01
BEFORE THE
DEPARTMENT OF HEALTH SERVICES
01
02
EMERGENCY
MEDICAL SERVICES COMMISSION
02
03
FOR
THE COUNTY OF LOS ANGELES
03
04
JOHN
M. EDELSTON, CHAIRMAN
04
05
05
06
06
07 In the Matter of the
)
07 Public Meeting Re:
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08
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08 IMPACT OF CLOSURE OF DANIEL FREEMAN
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09 MARINA HOSPITAL EMERGENCY DEPARTMENT
)
09 ___________________________________________)
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TRANSCRIPT
OF PROCEEDINGS
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18
Venice,
California
18
19
Wednesday,
July 17, 2002
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22
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23
23
24
24
25 Reported by:
25
26 FRANCES EGGLESTON, RPR,
26 CSR No. 11662
27
27 Job No.:
28 HEAM171
28
0002
01 BEFORE THE
DEPARTMENT OF HEALTH SERVICES
01
02
EMERGENCY
MEDICAL SERVICES COMMISSION
02
03
FOR
THE COUNTY OF LOS ANGELES
03
04
JOHN
M. EDELSTON, CHAIRMAN
04
05
05
06
06
07 In the Matter of the
)
07 Public Meeting Re:
)
08 )
08 IMPACT OF CLOSURE OF DANIEL FREEMAN
)
09 MARINA HOSPITAL EMERGENCY DEPARTMENT
)
09 ___________________________________________)
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17
TRANSCRIPT
OF PROCEEDINGS,
17
18 taken at
2232 Lincoln Boulevard,
18
19 Venice,
California, commencing at
19
20 6:00 p.m. on
Wednesday, July 17, 2002,
20
21 heard before
JOHN M. EDELSTON, CHAIRMAN,
21
22 reported by
FRANCES EGGLESTON, RPR,
22
23 CSR No.
11662, a Certified Shorthand
23
24 Reporter in
and for the State of
24
25 California.
25
26
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28
28
0003
01 APPEARANCES:
01
02 EMS COMMISSION MEMBERS:
02
03 JOHN M. EDELSTON
Public
member
03 Chairman
representing
04
Supervisor
Yaroslavsky
04
05
05
Association
06
06 ROBERT G. SPLAWN, M.D.
California Chapter
07
American
College of
07
Emergency
Physicians
08
08 NICHOLAS BERKUTA
Peace
Officers
09
Association
of
09
Los
Angeles County
10
10 MARK COSTA
Hospital
Council of
11
Southern
California
11
12 MARSHA ANDERSEN
Public
member
12
representing
13
Supervisor
Knabe
13
14 GARY WASHBURN Public
member
14
representing
15
Supervisor
Antonovich
15
16 DOVE SAVAGE PINKNEY
Public member
16
representing
17
Supervisor
Burke
17
18 VIRGINIA PRICE HASTINGS
Executive Director
18
EMS
Staff
19
19 VIDYA KAUSHIK
20
20 RICHARD ELLIOTT
Los
Angeles County
21
Chapter
California Fire
21
Chief
Association
22
22 ROBERT FLASHMAN, M.D.
Los Angeles County
23 Medical
Association
23
24 MICHAEL THOMPSON
League
Of California
24
Cities,
Los Angeles
25
County
Chapter
25
26
26
27
27
28
28
0004
01
01
I
N D E X
02 AGENDA ITEM NUMBER:
PAGE
02
03 1 - Call to Order and Introductory Remarks by
5
03 John Edelston, Chairman,
Emergency Medical
04 Services Commission
04
05 2 - Presentation by Harris Koenig
13
05 Chief Executive Officer
06 Daniel Freeman Hospitals
06 Tenet Health System
07
07 3 - Presentation by Virginia Price Hastings,
23
08 Director of Emergency Medical
Commission
08
09 4 - Presentation by Senator Debra Bowen
24
09
10 5 - Presentation by Supervisor Yvonne
27
10 Brathwaite Burke
11
11 6 - Presentation by Angela Davidson for
31
12 Assemblyman George Nakano
12
13 7 - Presentation by Sandy Kievman representing
33
13 Councilwoman Cindy Misikowski
14
14 8 - Presentation by Mike Bowden, Culver City
33
15 Fire Department
15
16 9 - Presentation by Mike Metro, Los Angeles
35
16 County Fire Department
17
17 10 - Kelly Calkin for Assemblyperson
36
18 Jane Harman
18
19 11 - Public Speakers:
19 Susan Burt Fogel
39
20 Christine Wood
41
20 Julie Inouye
42
21 Lark Galloway
45
21 Leslie Bennette
46
22 Lizzette Legarreta
49
22 Jeff Codar
49
23 John Murdoch
50
23 Dr. Mukesh Bhatia
54
24 Orethea Ensley
55
24 Paul Davis
56
25 Peggy Lee
57
25 Patti Sanchez
59
26 Genevieve Clavreul
60
26 Patrick Burns
61
27 Jack Cumming
63
27 Valerie Gordon
65
28 Dr. James Moore
66
28
0005
01
E
X H I B I T S (Continued)
01
02 PUBLIC SPEAKERS (Continued):
02
03 Rene Moore
67
03 Patricia Ramos
68
04 Sheila Bernard
69
04 Doris Burg
71
05 Tim Riley
73
05 Carol Powell
74
06 Dr. John Michael
75
06 Steve Williams
77
07 Sheila Nicholson
77
07
08 12 - EMSC. Comments/Actions
79
08
09 13 - Closing Remarks
79
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0006
01 Venice, California,
Wednesday, July 17, 2002
02
6:00
p.m.
03
04
05 MR. EDELSTON: I would like to call
the hearing to
06 order. Good evening, ladies and gentlemen. Can you all
07 here me? My name is John Edelston, and I am the Chairman
08 of the Los Angeles County Emergency Medical Services
09 Commission. I would like to welcome you to this public
10 hearing regarding the Announced Closure of the Daniel
11 Freeman Marina Hospital Emergency Department. Prior to
12 beginning the hearing, I would like to thank Mr. Connor
13 for his assistance in obtaining this hearing site in the
14 Girls and Boys Club of Venice, for his hospitality for
15 making this building available to the Commission and to
16 the public for this important meeting.
17 I also
personally want to thank Virginia
18 Hastings, the director -- to my left -- of the LA County
19 Emergency Medical Services Agency. She wants to let you
20 know she didn't put me up to this. This is one in a
21 progression of a number of hearings that we have had over
22 the past two years. I would like to thank her for her
23 time and effort to make these hearings meaningful and
24 productive. I also want to take this opportunity on
the
25 behalf of the entire Commission to thank the entire
26 agency staff who has spent countless hours preparing
27 documentation and materials in preparation for this
28 meeting.
0007
01 At this time
I would like to begin this public
02 hearing by making some introductory remarks about the
03 process. As you can see, there are many, many people in
04 the audience. And in order for this to be meaningful, we
05 are going to need to have this conducted in an orderly
06 manner. Prior to the closure of an emergency department
07 of an acute care hospital such as Daniel Freeman Marina
08 Hospital, state law requires that the affected county
09 perform an impact evaluation to determine the effect of
10 such closure on the community and on the emergency medical
11 services system. This impact evaluation consists of two
12 steps: one, the holding of a hearing concerning the
13 closure for the benefit of you, the public; and two, the
14 preparation of an impact evaluation study to be provided
15 to the State Department of Health Services.
16 The
17
18 public hearing. The results of this hearing will be
19 incorporated into the impact evaluation study to be
20 prepared by the LA County Emergency Medical Services
21 Agency. Following its completion, the study will be
22 presented to the Board of Supervisors for adoption and
23 then sent to the State Department of Health Services as
24 required by law.
25 The
Emergency Medical Services Commissioners you
26 see before you are appointed by the Board of Supervisors
27 and serve without compensation. I have served on this
28 Commission for the past several years, and I am
0008
01 continually impressed by the quality of Commissioners with
02 whom I am able to serve and am gratified that these busy
03 people are willing to give of their time to work on the
04 public's behalf.
05 The
Commissioners you see here represent a wide
06 range of professional, public, and private entities
07 involved in the prehospital -- paramedic, ambulance,
08 hospital, and emergency department -- medical care as well
09 as community representatives appointed by each of the
10 Board of Supervisors. You will find a complete list of
11 speakers and organizations they represent in the handout
12 materials that have been provided to you. If you have not
13 received them, they will be available at the door.
14 Ladies and
gentlemen, your attendance here
15 tonight is clear evidence that the proposed closure of
16 Daniel Freeman Marina Emergency Department is a concern to
17 you all. Your community involvement is to be commended.
18 Your concern is shared by your Fourth District Supervisor
19 Don Knabe, Second District Supervisor Yvonne Brathwaite
20 Burke, and the other members of the Board of Supervisors
21 who requested this meeting to be held within the Marina
22 Del Rey area as expeditiously as possible.
23 Please be
advised the primary purpose of this
24 hearing is to accept input and advice from all concerned
25 citizens and interested community organizations; however,
26 this Commission has no authority to overturn any final
27 decision by Tenet Health System to close the Daniel
28 Freeman Marina Hospital Emergency Department.
0009
01 As we begin,
I would like to review the
02 procedures for conducting this hearing. You have been
03 provided with a copy of the hearing procedures and the
04 hearing agenda. Hopefully by now, if you wish to speak,
05 you have completed a request-to-speak form; and if you
06 have not done so, please do so immediately and provide it
07 to an EMS, Emergency Medical Services, staff member. They
08 can be found, again, over by the door.
09 During the
time scheduled for this hearing, we
10 will make every effort to insure that you, the public, are
11 afforded the opportunity to speak. Please remember that
12 the Commission insists that the audience afford courtesy
13 to all the speakers. At this time I would like to give
14 each Commissioner the opportunity to introduce themselves
15 and to address the audience with any comments that you as
16 the Commissioners may have. I would like to start now to
17 my left with Gary Washburn.
18 MR. WASHBURN: Thank you. I am
Commissioner Gary
19 Washburn. I am Senior District Director for State
20 Assemblyman Keith Richman, who is the only physician in
21 the
22 public member Supervisor Michael Antonovich on this
23 Commission. I've been on this Commission for several
24 years and share your concerns.
25 MS. KIRBY: Good evening. My
name is Elizabeth Jean
26 Kirby. I am representative of the Emergency Medical
27 Nurses Association and I've been on the Commission for
28 several years and I share your concerns also.
0010
01 MR. KAUSHIK: Good evening. I'm
Vidya Kaushik. I'm a
02 cardiologist. I am the President of the Heart
03 Association. I have been with this Commission for the
04 last seven years. I've been to these hearings quite a few
05 times. Thank you.
06 MS. PINKNEY: Good evening. I'm
Dove Savage Pinkney
07 appointed by Supervisor Yvonne Brathwaite Burke. I am
08 serving my second turn on this Commission. I am also a
09 retired medical technologist and manager of the clinical
10 lab hematology, Children's Hospital. I've spent my life
11 in health care and as a volunteer in the community, and I
12 would like you to understand that I truly share your
13 concerns.
14 MR. EDELSTON: I am chair of the
Commission. I am
15 John Edelston. I am an appointee of Supervisor
16 Yaroslavsky.
17 MR. THOMPSON: I am Mike Thompson.
I represent the
18
19 Commission. Prior to serving as the representative for
20 the League of California Cities, I represented the LA
21 County Fire Chief's Association. I was the fire chief.
I
22 recently changed professions. Now I am chief
23 administrator also for the City. I am here to listen to
24 your concerns tonight.
25 MR. FLASHMAN: Dr. Robert Flashman.
I represent the
26 LA County Medical Association. I am an emergency
27 physician. And as every one of these people on the
28 Commission -- we are all concerned that emergency medical
0011
01 services be continued to be available to this community as
02 well as all communities in LA County.
03 MR. BERKUTA: I'm Nick Berkuta, and I
represent the
04 Peace Officers Association of
05 professional peace officer with nearly 34 years of county
06 service. I am currently employed with the Sheriff's
07 Department. My concern with the medical care in the
08 county is very deep. It is for all the citizens because
09 we truly need the best quality and quantity of medical
10 care that we can give.
11 MS. ANDERSEN: Good evening. My
name is Marsha
12 Andersen Antonelli. I was appointed by Supervisor Don
13 Knabe to this position about two years ago. I am recently
14 retired as a vice-president of a rather large
15 not-for-profit medical facility here in Southern
16 California.
17 MR. ELLIOTT: Good evening.
Richard Elliott,
18 representing the LA County Fire Chiefs Association. I am
19 the fire chief of the city of
20 interest is that people get timely and appropriate care in
21 the field. We are also concerned.
22 MR. COSTA: My name is Mark Costa.
I am
23 representative of the Hospital Council of Southern
24 California. We are represented on this commission because
25 the hospital industry does have an important role in
26 assuring access to ER care in our community.
27 MR. EDELSTON: Thank you.
28 MS. HASTINGS: We're having some
trouble with the
0012
01 interpreter equipment, so what we're going to ask is for
02 those people that only speak Spanish to move to one area
03 in the back of the room and we will have an interpreter
04 back there for you, because the equipment for whatever
05 reason did not arrive. Did I explain that correctly?
You
06 want to say that in Spanish?
07 (Spanish
translation)
08 MR. EDELSTON: Thank you. We
will now begin
09 accepting public testimony. Your agenda lists the order
10 in which this Commission will hear the public testimony,
11 at least the agendized speakers. We will have additional
12 public testimony from members of the public in addition to
13 those who are listed on agenda. What I will be doing is
14 asking those who are asked to speak to say your names,
15 start to move toward the podium so we are not waiting for
16 people to come to the podium to speak.
17 I request
the speakers, when they do speak, be as
18 concise as possible in making points that you want to make
19 for consideration by the Commission. In order to keep the
20 hearing moving along, I ask members of the public not on
21 the agenda to limit their comments to not more than five
22 minutes so that everybody has an opportunity who wants to,
23 to express their comments, their feelings.
24 Also I ask
those members of the public not to
25 reiterate statements, issues that have already been stated
26 so that it limits the amount of redundancy, again, as an
27 effort to allow as many people to present their issues and
28 opinions as possible.
0013
01 When your
name is called, please move toward the
02 podium and begin your turn. Please also remain at the
03 podium until you have answered any follow-up questions
04 from the Commissioners or the Emergency Medical Services
05 Agency Staff. Commissioners are asked to hold their
06 questions until the end of each presenter's presentation.
07 Will the
representative of Tenet Health System
08 please step up to the podium.
09 MR. KOENIG: Thank you, Mr. Chairman.
Good evening,
10 ladies and gentlemen. I am Harris Koenig, Chief Executive
11 Officer of Daniel Freeman hospitals, which includes Daniel
12 Freeman Memorial Hospital in
13 Marina Hospital in Marina Del Rey. Thank you for the
14 opportunity to speak before you this evening. I want to
15 first say that we welcome this opportunity to address your
16 Commission and the public tonight. We have already
17 consulted with many of you, and we want in the spirit of
18 openness to continue that process.
19 Before I
proceed, I hope you'll allow me to set
20 these remarks in context. We purchased these hospitals in
21 December, and the hospitals were both on the verge of
22 bankruptcy and closure. Our first task was to complete
23 our assessments as soon as possible. After doing that, we
24 had many decisions, some very difficult. While it was a
25 tough decision given its many implications, we made the
26 decision to close
27 There were
several reasons we came to this
28 conclusion; and among the most significant are as
0014
01 follows: First, the former operators of the hospital were
02 nearing bankruptcy when they sold the hospitals to Tenet
03 in December of 2001. The two hospitals lost more than
04 $55 million in the years leading up to the sale. Last
05 year alone the system lost $23 million. A significant
06 portion of the system's losses were incurred at the
07
08 Daniel
Freeman Marina has 166 beds but very few
09 patients. That is why Tenet agreed with the State
10 Attorney General to keep the Inglewood Daniel Freeman
11 Memorial Hospital open but did not make that same
12 stipulation for the
13 assessment of the future of the hospital during our first
14 six months utilizing outside consultants and experts from
15 within Tenet. Our comprehensive assessment indicated that
16 Daniel Freeman Marina has an average of only 40 acute
17 patients a day and that the current level of utilization
18 would not grow significantly over the next ten years. The
19 population of the
20 health care services given its current and projected
21 demographic makeup. 87 percent of the community
22 out-migrates, meaning they elect to obtain health care
23 services outside the community.
24 The facility
is 32 years old. It does not meet
25 seismic, life safety, or
26 complete rebuilding to continue to function as a hospital
27 and to complete with the newer, larger full-service
28 medical centers that surround the
0015
01 discussing the closure with our local governing Board and
02 concluding that closure of the Marina facility was
03 necessary, we began the notification process. We have had
04 several meetings with Virginia Price Hastings and Eric
05 Stone and many others and have complied with their
06 requests. We initially gave our 90-day statutory notice
07 and reported that the emergency room would remain open
08 until August the 26th.
09 In the
ensuing weeks it became apparent that
10 staffing levels would become unsafe by July 22nd. In
11 complying with Health and Safety Code 1255.1, we notified
12 the appropriate agencies of our inability to safely staff
13 the hospital so that they could make appropriate plans. I
14 want to make it clear that it is our intention to comply
15 with 1255.1 of the Health and Safety Code and maintain
16 emergency services open until the 90-day notification date
17 of August 26 if at all possible.
18 After we
provided our notice to the agencies, we
19 began to notify the public with posted notices, newspaper
20 advertisements and flyers. We also started to make
21 arrangements for free transportation services for Marina
22 Del Rey residents to access local medical services. That
23 service commenced operations today. Additionally, we have
24 continued and intensified the process of upgrading the
25 24-hour urgent care facility that we operate near
26 Los Angeles International Airport, the Centinela Airport
27 Clinic, which is a few miles south of Marina Hospital.
28 (Interruption
from the audience)
0016
01 MR. EDELSTON: Excuse me, ladies and
gentlemen, please
02 afford respect to the speakers as you would like to have
03 that respect afforded to you.
04
(Interruption from
the audience)
05 MR. EDELSTON: Excuse me. Sir,
I ask you to please
06 let the speaker speak.
07 MR. KOENIG: Thank you. We are
also assisting the
08 Venice Family Clinic with their ability to meet an
09 increased patient load and are exploring other urgent care
10 opportunities with some of our local physicians. The
11 closure of Daniel Freeman Marina Hospital, like the
12 20 small hospitals that have closed in Los Angeles County
13 over the past ten years, was ultimately caused by the
14 negative impact of managed care and the movement of
15 patients away from primary care hospitals to larger, more
16 modern full-service hospitals in the surrounding area. In
17 this case seven of those nearby hospitals have excess
18 capacity and are planning on future expansion.
19 We have been
working very closely with your staff
20 on several thoughts and concepts to mitigate the impact of
21 the
22 side. We appreciate this working relationship and look
23 forward to improving the changed
24 future. Additionally, we have and will continue to
25 evaluate and support the development of health care
26 services to meet the needs of
27 Thank you very much.
28 MR. EDELSTON: Do the Commissioners
have any questions
0017
01 for Mr. Koenig?
02 We are going
to address questions from the
03 Commission.
04 MS. KIRBY: Jean Kirby. I'm a
registered nurse and I
05 am here representing the Emergency Nurses Association. I
06 just have a couple questions. I have two questions.
The
07 transportation system that you started today, how do they
08 get to that transportation? Is it a bus system or you
09 pick them up at their home? If you could describe that.
10 And then how is it going with the 911 at the airport? Do
11 you receive 911 patients? Can you explain a little bit
12 about that?
13 MR. KOENIG: For the audience, I would
like to restate
14 the question of the Commissioner. One related to how the
15 transportation services intended to operate and how we are
16 progressing or what the aspects are of receiving 911 runs
17 to the LAX clinic.
18 First of
all, we have started posting flyers and
19 will have advertisements in the Argonaut and postings
20 about the transportation service. It is not intended in
21 any way to be an emergent or replacement for emergency
22 medical response. It is a medical van that allows access
23 to people to access outpatient services, physician office
24 appointments, and those kinds of things.
25 It will
operate five days a week during normal
26 business hours and will be accessible via telephone.
27 There's a telephone number in the postings that we're
28 making and people will be able to access that. We've made
0018
01 that our notification to the public in our advertisement
02 with regard to how to access that. That starts now and
03 will continue into the future for several years, as will
04 our notifying local residents of where they can obtain
05 emergency services at surrounding hospitals and urgent
06 cares as well. So our information to the public will be
07 ongoing over the next several years and will address
08 transportation access to emergency rooms and urgent care.
09 With regard
to our work with your agency and with
10 licensing on the upgrade of the Centinela Airport Medical
11 Clinic, we have had several discussions that have included
12 not only staff but also representatives from the LA County
13 Fire, LA City Fire, and ambulance providers in the area.
14 They actually visited the airport clinic and surveyed it.
15 It was designed as an emergency room. There is imaging
16 capability there and we have other resources available at
17 the airport clinic.
18 At this
moment -- and Ms. Hastings may want to
19 correct me if I misstate something or add to this -- in
20 our discussions, what we believe will occur -- and we've
21 entered into a letter of intent with the EMS agency to
22 pursue this concept -- that ambulance runs that carry
23 basic life-support patients in need of basic life-support
24 system could access the Centinela Airport Medical Clinic
25 once we get all the systems in place and established.
26 So that's
the goal that we are working toward.
27 We're working with licensing because the Airport Medical
28 Clinic is on the license of Centinela Hospital Medical
0019
01 Center. It is operated as an emergency room now and
02 provides service to the airport population in general on
03 an ongoing basis and had more of an important role to play
04 during 9/11 and more subsequent events, for those who are
05 interested in having that Airport Medical Clinic upgraded
06 to emergency room status being supported by Centinela
07 Hospital Medical Center and Daniel Freeman Memorial
08 Hospital.
09 MR. EDELSTON: Any other questions?
10 DR. KAUSHIK: Mr. Koenig, I need some
reassurance.
11 Last time you were in the Commission in May, I had asked
12 you who is going to educate the public about this closure
13 and where they can go; and you assured us that it would be
14 Tenet's responsibility and that Tenet would take care of
15 it. Now I come here and I see this letter from the
16 attorney general agenda that you have not done your share
17 to inform the community of the objective. I think
18 something has happened. That was not in your plans or you
19 plan to involve the community in the facility being closed
20 and other facilities not being closed?
21 MR. KOENIG: The question was have we
-- when we were
22 before the Commission before, I was asked the question,
23 are we going to be communicating with the public with
24 regard to access to services when we got to the time of
25 closure in the hospital; and the Commissioner raised the
26 issue of the Attorney General's motion that was filed
27 yesterday in court with regard to their opinion that we
28 have not been in compliance with the conditions that they
0020
01 set on us at the time of sale.
02 We have
communicated and we believe
03 overcommunicated; and we at one level have been criticized
04 for communicating the fact that we believed at the time
05 that we knew that resources would not be available to
06 support the emergency room, that we brought that to the
07 attention of the appropriate agencies to allow them to
08 plan the response to the closure.
09 We are
committed to doing everything we can do to
10 keep the emergency service open; but in the face of
11 closure, people that create the organization of a hospital
12 make independent decisions as to where they are going to
13 go, and those resources dwindle.
14 At the time
we believed our resources had come to
15 an end on one very critical service, we believed it was
16 our responsibility to notify the appropriate agencies; and
17 after we notified the appropriate agencies, we posted in
18 the newspapers and we posted in flyers the announcement
19 that we are going to close. We followed it with
20 announcements relating to where residents could get access
21 to emergency room services; and as of yesterday, we are
22 publishing announcements as to where they can access our
23 transportation.
24 And in
future advertisements and notifications,
25 we'll be talking to them about urgent care accessibility
26 as well. And we are doing that by posting notices and
27 advertisement in the Argonaut, in the
28 Los Angeles Times, in flyers, and notices posted. So we
0021
01 are doing that in a number of different venues.
02 With regard
to the action that was taken
03 yesterday by the Attorney General, we believe that we are
04 in full compliance with the conditions of the Attorney
05 General; and that's a matter that will be discussed at a
06 subsequent date.
07 MS. SAVAGE PINKNEY: I was wondering,
do you really
08 believe what you've just stated? Do you have a plan to
09 implement this transportation? I would also like to know
10 what one might expect to happen if for some reason six
11 weeks from now there isn't any transportation. Is there
12 any accountability on the part of anyone or any
13 responsibility? Thank you.
14 MR. KOENIG: Well, what I have stated
is a matter of
15 facts, Madam Commissioner; and the Attorney General has
16 the authority to insure compliance under the conditions
17 that were imposed on us at the time of purchase.
18 FROM THE AUDIENCE: So what happened
yesterday?
19 MR. EDELSTON: Excuse me, only the
Commissioners may
20 ask questions of the speakers. Other Commissioners have
21 questions.
22
23 MS. HASTINGS: I have one that I
would like to have
24 addressed, and that has to do again with the Attorney
25 General's document that came out in essence advising that
26 you have to abide by the August 26th date. As you know,
27 based upon the reported loss of some of your medical
28 staff, we advised paramedics that they were to stop
0022
01 transporting effective Friday. We would like to reverse
02 that, and I would like to know where you stand
03 specifically with your anesthesiology coverage for the
04 emergency department, which was the one issue that as a
05 911 entity we were concerned about.
06 Can you tell
us where you are with the position
07 of coverage for the emergency department so we can
08 redirect our paramedics back to you?
09 MR. KOENIG: On a daily basis, we are
monitoring the
10 availability of resources not only in the emergency room
11 per se but in the services that we need to support the
12 emergency department. The anesthesia situation was the
13 trigger that brought us to the point of bringing notice to
14 the agencies; and we are working with anesthesia to try to
15 put together an extended plan to allow us to go forth. We
16 have not completed that discussion yet. It is a two-party
17 transaction. We don't have control over it 100 percent,
18 and we are working diligently to try to extend that
19 coverage beyond the 22nd. We are monitoring all other
20 areas where we have staffing issues, and we intend to
21 comply with 1255.1.
22 If we come
to the point in time where we believe
23 that we are unable -- because patient safety is our number
24 one concern -- that we get to the point where we believe
25 we cannot provide safe patient care, we must and shall
26 inform the Department of Health Services, and they will
27 come and evaluate our situation and make a decision based
28 on what they see.
0023
01 MR. EDELSTON: Questions?
02 MS. ANDERSEN: You mentioned quite a
bit about the
03 communication plan. I did not hear you mention how you
04 will present access to the patients that have been at this
05 hospital through the emergency department or otherwise to
06 their medical records. In the short term and in the long
07 term, how will they access their medical records?
08 MR. KOENIG: I don't have a specific
answer for you at
09 this moment; and I will be glad to provide you with an
10 answer to that subsequent to the hearing.
11 MR. EDELSTON: Any other questions?
We are going to
12 move to our next speaker. The next presenter, which will
13 be Virginia Hastings, who is director of the Los Angeles
14 County Emergency Medical Services.
15 MS. HASTINGS: I am going to
move very quickly and
16 just advise the Commissioners that in the packet we
17 provided for you is the standard information we give when
18 you are evaluating the closure of emergency departments;
19 that includes the surrounding hospitals, the services that
20 the surrounding hospitals provide, the 911 transports that
21 are involved in this hospital -- would have to be
22 redirected, and Daniel Freeman Marina receives paramedic
23 traffic from LA City Fire, LA County Fire, and Culver City
24 Fire. We also provided you with the Board of Supervisors
25 motion and some other background information.
26 And for the
public, we have a lot in the
27 information packets; but we have also put some of the
28 information on charts here that you might want to look at
0024
01 before you leave. And if you have any more questions, you
02 can certainly reach us tomorrow. With that, I am going to
03 stop because we want to move on to the agenda.
04 MR. EDELSTON: Thank you.
05 I will ask
if the Commissioners have any
06 questions of Virginia Hastings? Hearing none, we will
07 move on to the next presenter, which will be Senator Debra
08 Bowen.
09 SENATOR BOWEN: Good evening, ladies
and gentlemen.
10 I am Senator Debra Bowen. I represent this area and I
11 also live in this neighborhood. I want to thank the
12 Commissioners for lending the community your ears this
13 evening. This is very important. My district chief of
14 staff, Arlene Pinzler, is here, and I also brought
15 Tara Dias, who advises me on health care issues, down from
16
17 I realized
that the Commission does not have the
18 power to prevent the Daniel Freeman Marina Hospital from
19 being shut down; however, I encourage you in looking at
20 this proposed closure to look at how it will affect the
21 county's EMS system as a whole, not just the Marina
22 Hospital, in a vacuum. This proposal needs to be
23 evaluated in the context of the County's dire health care
24 problems, and the proposal to shut down UCLA Harbor
25 Medical Center. And I think you must also consider the
26 probability that Tenet may eventually decide to revamp or
27 close down the
28
0025
01 The actions
and conduct of Tenet over the last
02 few weeks are in my view completely reprehensible. Tenet
03 made a series of promises to the Attorney General; to the
04 community; to the doctors, nurses, and staff of Freeman,
05 and to the patients there when they acquired the Daniel
06 Freeman facilities in
07 over the last six months, I realize that Tenet promises
08 were not worth the paper they were written on.
09 It wasn't
until yesterday when attorney general
10 Bill Lockyer hauled Tenet to court that Tenet agreed to
11 live up to the original conditions attached to the
12 purchase agreement, which included a 90-day closure
13 notice, various community hearings, and the like. I would
14 like to publicly thank Attorney General Lockyer who has
15 spent many hours working on that.
16 You know, as
chair of the Senate Energy
17 Committee, I have seen plenty of bad behavior in the last
18 two years. I am no longer shocked at greed, bad faith,
19 and even fraud when it comes to energy traders. But until
20 recently, I did not expect to encounter this dialogue in
21 the health care arena. This is a state of affairs that
22 the citizens of
23 particular must not tolerate.
24 Let me set
this in context: First the local
25 context. Like most people, I drove here tonight. I was
26 late because of the traffic on
27 not going to get better as we add residents to the Playa
28 Vista Development. Second, let's look at what's happening
0026
01 at the state level. The state is facing a $24 billion
02 budget deficit this year; and next year does not promise
03 to be significantly better. That means a lot of people,
04 most specifically a lot of poor, economically
05 disadvantaged people, are likely to face health care
06 cutbacks in
07 the time to be closing facilities.
08 Again, I
realize this Commission cannot preclude
09 the
10 forget the power of bully pulpit. That bully pulpit can
11 help us insure that the overall
12 county at a bare minimum lives up to the agreement with
13 the Attorney General on how this hospital would be
14 operated.
15 Now the
attorney I think rightly concluded the
16 same thing that I did, which is that Tenet cannot close
17
18 with two of the conditions in the Attorney General's
19 consent agreement. Condition 9 requires Tenet to conduct
20 a planning process including representation from the
21 hospital's governing board, medical staff, community
22 leaders, local elected officials, and hospital employees.
23 The consult and planning process does not include sending
24 a press release announcing the closure of the hospital.
25
Condition
15 requires Tenet to establish an
26 urgent care facility within two miles to provide
27 transportation. The press release I got said there wasn't
28 such a facility within two miles. As I said to
0027
01 "that is impossible. I live there. It is not two
miles."
02 Indeed, I clocked it. It is not. I am not a health
care
03 expert; but I do know from what I have seen that Tenet is
04 not an outfit that we should be giving the benefit of the
05 doubt.
06 I know you
have many speakers who will be much
07 more eloquent than I am about some of the stones Tenet has
08 pulled and about on the impact closing the
09 have on people's lives. Let me say in closing that this
10 incident is giving the entire hospital industry in
11 Southern
12 parallels that famous heavyweight novel, "The Scum Also
13 Rises." It is up to each one of us to change the
ending.
14 Life depends on it. Si se puede (in Spanish). Yes, we
15 can.
16 MR. EDELSTON: Excuse me. The
audience would please
17 control themselves. Thank you.
18 The next
presenter will be your Supervisor Yvonne
19 Brathwaite Burke.
20 SUPERVISOR BURKE: Thank you very
much.
21 The closing
of
22 Del Rey has a direct affect on me personally. I happen to
23 live three blocks from the hospital. I am saying to you
24 what I said to Tenet when I talked to them. I want to
25 share with you an experience I had. I was playing tennis
26 with a physician at the tennis facility that's right there
27 at Mendinow (phonetic) and the freeway when he had a heart
28 attack. The only reason he survived was that he went to
0028
01 that hospital. We were able to get him there right away.
02 The reality
of the
03 people who come there. They are involved in recreational
04 activities, very often strenuous activities; and that
05 facility is very urgent and important to the operation of
06 that
07 Thousands and thousands of people come into that community
08 every weekend.
09 It is not
just for those of us who are
10 residents. It is for all of those people who come from
11 all over Southern California; and as a matter of fact, all
12 over the world who come there on boats, that sometimes
13 have accidents; that come there to bicycle; who come there
14 for any number of activities. So it is not just a matter
15 of a facility that serves a community, it is a regional
16 facility.
17 What we have
been faced with is that more and
18 more urgent care and emergency facilities are closing in
19
20 the money; and the budget that we're seeing provides for
21 none of the kind of additional funds that are necessary to
22 carry on our emergencies. So what we have to do is to try
23 to protect what we have. I know that you heard this over
24 and over again, but last year 22,000 visitors, people who
25 needed care, came to that facility. In 911 calls, there
26 were 3,429 patients who were brought there by 911 calls.
27 So what we're talking about is something that is vital to
28 our community.
0029
01 We know that
Tenet has set forth a plan; and I
02 really appreciate the fact that the Attorney General of
03 the State of
04 by and they must fulfill their commitments. And part of
05 that commitment is before you can transfer people to
06 another emergency facility, it must be first of all
07 recognized and must be licensed and provide for all
08 facilities. I am looking at
09 one who has to look at that and make sure that that takes
10 place.
11 There also
is a question of the distance from
12 where people will have to go from that facility in order
13 to meet their needs. So I am concerned first of all that
14 we're faced with a possibility that it may be closed
15 before there is adequate facilities within two miles to be
16 able to replace it. Secondly, I am really concerned
17 whether or not the facilities that they have proposed
18 would ever be able to adequately meet the needs of the
19 community.
20 I introduced
a motion along with Supervisor
21 Knabe, who actually represents the
22 across the street from the
23 in this. This is something in which we all have to work
24 together. We have a responsibility as supervisors for the
25 health care of the people of
26 this seriously. It is important for us to be able to
27 assure that that system continues.
28 I would like
to say something to you too, Tenet.
0030
01 As you know, I requested a copy of the sales brochures for
02 the sale of those premises. I am very concerned that it
03 would be a business decision. That facility, because of
04 what it serves and its importance to the area, it's
05 important that it not just be a business decision. It is
06 necessary for it to be a health care delivery decision.
07 And what I say to you, is that you know that I have been
08 attempting to get another -- a group of doctors or
09 something to acquire it; and I am going to continue to try
10 to get someone to acquire it.
11 As they
negotiate with you, I would hope that the
12 dollar is not the most important thing. I would hope that
13 the lives of the people of Los Angeles County is the most
14 important thing; and that you have a reputation you need
15 to establish in this community. And if you value that
16 reputation, it won't just be a business decision. First
17 of all, anyone who acquires it will have to be sure and
18 will have to say they will continue to have at least
19 urgent care facilities there if they are able to provide
20 emergency medical conditions. But I would hope that your
21 demands for price are not so outlandish that the only one
22 who could purchase that is a hotel or some other kind of
23 facility. It is important that we keep it as part of the
24 health delivery system.
25 And I am
saying this to you in all sincerity and
26 I am saying it to you because I have been on the telephone
27 constantly and I believe that I will be able to find
28 people who are willing to purchase that facility. And I
0031
01 hope that they will continue and make a commitment and
02 that you will not make it impossible for them to keep that
03 commitment to keep emergency services here at Marina Del
04 Rey.
05 Thank you
very much.
06 MS. HASTINGS: I wanted to quickly
apologize to the
07 audience. We only have the one microphone. We were
08 expecting to have more. I know it is inconvenient, and we
09 apologize. Please bear with us.
10 MR. EDELSTON: Our next presenter
will be Angela
11 Davidson, the field representative for assemblyman George
12 Nakano.
13 MS. DAVIDSON: Thank you.
14 My name is
Angela Davidson. I am here
15 representing state assembly member George Nakano. I have
16 a statement to read on his behalf since he could not be
17 here. It is dated July 17th.
18
"I
regret not being able to attend tonight,
19 but the state budget crisis requires that I remain in
20 Sacramento. As you may know, I have been actively working
21 with the Attorney General's office, Tenet Health Care
22 Corporation, and the community on this issue. I want to
23 reaffirm my continued concerns over the impending closure
24 of Daniel Freeman Marina Hospital. As you know, Marina
25 Hospital is an important source of suitable health care
26 and emergency room treatment in the Los Angeles portion of
27 my district. On behalf of the constituents of Marina Del
28 Rey, Playa Del Rey, and Venice, I applaud the Attorney
0032
01 General's efforts to insure compliance with the state law
02 in the interest of safeguarding the well-being of area
03 residents.
04
"Though
I am pleased to see Daniel Freeman
05 Marina hospital will remain open for the immediate future,
06 its potential closure continues to be a major concern of
07 mine. Coupled with impending health care crisis facing
08 the Los Angeles County, the closure of Daniel Freeman
09 Marina Hospital will only exacerbate the lack of access to
10 quality and timely health care services for the
11 Los Angeles residents. It is my hope that Tenet Health
12 Care Corporation will consider maintaining services at the
13 current Marina location. If Daniel Freeman Marina
14 hospital ceases to exist, I am gravely concerned about the
15 impact on trauma care and timely access to emergency room
16 treatment. It is vitally important that Tenet Health Care
17 Corporation, the Attorney General's office, Los Angeles
18 County EMS, and the community work together with the
19 safety of the Marina residents as a foremost concern.
20
"To
the residents here tonight, I will
21 continue to work with your best interest in mind. Thank
22 you for coming here tonight as we voice this important
23 issue. Please continue to contact our office with your
24 support, and we really appreciate this time that the Board
25 has given us to speak."
26 Thank you.
27 MR. EDELSTON: Thank you.
28 The next
presenter is Sandy Kievman, representing
0033
01 councilwoman Cindy Misikowski.
02 MS. KIEVMAN: I am here on behalf of
councilwoman
03 Cindy Misikowski, who as of one week ago is very pleased
04 to be representing the Venice area -- and Westchester,
05 that's right. She is very concerned as well about the
06 closure of the facility, and having known that the number
07 of emergency visits was over 22,000 in the last year, and
08 as Supervisor Burke said, so consequently Cindy Misikowski
09 passed a motion with the City Council urging that,
10 Number 1, that the City work very closely with the County
11 to try to see whatever can be done to help bring emergency
12 facilities and keep emergency facilities in this
13 community. And I will leave this. I had brought copies
14 of the motion, which I will leave with you.
15 MR. EDELSTON: Thank you. The
next two speakers:
16 First will be Captain Bowden from the Culver City Fire
17 Department; and then Chief Mike Metro from LA County Fire
18 Department.
19 CAPTAIN BOWDEN: My name is Mike
Bowden. I am a
20 Captain with the Culver City Fire Department. I want to
21 give you a little bit of history about the number of
22 patients that we currently transport to the Daniel Freeman
23 Marina and the impact it is going to have on our community
24 to close this emergency room.
25 Currently
the Culver City Fire Department
26 transports approximately 500 patients a year to Daniel
27 Freeman Marina. I represent 20 percent of our total
28 number of patients that we transport to hospitals. These
0034
01 are emergency transports, 911, just to let you know.
02 We're expecting that number to increase. Our trends have
03 shown that over the last three years, the number of
04 patients that we have responded has increased
05 8 percent a year; and in the last 10 years has increased
06 34 percent.
07 The impact
of closing Daniel Freeman Marina at
08 this point, in 2000 local hospitals had to close to ER
09 saturation, not undivergent status, which means that
10 paramedics had to transport to a different hospital. They
11 are so impacted, there are no beds for patients; and
12 patients are rerouted to another hospital. In 2000, that
13 happened 6,720 times. Last year the area hospitals -- and
14 this is just one in the general vicinity that we show on
15 the map -- Providence, Santa Monica Hospital, Saint John's
16 Hospital, Midway, UCLA, Cedars, and Kaiser West LA closed
17 16,167 times, which represents an average increase over
18 the year before -- over the two years before of
19 248 percent.
20 Obviously
that's going to show you our emergency
21 medical service is severely impacted. And what the
22 results of this is, is that paramedics are required to
23 transport patients longer distances to farther and farther
24 hospitals; there are longer waits at the hospital for a
25 bed. Often the paramedics will arrive at the hospital and
26 have to wait in line as other paramedics who are ahead of
27 them wait for a bed to put the patient in. As a result of
28 that, the paramedics are driving to hospitals farther away
0035
01 from the city and are not able to respond in
02 a timely manner to other medical emergencies.
03 In Culver
City, currently we operate with two
04 paramedic rescues; and 33 times a month, on average, both
05 of those rescues are tied up transporting patients that we
06 don't have a rescue availability. So obviously, the
07 Daniel Freeman Marina is a big part of where we
08 transport. It is close to our city, just outside of the
09 border; and it is going to impact our service greatly.
10 I would like
to say that with that type of
11 information, it doesn't seem very responsible to close an
12 ER, emergency room, in a community that does not have what
13 we need without having some other type of contingency plan
14 in place prior to that closure.
15 CAPTAIN METRO: My name is Mike
Metro. I am chief of
16 medical services for the Los Angeles Fire Department. I
17 am going to attempt to objectively measure the impact of
18 the closure of the Daniel Freeman Marina Hospital.
19 Based upon
current trends, we estimated a total
20 of 420 patients to be transported to Daniel Freeman
21 Marina, of which approximately 60 percent of those will
22 require paramedic intervention; in other words, those are
23 patients who desperately need medical care. After Daniel
24 Freeman Marina closes, the next hospital will be Brotman
25 Medical Center in Culver City, 4.6 miles away.
26 It is
important to note that the closure will
27 increase patient transportation time significantly. Under
28 good driving conditions, Brotman is an additional 12 to 15
0036
01 minutes away. Other hospitals are as high as 22 to 25
02 minutes away, under good driving conditions. To fully
03 understand the complete impact of this closure -- although
04 our jurisdictional responsibility is insignificant in this
05 area, Los Angeles City Fire Department, Culver City Fire
06 Department, and LA County Fire Department combined
07 transport over 3,400 patients to Daniel Freeman in the
08 year 2001, or about 9 patients every day. Again,
09 60 percent of those patients require paramedic
10 intervention.
11 In summarizing,
there will obviously be an
12 operational impact to LA County Fire Department and our
13 ability to deliver timely EMS services. There will also
14 be a cascading impact to the health care system, an impact
15 yet to be made. Most importantly, there will be an impact
16 with the people, the patients who we are trusted to serve,
17 due to longer transport times to adjacent hospitals
18 where everyone will find it is open. Thank you.
19 MR. EDELSTON: Our next presenter
will be
20 Kelly Calkin, the district representative of Jane Harman,
21 Assemblyperson.
22 MR. CALKIN: Thank you very much. Two
things. Just
23 like the Senator and the Supervisor, Congresswoman Harman
24 is a nearby resident of Venice, so she's taken on personal
25 interest in Daniel Freeman. Second, when our chief of
26 staff from Washington DC was out here last, she hurt
27 herself; and the first place she went to get twelve
28 stitches was Daniel Freeman. So before I came here, she
0037
01 sent me an encouraging e-mail with the two words or three
02 words, "Go get them." With that, I want to say
that I
03 only brought 150 copies. I've brought 150 handouts. So
04 please contact our office if you would like to know the
05 content of the letter.
06 The letter
that I am about to read was sent to
07 Mr. Koenig, if I am pronouncing his name right, on
08 July 19th. "Dear Mr. Koenig, I would like to express my
09 concern about the closure of Daniel Freeman Marina
10 Hospital. As you know, Los Angeles is currently facing a
11 crisis in its public health care system. Hospitals and
12 clinics across the country are facing closure, including
13 Harbor UCLA hospital in Torrance; and low-income and
14 uninsured residents are finding fewer and fewer places
15 they can turn to for medical services. In addition to
16 overcrowded emergency rooms, we will be forced to turn
17 away patients delaying urgent care that is necessary.
18 "Daniel
Freeman Marina has provided essential
19 medical services and quality health care to residents of
20 Marina Del Rey, Playa Del Rey, Venice, and Westchester for
21 over 20 years. Its closure will make it difficult for
22 residents of these communities to access quality care in
23 eliminating emergency rooms near the Los Angeles
24 International Airport and increase the caseload on free
25 clinics like the Venice Family Clinic and South Bay family
26 Clinic, which is already struggling.
27 "I urge
Tenet to fully comply with the spirit and
28 conditions of the sale required by the California Attorney
0038
01 General."
02 Let me
repeat that. "I urge Tenet to fully
03 comply with the spirit and the letter of the conditions of
04 sale required by the California Attorney General. I
05 strongly encourage you to work with the community and
06 medical professions to develop outreach programs and
07 individual care for the individuals and families who will
08 be most severely impacted by the closure of Daniel Freeman
09 Marina. I plan to monitor this unfortunate situation very
10 closely and be in touch with you on these issues.
11 Regards, Jane Harman, Member of Congress."
12 And for
anybody who has met the congresswoman,
13 they know that her monitoring the situation is a very
14 intense act. So with that, I would like to turn the
15 microphone over.
16 MR. EDELSTON: This seems to be better.
We will try
17 to use the two microphones. What we're going to do now is
18 take testimony from the public and community groups.
19 Again, what I would ask is that each of those who are
20 presenting, to limit your comments to -- not to exceed
21 five minutes; and we do have a timer, so we'll be able to
22 help you along.
23 The first
microphone will be sitting to your
24 right at the podium. Also, in limiting your comments,
25 limit your comments to that which has not already been
26 stated.
27 The first
presenter I would like to invite is
28 Susan Burke Fogel. She is an attorney, and she is with
0039
01 the SEUI.
02 MS. FOGEL: Thank you. My name
is Susan Burke Fogel.
03 I am a health policy attorney. I am working with Service
04 Employees Union International; and I want to talk to you.
05 You will hear a lot about the actual impact that the
06 closure of this emergency room, this hospital, would have
07 on this community. So I want to talk about the process.
08 In addition
to Tenet's clear disregard for the
09 needs of the community, it also appears that they have
10 contempt for the law and the legal processes that they
11 already agreed to. In California we have legal processes
12 to protect important health care services. We believe
13 Tenet has flaunted that system in two important ways.
14 One is the
original purchase. As you've already
15 heard when Tenet purchased Daniel Freeman Marina, they
16 agreed to consult with the community, to consult with EMS;
17 and it was interesting listening to Mr. Koenig's time line
18 because the conditions call for a comprehensive planning
19 process. And according to Mr. Koenig, he called you after
20 they decided to sell the hospital. That's not a planning
21 process. That's a closure process. A true planning
22 process would have had a critical impact on the decision
23 to close the hospital. It probably would have meant they
24 wouldn't close the hospital, and I assume that's why they
25 didn't want to do it.
26 Now, we all
know the Attorney General has gone to
27 court and they have to keep the hospital open; but we are
28 kind of dismayed to hear Mr. Koenig talk about the fact
0040
01 that they were having trouble keeping critical staff when
02 many of you in this room will testify to the fact that
03 they did much to lure staff out of that hospital. They
04 provided incentives and bonuses and incentives for people
05 to leave.
06 We know that
Tenet thinks it's above the law. We
07 already heard about the 90-day notice, and now they say
08 they are terribly, terribly sorry they can't comply with
09 it, and that the exemptions to the law as you may know is
10 when there are unsafe staffing conditions. But we believe
11 Tenet created those unsafe staffing conditions.
12 There will
be lots of testimony today about their
13 deliberate attempts to undermine the viability of this
14 hospital; and we all have to wonder what is their hurry.
15 Physicians and local staffing residents will testify that
16 people did not make independent decisions to leave. They
17 were offered incentives to go. People will testify that
18 they removed equipment. They took no steps to keep the
19 anesthesiologists there until, of course, the Attorney
20 General said they have to. And they've done several
21 things like closing basic amenities like the cafeteria
22 just to make life harder for the staff who tried to stay.
23 We know you
have no authority to order them to
24 keep the emergency room open; but you do have fact-finding
25 authority. And we want you to investigate. We want you
26 to look under their statements and investigate and make
27 public the steps that they took to try to force the
28 closure of this hospital.
0041
01 And the last
thing we want everyone in this room
02 to know, Tenet should not be able to profit one dime from
03 the sale of this hospital. Daniel Freeman Marina is
04 nonprofit. In six months they are trying to launder a
05 hospital they bought for a song at a fire sale and turn it
06 into millions of dollars in their stockholders' pockets.
07 If there's any money to be made on the Daniel Freeman
08 site, it belongs in health care for this county, not in
09 Tenet's pockets. Thank you.
10 MR. EDELSTON: Our next presenter is
going to be
11 Christine Wood; and what I would like to do also at this
12 time as she is coming to the podium, we are going to
13 change the amount of time. Because of the number of
14 people who wish to present, we would like to get
15 everybody's comments in, but we need to have people limit
16 their comments to three minutes instead of five minutes so
17 we are out of here today and not tomorrow.
18 MR. WOOD: Thank you for your time.
My name is
19 Christine Wood. I recently have been elected second
20 vice-president of the neighborhood council; and I am going
21 to keep my comments very brief. Venice must have an
22 emergency facility to go to. We have many residents who
23 must have a facility. I know that many of you are aware
24 of that. My own neighbor upstairs -- there are two
25 reasons that he survived a medical crisis that he had in
26 December. One was because of the fine paramedic care that
27 he received that night; the other was because of Daniel
28 Freeman.
0042
01 The Tenet
Health Care System is a $23.8 billion
02 company with 107,000 employees; and I personally find it
03 very hard to believe that they are unable to keep one
04 anesthesiologist on staff at that facility to keep the
05 emergency room services open. So whatever I can do to
06 keep this hospital open and keep emergency services
07 available to the residents for us and folks who even live
08 in the surrounding areas, please let me know because we
09 must have it here.
10 MR. EDELSTON: Thank you.
11 Terry Connor
is the next presenter, who will be
12 followed by Julie Inouye. I apologize ahead for any
13 mispronunciation.
14 MS. INOUYE: I will go first and
Terry will follow.
15 Thank you so
much for having us, Commissioner.
16 Only 48 days ago on May 30th, the day after Tenet
17 announced its closure of its hospital's ER, Save our
18 Marina Hospital was born. Since the Argonaut article on
19 June 20th, thousands of citizens have become quickly
20 united throughout this region to save our Daniel Freeman
21 Marina Hospital.
22 We had over
7,000 visits to our website designed
23 by volunteer Jim Moore of Marina Del Rey, along with
24 hundreds of phone calls and e-mails. We had thousands of
25 hours of volunteer time donated including phone calling,
26 petition signing, canvassing door-to-door, and sending
27 your donations for this very important and vital cause.
28 Thank all of you.
0043
01 Tenet has
not been a good neighbor because Tenet
02 never intended to be. Their recent actions attempting to
03 snuff the Department of Justice of the state of California
04 requests for compliance is the perfect example of how they
05 run their day-to-day business. You really expect them to
06 include us in any comprehensive planning when their
07 actions have been to the contrary?
08 There has
been little or no publication of
09 proposed closures. Quick, fast, and run right through is
10 their mode of operandi. Enron, WorldCom, and Tenet Health
11 Care. Health care, huh. All Tenet wanted to do was
tear
12 apart this hospital from day one and sell the property to
13 double their investment. As Warren Gekko said in the film
14 "Wall Street," "Greed is good."
15 We have a
health care crisis in Los Angeles.
16 With ERs and hospitals closing, with each closure adding
17 to the cumulative total of loss of beds, will there be any
18 left to us? When the anthrax and small pox alert happened
19 recently, physicians met with county health officials and
20 biological warfare experts. This city will be in crisis
21 mode with just an influenza outbreak of 99 people. That
22 statistic came directly from the Director of County Health
23 Department. Because of the lack of beds already existing
24 in the hospitals, we would have to create tent quarantine
25 sites. We are talking about the possible loss of 166 more
26 beds at Daniel Freeman hospital.
27 Please
remember we are located four miles away
28 from LAX, and that is the number one terrorist target in
0044
01 the City of Los Angeles. On the 4th of July, the airport
02 was closed off. No one could approach it. I spent the
03 afternoon with senior lead officer Tony Ramos of the
04 Pacific Division of the LAPD. He said, "You can forget
05 about ever using that little Workers' Comp building for
06 any medical services. We won't let anyone in that area."
07 Scenario, you have a heart attack --
08 MR. EDELSTON: Ms. Inouye, I need to
stop you.
09 MS. INOUYE: I have just few more words to
say.
10 Scenario, you have a heart attack --
11 MR. EDELSTON: There are other
members --
12 MS. INOUYE: Thank you. They do
want me to speak.
13 You are faced with an emergency situation. Traffic
14 gridlock is real in LA, as you know. If you are smart
15 enough to go to a non-Tenet hospital in Santa Monica, you
16 might not get there. People may die.
17 Our
emergency room and hospitals are a vital part
18 of this community. We all need to begin to think
19 regionally about health care. We are now a united front
20 in the thousands, and we must fight all the way with the
21 help of the Department of Justice, Attorney General
22 Lockyer, the County, the City, the State, and federal
23 agency elected officials to save our Marina Hospital
24 including the ER. Remember, this is not just one little
25 hospital. It is your only local hospital. Thank you.
26 MR. EDELSTON: If you would like the
public hearing
27 to continue, I ask you to please restrain yourselves.
28 Graciously, Terry ceded his time to Ms. Inouye. Thank
0045
01 you. And I want to also thank Terry Connor for having
02 arranged for this facility and for ceding his time so that
03 Ms. Inouye could continue her comments.
04 The next
speaker will be Lark Galloway, who will
05 be followed by Jeff Codar.
06 Ms. GALLOWAY: I am Lark Galloway,
filling in for
07 Community Health Council and members of this community.
08 We did our own health impact study. I want to thank Cathy
09 of EMS and the paramedics for providing data. We were
10 confident that you are understanding the full picture
11 because when you take on the task of deciding this
12 hospital and this emergency room should close, we wanted
13 you not to look at Marina Del Rey. We wanted you to look
14 at the capacity in the larger community.
15 The EMS plan
right now calls for the transfer of
16 patients to St. John's in Santa Monica. The population
17 that comes to this particular hospital is just not the
18 northern end. If you look at the numbers in our chart, we
19 looked at the emergency capacity -- and I apologize to the
20 community but I don't have enough copies for everybody --
21 on page 6, three of the five hospitals that are designated
22 to this area have no more capacity to take any more
23 emergency room visits.
24 When you
look at the number of beds that we
25 moved, the ER patients that we moved in this community as
26 a result of this, we are falling significantly below the
27 County's standard. You cannot do this. We are asking
the
28 Commission to, number one, recommend to the Los Angeles
0046
01 County Board of Supervisors, the Daniel Freeman Hospital
02 Emergency Room remain open. If Tenet doesn't want to own
03 it, that's fine. Give it back to the community. We
have
04 no problem with that.
05 We are
asking to, secondly, to investigate
06 Tenet's actions to circumvent the legal process. We
07 believe that they are forcing an earlier closure; and that
08 was not what was intended by the out clause. Number
09 three, we are asking you to look at the impact of these
10 monopolies because when Tenet, like Enron, fails -- we
11 all know they've had problems with the federal government
12 in the past -- when they close, we have nowhere to go.
13 Ladies and
gentlemen, I ask you to look very
14 seriously at these numbers. I think it gives you a very
15 different picture about how this little hospital makes a
16 big difference. It is the plug in this community that
17 starts the flood going.
18 MR. EDELSTON: Next presenter is Jeff
Codar, then
19 we'll move on to Leslie Bennette. And she will be
20 followed by John Murdoch, if he will also move toward the
21 podium.
22 MS. BENNETTE: Thank you for
opportunity to comment.
23 My name is Leslie Bennette. I am a staff attorney at
24 Consumers Union. Since 1936 Consumers Union's mission has
25 been to test product, inform consumers, and protect the
26 public; and that is why I am here tonight. When the
27 Attorney General asked Tenet about its compliance with the
28 requirement to conduct a comprehensive planning process,
0047
01 Tenet said that the decision to open the Centinela LAX
02 Clinic for basic life-support ambulances and close the
03 Marina was based on a thorough evaluation of the area's
04 needs and the two existing facilities, historical
05 performances, and in long-term viability.
06 Now, we
questioned whether that occurred because
07 Tenet admits that research that it hired the Camden group
08 to do was not completed as of June 27th. In fact at that
09 time, Camden had not even finished gathering information
10 on the availability of services in the Inglewood area and
11 the expected needs of the year 2012. That does not
12 qualify as a thorough evaluation of the area's needs. In
13 addition, we questioned whether Tenet actually looked at
14 the historical performance and long-term viability even
15 though the data that we obtained from the Office of
16 Statewide Planning and Development shows that the number
17 of people who rely on hospitals for emergencies, inpatient
18 and outpatient care actually increased from 1995 to
19 2000.
20 First, there
was a 32-percent increase in the
21 number of people using Marina's emergency room. Second,
22 there was a 7-percent increase in the number of Medi-Cal
23 patients seeking emergency treatment. There was a 40
24 percent increase in Medicare patients receiving
25 outpatient; a 24-percent increase in Medi-Cal patients
26 getting their outpatient services; and generally a
27 58-percent increase in the number of outpatient visits.
28 Finally there was a 26-percent increase in the number of
0048
01 patients who went to the hospital for medical treatment.
02 Somehow,
Tenet overlooked that information in its
03 review of the historical performance and long-term
04 viability of Marina. In addition, Tenet states that
05 Marina has 166 beds and averages less than 40 acute care
06 patients a day. That is supposed to be the reason to
07 close the hospital. Well, Marina's average occupancy rate
08 from '95 to 2000 was 56 percent for its available beds.
09 For its licensed beds, it was 49 percent. That is
10 actually better than both Brotman and Century City. In
11 fact, Marina's available bed occupancy rate beat
12 Centinela's beds and also came 2 points shy of its
13 licensed bed occupancy rate.
14 Marina is no
longer a small community hospital.
15 It joined Tenet's family last December, and nothing is
16 stopping Tenet from using some of its profits that it has
17 made most recently last week -- where the announcement was
18 in the Wall Street Journal how well it has been doing --
19 to support the Marina facility.
20 MR. EDELSTON: We would like to ask
you one question,
21 Leslie. You are with Consumers Union?
22 MS. BENNETTE: Yes, I am.
23 MR. EDELSTON: In terms of the
information that you
24 looked at in terms of this, do you know what the average
25 daily census of the hospital is? What is the breadth of
26 the information that you looked at?
27 MS. BENNETTE: What year are you
talking about?
28 MR. EDELSTON: 2001/2000.
0049
01 MS. BENNETTE: I have up to 2000,
which is the most
02 current data from the Offices of Statewide Health Plan and
03 Development that has been audited with them.
04 MR. EDELSTON: So basically the
information, you
05 obtained from the Offices of Statewide Health Planning
06 Development?
07 MS. BENNETTE: From OSHPD.
If you would like, I
08 would be happy to provide that information as well as
09 Brotman, Century City, and Centinela. I can commit that
10 if you are interested in looking at it.
11 MR. EDELSTON: I think my attempted
pronunciation of a
12 name was incorrect. I did ask for Jeff, and here it looks
13 like Codar; but it's Codar. Is there a Jeff Codar?
14 MR. CODAR: Hi, my name is Jeff
Codar. I'm the
15 president of Loyola Marymount University, University
16 Medical Services; and this is Lizzette Legarreta. She's
17 our vice-president. She's going to describe our
18 organization, and I'm going to talk about the impact that
19 the closure will have on our organization.
20 MS. LEGARRETA: Loyola Marymount has
an emergency
21 Medical Service, and it's called LMU EMS; and we are
22 composed of seven certified EMTs, and we are all
23 students and we do this voluntarily. Each EMT provides
24 575 hours of volunteer work. That's 8,032 hours total.
25 We respond to any medical emergencies. That's for any
26 student, any faculty member, or any visitor that attends
27 the campus. If you have seen Loyola Marymount recently,
28 you will notice the great changes that are near.
0050
01 Recently
we've had the Burns Rec Center, we've
02 had the university hall, and we've had five new apartments
03 within the last seven years. Each year the freshman class
04 gets even larger: 5,000 students for one class. More
05 students means more faculty, more staff, and more chances
06 for emergencies. Here is Jeff Codar for statistics.
07 MR. CODAR: We send all of our
patients down to the
08 Marina by LA paramedics transport, fire and public safety,
09 or through the students themselves. We believe it needs
10 to be open because of the accessibility to the patients
11 from the campus. The patients volume is going to be too
12 backed up and too high to send over to Centinela Hospital.
13 It is important because we get a wide range of calls
14 because of seizures, heart attacks, and overdoses.
15 Finally,
some conclusions of some statistics.
16 We received a record number of calls last year, 245, of
17 which 33 required immediate LA paramedic transport to
18 Daniel Freeman Marina; and we've had approximately two
19 dozen emergency calls. It is important Daniel Freeman
20 Marina Emergency room stays open. Thank you.
21 MR. EDELSTON: Next up is John
Murdoch, and then to
22 be followed by Dr. Bhatia. I would also like to ask that
23 those who are presenting, if you have written testimony,
24 while this is being taken down in transcription and on
25 tape, if you could provide your written testimony to the
26 EMS agency staff, it would be greatly appreciated.
27 MR. MURDOCH: Thank you, Mr.
Edelston. Members of
28 the Commission, my name is John Murdoch. I am an
0051
01 attorney. I practice in Santa Monica. I am not going
to
02 be saying anything that would draw any applause here. So
03 I hope you hear me because I do have some information that
04 I think will help you through this process.
05 I've
practiced corporate securities laws for an
06 intensive period of time before turning a new leaf and
07 practicing environment law. But in my practices, I've
08 learned many things: First of all, how to read documents
09 that are filed with the SEC. I've read Tenet's documents.
10 They are available on the Tenet website.
11 They just on
June 20th took down $400 million in
12 debt and $2 billion shelf registration. A shelf
13 registration means they have already filed with the SEC a
14 registration statement which would enable them over time
15 to take down $2 billion in borrowings. They just took
16 down $400 million. The reason they are doing that is
17 because lower interest rates enables them to make more
18 money on their money. Another document in the SEC filings
19 is the 10(q) wherein they report that they anticipate
20 they will spend $800 million in the year 2002 on capital
21 improvements.
22 Now, Tenet
is a corporation. They decide where
23 to spend that money. Apparently they are deciding not to
24 spend it at Marina Hospital. Wait, this is important.
So
25 the question that I have for you, when Mr. Edelston
26 started this hearing he said, "However, we have no
27 authority to overturn Tenet's decision to close." That
is
28 not legally correct. Listen to me.
0052
01 Your
authority under County EMS Policy 222 is "to
02 conduct a hearing to receive evidence to prepare an impact
03 evaluation, and then you can, according to policy 222
04 Section 2(d), establish the reason for the proposed
05 closure and then you shall attempt to determine whether
06 any system or changes may be implemented to either
07 maintain the hospital service within the system or develop
08 strategies for accommodating the loss of the emergency
09 department."
10 So your
regulations tell you that you should
11 convene, review all of this evidence, review all of the
12 reports, and make one of those two determinations.
13 Can I have
five minutes from somebody in the
14 audience? Because I am also an environmental lawyer. I
15 am used to impact statements. We call them EIRs. I am
16 sure that many of you have participated in EIR reviews and
17 presented -- you know how long it takes to get through an
18 EIR, an environmental impact statement. Four years, if
19 you're lucky. Okay. You're at the beginning of an
impact
20 evaluation.
21 Now, Tenet
has just been told by a judge in the
22 Superior Court that they cannot close on July 22. So what
23 are they going to do? Well, they're telling you, "For
24 safety reasons, we have to close." They have $800
million
25 to spend for a couple of anesthesiologists.
26 Please, the
second thing that you need to
27 consider is how are you going to make that impact
28 evaluation. You are going to need this court reporter to
0053
01 do a transcript. Each one of you wants to read that
02 transcript because this evidence came so fast and
03 furious -- and I've been trying to write it -- no one
04 could possibly comprehend it in one moment or one
05 evening.
06 So it is
going to take a while to do that impact
07 evaluation. Then it is going to go to the Board of
08 Supervisors for a vote. We know how long the Board takes;
09 correct? That could take several months. Then it goes
to
10 the State, and the State has to give the final approval
11 before that license can be closed.
12 So you do
not have a powerless Board here. You
13 have the power to require an analysis of the evidence.
14 And you are only beginning. Now, don't forget Tenet made
15 their internal analysis. They ran the numbers, they say
16 "We cannot afford to keep it open." May 29th they
just
17 said, "We're closing. Everybody get out."
First they
18 said August 26; then they said that's way too far in
19 advance, out by July 22nd. Well, finally the Attorney
20 General had enough of that and said, "No, you are going to
21 keep this open until we go through the planning process."
22 So we're at
the beginning of the planning
23 process. As you can see, I think you have plenty of
24 evidence. The wording is there that says that you shall
25 have sufficient time to evaluate this. So don't be
26 rushed. Take your time. Make sure there is a facility
27 within two miles of this facility before this one closes.
28 They are under court order to keep it open. Thank you.
0054
01 MR. EDELSTON: There is a grayish
Landcruiser,
02 license number 4ESP142, that is blocking the exit. If it
03 is not moved, it will be towed.
04 The next set
of presenters -- I already
05 introduced the next one, Dr. Bhatia. Following Dr. Bhatia
06 will be Lawrence Williams, and then Ernestine Miller.
07 DR. BHATIA: Thank you for allowing
me three minutes
08 to talk to you about my personal experience. I am a
09 board-certified internist, and I represent the majority of
10 the HMO patients in the Marina area. My group has a total
11 of 8,000 managed care lives; 1500 of those are senior
12 members. And I just want to give you one simple example
13 of the lack of planning or advance notice of this
14 closure.
15 As is
required by my contractors with the HMO's,
16 I need to have a hospital in place to hospitalize any of
17 these 8,000 patients. I was not given sufficient time to
18 plan. There was nothing communicated in a timely fashion
19 that says "Dr. Bhatia, we are going to close this facility
20 in X number of days. You better get your rear end out
21 there and find another hospital for these patients."
All
22 of a sudden we received this notice that the hospital is
23 going to be closing; and of course, the only facilities
24 that I could contract in an expeditious manner were other
25 Tenet facilities.
26 If the
process had taken place -- and I'm not
27 involved in the Attorney General and anything like that.
28 I am just speaking from a point of view of how can I get
0055
01 my patients taken care of. If the process had been done
02 properly, I would have been given several months to allow
03 contacts to take place, and that was not done.
04 MS. ENSLEY: I am not Lawrence
Williams, but I am
05 substituting for him. My name is Orethea Ensley. I am
a
06 south Los Angeles resident for over 30 years. I have had
07 access to Centinela Hospital and Daniel Freeman Marina
08 hospital in Inglewood. And just recently, I know for a
09 fact that there is absolutely no way that those hospitals
10 can take any overflow. We were at the hospital from 8:30
11 in the morning until 1:00 p.m. before we could be even
12 looked at, and my daughter was actually having difficulty
13 breathing; but because of so many other emergencies, she
14 just stayed there.
15 This is incredible
that we think that a closing
16 of a hospital is not connected to anything else. If you
17 look at my fingers, what do they do? They do not wiggle
18 because they are by themselves an individual. They are a
19 part of -- there is a wrist. There is the arm. All of
20 this is connected.
21 South LA is
impacted more than anyone. We
22 already do not have quality health care. We already are
23 overloaded in the hospitals. There is no beds, and we are
24 not being paid attention to. This cannot happen. We
must
25 stop this. Centinela will not be able to handle any
26 emergency. They can't even handle what we have now.
27 Thank you very much.
28 MR. EDELSTON: Next speaker is Paul
Davis from Adult
0056
01 Protective Services, to be followed by Peggy Lee from
02 Neighborhood Legal Services.
03 MR. DAVIS: Good evening, brothers
and sisters. I'm
04 a retired Adult Protective Services social worker, and I
05 have been a patient at Daniel Freeman Marina and also
06 visitor, and I just want to share with you some of my
07 observations.
08 There's many
problems with Daniel Freeman Marina
09 Hospital at 4650 Lincoln Boulevard. On July 10th, '02 at
10 10:50 p.m. I went to the emergency room nurse and asked
11 "Is there a surgeon and/or an anesthesiologist here?" I
12 was told, "None are available."
13 July 12th,
11:40 a.m., I was exiting the parking
14 lot and attempting to take a picture of the compartments
15 that state "biohazard" that are right next to the
16 ambulance entrance, right next to the emergency room. A
17 security guard ran after me and warned me, "You cannot
18 take photographs because they are selling the property to
19 the Hilton."
20 I wish to go
back in time. I was in the hospital
21 as a patient, 2/23/02 to 3/2/02. I was also planning and
22 environmental director for Del Rey Homeowners and
23 Neighbors for five or six years. It was my job to
24 document and report environmental hazards. Although the
25 health care field is not exactly my field, I do know how
26 to document. There were no heaters in rooms. There was
27 no bath, no shower available for one week. I had to wash
28 up in the sink. They left the needle in my left arm for
0057
01 six or seven days. They refused to remove it; and after
02 five days, I just removed it myself. I did not need any
03 injections.
04 Basically we
heard testimony from a lot of people
05 who have very good intentions. And I do believe we need a
06 full-service emergency medical services center in this
07 area, but I want you to know there is no elevator from
08 floor 2 to floor 1. They are in violation of the ADA Act
09 of 1990. Let the chips fall where they may. That's all
I
10 have to say.
11 MR. EDELSTON: Peggy Lee, to be
followed by
12 Patti Sanchez.
13 MS. LEE: I'm a staff attorney at the
Health Consumer
14 Center, which is a part of Neighborhood Legal Services.
15 We are an independent health consumer assistance program
16 that helps low-income residents. The Los Angeles County
17 obtains quality health care from public and private health
18 care providers. Since November of '98, we have received
19 approximately 25,000 calls which have resulted in
20 approximately 5,000 cases each year.
21 I am here to
talk about something that is
22 probably not all that popular. For Tenet it is about
23 charity care. I came in October when they had their
24 hearing and spoke of charity care. Tenet was very clear
25 that they intended to provide the same level of charity
26 care that the sisters had provided when they took over the
27 hospital. They were also very vehement in denying the
28 fact that they had any intention of closing the emergency
0058
01 room.
02 Here it is
nine months later, and they are
03 telling us that after they purchased the hospital, they
04 did an analysis, and decided they could not keep the
05 hospital open. I think their intentions were clear.
They
06 knew they could not run this hospital, and now they are
07 saying "That's it. We're done." I don't
think that's a
08 true negotiation of the contract.
09 I also want
to talk about the fact that charity
10 care is a very important part of health care in Los
11 Angeles County. There are approximately 3 million people
12 who are uninsured. Approximately 88 percent of those
13 people are people who are working people and their
14 dependents. When we are talking about charity care, you
15 are not talking about people that -- it is politically
16 incorrect to say these are people who are not working.
17 these are people who are working, who are trying to make
18 it in Los Angeles County.
19 Recent
budget cuts for the State and the County
20 keeps uninsured people from accessing care at county
21 hospitals as well. County programs like ATP, ORSA,
22 Prepay, allow uninsured people to receive care in county
23 hospitals. Even as all of you know, Harbor UCLA, they are
24 intending to close down their emergency care, which is the
25 closest hospital, county hospital care. We are not
26 talking two miles. We are talking about more than two
27 miles.
28 I know that
Tenet should be held responsible for
0059
01 the fact that they stated that they are going to provide
02 charity care. I think it is irresponsible on their part.
03 They have approximately 40 hospitals within the state of
04 California. That is from their own statement. When
they
05 were here in October, they had their Powerpoint
06 representations, all slick slides; and they had a lot of
07 people come from the hospital to say they were going to
08 provide all this good care.
09 They even
stated that hospitals -- there's one in
10 Pennsylvania where they were able to maintain charity
11 care -- they were fully aware of what was involved here;
12 and for them to come back and say they are not able to do
13 it, I think it is really outrageous. Thank you very
14 much.
15 MR. EDELSTON: Patti Sanchez. I
would like to take
16 this opportunity just to remind the fellow members of
17 public that are here to avoid repeating, for those
18 speakers who come beyond this point, what has been already
19 said because we need to hear additional new information
20 and we still have two-thirds of additional speakers,
21 members of the public, who would like to speak. Also, the
22 court reporter has asked if you would, for those who are
23 speaking, to very clearly state your name so she can get
24 it down correctly.
25 (THE
FOLLOWING TESTIMONY WAS TRANSLATED THROUGH
26 A SPANISH INTERPRETER:)
27 MS. SANCHEZ: Good afternoon.
My name is Patti
28 Sanchez. I have lived in Venice for 15 years. I am
going
0060
01 to tell you about an experience I had. I have a six-year
02 child. Three years ago my child got very sick and
03 I took him to Daniel Freeman Hospital. They don't do
04 pediatrics there, but they did take care of him until they
05 could get him to another hospital. They put him on
06 oxygen. They were able to transport him to UCLA. They
07 weren't able to care for him completely, but they were
08 able to at least get him to UCLA.
09 I want to
ask that you help stop the closure of
10 this hospital. It is important for this community and for
11 the entire City of Los Angeles. I know you want us to
12 remain calm, but we want to make sure that this hospital
13 does not close. That's all I have to say.
14 MS. CLACREUL: Genevieve Clavreul,
C-l-a-c-r-e-u-l. I
15 am concerned about what is going on, and I agree with the
16 attorney in that you have a lot of power as a Commission.
17 You can make a report that speaks for itself and the deal
18 is not closed. You can demonstrate that Tenet has done a
19 pattern of deceit, not only by Freeman Marina but about
20 Saint Luke. They closed Saint Luke a few months ago in
21 Pasadena. It was done overnight without the appropriate
22 scenery. It was so quick, one announcement. They did
the
23 same thing with Presbyterian Hospital. They did the same
24 thing when they bought Brotman.
25 How long are
you going to allow it? When they
26 bought Brotman, they said, "We will not close the labor
27 and delivery." At Brotman, most of the patients who
came
28 to labor and delivery were minority patients. I happen
0061
01 to be doing a study on the quality of health care in
02 Los Angeles. When Brotman labor and delivery was closed,
03 that last night, we had a patient who came to delivery.
04 They had already turned off the oxygen and everything.
05 She almost lost the baby because they were too cheap to
06 leave the oxygen on. How long are we going to allow that
07 pattern? It is all over.
08 If anyone
would do their homework, especially in
09 the state of California, you will see the pattern. They
10 buy two hospitals; they close one. They buy two; they
11 close one. That way they can control the market. And I
12 don't see how we can allow it any more.
13 I was a
consultant for Amar (phonetic). I was a
14 consultant AME. I was a consultant for Tenet. And only
15 one thing counts, the bottom line. Patient care is
16 secondary. That is business. Thank for your time.
17 MR. EDELSTON: Patrick Burns, to be
followed by
18 Jack Cumming and Valerie Gordon.
19 MR. BURNS: Good evening. My
name is Patrick Burns,
20 and I am a member of the West Los Angeles Metropolitan
21 Alliance. It is one of the many groups in the west side
22 that joined tonight in an effort to try to keep this
23 hospital open. Metropolitan Alliance is an organization
24 that focuses primarily on trying to improve the lives,
25 economically and otherwise, of poor working class people
26 throughout Los Angeles. And we kind of focused on this
27 issue because we feel that health care is a critical
28 issue, and it is something that is very important to
0062
01 everyone in this room.
02 If we think
of the context of everything that is
03 happening with potential county cutbacks in the public
04 health infrastructure, one that has been primarily
05 concerned with reaching out to working class folk
06 throughout the county -- and the County itself, the county
07 government has said that, "Hey, you need to rely upon the
08 private health care sector to fill the gap to take up the
09 slack of quality health care."
10 Now,
actually based upon testimony that we have
11 already heard, I am worried about this pattern that has
12 been happening also in the private health care sector,
13 one where there is to be intense amounts of
14 consolidations, intense amounts of closures that have been
15 happening throughout southern California such that access
16 to hospital care is really becoming scarce. We are on the
17 verge of having something like this happen in the Marina
18 as well. So our organization is here to say that the
19 reverse actions must happen. Both the county's public and
20 private health care infrastructure must be expanded.
21 As mentioned
before, the representatives from
22 Tenet said that somehow the Venice Family Clinic, a free
23 clinic that is mostly staffed by volunteers, must be
24 heavily aided because it is going to have to pick up the
25 slack. So now public and private health care is going
26 down the tubes, and we are going to have to rely on
27 volunteers. The population is growing in this county.
We
28 need to expand these services.
0063
01 I just want
to conclude by saying this
02 past weekend, I was doing some door-to-door work trying to
03 get people to turn out for this meeting. One of the
04 things that struck me as I was talking to people -- I
05 knocked on the door of a nurse who worked at the Tenet
06 Daniel Freeman Marina Hospital for 30 years. She was
07 trying to convince me that, "No. No. What you're
doing
08 here is kind of in vain. I've been hearing that on the
09 job, it is a done deal. They're closing and that's it.
10 You're too late."
11 And you
know, I think that the presence of the
12 Board here says that it is not too late. The second
13 person whose door I knocked on is a person who told me
14 nonchalantly that he had had his life saved at Daniel
15 Freeman Marina Hospital. I wanted to make those things
16 clear. I appreciate your time. Thank you.
17 MR. EDELSTON: I would like to do
again is have the
18 speakers, the presenters, be followed by Jack Cumming.
19 MR. CUMMING: Jack Cumming,
C-u-m-m-i-n-g. You, the
20 Commissioners, are responsible for health care in
21 Los Angeles County. I am sitting here listening, and I am
22 hoping you're investigating whether we in Los Angeles
23 County can afford to have any of our health care under the
24 control of the management of this company.
25 Now, Mr.
Koenig is brave to be here tonight. His
26 masters are not. His masters at Tenet have chosen not to
27 come meet our community with their presence. I say that
28 Mr. Koenig has no say in this decision. This decision is
0064
01 made elsewhere with the people who are in charge of the
02 financial circumstances.
03 I am impressed
that our political leaders are
04 here; and health care is too important in the county of
05 Los Angeles. I hope that our political leaders and you
06 who are responsible for health in this county can do
07 something to maintain the standards and improve standards
08 and not see it deteriorate merely by a profit motive.
09 Tenet has
said this is about money and I believe
10 them. They are money driven and not people oriented.
11 Mr. Koenig made that very clear when he spoke. Tenet
12 clearly had this in mind at the time of the purchase.
13 They seem to have been more interested in selling the real
14 estate which is at the heart of the Marina community than
15 in providing health care. That's pretty clear.
16 Mr. Koenig
said that people walked off of the
17 facility. People will go to a quality facility. People
18 did come to the Marina hospital when it was a quality
19 facility. There is a question now of Tenet whether that's
20 true. The day has come, we need people. Hospitals are
21 not well dispersed geographically. You can see that on
22 the map. The Marina Hospital fills a critical need.
23 And finally
in my 30 seconds I see I have
24 remaining, there are a number of imaginative things that
25 Tenet might have done to make this facility work. If it
26 doesn't support itself as a hospital alone, we have a need
27 for a vitality center to promote fitness for nutritional
28 food, activities. We have a need for senior care. And
if
0065
01 Tenet is unable to manage it, I hope that they will
02 finance it with these tremendous resources they have, a
03 leveraged buyout to let people who are competent in that
04 area can become the businessholders and run.
05 MR. EDELSTON: Next speaker is Rene
Moore, followed
06 by Dr. James Moore.
07 MS. GORDON: My name is Valerie
Gordon. And by this
08 time many of the things I wanted to say have been said. I
09 will briefly mention those things, and then ask Tenet a
10 few questions. We're a community near the water. We
have
11 people that roller skate and bike ride, and they need that
12 hospital as well as the children and the people in this
13 community.
14 Again, the
other hospitals on paper may look
15 close at four miles away; but in the middle of traffic,
16 that's more like 20 miles away. The general from Tenet, I
17 would like you to know that as a resident of this
18 community and member of the homeowners association and a
19 marriage and family therapist, when I was having my heart
20 attack, I chose to go to Daniel Freeman, and I chose to
21 stay there.
22 I have
insurance. I can go to any hospital in
23 this city. And I am very fortunate I have the funds to go
24 to any hospital in the city. Not only did I stay there
25 with my heart attack, I opted to have several other
26 elective surgeries. They have fabulous doctors. I have
27 received wonderful care at that hospital, and I think that
28 needs to be considered.
0066
01 What I want
to ask you is did you ever make a
02 plan to make this hospital work or did you just look at
03 pieces of paper? You could have expanded your emergency
04 department. You could have expanded your outpatient
05 department, which are very popular departments. You need
06 to rethink and you need to redo. You need to work with
07 the other hospitals that you own. One of them could be
08 for orthopedics. One of them could be for cardiac. You
09 could make them specialty hospitals. We cannot close this
10 hospital.
11 And, again,
I am asking you, did you ever try to
12 make this work? From what I understand, you paid
13 $55 million for two hospitals. I would really hate to see
14 in the newspaper that a hotel or another apartment complex
15 then pays you 55 million because that would be a real
16 wash.
17 DR. MOORE: Hello. My name is
Dr. James Moore. I am
18 a resident of Villa Marina. I serve on the Board of the
19 Villa Marina Council. Tenet's responsibility is not for
20 emergency health care. Their primarily responsibility is
21 profit to their shareholders, bottom line. That's not
22 evil. That's not wrong. That's business. If
Tenet
23 cannot operate the hospital at a profit, and if they will
24 not operate it at a loss, they had no business buying it.
25 I suggest
that the primary responsibility to
26 ensure health care, especially emergency care, in the
27 County is the county's. It is their responsibility to
28 find the management and a funding mechanism to continue
0067
01 emergency health care in our area. To relegate our health
02 care services to the free market system and then permit
03 the system to fail if it isn't a good business is to
04 abdicate the county's responsibility of this matter.
05 We've heard
cases of coyotes that come down from
06 the hills and attack dogs and domestic pets; and to think
07 about this, you don't hate the coyote -- that is their
08 nature -- but you don't hire coyotes to take care of your
09 pets.
10 MR. EDELSTON: Those who are in the
back near the
11 door, please allow the speakers the opportunity to speak.
12 It's hard for us to hear them when we're hearing the roar
13 in the back and over by the door.
14 DR. MOORE: Is there anything I've said you
would like
15 me to repeat?
16 MR. EDELSTON: We'll move forward.
17 DR. MOORE: I will take the mike to
my wife. It will
18 be faster to get it to her than to get her to the mike.
19 MS. MOORE: Thank you. I don't
have that kind of
20 speech, but I've been a patient a number of times in this
21 particular hospital. But more important than that, I have
22 been making use of the emergency room. If anybody has
23 ever had a dislocated shoulder, I don't think I have to
24 tell you anything more than -- having a dislocated
25 shoulder in the airport, bad place for it to happen. And
26 after about an hour of being on my knees, which wasn't a
27 good idea, I felt that I dislocated the shoulder.
28 I couldn't
be taken to that cute little silver
0068
01 building that they have right there at the hospital, which
02 is supposed to be some sort of medical facility. I never
03 did find out what it is supposed to be. I was taken, not
04 to the one that is across the street from where I live,
05 but I was taken all the way to Centinela -- where it is --
06 somewhere else. It didn't make any sense to me.
07 But with a
dislocated shoulder -- by the way, as
08 a result of a dislocated shoulder, I couldn't drive by
09 myself and asked the hospital to do me one favor, call a
10 cab so I could go home. I really and truly need a
11 hospital that is almost right across the street from me.
12 It is about a half a block away.
13 I also heard
Tenet make another comment that was
14 very interesting; and that is that they don't fill up the
15 beds in the hospital. I was in that hospital as a
16 patient, not the emergency, for almost two months; and I
17 didn't have any problem whatsoever with the care. And it
18 looked sort of busy to me. I don't get it.
19 MS. RAMOS: My name is Patricia
Ramos. I am here
20 to speak on the behalf of my sister and her husband.
21 Eugene was admitted to Daniel Freeman Marina Hospital on
22 June 21st. He was 38 years old. He came in, passed out
23 at LAX. Daniel Freeman was the closest facility.
That's
24 where they took him. He had a septic infection and blood
25 pressure of 50/40. Also the doctors informed us at that
26 time they were going to have to put him on a respirator.
27 At this time his chances for survival were next to
28 nothing. My sister and I immediately flew out from Texas
0069
01 and arrived that Saturday. Since we've been here, we come
02 to realize that had that hospital not been there, my
03 brother-in-law would have died.
04 We asked
after the shock of what was going on
05 wore off why he was taken there. We were told that it was
06 the closest hospital for him to be taken to. It was not a
07 question of taking him somewhere else. It was the
08 necessity of taking him to the nearest medical facility so
09 he would not die. We have been here 26 days. In that
10 time it has been an uphill battle for Eugene's life. I
11 know if it wasn't for God's grace and the medical
12 treatment he received from the doctors and staff at this
13 hospital, he would have been taken from our families and
14 his three children.
15 In closing,
I urge you to please do everything
16 possible to keep this hospital and the staff up and
17 running. My family is very grateful that he received the
18 medical treatment he needed. How many others have been in
19 that position or how many others have not been, I don't
20 know. Eugene has been in acute care for 19 days. They
21 are now trying to wean him off the respirator. Thank you
22 for your time and consideration of this matter.
23 MR. EDELSTON: Frances Longmire,
followed by Rosa
24 Castro and Sheila Bernard. Frances Longmire, then we'll
25 move on to Rosa Castro -- no. Sheila Bernard.
26 MS. BERNARD: Commissioners, my name
is Sheila
27 Bernard. I am the president of the Lincoln Place Tenants
28 Association. Lincoln Place is an 800-unit apartment
0070
01 complex in Venice. It is up to us, the public, to find
02 ways to provide the necessities of life to all of our
03 people in ways that invests rather than spend public
04 money, tax money, our money; for example, concerning
05 Daniel Freeman Hospital, we need to try some bold
06 innovations, such as a combination of cooperative private
07 and public ownership.
08 Mr. Koenig
from Tenet said that in the years
09 leading toward the bankruptcy of the hospital, the owners
10 had a deficit of about $55 million. He didn't say how
11 many years that was; but to be conservative, let's assume
12 that was two years. Let's also assume that hospital
13 serves a population of about 250,000 people, because
14 according to the packet that we got tonight, that is the
15 only hospital in the 11th council district of the county
16 of Los Angeles.
17 When you do
the math, that deficit amounts to
18 about less than $10 per month per person, which could
19 potentially come from membership dues arranged in a
20 sliding scale, which could entitle members of the public
21 to participate in decision making for their health care
22 enterprise.
23 Also, a
holistic component to care, including
24 preventative care and natural alternative treatments,
25 would attract other kinds of foundation and private
26 support. Cooperative investment by doctors and other
27 professionals could also be included. UCLA has offices
28 across the street from the hospital and could be
0071
01 approached for participation. There are other health care
02 cooperatives in our country, which we could research to
03 learn from their experience; and there are many countries
04 in the world in which large portions of the health care
05 industry and in some cases the entire health care industry
06 is owned by the public.
07 Also, the
public acquires property all the time
08 through eminent domain, usually through property owners
09 that have done nothing wrong in situations where the
10 corporation deceives the public or makes bad business
11 decisions or knowingly cheats the public. We must learn
12 from that. The private ownership of some facilities is
13 just not always the answer and sometimes public ownership
14 is a better alternative. Thank you.
15 MR. EDELSTON: The next speaker is
Doris Burg,
16 followed by Tim Riley and Carol Powell. At the request of
17 the facility here, we ask you to keep comments brief.
18 We're running past the time that we had anticipated, and
19 they have a cleaning crew clean the facilities. It is
20 going to cost them money if we don't do this as
21 expeditiously as possible.
22 MS. BURG: Lady, I'm so thankful the
last thing you
23 said was money. It seems like all we talk about here
is
24 money. I think when I look around and I see so many
25 people to come up here to speak, when I look at your ages,
26 there's a lot of young people that are not here. But a
27 lot of us have gotten to the age to really think about
28 what we want to do with our lives. The worst thing there
0072
01 is to do is to let us know there are no doctors for us, no
02 facilities or hospitals for us. We can't go all the way
03 across town just looking for a place to receive emergency
04 care or whatever.
05 When I think
about all the years that we have
06 taken to put some of these things together, it takes only
07 a few years to undo. This should not be about what is
08 down the street at the hospital, how many patients come in
09 there. This should be about the hospital taking care of
10 the patients.
11 So many
people are going to the county, including
12 myself. I go there because I have a very -- a serious
13 part of my body is infected with arthritis. I have
14 wondered so many times why is it that we have gotten to a
15 place in America that we have so many people so sick. We
16 waste a lot of time here tonight with papers that deal
17 with what we say, what we are going to do with this
18 facility. We need all the help we can get.
19 It seems to
me that when we have an emergency, we
20 all have them, and we go. It shouldn't have to get to
21 that point. We should think about it before we get to
22 that point. America, we are under attack. We've been
on
23 attack for emergency, for hospital care, insurance care,
24 for quite some time. Many people refuse to go to doctors,
25 not because they are not healed, but because they feel
26 they are not going to get the care.
27 The worst
thing there is is to tell a patient, "I
28 am going to come by, pick you up and take you to the
0073
01 doctor," and that transportation, they just don't come to
02 you. This is not a yellow cab company. This is
something
03 they provide for you, and they take you all over the
04 county. They pick up all the patients, then you leave
05 when all of them are ready to come home.
06 When you
start getting older, the worst thing to
07 do is tell them where you have to go. We don't make
08 choices to get in wheelchairs. We don't make choices to
09 call in for prescriptions and nobody is there. We don't
10 make that kind of choices. It just happens that way.
The
11 worse thing in the world is when you can't get somebody to
12 okay a prescription and you run out of time. It is
13 something I know a little something about, medication. I
14 can call all kinds of sources to get something. Let's
15 think about that because in the next four or five years,
16 you are going to be as old as I am.
17 MR. EDELSTON: Thank you.
18 MR. RILEY: Commissioners, my name is
Tim Riley
19 representing the Marina Del Rey Realtors Association.
20 We're the major leaseholders in the county's
21 unincorporated Marina. They built the apartment buildings
22 in which we have thousands of tenants. Their well-being
23 depends on the availability of this emergency service at
24 Daniel Freeman Hospital. I am sure many of us on
25 occasions have had to use it over the years.
26 I just want
to illustrate a point that about a
27 year ago, Tenet was very interested and eager to meet with
28 community organizations to discuss the plans to purchase
0074
01 Daniel Freeman Hospital. It was represented to us at the
02 time that Daniel Freeman Hospital's existence was
03 threatened if they did not sell it to Tenet health care.
04 We met with the representatives. They were assuring us
05 that they were going to keep this open as a facility for
06 emergency medical services in this area. We wrote a
07 letter to the Attorney General of California. We
08 conditioned our support of this purchase of the hospital
09 by Tenet on the condition that it would remain a health
10 care facility.
11 So a year
ago they are eager to talk to us. Now
12 we don't know where they are in terms of responding to the
13 community. We do need this facility. We hope that you
14 will find a way to use your persuasive powers as a
15 government entity through this Commission, through some of
16 the local elected officials that came here tonight, and
17 find a way to make this a reality to keep this hospital
18 open. I am sure there are avenues for you to take. I
19 hope that you can do that, put the pressure on Tenet.
20 Shine the light on the situation that representations were
21 made and they have not been followed. Thank you.
22 MR. EDELSTON: Carol Powell will be
followed by Morton
23 Bloom and John Michael.
24 MS. POWELL: Hi, my name is Carol
Powell. I have
25 lived in this community for over 35 years. I am a nurse
26 at the VA Medical Center, West LA, and I am a member of
27 Metro Alliance. I am just here to ask you how much is a
28 life. What is the cost of a life? Can you put a price
0075
01 tag on a life? Your life, your family's life, your
02 children's life, your parents' life, your neighbors' --
03 how much is a life? All we're talking about is money.
04 And I think there's money available to keep that hospital
05 open, keep it running.
06 There are
people that need jobs, that want jobs,
07 that applied for jobs there. I know several nurses that
08 work there that were paid to leave, and that's really
09 unfortunate. Soon I will getting my bachelor's degree in
10 criminal law, and I think that you've committed a crime
11 and the crime that you've committed is almost murder and
12 you should go to jail for that.
13 MR. EDELSTON: Morton Bloom; if not
we'll move on to
14 John Michael; and following John Michael will be
15 David Yon and Sheila Nicholson.
16 Dr. MICHAEL: I am Dr. John Michael.
17 MR. EDELSTON: I apologize.
18 DR. MICHAEL: Now, this is for
everyone here. It is
19 not just for the hospitals. It's the schools as well.
20 Now, this is what we need to do is actually get people to
21 unite because all taxes are supposed to go for our
22 hospitals or schools or paramedics or the firemen. The
23 public pays taxes. This is an actual crisis. It is
24 irresponsible that we have had leadership that is being
25 exposed. Just like Enron, Tenet is guilty of not
26 providing health care under the guise of trying to bring
27 in a hotel is being exposed.
28 Now, what I
want to do is invite all people to
0076
01 join in a demonstration at the federal building in two
02 weeks for supplies for our schools, which are understaffed
03 and overwhelmed. This is actually a crime that has been
04 going on for some time. It is a wake-up call for all of
05 us.
06 Mother's Beach,
the most political beach in the
07 world, this weekend, there will be -- between 3- and
08 400,000 people are coming to Venice, Marina Del Rey, the
09 beaches, to enjoy the open air. It is going to be a hot
10 summer. There are going to be emergencies. Now, all I
am
11 saying is let your conscience be your guide. And I talked
12 to the heads there to keep the Daniel Freeman Hospital
13 open. We can campaign for more funds to supply our
14 hospitals and schools.
15 In closing,
I also work -- because I am Veteran
16 of the American Peace Corps. John Kennedy was the last
17 president who actively served, and the good news is that
18 Marymount College, UCLA, Santa Monica College, all of the
19 students that need education that can't afford to go to
20 school and earn tuition through our government -- this is
21 what President Bush just announced, something that hasn't
22 been done in the American culture. It hasn't been done
23 yet. The answer is actually with our college students
24 working in hospitals, working in schools for our children;
25 and what I want to do is hire the best and then fire all
26 corrupt officials. Thank you.
27 MR. EDELSTON: Mr. Lance; if not,
followed by Sheila
28 Nicholson and Patrick burns.
0077
01 MR. WILLIAMS: My name is Steve
Williams. My wife and
02 I and our daughter have lived and worked in the community
03 for a very long time. 22,500 ER visits to Daniel Freeman
04 Marina last year could not possibly be handled by the
05 Centinela's Airport Clinic, which could not handle the
06 recent injuries and deaths at Bradley International
07 Terminal.
08 Daniel
Freeman must meet the demands of 45,000
09 new residents or more in the developing Playa Del Rey
10 area, not including new businesses and their employees,
11 thousands of them, in addition to the existing
12 neighborhood communities. And let's not forget about our
13 protectors; the needs, for example, of the life guards,
14 Coast Guard, as well as the sheriff, police, fire
15 department and EMT personnel themselves, especially in a
16 disaster scenario, especially when affecting them,
17 including our beaches, including our airport.
18 I propose that
the doctors who will be displaced
19 with the additional funding by these, our local neighbors,
20 purchase Daniel Freeman Marina to be sold by Tenet to us
21 under band-aid from the city and state. I propose this
22 mandate be based on the past and present performance of
23 operations by Tenet closing hospitals for more profitable
24 ventures. They have demonstrated they are not really
25 interested in health care, hospitals, doctors, and care,
26 the ER, the ER facilities for our communities.
27 MR. EDELSTON: Thank you.
28 MS. NICHOLSON: Good evening. I
want to thank all of
0078
01 you for coming to our community and hearing our concerns,
02 which have been in abundance. I also want to thank
03 attorney Murdoch for giving the community the teeth to
04 represent us.
05 MR. EDELSTON: Your name, please.
06 MS. NICHOLSON: Sheila Nicholson, and
I am a member of
07 Steering Committee of Westchester Neighborhood Council. I
08 am a little nervous. This is a very, very important
09 decision that you are going to be making this night. This
10 is a decision which many Tenet members here understand
11 very well. It is called code blue. This is life or
12 death. They are throwing our community into a state of
13 crisis. As a member of the Westchester community, I would
14 like to give you some statistics. We have a community of
15 almost 50,000 people up the hill. As Mr. Weiman pointed
16 out, we are going to be accepting an additional 35-,
17 45,000 residents with the development of Playa Vista.
18 Mayor Hahn's
new plan for LAX expansion is mapped
19 out at 78 million passengers. There is no way it is
20 feasible that one more hospital in this county can close
21 and provide the needed emergency and inpatient hospital
22 care that we all must have. Whether it's here in this
23 community, whether it's in Inglewood, whether it's in west
24 Los Angeles, whether it is anywhere in Los Angeles, we
25 have to have hospitals. It's not a right. It is a
26 necessity.
27 We come
before you tonight and say "This hospital
28 cannot close." You have an obligation to represent us
as
0079
01 people. They have an obligation to do what's best for
02 their Board members. And I would also like to point out
03 on your ballot sheet, there is an asset called goodwill.
04 Think about that. Thank you.
05 MR. EDELSTON: Thank you. Andy
Burns? Then that
06 concludes the public testimony. I would like to ask at
07 this time if any of the Commissioners have any comments or
08 want to engage in any discussion? Hearing none, then I
09 would like to thank Terry Connor for arranging for the
10 facility -- thank you very much; the Venice Boys and Girls
11 Club, which I urge all of you to support; and I would like
12 to have a motion to adjourn. Motion seconded.
13 MR. EDELSTON: Any disagreement?
No.
14 (Vote was
unanimously carried)
15 MR. EDELSTON: And we are adjourned.
Thank you all
16 for attending.
17 (Hearing
adjourned at 8:30 p.m.)
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