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Endorsements: Here's to our health
Our recommendations for the Marin Healthcare District Board

The Marin Healthcare District serves all of Marin County except Novato and portions of West Marin. The district defines its mission as enhancing the provision of quality and reasonably priced healthcare in the community and supporting the highest quality medical, trauma and psychiatric care at Marin General Hospital (MGH). Two seats are at stake in this election with both incumbents running to retain their positions. The three incumbents who are not running in this election cycle and who will continue on the board are physicians James Clever and Larry Bedard, and Jennifer Rienks, a social psychologist at UC San Francisco and member of the Health Council of Marin.

Incumbents seeking reelection: Archimedes Ramirez is a practicing neurosurgeon at Marin General Hospital where he served as chief of neurosurgery from 1981 to 2003. He is also a consulting neurosurgeon at Kaiser. Sharon Jackson holds an MBA and has 27 years of experience in healthcare management and consulting. Jackson is former executive director of Napa Emergency Women's Services and served on the Marin County Mental Health Board and Marin Women's Commission.

Two challengers are physicians. Frank Parnell lists 28 years in Marin private practice with a background in head and neck surgery and service as deputy commander of a 1,000 bed Army hospital. He has a long record of community service, having been a College of Marin trustee for eight years, a director and president of the College of Marin Foundation and member of the Ross School Board. He founded and heads his own company, Parnell Pharmaceuticals. Harris (Hank) Simmonds is a retired OB/GYN and was on staff at Marin General from 1971, including service as chief of staff and chair of the OB/GYN department. He has also been a board member of the Marin Medical Society. The fifth person on the ballot is perennial candidate Peter Romanowsky, "minister, entertainer, artist."

Background: The district operated MGH until 1985 when the facility was leased to Marin General Hospital Corporation, a nonprofit organization, now an affiliate of Sutter Health. The district, which has become known for its internal battles among board members and as a focus for conflict among different factions in the community, agreed with Sutter, through a stipulated judgment approved by a court, to sever ties by 2010. This action means the district will reassume direct responsibility for the hospital and for the expensive undertaking of meeting earthquake safety standards. The board is in the process of making crucial decisions that will determine the future course for the hospital as well as important elements of healthcare in Marin.

The major issue in this election has become the governance structure for the hospital. Jackson and Simmonds insist that a separate board should be appointed by the district to oversee the staff and day-to-day operations. The separate board would assure that the CEO and hospital operations are insulated from board politics. Ramirez and Parnell argue that a separate board should not be created that perpetuates the problem of secret hospital operations, screened from the public view, which has existed during Sutter's tenure.

The separate board structure was recommenced by consultants Kurt Salmon Associates (KSA), hired by the district, and is common at other hospitals. It's also one of the requirements laid out by the county, led by Supervisors Steve Kinsey and Susan Adams, for a needed transition bridge loan to the district. KSA conducted a review of the MGH situation, including, it says, a confidential survey among 829 physicians and nurses at MGH. It concluded that "MGH's success hinges on whether the hospital governance can be depoliticized and stabilized. It is KSA's opinion that this is a foundational issue for MGH's future success...A hospital cannot be expected to succeed in a highly volatile and unstable political landscape. A governance model that utilizes an Operating Board structure enables MGH to conduct day-to-day governance responsibilities effectively without slowdowns and disruptions." Further, KSA recommended that the district contract with a hospital management company and immediately develop a transition board of directors to oversee the day-to-day transition activities.

All four serious candidates are well qualified with deep roots in the community and sincerely believe that the hospital's future is at risk. Given the hospital's pending divorce from Sutter there are more areas of agreement than there have been among hospital factions in the past. All agree the next few years will be a transition period. A plan that addresses seismic needs, including a bond measure, must be developed quickly. There is agreement that strong relationships need to be built with physicians, the community and other healthcare providers. And there is concern about competing facilities skimming lucrative services and leaving Marin General with high-cost care, undermining its financial base. The stakes are high. Depending on how it is managed and how it is able to survive in a hostile, competitive healthcare environment, Marin General could thrive as an independent hospital offering a broad range of high-quality services, or, at worst, be squeezed out of existence by economics and decisions made by its board.

Our exploration of this situation, including interviews with candidates and discussions with healthcare experts outside of Marin, leads us to conclude that the separate board structure makes sense. It can provide a greater range of expertise than exists on the elected board and some insulation from the heated political environment. However, we don't buy the notion that its activities should be screened from public view. We know of at least one educated legal view holding that it would be subject to the Brown Act, California's open meeting law, whether or not its creators want it to be.

Unfortunately, this is another Marin Healthcare District board race with candidates running as slates, which helps perpetuate past battles. There is a sensible middle ground on the issue of the separate board. Create a separate operating board, but also make its operations fully transparent. We hope that the winning candidates, whoever they may be, will seek this middle position. We believe that Frank Parnell has valuable medical, business and elected experience as well as a strong connection to the broader Marin community. We also appreciate his passion for accountability, local control and openness. We think his skills and commitment could be very valuable on this board. Sharon Jackson seems to have the ability to make pragmatic decisions and understands that it's possible to have a two-board structure in which the district board retains important powers. We would like to see both of them embrace the need for and benefits of a separate operating board and also commit to ensure that it functions in an open and transparent manner.

The Sun endorses Sharon Jackson and Frank Parnell.

Posted by Lori Wood, a resident of the Mill Valley neighborhood, on Oct 24, 2008 at 10:44 am

On your questionnaire Jackson said the district should have accepted Sutter’s offer to build a new hospital in 2004 (to comply with seismic safety laws for Marin General) but she doesn’t mention that Sutter's offer was conditioned on the ELIMINATION of the publicly elected district board.

Jackson (and her running mate Simmonds) have no problem overturning the district’s 1946 PUBLIC charter in favor of PRIVATE control. Jackson shows no shame in her attempts to disenfranchise voters based on her recent actions when she tried to sell the hospital (last year) and now while she is trying to "re-distribute" the powers of the elected board to a private board who can meet in secret. Her "private board" concept is not in place ANYWHERE in California's 70 district hospitals and the idea of meeting in secret violates the law (the Brown Act).

The Sun should have asked Jackson and Simmonds “Didn’t Sutter’s 1996 lease REQUIRE them to do the earthquake repairs?” and “Why did Sutter refuse to spend a penny of their $150M+ profit since 1996 to pay for a retrofit (estimated at just $60M four years ago)?” Ask her why she didn’t want a retrofit and why she stalled on the repair plans and why she voted for the secret settlement discussions that let Sutter off the hook for all the repairs and all past claims by the district. Ask her why we should vote for her again when she basically stuck Marin taxpayers with a $500M seismic repair bill (current estimate).

Not only that, but ask her how she thought the district would be able to pay for a new $55M computer (IT) system and other needed transition costs when she voted for the settlement terms two years ago with no financing plans in place. When 20 banks refused to lend her any money, she was forced to go to the County as a last resort. Why should we choose a leader who had to rely on a “last resort” (and future taxpayer bonds) for the hospital to survive Sutter’s departure? Why do we want to elect someone who cares more about saving Sutter’s money than the taxpayer’s money?

Jackson and her crew--the “Alliance to Save Marin General” are totally delusional about who has done the damage to Marin General. They have become so accustomed to projecting the blame onto the “activists” for the hospital’s problems, they can’t see the real perpetrator has been Sutter all along. Just look at the finances--look at how much Sutter has profitted and how much the public will have to pay to make up for Sutter’s greed. Look at the risky, vulnerable position the district and residents in Marin have been put into right now while Sutter walks away without any consequences and look at the way the facility has been degraded while Sutter was taking out millions in profits.

Posted by Tired of the Battles, a resident of the San Rafael neighborhood, on Oct 27, 2008 at 1:12 pm

This seems like another case where there are two factions locked into their ideologies. Your side doesn't seem to understand that for the hospital to survive it needs a credible board with some support. Jackson and Simmonds have the overwhelming support of the medical community which is needed to run the hospital and build support for a bond measure. She must be doing something right.

The other side doesn't seem to understand very well that the public deserves an open public process where interested local people can see how things are being run. Both sides need to learn that working together and trying to understand the other's point of view works better than constant blame and attack.

Posted by Just a physician who wants a hospital to work in for the next 30 years., a resident of the Greenbrae neighborhood, on Oct 28, 2008 at 12:36 am

Lori, get your facts straight.... Sutter offered to build a new hospital with the condition of a 50 year lease NOT elimination of the board, but no matter they are on the way out. The "private board" you are eluding to is not some secret cult, but an operating board to run the day to day operations of the hospital, sheltered from the political turmoil that has plagued the county health district board for over 30 years.

Clearly you don't work or visit the facility because you would realize that retrofitting a 50 year old building with heating, cooling and physical plant issues is pointless. A new building is required and that is why Sharon voted against a retrofit, and that is why Sutter did not want to spend money to "fix" a building that will need to be replaced in 10-20 years anyway. When it comes to funding this enormopus project, remember the district decided to divorce Sutter when the housing market was booming and the economy was stable. No one imagined having to ask lenders for money with our current market situation.

Finally, the "Alliance to Save Marin General" is backed by over 270 physician members of the CURRENT medical staff at MGH. We are the individuals who provide care for the community and want only the best for our patients. No one wants the hospital to survive more than we do....That is why we back Sharon Jackson and Harris Simmonds who we think are our best chance to successfully transition the hospital back to the public.

Interestingly, for all the Sutter opponents out there, if we don't survive, your health care is likely to be back in their hands. After all, they run the nearest facilities both north and south!

Posted by Lori Wood, a resident of the Mill Valley neighborhood, on Oct 28, 2008 at 12:14 pm

I stand by my facts...YES Sutter demanded the district board be eliminated. Check the public record and you will see that is true.

Posted by Lori Wood, a resident of the Mill Valley neighborhood, on Oct 28, 2008 at 3:22 pm

Who is "Just a Physician"? You work at MGH? Why don't you use your real name like I do? I've been inside the hospital many, many times. When I worked for the district, I would go to Marin General to post meeting notices and work at meetings. I was a volunteer at MGH in 1988. I wore the pink jacket and ran around helping patients and nurses.

I sat in every meeting during 2004-2006 that compared retrofit with other options for making the hospital earthquake safe. My main concern is (and has been) the waiting.

The earthquake safety laws were written in 1996 but Sutter and its supporters have blocked any repairs from being done. They played politics with the seismic safety of our hospital by claiming a retrofit wouldn't work and a new hospital had to be built so they could get the public to accept their offer in exchange for a new, 30 year lease and NO DISTRICT OVERSIGHT (no elected-board). Sutter's goal in getting everyone to reject retrofit killed two birds with one stone--(1) Let Sutter out of their current lease obligation to do the (more minimal) repairs AND (2) Set Sutter up for a future deal that would allow them to continue making millions in profits for 30 more years.

Experts have said there are many unsafe areas including labor and delivery rooms. Engineers said the piping will fall down on medical staff and women in labor, but NOTHING has been done. I ran my whole election campaign 2 years ago on this point--DO THE REPAIRS NOW! A retrofit would be a minimum "fix" (at least until a new wing could be added) and by the way, how do you know the construction of a new wing wouldn't cause as much (or more) disruption and dust as a retrofit would?