don’t have to pay for it.” “It’s a good system,” Brosch said. “I think everyone should have access to health care. In America, because I don’t want to pay my deductable, if I get sick, I just take care of it myself.” With Congress in recess, the debate over President Obama’s health care plan to give medical coverage to an estimated 46 million uninsured Americans has left Washington, D.C., and moved to the rest of America. On Thursday, Senate’s most powerful Democrat – Majority Leafer Harry Reid, D-Nev., scolded health care protesters dogging his party’s lawmakers at local meetings, arguing that some critics on the political right have run out of ideas – and ditched their civic manners. “These are nothing more than destructive efforts to interrupt a debate that we should have, and are having,” Reid said. “They are doing this because they don’t have any better ideas. They have no interest in letting the negotiators, even though few in number, negotiate. It’s really simple: they’re taking their cues from talk show hosts, Internet rumor-mongerers … and insurance rackets.” Republicans answered back. “All the polls show there is serious concern, if not outright opposition, to the president’s health care plan,” said Antonia Ferrier, spokeswoman for House Republican Leader John Boehner of Ohio. “Democrats are ginning up this cynical shell game.” And not all South Lake Tahoe residents buy the idea that health care should be government run, either. “It’s big. It’s convaluted. To me, that means it smells like it stinks,” said local Jon Trainor, during his lunch at a local deli on Thursday. With Democrats arguing that Americans are facing bankruptcy over medical care and Republicans arguing a health plan run by Washington can’t be efficiently run and will be expensive, local health care providers are weighing in on the issue. John Williams, Chief Executive Officer of Barton Memorial Health Care in South Lake Tahoe, said the plan doesn’t yet provide enough clarity to know how it will affect hospitals. Williams said his districts could benefit from the plan – Barton receives about 9 percent of its payments through charity care – and has a relatively large uninsured population. “I anticipate rural (hospitals) will get some sort of benefit out of this – we all support affordable health care and meaningful health care reform,” Williams said. “But the age-old question is, ‘Who’s going to pay for this?’” Williams said he was concerned about who will pay for patient care. If the government pays for uninsured patients at the same rate as the federal Medicare plan, he’s not a fan. “They’re not one of our better payers … it’s been historically underpaid,” Williams said. Bob Schapper, Chief Executive Officer of the Tahoe Forest Hospital District on the North Shore, expressed similar sentiments. Tahoe Forest subsidizes care for about 12 percent of its patients. “We’re not seeing a lot of detail in the legislation, so right now I’m very skeptical,” Schapper said. “That said, as an organization, anything that’s going to improve our community’s health care access we’re absolutely in favor of.” Schapper said any reform cannot be rushed and must be meticulously designed. “The industry is so complex,” Schapper said. “We’re talking about reforming the entire industry, it’s not just as simple as the government purporting to create a new health plan, that’s a very naive solution.” Dr. Dennis Chez of Gateway Urgent Care in Truckee said he thinks it’s time for change in health care. “There are too many costs going up too fast,” Chez said. “And from my perspective, I don’t think physician fees have gone up as high or fast as other areas of medicine, like hospital costs or pharmacy costs.” Jerad West, an Orthodontist with West Orthodontics, said he still wants more detail on what health care reform would entail, but also thinks the change is necessary. “I have a lot of friends and colleagues in the medical field that see a drain from the uninsured; it drives the cost up quite a bit for those that are insured,” West said. “Looking at the issue of Medicare, it’s basically a bankruptcy situation as it stands unless it’s reformed.” Chez said the Tahoe area hasn’t been hit as hard by medical costs in the past, but that’s changing. “It’s not cheap to live here, so most people have some means so we haven’t been hit as much as other areas, but it’s creeping into this community more and more. I’m seeing more patients without insurance,” Chez said. This, Chez said, could be attributed to the hard-hit fields of construction and tourism, both staples of the Tahoe economy. West said he hasn’t seen much change, and doesn’t expect much from the proposed national healthcare reform, in the world of orthodontia. “This could help with things of a catastrophic nature, not dentistry, things that can bankrupt somebody,” West said. President Barack Obama met Thursday with six members from the Finance Committee: Max Baucus of Montana, and Kent Conrad of North Dakota, Jeff Bingaman of New Mexico, Chuck Grassley of Iowa, Olympia Snowe of Maine and Mike Enzi of Wyoming. Baucus, Conrad and Bingaman are Democrats and Grassley, Snowe and Enzi are Republicans. Four of five congressional committees have completed work on health care legislation. White House spokesman Robert Gibbs said, “The president’s message to them is to continue to work and find consensus.” – Associated Press

Tahoe-Truckee’s highest-paid public employees will make $3.7 million, as base pay, in 2014 (special report)

EDITOR'S NOTE: An earlier version of this story had the wrong timespan in terms of when these salaries were analyzed. We probed the numbers over a 30-year timespan — not 40 years, as originally reported. The Sun regrets the error. ——- TAHOE/TRUCKEE, Calif. — The average base salary of the top leaders of public agencies throughout the Tahoe/Truckee region in 2014 is three and a half times that of the average American worker, according to data analysis performed by the Sierra Sun. Executives of these public entities — whether the Tahoe Truckee Unified School District, the smattering of public utility districts, various fire protection districts that have separate jurisdictions throughout the region, or the bistate Tahoe Regional Planning Agency — make an average of $165,000 per year, a figure that does not include varying insurance benefits, bonus opportunities and other forms of compensation. This figure does not include Tahoe Forest Hospital CEO Robert Schapper, as his $404,000 annual base salary would have skewed the numbers and ensuing comparisons. The average American worker in 2014 makes about $45,000 annually, according to data compiled by the Social Security Administration — about $3,000 less than the average salary for a CEO of a public body in Tahoe/Truckee 30 years ago, in 1984. Further, the average American worker makes about $7,000 less than the living wage, defined as the amount of money an individual must make to support his/her family if that person is the sole provider. The issue of salaries of public leaders elicits a spectrum of opinions, often firmly rooted in political persuasion — some believe it is indicative of loose spending practices in the public sectors, while others believe the salaries given to leaders who oversee multi-million budgets are proportionate with their responsibilities. Likewise, some believe occupying high-ranking positions in the public sector should be more about service and community pride and less about lucre, while others counter that in order to attract and retain the types of capable individuals necessary to efficiently run critical agencies, being competitive in the employee market is a must. "It's all relative," said Truckee Mayor Patrick Flora, an elected official on the Truckee Town Council. "(Truckee Town Manager) Tony Lashbrook makes about 3.7 times the average employee (about $185,000 for the town manager compared to the average wage of a town of Truckee employee, $48,000). In the private sector in 2013, the average CEO makes about 331 times the average employee. "If you are asking me if Tony is overpaid, I would say no," Flora continued. "But if you are asking me if he is underpaid, I would also say no. Considering he managed 100 employees and oversees a $25 million budget, I would say his salary is about right." Flora and most sources quoted in this story sit on boards composed of officials elected by the agency's constituents. In all cases, they are tasked with establishing the salary range for the public agency's leader, and in most cases, the elected officials either receive zero compensation, or a comparatively modest amount. LOOKING AT THE RANGE Of the salaries analyzed at 21 public agencies in the Truckee/Tahoe region, the going rate for the services of a Chief Executive Officer ranged from $131,000 to about $215,000 (again, this excludes the Tahoe Forest Hospital CEO). The leaders include airport district managers, general managers for public utility districts, fire chiefs, police chiefs, town/city managers, TTUSD superintendent and the executive director of TRPA. According to the data, public utility district general managers earn the most, and Truckee Donner Public Utility District GM Michael Holley leads the way with $215,000 in base pay in 2014 — which, again, does not include a benefits package that escalates his compensation past a quarter of a million dollars annually. Aside from Schapper, Holley earned the highest compensation package of any public leader, for managing a roughly $34 million annual budget and overseeing 77 employees, according to the California Controller's Office. Coming in second, South Lake Tahoe Public Utility District GM Richard Solbrig garners a base salary of $205,000 for overseeing a budget of $15.4 million and a roster of 128 employees. Toward the lower end of the spectrum, Truckee Tahoe Airport District General Manager Kevin Smith pulls in approximately $143,000 per year for managing a roughly $4 million budget and 35 employees. The lowest annual base salary is that of North Tahoe Fire Protection District Chief Michael Schwartz, at $131,000. Despite TRPA's stature as the most significant regulatory agency in the Lake Tahoe Basin, with much of its framework superseding that of the counties, cities and special districts, its executive director, Joanne Marchetta, receives one of the lowest base salaries at $149,000. Treading the middle ground, city managers, special district leaders and police chiefs receive compensation packages that are closer to the average of $165,000 per year. Breaking things down beyond annual salary, public agency leaders in Truckee/Tahoe make on average $80 per hour — which is roughly nine times that of minimum wages in California and Nevada. Some make as much as $108 per hour, or about 11 times minimum wage. INFLATION OVER TIME During the process of seeking and analyzing data, the discrepancy between minimum wage workers and the leaders of public institutions were not always so pronounced. For example, in 1984, leaders of public agencies in Truckee/Tahoe received an average salary of about $48,000 per year, with leaders at the upper edge of the spectrum earning about six times the minimum wage. In a 10-year period, that average rose 31 percent to roughly $63,000 annually in 1994. The largest percentage increase came between 1994 and 2004, when the United States economy grew at a rapid rate. Salaries for Truckee/Tahoe public leaders escalated 82 percent, climbing to about $115,000 per year. By comparison, the average wage in the United States climbed 45 percent from $24,000 to $35,000, a more tepid growth pattern, but by far the largest jump over the 30-year period analyzed in the study. Over the 30-year period, wage inflation for public leaders in Truckee/Tahoe amounted to 243 percent increase, from averages of $48,000 to $165,000. Over the same period, average wages in the nation grew by 181 percent, from $16,000 to around $45,000 in 2013, the last available data set recorded on the Social Security Administration website. Between 2004 and the present year, a period of time that encompasses what is now known as The Great Recession, wages for the average American grew by 28 percent, while compensation for public leaders grew by 43 percent. And to put things at mass perspective, when you add up all 21 base salaries analyzed for this story for 2014, the highest-paid public leaders at Tahoe-Truckee make more than $3.7 million annually (this figure includes the Tahoe Forest CEO salary of roughly $404,000). SPREADING THE WEALTH Economists universally agree the pace of America's recovery has been sluggish since Lehman Brothers went bankrupt in 2008 and the U.S. Government bailed out AIG and infused over $700 billion into the private sector in the ensuing months. Economists, who perhaps by profession are allergic to consensus, also agree that recovery has disproportionately benefited America's most wealthy — commonly known as the "1 percent." However, elected and appointed representatives do not necessarily agree that salary inflation for public CEOs conforms to the same market forces steering the private sector. "That's just not true in our case," said TRPA Governing Board Member Larry Sevison, whose position is appointed. "We haven't been able to give employees a raise in years, so we keep losing them to other agencies. We've been tight-fisted because we have to be. We are a bistate agency and we cannot get out of touch in terms of our salaries." Truckee Mayor Flora said the town of Truckee — unlike some other agencies — has "trimmed from the administration down." "We cut weight from the administrative level on down," he said. "We have managers taking on more work for the same amount of money, and to my mind, that is a bit of an anomaly." Nancy Ives, president of the Northstar Community Services District board of directors, said her board was careful to give all employees raises once district finances grew more favorable out of the recession. "We raised everybody," she said. "They went three years without any type of an increase except for cost of living, and when we could, we gave everybody a raise, from the plow guys up to the CEO." The Northstar Community Services District doubled its fire chief's salary from $80,000 to $160,000 from 2004 to 2014, one of the largest increases of any agencies analyzed for this story. Ives said the jump can be explained by a combination of forces, including hiring a new chief, having that chief accrue seniority pay, and the fact the district has grown exponentially with the addition of the Northstar Mountain Residences and The Ritz-Carlton, Lake Tahoe in the intervening years. BIG RESPONSIBILITIES Most elected representatives interviewed for this story asserted the compensation packages presently on the books struck the appropriate balance between being responsible stewards with public money with expanding the necessary dollars to attract talented administrators to critical positions. "We want somebody great, but we always know we are spending other people's money," said Kim Szczurek, president of the Tahoe Truckee Unified School District board. TTUSD hired a new superintendent, Robert Leri, in 2012. Leri's base salary package is worth $174,000 for 2014, but Szczurek said it's not only competitive with that of other similarly sized school districts, but raises are tied to performance, as opposed to length of term. "There are no more automatic range changes," Szczurek said. "In fact, our entire executive staff has been changed to performance-based contracts. It's no more you live and breathe and get a raise." On average, leaders of public organizations at Tahoe-Truckee earn about 3.5 times more than the average employee at the agencies, but Szczurek said the superintendent position is in many ways an unenviable one. "Our teachers work fewer days in a year than executives," she said. "Dr. Leri has to make decisions that affect a $40 million-a-year organization that is highly complex and highly regulated with a large constituency base." Additionally, the job security at many of the leadership positions in the public sector is fluid, as politics can shift dramatically, where as many of the rank and file members of the public sector have legislatively enhanced job security by comparison, Szczurek said. OVER AT TAHOE FOREST Bob Schapper, CEO of Tahoe Forest Hospital, has been the subject of much commentary in the Tahoe-Truckee community the past few months, since it was reported that the hospital directed roughly $915,000 toward Medical Practice Solutions — a company helmed by Marsha Schapper, Schapper's wife — over the course of more than seven years. While that has been investigated and deemed by the hospital board as a non-issue after a board-hired attorney concluded insufficient evidence exists Schapper violated California's conflict of interest laws, some of the focus has also centered on the fact his approximately $404,000 annual salary is far and away the largest for any public leader in the Truckee/Tahoe region. The annual base package represents an 80 percent increase from his 2004 salary, which was $223,000, one of the large increases of any of the salaries analyzed. "Admittedly, it's a lot of money," said Tahoe Forest board member Roger Kahn, who added that Schapper oversees a budget of a $100 million and a complex organization that includes doctors, nurses and paid hospital staff. "There is an incredible amount of federal and state regulations. You have to be able to balance a lot of tasks and keep everybody happy. Running a hospital is more complex than other public agencies." Kahn said the board uses an objective methodology to determine the hospital CEO's salary, and his best guess is that after things settle down and if Schapper moves on from the hospital, the next CEO will be making a similar amount. LARGER COMPARISONS The complexity of running a public agency; the large dollar amount of annual budgets that must be managed and ideally balanced; and the healthy roster of employees who must be kept happy and productive are the reasons universally cited to justify the salaries at public institutions throughout the region. As a point of comparison, the salaries of eight of the 21 public CEOs at Truckee-Tahoe exceeded the annual salary of California Gov. Jerry Brown. Brown made about $173,000 in 2013. He oversees a budget of about $120 billion and a roster of 130,000 employees. Nevada Gov. Brian Sandoval, meanwhile, makes about $145,000, less than nearly all of the 21 public leaders analyzed. Sandoval manages an $8.9 billion operation, and the state of Nevada employs about 3,700 people. You can also compare the states to a large county government such as Washoe County, where County Manager John Slaughter gets paid $200,000, nearly $50,000 more than Sandoval for overseeing an annual budget of approximately $330,000 million with a roster of 2,500 employees. Marsha Berkbigler, Washoe County Commissioner for District 1 (which represents Incline Village), said the discrepancy in salaries is attributable to the fact governors often have a full slate of officials, both elected and not, to help with the administration of the complex mechanisms of the state government. Further, while there are only 50 state governors, there are thousands of county managers in America, and when counties such as Washoe conduct analysis of similarly populated jurisdictions, the sheer number of other positions means there is natural upward pressure on the salaries. "When we look at negotiating contracts with our unions, we are looking at communities of the same size, and our employees will often come back and ask for a raise that puts them in the same range," Berkbigler said. Perhaps, the lack of peers accounts for why President Barack Obama takes home $400,000 in base salary — roughly the same as Tahoe Forest's Schapper. — Matthew Renda is a former reporter for the Sierra Sun and North Lake Tahoe Bonanza and currently is a Santa Cruz-based writer. He may be reached for comment at matthew.renda@gmail.com. Ardy Raghian is a fourth-year undergraduate student and editor at City on a Hill Press, the student-run weekly at University of California, Santa Cruz.

Barton gets ‘average’ rating

Barton Memorial Hospital received an overall “average” rating from patients in a survey of California hospitals released Wednesday. More than 21,000 patients were interviewed as part of the survey by the California HealthCare Foundation, a charitable organization, and the nonprofit California Institute for Health Systems Performance. Barton’s across-the-board “two-star” rating is a “good, strong performance,” said Marsha Nelson, the institute’s vice president. “We feel pretty proud of it. We went into it never really having a great return rate on customer satisfaction surveys,” said Kathryn Biasotti, director of quality improvement and risk management. The “Patients’ Evaluation of Performance in California” project, called PEP-C, compiled mail surveys sent to patients from 113 of the state’s acute care hospitals. Seven factors were evaluated including respect for patient preferences, coordination of care, education and emotional support. Barton was rated average in each of the seven categories. The Tahoe Forest Hospital District, which operates Tahoe Forest Hospital in Truckee, scored above average in every category. Overall, the study found patients believe hospitals do well attending to physical comfort, including pain control, but they see room for improvement in easing the transition from hospital to home. The study also found that patients admitted for maternity care or surgical procedures had more positive responses than those admitted for medical reasons.

Election 2014: Tahoe Forest Hospital candidates sound off

TRUCKEE, Calif. — Health care costs, public trust and the CEO's contract were among topics discussed by seven candidates running for the Tahoe Forest Hospital District board at a political forum Wednesday at Truckee Town Hall. Dale Chamblin (incumbent), John Falk, Mark Spohr, Charles Zipkin, Greg Jellinek, Ned Hughes and Ronda Brooks are vying for three, four-year seats in the Nov. 4 election. Below is a sampling of some of their comments given at the forum in front of roughly 100 people, presented in random order: Regarding Health care costs in Tahoe Forest Hospital District… Hughes: As far as administrative cost, there's been some criticism about the high salaries. I can't address that. I think you get what you pay for, and as far as I am concerned, the management has delivered an excellent hospital. You just have to walk down a corridor or be a patient to realize the quality of care you are going to get here … As far as our cost compared to other hospitals in the community, we've already seen and I have printouts that show that we have cheaper rates as far as inpatient care, emergency room visits, X-ray and labs, and the only thing that we actually charge more for is MRIs. Chamblin: Tahoe Forest Hospital in order to keep its doors open has to generate about $115 million a year in addition to the $5 million they get from taxes. It is a large and complex business. It's got over 750 employees, and it takes very talented and experienced people to run that business. Claims of outrageous salaries are false …. We are paying median wages for top level quality service, so rather than listen to the unsubstantiated, please get the facts … High prices, no. Tahoe Forest Hospital isn't charging high prices. It's comparable … We are very competitive not only with California hospitals but with Reno hospitals, as well. Jellinek: Director Chamblin if there is no problem with the finances in the hospital district, why is the district projecting a $2.5 million operating loss for this next fiscal year? Something's got to change, and … it can either come from administrative costs, the cost of delivering health care or from facility fees, so those are (the) three areas that have to be looked at with a critical, independent eye. Zipkin: I reviewed this question with the people in finance at the hospital, I've also spoken with board members separately, and I agree with director Chamblin that we are paying our CEO about the median. You have to remember that the search for a CEO (of) a $110 million budgeted company with over 700 employees is a national search … You're competing with all the hospitals in the country, not just small little rural hospitals, but with all of them … In terms of how much we charge, Mr. Chamblin is again correct. Our charges for MRIs and the 20 most popular used services at the hospital are actually comparable with other hospitals. In fact, a little lower than some. When you compare us to free standing centers such as Reno Diagnostic for X-ray or GI Consultants in Reno, it's true, you can't compete with a free standing center and an attempt to do so results in financial disaster and closure of services. Brooks: … I think administrative costs are too high. Facility costs, I don't know how you can drive down Donner Pass Road and see that fancy, schmancy building and not think there's a lot of money there … As far as health care costs, I'm still on the fence about that. I've heard conflicting data. I've tried to do my homework and find more data on the hospital website, but you know what, that data is not available. … (Until then) I really can't comment. Spohr: I believe administrative costs are too high. Every time I investigate or look into different areas I find administrative waste and overcompensation. This adds up. It's a few million here and a few million there, and pretty soon you're talking about real money … In terms of prices, according to reports filed with the state, the cost of inpatient care over the last eight years has increased by 50 percent and the cost of outpatient care has almost doubled, this is unacceptable. Falk: When we speak of health care costs and the various components of health care costs, there is a recurring theme of talking about the comparison of Tahoe Forest Hospital or Tahoe Forest Hospital employees or whomever, or the cost of a given service against other. I challenge that. I challenge that because we don't want to be comparable to others, we want to be better. We want to do it better, and so I suggest that we aren't striving to be in the middle of the bell curve — that we shouldn't even use that as our tool. Our tool should be the simple question of: How low can we drive cost down without damaging the quality of service and care provided? And it shouldn't be based on a benchmark of others in the region or beyond. It should be what we can do, and how best we can do it. Regarding Bob Schapper's existing CEOs contract/conflict of interest policies… Zipkin: It's a serious question. I have reviewed the due diligence that the board did in cooperation with the human resources department at the hospital in terms of deciding what the CEO's salary should be, and I really have to concur with Mr. Chamblin that the CEO's salary — it sounds outrageous for some in the community where the average income is maybe $40,000 a year, for the CEO to be paid this much — but the truth is once again you're competing with national hospitals and very large hospitals, so I really think the compensation package should really be off the table … I think our present CEO has done a spectacular job. I think there are some issues maybe with some of the way he has dealt with some of the physicians and that can easily be dealt with. Brooks: My opinion is how could there not have been a conflict of interest, and I think we're not done yet. I think the DA needs to speak about it and may even go down to Sacramento, but in my opinion, Mr. Schapper should not continue as the CEO, and I look forward to the board's discussion on his contract in open session. Spohr: I agree there's a clear appearance of a conflict of interest. The board has voted to keep a report secret, and the report said there might be the appearance of some but not enough evidence. Well, what's the evidence? We need to know. The board needs to be less secretive, more open, more transparent; we need to publish the report, and I think the district attorney should be involved. Falk: I really think that comes down to answering the question: What's best for the district in total (for) the people it serves? And I don't think given 45 seconds or whatever I have left it's possible to adequately address that, but I can say that it would be imprudent for me to cast judgement at this juncture with the limited knowledge that I've had access to and weigh in one way or the other. I need more information before I can make an informed decision … Regarding conflict of interest … I think this is an important issue to get out in front of, which is to say, you need a conflict of interest policy before you get a situation in front of you that may or may not be a conflict of interest that way you can apply it to a diverse set of situations, and you're not actually dealing any particular issue or relationship. So it needs to be done early and it needs to be done by the board of directors proactively. Hughes: I would renew the CEO's contract if I had the right material to appraise what's going on, and if I was a board member, it would part of a decision I would make with a flexible opinion and looking at the facts … Everything is seamless and efficient. One of the new general surgeons that we hired has told me that it's the best hospital she ever worked in, with the best nursing care, the best staff cooperation and she really looks forward to staying here, and I hope that losing the CEO won't change the rest of the hospital, which would be lowering all of the qualities that we have now with our specialists and the contracts. Chamblin: I was not a member of the board when Marsha Schapper was hired, and I had to rely on the short period of time I've been on the board on the investigators who investigated this whole issue. My decision on the issue was based on the facts like I make all of my decisions based on fact … My responsibility, my fiduciary responsibility is to the public; it's not to Bob, and I want to do whatever is best for the hospital. If I can use this metaphor — this airplane is flying along at 30,000 feet. I don't think it's in the best interest just because there's a red light flashing on the cockpit dashboard to open the door and throw the pilot out. It's got to be done in a thoughtful and careful manner. Jellinek: We've all gotten a lot of information from a lot of different sources, and I for one am going to reserve judgement until I can drill down a little bit. You have director Chamblin on one hand supporting the CEO and you have Brooks on the other hand saying he's got to go, and quite frankly, I'm confused, and if I'm elected to the board, hopefully, I'll be less confused, but right now, I'm reserving judgment … As to the conflict of interest charge, I've thought from the very beginning that this needs to be addressed by an independent trier fact. For the board to in close session come to a conclusion, it's like having the fox guarding the hen house. Regarding the public's trust and communication… Chamblin: If I am elected to the board that would be one of my very first priorities. I want to see more public input, and I want to see an improvement in transparency … I have been working with staff for the last six months to get our board meetings televised, and I can tell you as of January, if the new board will allow it, those meetings will be televised. I think that's going to go a long ways toward improving our transparency, but public input and transparency are (on) the top of my priority list for my participation on the board. Jellinek: … We came up with affordability, accountability and transparency. Affordability to local citizenry … The reason why I got started with this was when my own patients started asking me if I could take them to Reno for surgery. It has to be affordable to the folks that live in town. Accountability of the board to our bosses, and that is you guys, the public. That's who the board works for. Transparency. I'll echo what director Chamblin said, the board needs to be transparent in all of its actions, so that you, the public, can understand what's going on with your money. Zipkin: I think a lot of the problems that we've read about in the press result(ed) from a lack of communication. I think if the public knew what the hospital was doing or what the board was doing, there would be a lot less distrust. Obviously, they go hand in hand, and one way to do that is to have an information officer who's responsible to the community. I think that's really critical. We have excellent marketing now, but the outreach to the community has been less than stellar, and I think that needs to be improved … I would also move the board's meetings to different venues. I think it's a mistake to have them only on campus in Truckee every time. I think it's important for people on the board (to) promise critical review of all programs and contracts on a regular basis and let the public know what they are doing. Brooks: Many a hospital employee has told me that communication at the hospital is one of the biggest problems, and I think that is because it starts at the top. A couple of ideas I have are that the minutes for the hospital board meetings should be more open. They should not only be on a website, but they should be in our public library. Everyone should be able to go in and sit down and open a book or a binder and read those meeting minutes … The other thing I think we need is more spontaneous dialogue with the board. It's not good enough for the public to come to a meeting and be limited to two minutes. I think … the public should be allowed to speak more, they should have more opportunities at the beginning of the meeting, (and) they also should have opportunities at the end of the meeting. Spohr: I'm glad to see that Dale is now touting transparency. Unfortunately, the board is one of the most closed boards that I have ever experienced. Most of the board's business has been conducted in closed session, with very little information released. It's been going into closed session even when it doesn't need to be in closed session … We need more transparency to build trust. Also, in terms of pricing, it's impossible to find out what the price of anything is at the hospital. We need to publish the prices of everything, so when you come to the hospital, you know how much it is going to cost you. Falk: I think that we do need to meet not just at the main campus, but throughout the district. I think it makes sense to go out and meet on the North Shore on occasion and other venues that would help increase the likelihood that people from that area of the community will attend and engage. The main point … regarding trust is to do the public's business in public. That means that you don't go into closed session by default because you can, but you stay in open session every time you can and only go into closed session when it's absolutely prudent to do so, when you must. That way the public doesn't feel that there are things being hidden whether or not they are being hidden. Hughes: I think … meetings that are televised … would be very helpful. I have only been in this race for over six weeks, so I'm not too familiar with how transparent the board has been. The hospital, to me, while we've been getting oriented with this whole process, has been very transparent and very helpful in getting use oriented for the job … I think we need to talk more about the great things that are happening with the hospital such as the hospice and weight reduction plans that are going on in Kings Beach for adolescents, I don't think people know about that. I think the cancer center needs bragging rights; they need to say and get out to the community and tell people how good they are.

Vikings struggle against Manogue Miners

South Tahoe High softball coach Anneliese Neitling didn’t recognize the team that took the field against Bishop Manogue on Thursday in Reno. “We have a doubleheader with them (on Saturday) so hopefully we’ll see the team we’re used to seeing come out to play,” said Neitling after a 10-0 Sierra Division defeat. Neitling called the game after the Vikings hit in the fourth inning. “They had another at-bat, but there was no reason to go higher,” Neitling said. “They were hitting the ball, but they weren’t super hits. They had an excellent pitcher, but it doesn’t matter. The Carson pitcher is just as good, and we were hitting her.” The Vikings (2-5 overall and in division play) mustered two hits in the four innings. One came off the bat of Sarah Breisacher and the other was delivered by Brittany Barcellos. Saturday’s doubleheader begins at 10 a.m. “We have faith in them. Now they have to have faith in themselves,” Neitling said. Schapper two-hits Vikings Bishop Manogue pitcher Casey Schapper was a puzzle that the South Tahoe Vikings’ baseball team couldn’t solve Thursday in Reno. Schapper pitched a two-hitter as the Miners routed the Vikings 15-2 in a Sierra Division game. “He throws pretty hard and he throws a lot of strikes,” said STHS coach Matt Tillson. “If we were in the game, I think we could have gotten to him.” The Vikings scored both of their runs in the second inning, trimming Manogue’s lead to 6-2. Gary Prescott started the rally with a walk and advanced to third on Kyle DiGrande’s double. Max DeLallo’s hard shot to short scored Prescott. Derek Holmgren plated DiGrande with a double down the right-field line. The Miners, however, scored eight times in the third inning to put away the Vikings. “For a 15-2 game, our kids didn’t play too bad. They didn’t quit,” Tillson said. STHS (5-7 overall and 0-4 in the Sierra Division) plays a twin bill against Manogue on Saturday. Game 1 begins at 11 a.m.

Governor rejects lesser-known health reform bills

SACRAMENTO, Calif. (AP) – Gov. Arnold Schwarzenegger vetoed a handful of health care bills Wednesday but has yet to take action on major legislation aimed at readying the state for federal health care reform. The governor rejected seven measures mainly aimed at expanding the range of services covered by health plans and placing more scrutiny on insurance rate changes. One bill, AB2042, would have limited fee hikes to once per calendar year. Another, AB1600, would have required most health plans to cover the diagnoses and treatment of mental illness, while a third, AB113, would have done the same for mammograms. In his veto messages, Schwarzenegger said some of the bills were unnecessary because of existing state laws or federal legislation due to take effect in 2014. Some of the other bills would contribute to skyrocketing health care costs, he said. The Republican governor did sign one health care measure Wednesday. AB1503 will require physicians who provide emergency services in hospitals to provide discounts to uninsured patients or very low-income individuals with high medical costs. Nearly a dozen closely watched health care reform measures remain on Schwarzenegger’s desk, including two bills setting up a web-based health insurance exchange and a bill allowing young adults to remain on their parents’ health insurance plan until they turn 26. Thursday is the deadline for the governor to sign or veto all remaining bills.

Guest view: Balancing health care costs: for-profit vs. non-profit

In today’s economy, health care prices are a sizzling topic. And while Barton HealthCare System’s pricing is not immune from these heated discussions, we must be mindful to compare apples to apples. We will all need medical care at some time, but whether we are insured, eligible for a discounted program, underinsured, or not insured and ineligible for state or federal programs, pricing impacts us all. It is imperative to me that Barton helps our community understand pricing, including the non-profit verses for-profit structure and to present the big picture for a better understanding. Barton Memorial Hospital is a non-profit, 501(c)3 organization. Unlike for-profit agencies, non-profit status specifically mandates that Barton cannot and does not turn anyone away for medical treatment, regardless of their ability to pay. This is vital for our communities since none of us wants to be exposed to an infectious person who is unable to access the medical system for treatment. Therefore, access to health care becomes everyone’s concern. We all shop at the same stores, eat at the same restaurants and our children sit next to one another in the classroom. Unknowingly, germs are passed around. This is where Barton’s public duty comes in, to ensure that everyone has access to health care. In 2006, the hospital wrote off more than $3 million for “Charity Care” in hospital charges alone. That does not include the care provided through the Barton Community Clinic or any physician practices. An additional $7.3 million in uncollectible accounts was written off as bad debt. The Barton Community Clinic, which represents a loss to the Barton HealthCare System’s bottom line of approximately $1.3 million annually, is another avenue for the health care system to provide medical care to patients on a sliding scale, based on their income. In addition to those services for which the hospital was not reimbursed, Barton HealthCare System has a “Helping Hands” program that offers medical care to those who are uninsured or underinsured at substantially reduced prices. It is our mission to provide medical care to everyone and to ensure that our community’s health is as good as possible. However, this comes with a price. If Barton were a for-profit, free-standing clinic for medical imaging or laboratory services, we would set a lower price and only patients with insurance or the ability to pay out of pocket would be treated. There would be no “Charity Care” or “Helping Hands” safety nets for those unable to pay. Due to the high costs of running a hospital, it is very different than operating a retail business or other public entity. It’s a 24-hour operation with specialized staff and high-priced technology to accommodate whatever medical emergency might arise. The 64-slice CT scanner is an example of having the best technology available, but if you want the best for you and your family, it has a price tag. To provide the highest quality services, it is vital that Barton maintain the latest equipment available. A free-standing, for-profit company has limited hours and limited services, and if you can’t pay, you receive no care. If Barton were to become a free-standing, for-profit system, there would be limited services, no ER, no health fairs, no community clinic and no outreach programs. It is important to understand the real value of having a non-profit acute care hospital in town with a myriad of services. Paying a higher price for lab tests at a non-profit hospital versus a for-profit clinic helps cover the additional overhead of the 24-hour operation and gives us all the importance of having a local, full-service hospital. When you pay for a service at a hospital, the reality is that your charges are supporting the entire operation. It takes every citizen to support a community-based non-profit hospital, and it is ultimately up to the residents to determine how important it is to have a full service hospital within minutes of their home. Barton’s management is constantly looking for new ways to add more services that can benefit the community. Just this year, the decision was made to offer monthly appointments for lab blood panels, a prostate serum antigen test and thyroid and glucose tests at discounted health fair prices. EKGs are also offered on a monthly, scheduled basis at the discounted health fair price. With open minds, we continue looking for opportunities to streamline costs. Barton operated on a $113 million budget in 2006. With an operating margin of 3.3 percent, the hospital quickly uses the excess revenue. About $10.3 million is approved for 2007 expenses. Some of those include a new MRI machine that is being installed this month, construction of two new buildings and additional patient services. We are also converting from semiprivate patient rooms to private suites to enhance patient privacy and comfort. Each year regulatory agencies increase monitoring of patient care at higher levels with more staff – all of which increase our costs. Unfunded federal mandates also continue to raise our costs. Although good for patient safety, tight nurse-to-patient ratios cost more and that increase must be shared. For-profit, stand alone clinics do not have such initiatives and related costs. Health care coverage impacts every business and individual, nationally and locally, and it’s something that Barton understands all too well. It is important that we as a community work together on this issue. In the meantime, we encourage everyone to take advantage of Barton’s deeply discounted monthly lab draws and frequent health fairs for your lab work. I will be personally meeting with other community leaders in the coming weeks to discuss what we can do to meet this challenge and to maintain a healthy community and grow a vibrant, healthy economy. – John Williams is CEO of Barton HealthCare System.

Artist ‘clear-cuts’ hospital mural

TRUCKEE — Two years ago, Erik Holland volunteered to paint a mural in the halls of Tahoe Forest Hospital. In the depiction of an old-growth, red fir forest, Holland wrote two cryptic messages in the trees. One read: “Stop clear-cutting.” The other: “Sierra Pacific, don’t destroy the Sierra Nevada.” Two years later, hospital administrators have decided to paint over the mural. But before they made their decision, they gave the 44-year-old Reno artist one last chance to remove his messages from the second-floor wall mural. Holland had his own plan. “I’m going to give them what they want: a clear-cut forest. I’m going to turn those trees into stumps,” Holland said before he got set to paint it. Hospital administrators told Holland to remove the hidden text after a family member of an employee of Sierra Pacific called the hospital, upset with the painting’s messages. Hospital auxiliary member and art chair Marjorie Woodbridge told Holland he had one week to remove the text. The auxiliary is in charge of the mural project. The murals were painted on the walls because fire code would not allow hanging art in the upstairs floors of the hospital, Woodbridge said. “We make it very clear with the artwork we display: nothing religious, nothing political, nothing naked,” Woodbridge said. “Environmental politics don’t really have a place in the hospital; it’s all about healing.” Holland contends that the hospital auxiliary OK’d his mural — including the message — when he created it in 2001. So on Friday, armed with a paintbrush, Holland set out for Tahoe Forest Hospital’s second floor. Figuring that someone would tell him to stop, he knew he had to “rapidly take the trees out,” he said. “This is definitely one of the crazier things I’ve done in my life,” he said as he got to work. Someone had already painted over the “Stop clear-cutting” message but not the reference to Sierra Pacific. Twenty minutes later, most of the giant red firs in the painting were stumps, and Holland had received no admonition for painting over his old work, save for a frown from one hospital employee. Thirty minutes into his work, another hospital employee stopped to watch as Holland painted “Don’t worry, I’ll replant” in large white letters on the mural, promising that he will repaint the mural to the original composition if the hospital administration would allow him. After adding and then removing a gated community from the mural, Holland decided it was time to walk away from his art. In 45 minutes, he had turned his red fir forest into a half-barren landscape. Before he walked away, he left a note for Woodbridge: “Dear Marjorie, I imagine the changes will upset you. I will repaint the mural to its original if you are still speaking to me. Erik.” After the weekend, hospital administrators noticed the changes in the mural and said they planned on painting over it immediately. “We didn’t know the artist had placed a political message in the mural,” said Tahoe Forest Hospital CEO Robert Schapper on Tuesday. “Effectively, we’re going to paint over it. We’re appalled that the artist would do what he has done. “It’s disappointing that members of the community would deface the hospital,” he added. “[The mural] should be gone today.” After the weekend, Holland said he regretted what he did to Woodbridge and the hospital auxiliary and that he didn’t spend more time making his mural look more “artistic.” So, he returned to his mural, still on the wall as he’d left it, and touched up the paint on the stumps and sky. Despite his regrets, Holland said the incident has revamped his interest on clear-cutting issues. A professional artist, political cartoonist and teacher, Holland said he has been involved in logging issues for years. In 1996 he said he ran for an Alaskan legislative seat on a platform that was for limited logging but against clear-cutting. He hasn’t been active in forestry issues since 2000. “Basically I’m going to re-inject myself back into the process,” Holland said. “That’s the irony: If they wanted to get me moving again, they did it.”