Palo Verde HealthCare District

The annual fees are disproportionate with the size and financial capability of PVH. The present fees charged by AHM, is approaching a million dollars annually for two executives.

AHM staff wage rates are not consistent with other hospitals. A wage comparison of hospitals similar in size and location is shown in the following chart. The PVH Registered Nurse (RN) maximum hourly wage is not shown, as there was no maximum listed on the hourly current wage rates. RN HOURLY WAGE RATE 50 45 40 35 30 MAX 25 MIN 20 15 10 5 0 BIG BEAR, CA LA PAZ, AZ PVH BLYTHE,CA HOSPITALS The above wage comparison indicates that PVH’s RN minimum hourly wage rate is higher than either Big Bear or La Paz Hospitals’ maximum hourly wage rate. LVN HOURLY WAGE RATE 35 30 25 20 15 10 5 0 BIG BEAR, CA LA PAZ, AZ PVH BLYTHE,CA HOSPITALS SETAR EGAW YLRUOH MAX MIN 4 A similar chart shown above for Licensed Vocational Nurses (LVN) at each hospital illustrates the difference in pay for the PVH’s LVNs. Again, the PVH minimum hourly wage rate is higher than the others shown and the maximum hourly wage rate is well above the other hospitals’ maximum. DIRECTOR OF PLANT OPERATIONS 70 60 50 40 MAX 30 MIN 20 10 0 LA PAZ, AZ PVH BLYTHE,CA RCRMC, CA HOSPITALS This practice extends to other job classifications, including Director of Plant Operations, which is a non-medical position. Riverside County Regional Medical Center (RCRMC) has 439 beds compared to PVH, which has only fifty-one beds, and yet the minimum hourly wages of PVH are close to the maximum of RCRMC. The La Paz Hospital hourly wages are more in line with RCRMC.

The President of the Board has failed in his authority to appoint standing, special, or community ad-hoc committees of non-board members to act as an advisory group to the Board. The function of the standing committees is, if assigned, would be to review: • Budget and business plans; • Personnel matters; • Legal and legislative issues; and • Periodic inspections of the hospital facility to ensure that the hospital meets regulation requirements. 5

Interviews with existing Board members revealed a lack of understanding of the By-Laws governing the PVHD. This lack of understanding exists in spite of the fact that each elected or appointed Board Director is provided with a training manual. This manual contains the current District and Medical Staff By-Laws, as well as a copy of the Brown Act, and the complete California Health and Safety Codes, Division 23, “The Local Health Care District Law”.

AHM has failed to respond to some of the doctors’ complaints, as exemplified by assigning nurses with insufficient training for their assigned departments.

The current Medical Staff By-Laws, Section 6.4-1, requires only an authorized certified member of the medical staff to be the only one to admit patients to the hospital. This section is used by some physicians to withhold the admission of patients, bringing the hospital to near bankruptcy.

The existing contract between the PVHD and AHM authorizes an automatic five-percent increase in the fees paid to AHM in January of every year. The automatic increase has no performance targets as a requirement to receiving this increase.

PVHD Board Members receive agenda packets just prior to board meetings, giving them little time to study the financial and operational data, regulatory compliance issues, and previous Board meeting minutes.

PVHD By-Laws grant the Board primary responsibility on matters of policy. The Board is responsible for the regular review of PVH budgetary and financial matters related to, and including, the annual audit. The Board has relinquished its oversight to AHM. These inactions approach misfeasance.

The PVH Obstetrics Department was closed in June 2007, as a result of some doctors refusing to admit patients to PVH. Women are currently being transported great distances to other hospitals, putting them at risk. 6

The lack of hospital services at PVH impacts the nearby prisons, CVSP and ISP. Prisoners with surgical needs are being transported to outlying hospitals in Riverside, Brawley, or San Diego. Each incident requires two vehicles, one for a guard and the prisoners, and a second for back-up guards. ADDED COST TO LOCAL PRISONS 2007-2008 Month AUG SEPT OCT NOV DEC JAN $1,000’s 976 421 321 417 567 666 These costs, totaling over $3.3 million annually, do not include the high cost of fuel. Concurrent with these costs to the prisons is a substantial loss of revenue to PVH.