Response to the Interim Report of the Mariposa County Civil Grand Jury 2019-2020 John C. Fremont Healthcare District*

Recommendations 3

• R1

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  The John C. Fremont Healthcare District should immediately and aggressively pursue planning for the necessary and required construction, retrofit, and repairs to the hospital in order to obtain compliance with AB1953 by year 2030. In order to develop a coordinated plan to address its needs, JCF has assembled a top flight team of consultants, who are experts in their respective fields of finance, architecture, engineering and construction management, scientific polling, and political strategy. The consulting team includes Cuningham Group Architecture, Inc. and ProWest Constructors, highly respected organizations with experience working cooperatively together in building truly functional medical facilities; Gary Hicks, who has been JCF's Financial Advisor for years; Dr. Timothy McLarney of True North Research, who has provided a clear understanding of the opinions, perceptions, priorities, and behaviors of our residents and stakeholders; and Larry Tramutola of Tramutola LLC, a leading political strategist well known in California. Page
• R2

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  JCF must aggressively pursue all avenues of funding, including grants, large donor contributions and other forms of finance. Our consultants have helped multiple hospital districts throughout the State of California prepare for and pass local revenue measures. As the JCF hospital staff and volunteers continue to direct their valuable time and energies towards preparing for a surge in Coronavirus (COVID-19) patients, the consultants will continue to support the management team in implementing a plan to place a revenue measure on the November ballot. JCF will be working with the Mariposa County Board of Supervisors to place the sales tax measure on the November 3, 2020 ballot. [We must correct a misconception here - the District Board never considered raising the property tax because we believed the community might object.] The Board of Supervisors must reach a decision by August 7, 2020 for that to happen. The public will have opportunities to provide input to the Board of Supervisors at regular meetings scheduled in June/July. Actual dates will be posted on the Mariposa County website at: www.mariposacounty.org Until the Shelter-at-Home order is lifted, in-person participation will not be possible at Board of Supervisors meetings, although we have already met with them two times in person prior to COVID. Alternate ways for participating are available at the link below: https://www.mariposacounty.org/2409/Participate-in-Meetings As you know, the election phase is driven by an <i>Independent</i> citizens' campaign committee, established to persuade voters to support a ballot measure. While public agencies typically fund pre-electoral feasibility, planning, and public education the campaign activities cannot be funded using District resources. While JCF cannot advocate for the ballot measure, the District will provide voters with factual information, presented in a fair and unbiased way. . í Our team of consultants has already started to pull together smoothly, both simultaneously and sequentially, to create a dynamic plan for this multifaceted project. They have met together in person and through conferencing technology. They are addressing all our needs down to the last detail. Our consulting team includes the following: Cuningham Group Architecture, Inc. will conduct interviews with department heads to determine what is essential, what is needed, and what is merely desirable in the new hospital; they will then help the medical staff to pare down expectations to the most productive and cost effective level. <b>ProWest Constructors</b> is helping Cuningham to keep costs down by developing estimates when the building is in the design phase. Cuningham has prior experience working with the Office of Statewide Health Planning and Development (OSHPD), which oversees hospital planning and construction to exacting seismic standards. Cuningham and ProWest are highly respected organizations with experience working cooperatively together in building truly functional medical facilities. Gary Hicks, principal of G. L. Hicks Financial, LLC, has been JCF's Financial Advisor for years. He developed and continues to refine the financial structure and financing estimates given recent changes in the economic climate. True North Research President Dr. Timothy McLarney has provided a clear understanding of the opinions, perceptions, priorities, and behaviors of our residents and stakeholders by conducting a poll which indicates that the community appears receptive to a sales tax measure to fund the facility's construction needs. Tramutola LLC and their team of political analyzers is coordinating the strategic effort, providing ongoing advice about communications and community engagement, and working closely with Matthew Matthiessen on a daily basis. Together, they are in the process of developing the specific terms for placing the sales tax measure on the November ballot. Page
• R4

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  Senior management and members of the Board of Directors must continue to promote the hospital as a quality healthcare center which utilizes state of the art equipment, a highly trained professional medical staff, a quality customer service philosophy. We are in total agreement. Our CEO and some board members speak to local organizations about our plans. In addition, we have hired Therese Williams, our new Director of Public Relations & Community Outreach, to be sure we keep the public informed in person and through media. INVITED RESPONSE ŀ 4 Yes, we believe that transparency is essential. What information we have at this point we will make public. The Grand Jury requested accurate estimates with supporting documents of three options. The JCF Board has already decided to go with Option 2. We would like to share with you the reasoning behind our choice: OPTION 1. (Rejected) Retrofit the existing hospital at an estimated cost of $35-40 million. We decided not to do this again because we've done it in the past, and when we opened the ancient walls we found unwelcome surprises that greatly increased the costs of construction. This makes it hard to estimate costs with any precision. Also, this option would limit the flexibility of the architectural design, which could not accommodate the advances made in medicine over the past 70 years. Furthermore, if we were to renovate the entire hospital, it would mean demolishing interior walls to retrofit electric, water and sewer conduits while patients were lying helpless in the noise and dust. OPTION 2. (Chosen) Build a new hospital AT THE EXISTING SITE at an estimated cost of $75-80 million. This option looked most attractive to us because costs would be limited and predictable. We already own the land, plus we know that we already have adequate infrastructure to support a new hospital. At a later date, we can repurpose the old building as it is at minimal cost; it is built like a bunker even though it does not meet California's strict seismic requirements. OPTION 3. (Rejected) Build an "Everything Brand New" hospital from the ground up WHICH MEANT BUILDING A NEW HOSPITAL AND SIMULTANEOUSLY REPLACING THE EXISTING BUILDING FROM THE GROUND UP. We decided against this because we did not want to add the costs of tearing down and rebuilding the existing building to the costs of constructing a new hospital. That would be cost prohibitive. OPTION 4. (Rejected) In 2016, we considered building AT A DIFFERENT SITE. We decided against this because purchase of land was cost prohibitive. Even if we could persuade a donor to give us land for free, infrastructure is rare on land in Mariposa County. The costs of installing infrastructure combined with land costs would make payment unsupportable. Additionally, purchasing land and adding new infrastructure would take extra time we don't have. We are up against a deadline. The cost of construction is important to the JCF Board of Directors. To estimate the cost of building a hospital, we first contracted with ADAMS Management Services Corporation in 2016 to prepare a strategic facility master plan, including a market analysis and initial evaluation of location and estimate of basic costs based on hospital square footage. They estimated $85.5 million for new construction on purchased property and $64.5 million for repurposing the legacy facility. They further stated that every year costs can increase by about ten percent. Cuningham Group Architecture, Inc. and ProWest Constructors were reluctant to estimate the costs without complete plans, which they will prepare after evaluating our precise needs. However, in 2019 (in an open meeting) they estimated between $50 and $80 million for new construction for Option 2, based on square footage. The current design is conceptual in nature. At this point, our architect says there is not enough detailed information to get an accurate construction cost estimate necessary in time for this response letter. Our builders will need to see at least a design development level of drawings, f 0 including engineering drawings, in order to put together the quantities of materials, equipment, medical gases, utilities, governmental / design / construction fees, etc. necessary for an accurate estimate. Developing that detail will be part of that architectural process. When we go to the public for the sales tax measure on the November 3, 2020 ballot, we will be in a better position to estimate the cost. Thank you for the opportunity to respond to the Interim Report prepared by the Mariposa County Civil Grand Jury, and thank you for your supportive statements in the report. Candy O'Donel-Browne, Chair of the Board Reviewed Honorabl Dana Walton, Per PC933 E