Jun 19, 2008

Sequoia should fund more direct care

By Bil Paul

The Sequoia Healthcare District, which includes cities in southern San Mateo County, has been going through a lot of transitions. The latest involved relinquishing partial control of Sequoia Hospital in Redwood City to Catholic Healthcare West, which has been running it since 1996. At the same time, the district contributed $75 million to a seismic upgrade of part of the hospital.

The district receives a portion of the county's property tax revenue, approximately $7 million per year, for its programs. Over a long period of time, the district, run by an elected board of directors, has gradually spent less and less of its tax revenue on maintaining and running the hospital and - enabled by a change in state law - begun a new era of contributing to local nonprofits and charities. These grants are to go to health-related organizations.

Personally, I feel that the district should be dissolved because it's no longer needed to maintain a hospital, but there's only one person on the board who also believes that - libertarian Jack Hickey.

The district's annual giving of grants to organizations serving people living within district boundaries should come under examination in light of state budget cutbacks being negotiated between the Legislature and the governor.

It's been reported that approximately 4,500 medically uninsured kids in San Mateo County could lose Medi-Cal coverage under these state cutbacks, and payments to doctors working in the county's Medi-Cal system (administered by the publicly run Health Plan of San Mateo) could be reduced, prompting some doctors to leave the program. The latter program is for adults. As a result, many more children and adults could effectively move into the uninsured category, and begin to use "free" county health system facilities - especially the county-run San Mateo Medical Center.

Also, simply due to the downturn in the economy, high rents and gasoline costs, more and more people may be dropping their medical insurance and using county facilities, charity facilities such as those run by Samaritan House, and other hospitals' emergency rooms. The county medical system now makes up by far the largest chunk of the county budget, with increasing amounts of money needed each year. In 2009, needs from the San Mateo Medical Center are projected to increase $12 million over this year.

In light of these increasingly pressing and direct health care needs, how is the Sequoia Healthcare District responding? Increasingly well, but with room for improvement.

For example, the district recently granted a county-run North Fair Oaks clinic (near Redwood City, Menlo Park and Atherton) $1.6 million for its valuable operations in a largely Hispanic area. Also, the district committed itself to extending its support of the Samaritan House clinic in San Mateo through next year, to the tune of $500,000 per year. Other grants that offer direct medical services include those to Planned Parenthood, some programs at Sequoia Hospital, and the county-run San Mateo Medical Center.

Some of the district's funded projects are of borderline value in the area of providing direct medical care to the uninsured or underinsured. These include programs to train nurses (a response to a nurse shortage) at the county's community colleges and to provide a school nurse for the Sequoia Union High School District. Also, the district funded a program to prepare low-income people for health care careers and a program to detect breast cancer in low-income women.

But beyond these gray-area grantees, there are a host of nice-to-do, "soft" programs that are too distant from the direct medical care mission that should be the cornerstone of the Sequoia Healthcare District. Better funded by foundations and corporations, these organizations offer peripheral programs and services, such as health and nutrition education, fitness programs, counseling for those with substance-abuse problems, help for parents dealing with neonatal death, a sexuality program for teens, bereavement services, CPR training, domestic violence intervention, help for at-risk women, general mental health and mentoring, volunteering programs, general programs for children and foster kids, disaster preparedness, obesity prevention in children, breakfasts and exercise for seniors, and helping seniors in long-term care facilities.

The term "at-risk" seems to be a successful catchword for obtaining funds from the district.

I'm told that the district is currently obtaining input from community and county leaders to develop a new strategic plan. Hopefully, the plan will include more direct medical care ("hard" programs) and fewer "soft" programs such as those mentioned above.

Another questionable attribute of the Sequoia Healthcare District board is its willingness to attend ceremonies put on by the organizations it funds, giving them strokes for providing money. It's true that the board itself often pays for a table at these events, but it seems to me that board members should remain above forging special relationships with those organizations that will seek more money in the future. As district board member Jack Hickey says, the connections between the district and the nonprofits it funds can resemble interlocking directorships between corporations.

Also, I understand that those helping to fund re-election campaigns by incumbent district directors sometimes have connections with organizations seeking funding, which may influence who wins grants.

The world of nonprofit funding can be every bit as political and who-knows-who as mainstream politics. You could say that nonprofits are a tributary to the main river of political movement.

Bil Paul's column appears Thursdays in the Daily News. Reach him at natural_born_writer@yahoo.com.