⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 18 findings
20-7
Page 1
The friction between AHS’s responsibility for operational control and Alameda County’s health service mandate and allegiance to other constituencies continues to frustrate both parties, exacerbate their mutual distrust, and interfere with their ability to communicate and implement long-lasting solutions to AHS’s financial crises.
No recommendations for this finding
F20-7
The friction between AHS’s responsibility for operational control and Alameda County’s health service mandate and allegiance to other constituencies continues to frustrate both parties, exacerbate their mutual distrust, and interfere with their ability to communicate and implement long-lasting solutions to AHS’s financial crises.
No recommendations for this finding
20-8
Page 1
AHS’s narrow focus on a balanced operating budget and EBIDA does not adequately represent the actual financial position of AHS.
No recommendations for this finding
F20-8
AHS’s narrow focus on a balanced operating budget and EBIDA does not adequately represent the actual financial position of AHS.
No recommendations for this finding
20-9
Page 1
Even with transparent and efficient management, an average annual EBIDA Margin of 3% to 5% is not sufficient for AHS to pay off its outstanding debt and buffer against any future financial crises.
No recommendations for this finding
F20-9
Even with transparent and efficient management, an average annual EBIDA Margin of 3% to 5% is not sufficient for AHS to pay off its outstanding debt and buffer against any future financial crises.
No recommendations for this finding
20-10
Page 1
AHS and Alameda County do not agree on whether AHS can establish a cash reserve to pay prioryear liabilities. The lack of a cash reserve exacerbates the long-term financial stability of AHS and its ability to comply with the Permanent Agreement, leading to further distrust between AHS and Alameda County.
No recommendations for this finding
F20-10
AHS and Alameda County do not agree on whether AHS can establish a cash reserve to pay prior- year liabilities. The lack of a cash reserve exacerbates the long-term financial stability of AHS and its ability to comply with the Permanent Agreement, leading to further distrust between AHS and Alameda County.
No recommendations for this finding
20-11
Page 1
AHS does not provide its financial reports to county supervisors and staff sufficiently in advance of regularly scheduled meetings between the parties to allow county supervisors and staff time to familiarize themselves with those reports prior to being presented by AHS. 52 2019―2020 Alameda County Grand Jury Final Report
No recommendations for this finding
F20-11
AHS does not provide its financial reports to county supervisors and staff sufficiently in advance of regularly scheduled meetings between the parties to allow county supervisors and staff time to familiarize themselves with those reports prior to being presented by AHS. 52
No recommendations for this finding
20-12
Page 1
AHS and Alameda County acknowledge the need for flexibility in the use of Measure A funds to take advantage of matching-fund opportunities. However, they often disagree on how AHS should specifically allocate Measure A funds to support its operations. This disagreement magnifies and exacerbates the distrust between AHS and Alameda County.
No recommendations for this finding
F20-12
AHS and Alameda County acknowledge the need for flexibility in the use of Measure A funds to take advantage of matching-fund opportunities. However, they often disagree on how AHS should specifically allocate Measure A funds to support its operations. This disagreement magnifies and exacerbates the distrust between AHS and Alameda County.
No recommendations for this finding
20-13
Page 1
Political pressure from some Alameda County supervisors has interfered with AHS operations and efforts to control costs.
No recommendations for this finding
F20-13
Political pressure from some Alameda County supervisors has interfered with AHS operations and efforts to control costs.
No recommendations for this finding
20-14
Page 1
Negotiating separate contracts with 18 different labor unions is both time consuming and expensive for AHS and limits AHS’s negotiating flexibility. AHS’s negotiations with labor have been further compromised by public support of negotiating labor unions from some county supervisors.
No recommendations for this finding
F20-14
Negotiating separate contracts with 18 different labor unions is both time consuming and expensive for AHS and limits AHS’s negotiating flexibility. AHS’s negotiations with labor have been further compromised by public support of negotiating labor unions from some county supervisors.
No recommendations for this finding
20-15
Page 1
AHS and Alameda County agree that the governance structure of AHS is problematic and needs to be revisited and strengthened in order for the parties to better understand and respect each other’s governance and operational roles.
No recommendations for this finding
F20-15
AHS and Alameda County agree that the governance structure of AHS is problematic and needs to be revisited and strengthened in order for the parties to better understand and respect each other’s governance and operational roles.
No recommendations for this finding
Conclusions 2
-
CL1 Page 20AHS and Alameda County have a complicated relationship that reflects the inherent complexities of operating a public health care system. In its investigation, the grand jury did not delve into and report on every detail of this relationship. Rather, we focused on broader patterns of interaction that reflect long-standing sources of tension in the relationship. AHS faced a financial crisis heading into FY2020, with a projected lack of operational profitability and no cash to pay for substantial liabilities from previous years. The AHS trustees and administration addressed the budget shortfall head-on and seemed to be back on track. Diligent financial oversight by the AHS trustees and budget management by the AHS administration needs to continue. Better transparency and efficiency of operations must also occur. Nevertheless, AHS and the county have not yet determined how to resolve the current cash and debt crisis. Long-standing issues of distrust and posturing around those issues continue to slow the effort to do so. Evidence considered raised the question for the grand jury: Can AHS ever fully repay its debt to the county? Even with transparent and efficient management, an average annual EBIDA Margin of 3% to 5% does not appear sufficient to pay off AHS’s outstanding debt and buffer against any future financial crises. Alameda County and AHS must collaboratively resolve how to pay for AHS’s long-term debts with the county. The county must meet its statutory obligation to provide medical care to indigent county residents. AHS must operate the hospital system to provide that medical care as efficiently and transparently as possible. If resources prove insufficient, AHS and the county need to identify and agree on the scope of services to be provided. If that scope is determined to be less than currently offered, AHS and the county need to agree on the least damaging way to provide health services—by cutting back on services, increasing the county’s financial support, or some combination of the two. Both parties then will need to present a uniform public face in support of that decision. As one witness aptly stated, “It’s not about the money. It’s about the political will and competency to make the tough decisions.” An improved relationship between the county and AHS is necessary to focus on defining a reasonable scope of the care to be offered by AHS, along with AHS reducing expenses and achieving revenue targets. Put another way, resolution will require the parties to make difficult decisions which appear to have been avoided or delayed to please special interests. These decisions cannot continue to be “kicked down the road.” The future of a critical county safety net is at stake. 51
-
CL2 Page 21ADDENDUM This time of COVID-19 pandemic is creating unprecedented demands on the finances, services and operations of both Alameda County and AHS. Nevertheless, the pandemic should not be an excuse to “kick the can down the road.” Alameda County and AHS should make a concerted effort to address the long-standing matters presented in this report. The pandemic takes highest priority, but the review and implementation of these findings and recommendations also must be of high priority. Otherwise, history most assuredly will repeat itself.
No Responses Found 2
Government entities assigned to respond to this report. No response documents have been linked in our database.
Alameda County Board of Supervisors
Elected County Office
Alameda Health System
Special District