Malcolm Macdonald
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River Views  - -  Published in the Anderson Valley Advertiser  April 20, 2016

4/26/2016

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                                                                             Link to Anderson Valley Advertiser:  www.theava.com

It all stems from April 20th. If you don't know why, hang onto your ticket stub it could be valuable.

On April 20, 1611 Shakespeare's Scottish play was first performed in London's Globe Theater. Of course, we are not referring to the lead character by name because of the curse placed on Shakespeare and company 405 years ago when they stole a cauldron from an actual coven to enact the three witches scene. The real witches retaliated by placing an everlasting curse on the play and the utterance of its title.
That's one of the tales that surrounds the alleged curse of speaking the Bard's Scottish play's title aloud in the proximity of a stage. Accidents have happened after the name got mentioned inside a theater by a member of its company, including injuries sustained by multiple actors during a 1937 Old Vic performance which starred Laurence Olivier. (Several wounds were incurred by a spate of actors portraying MacDuff when they parried swords with the exuberant Olivier.)
Then there was the Astor Place Riot of May, 1849. The two most renowned Shakespearean actors of the time were William Charles Macready, a Brit, and the up and coming American, Edwin Forrest. On a previous tour of the U.S., Macready was followed from city to city by Forrest who took on the same Shakespearean roles as the English thespian. Most American newspapers supported Forrest with positive, if not glowing, reviews while denouncing Macready's talent.
Forrest had debuted in New York at the Bowery Theatre, which catered to the working classes and the gang members from the areas surrounding the Five Points neighborhood of lower Manhattan. Forrest trod the stage a hundred years earlier like Brando screaming for his Stella in A Streetcar Named Desire.
Macready offered up a much more genteel method of acting.
In May, 1849, Macready made his third visit to New York to perform at the Opera House, which was deigning to allow actors to perform in its confines while the opera season was dark and calling itself the Astor Place Theatre for such runs. On May 7th, hundreds of Forrest supporters bought tickets to Macready's turn at the Scottish play. They hurled every thing from rotten eggs to shoes at Macready and his fellow Shakespeareans. Seats were torn apart, while a few blocks away at the Broadway Theater (even the spelling of the two houses denoted a form of class differentiation) Forrest's fans rose to a roaring ovation when their actor uttered the Bard's line, “What rhubarb, senna, or what purgative drug will scour these English hence?”
Macready threatened to leave straightaway for England, but agreed to stay after a letter imploring him to do so arrived. The petitioning letter stated in part that, “the good sense and respect for order prevailing in this community will sustain you on the subsequent nights of your performance.” The document was signed by many of New York society's elite and by some literary luminaries of the day, including Washington Irving and Herman Melville.
By 7:30 p.m. on May 10th, when Macready took the stage for another go at the Scottish play, about 10,000 people had crammed into the streets nearest the Astor Place Theatre. Of particular note among the crowd outside was one Ned Buntline (born Edward Zane Carroll Judson, but under the pseudonym Buntline he would go on to gain fame as the dime novelist chronicler of such Wild West figures as Buffalo Bill and Wyatt Earp). His newspaper column “Ned Buntline's Own” often championed nativism. Throughout the previous week Buntline had created and passed out hundreds of posters and handbills proclaiming, “Shall Americans Or English Rule This City?” Buntline and friends had purchased many of the tickets that allowed Five Points toughs to attend and disrupt Macready's May 7th performance.
On May 10th Buntline and friends were well supplied with rocks and bricks to pelt the Astor Place Theatre. An attempt was made to burn the Astor from inside, but the blaze was smothered before it could do any real damage. However, the stones and chunks of masonry hurled through windows caused something close to a general panic inside. Macready finished his performance in a rush, though virtually no one could hear him, then sneaked out a side door in disguise to avoid the mob.
For the first time in New York history, the state militia was called in to quell the crowds. Rocks, bricks, and punches were thrown at the soldiers who eventually fired warning shots in the air, then point blank rounds into the throng. Several of those killed were simply bystanders who'd gathered at the edges to see what all the fuss was about. Most reports put the dead at twenty-five or slightly more, with the number injured equaling five times that. Anywhere from fifty to seventy of the injured were men serving in some sort of law enforcement capacity.
As a consequence New York became the first American city to arm its police force with guns. The class divide in New York continued. Truly professional actors like the Booths then the Barrymores played more and more in respectable theatres. As the nineteenth century gave way to the twentieth, Shakespeare in America became less and less a subject of popular culture and something only appropriate for the highbrows of society.
It wouldn't be until well into the twentieth century when actors like Olivier brought the Bard of Avon to the silver screen that Shakespeare would return to some semblance of broad popular acceptance. Just don't utter the name of the Scots laird whose name adorns one of Willie's plays. Even famous film stars aren't immune from the curse. In a 1953 open air production in Bermuda a gust of wind blew a flame onto Charlton Heston's pants, which had somehow been partly soaked in kerosene. Though not nearly fatal, let's just say a burning pain in the groin ensued.

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River Views  - -  Published in the Anderson Valley Advertiser  April 13, 2016

4/19/2016

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                                                                           Link to Anderson Valley Advertiser:  www.theava.com

Not many noticed, but part way into the March 31st Mendocino Coast Hospital (MCDH) Board of Directors meeting two members of that body's Finance Committee got up and left. One of those Finance Committee members could only be described as ticked-off.

Why? Anyone who had attended the MCDH Planning Committee meeting nine days earlier would have seen the reason right there on that Planning Committee meeting's agenda.
Item VI. of the March 22nd Planning Committee agenda states, “ JOINT COMMITTEE MEETING W/ FINANCE [Committee] & BOARD [Re] HOSPITAL FEE/HOSPITAL STRUCTURE 3/31/2016.
The major item of new business at the Thursday, March 31st MCDH Board of Directors meeting was a telephone presentation from attorney Lloyd Bookman (from the firm of Hooper, Lundy & Bookman) regarding what he termed a hospital provider fee that might bring in millions of extra dollars if MCDH is willing to become a private non-profit hospital whose day to day operations would be under the direction of its own non-profit board. This matter had been discussed at the March 22nd Planning Committee get together, but without Mr. Bookman's verbal input.
At the March 31st meeting of the full MCDH Board of Directors Mr. Bookman outlined the hospital provider fee program then answered a few questions from Board members, Chief Executive Officer (CEO) Bob Edwards, and Chief Financial Officer (CFO) Wade Sturgeon. When they were done Board Chair Tom Birdsell started to bring the gavel down. Board member Bill Rohr pointed out that a member of the Finance (and Planning) Committee had a hand up. Birdsell stated that he was following Robert's Rules of Order and there would be no questions from the public. Gavel down. Boom. No questions, no JOINT COMMITTEE MEETING W/ FINANCE & BOARD.
Mr. Birdsell, who took over the chair of the MCDH Board in January, made a statement to the effect that their would be no questions, no input from the public on agenda items unless they were designated as public hearings. This proves quite the contrast to Fort Bragg City Council meetings, including the one from three days before. On March 28th the City Council allowed lengthy public comment during its “Conduct of Business” session. The items in question were not even “action” items, but matters in which the city council was merely seeking input in order to give further direction to city staff.
The Fort Bragg City Council not only takes input on such non-action items, it also provides for public comment on non-agendized items early in the meeting and near the end of the meetings as well. Under Mr. Birdsell's chairmanship there is no provision for public comment after or during agenda matters titled “New Business,” “Old Business,” and “Reports.” The “New Business” section of the agenda contained six separate items, not only including the aforementioned presentation by Mr. Bookman, but proposed changes to the Board of Directors Bylaws. There were at least nine “Reports” on the agenda.
Mr. Birdsell may be speeding up MCDH Board meetings by employing his sense of Robert's Rules of Order, but he is ignoring the basic tenets of the Brown Act, which states in its opening paragraphs, “In enacting this chapter, the Legislature finds and declares that the public commissions, boards and councils and the other public agencies in this State exist to aid in the conduct of the people's business. It is the intent of the law that their actions be taken openly and that their deliberations be conducted openly.
“The people of this state do not yield their sovereignty to the agencies which serve them. The people, in delegating authority, do not give their public servants the right to decide what is good for the people to know and what is not good for them to know. The people insist on remaining informed so that they may retain control over the instruments they have created.”
With all the public attention given to Fort Bragg's City Council over the past couple of years, it is interesting, if not down right alarming, how few citizens outside of hospital employees attend the MCDH Board meetings let alone the empty chairs at MCDH Finance and Planning Committee gatherings.
All of this takes us back to that March 22nd MCDH Planning Committee meeting at which CEO Bob Edwards declared a letter, that was discussed at some length, was not going to be released to the public because it was, according to Edwards, a “trade secret.” Unfortunately for Mr. Edwards the California Health and Safety Code Section 32106 states that “trade secrets” are to be discussed in closed sessions. As was pointed out to Mr. Edwards at the time, something already discussed at an open and public meeting is inherently subject to further public scrutiny.
Mr. Edwards thinks otherwise. Anyone listening to the discussion in the March 22nd MCDH Planning Committee could tell that the letter Mr. Edwards wants to hide under a claim of “Trade secrets” was about the very same topic Mr. Bookman spoke to the MCDH Board about on March 31, the possible conversion of MCDH to a different kind of private non-profit entity. Further in the California Health and Safety Code this is addressed. “Nothing in this section shall be construed to permit the board of directors to order a closed meeting for the purposes of discussing or deliberating, or to permit the discussion or deliberation in any closed meeting of any proposals regarding: The conversion of any district health care facility to any other form of ownership by the district.”
Mr. Edwards appears intent on hiding as much as possible about the present and future goings on at MCDH from the public. The new chair of MCDH's Board, Mr. Birdsell, better be careful he is not a tool in such shenanigans.

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River Views  - -  Published in the Anderson Valley Advertiser  April 6, 2016

4/13/2016

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                                                                             Link to Anderson Valley Advertiser:  www.theava.com

You know there is a problem when you type the following phrase into your search engine, 'Is free cell solitaire an addiction?' and all that comes up is page after page of differing versions of free cell solitaire. If you truly need help, the only answer is endless variations of your addiction.

Pretty much like the health care dilemma in the good old U.S. Of A. The sicker we get (see numbers on obesity, diabetes, and more or less any self-inflicted calamity known to man or womankind) the bigger mess we allow to be made of our overall health care system.
Not that we aren't granted little nibbles of hope. The Affordable Care Act (ACA – what most Americans, in our short attention span glory, can only recall as “Obamacare”) allows us to switch insurance companies without being penalized for our previously existing medical conditions. On the other hand, if you think large insurance companies and Big Pharma haven't profited while the ACA has been rolled out, well, then you probably don't know much about health care finances let alone that Burl Ives played Big Daddy in the film version of Cat on a Hot Tin Roof.
Health care, in general, is indeed a mess in this country, and yet there are doctors and nurses doing their level best all over the place. They just get re-wound every so often, like an old watch that's supposed to keep on ticking no matter how much you use and/or abuse it. Ten to fifteen years ago the medical profession admonished its practitioners to honor pain relief for patients. Today the pendulum has swung the other way. Even senior citizens who have never sniffed a mimeograph let alone had a problem with booze, marijuana, cocaine, or heroin are being pee-tested and asked to sign a contract in order to get their next dose of pain relief from excruciating rheumatoid arthritis. Tough love has found the land of the dope grower and the home of the weed; on the Mendocino Coast a good opioid is hard to find.
I come not to praise medicine, but to question how it can afford to go onward at Mendocino Coast District Hospital. The answer may in part lie in the “California Medi-Cal Hospital Reimbursement Initiative” which will be on your ballot, not in June, but during the November general election.
A little background to get us to said initiative. The federal government's Medicaid program helps pay for health care services provided to low-income patients. Mendocino County has a whole bunch of those/us folks.
This program is called Medi-Cal. For California to receive federal Medicaid funds, the state has to contribute a matching amount of money. In 2009, a new program was created in which California hospitals were required to pay a fee to help the state obtain available federal Medicaid funds. That program has resulted in California hospitals receiving about $2 billion a year in additional federal money to Medi-Cal. However, year after year the state has been diverting a higher and higher percentage of these Medicaid matching funds away from the hospitals and into the state's general fund. Currently that diversion amounts to more than 20% of the matching Medicaid money. If passed by the electorate in November, the “California Medi-Cal Hospital Reimbursement Initiative” would not only continue the funding more or less in perpetuity, but cap the state diversion of Medicaid funds at 24% permanently.
The catch for Mendocino Coast District Hospital (MCDH) is that currently it is not in the aforesaid reimbursement system. This is what the latest brouhaha at MCDH is about. The major item of new business at the Thursday, March 31st MCDH Board of Directors meeting was a telephone presentation from attorney Lloyd Bookman (from the firm of Hooper, Lundy & Bookman).
According to Bookman, in order for MCDH to become a recipient of the Medi-Cal “Provider Fee” program the now public hospital would have to become a private non-profit hospital whose day to day operations would be under the direction of its own non-profit board. Presumably the non-profit board members would be appointed by an overseeing Board of Directors who would still be elected by the public.
In order for that process to take effect the Mendocino Coast District Hospital voting public would have to approve the change. At the March 31st meeting, no one asked directly whether or not the hospital's employee union would have a yea or nay vote on the matter.
MCDH Chief Executive Officer (CEO) Bob Edwards and Chief Financial Officer (CFO) Wade Sturgeon are touting anywhere from a $3 million to $6 million gain in funding over the current methodology employed at MCDH. At one point Sturgeon asked Bookman if the new system would allow MCDH to keep all of the parcel taxes it collects annually. Somewhat cryptically Bookman replied that MCDH would continue “to receive a portion” of its taxes. Neither Edwards or Sturgeon nor anyone on the MCDH Board of Directors followed up to ask what that portion might amount to.
The considerable number of people in the audience (mostly hospital staff) were not allowed to query Mr. Bookman. This leads us back to the MCDH Planning Committee meeting from the prior week. At that gathering a letter, either from Mr. Bookman or a competing legal team, concerning the hospital reimbursement program was discussed at some length by CEO Edwards and other members of the Planning Committee, including Board members Kitty Bruning and Peter Glusker. When this writer asked for a copy so that the public could read about the letter and its contents, CEO Edwards more or less leaped to his feet, declaring, “Trade secrets.”
In an email to this correspondent later that day, Edwards added the phrase “attorney-client privilege” to the “trade secrets” claim. This should continue to make the public wonder why the voting public of the Mendocino Coast Hospital District cannot be privy to information about an issue they may very well be asked to vote on?
“When logic and proportion
Have fallen sloppy dead
And the white knight is talking backwards
And the Red Queen's 'off with her head!'
Remember what the dormouse said
Feed your head
Feed your head.”


I'm going to move the red queen onto the white knight and beat this darn free cell yet.

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River Views  - -  Published in the Anderson Valley Advertiser  March 30, 2016

4/4/2016

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                                                                               Link to Anderson Valley Advertiser:  www.theava.com

Bob Edwards, the Chief Executive Officer (CEO) of the Mendocino Coast District Hospital (MCDH) does not want the public to know what is discussed at standing committees of MCDH's Board of Directors. At a March 22nd Planning Committee meeting Edwards claimed “trade secrets” after a letter, presumably authored by an attorney, was discussed at some length by Edwards, MCDH Board members Kitty Bruning, Dr. Peter Glusker, and several civilian members of the Planning Committee.

The letter appears to be a communication from a lawyer who is potentially seeking out MCDH as a client. The contents of the letter seem to indicate that the attorney would be willing, for a fee, to guide MCDH through a process that could potentially change its status from a “District” hospital to a “Hospital Fee Reimbursement” institution, possibly governed by a non-profit board instead of a publicly elected board of directors.
The words public and civilian are relatively crucial here. At that March 22nd MCDH Planning Committee meeting the audience was comprised of two or three MCDH staffers and one member of the press. Once the aforesaid letter was thoroughly discussed the lone member of the press requested it be made public, meaning added to the meeting packet on line and/or handed over in person. This is when CEO Edwards called out, “Trade secrets,” and Planning Committee Chair Bruning nodded, rather feebly.
That evening Edwards sent the AVA the following: “I spoke with Legal Counsel, regarding making you a copy of the document [name of civilian MCDH Planning Committee member here] had in her possession during the Planning committee meeting.
“The document... is an Attorney Client privilege document, and because it is such, I cannot release it to you as it has trade secret information.”
Edwards did offer his apologies for not releasing the document; however, sorry doesn't really cut it for the chief executive of a public hospital who won't let that very same public know the full extent of documents that could prove crucial to the future plans of said hospital.
Members of the public need only take a look at the MCDH February Board meeting minutes to grasp where things may be headed. Quoting those minutes, “Mr. Edwards reported on Hospital Fee Reimbursement for District Critical Access Hospitals and those Critical Access Hospitals governed by Non Profit Boards...
“Recent discovery by MCDH surfaced around finding disparities between Hospital
Fee reimbursement (NOTE: Provider Tax Assessment with Medi-Cal and IGT funds) for District Critical Access Hospitals and those Critical Access Hospitals
governed by Non Profit Boards.
“FACT: MCDH had a net receivable of about one million dollars last fiscal year, plus
had to submit over one million of its own dollars to receive its IGT(inter government
transfer monies).
“FACT: Some Non Profit Boards of Critical Access Hospitals have been receiving
four to six million dollars via the Provider Tax, and are exempt from sending in their
own monies for a match (IGT monies).
“Recent conversations have been held that focused on MCDH exploring an
alignment with another Hospital or Hospital System that could enhance the financial
performance of MCDH. Within the last month, the Administration has discovered
that two District Hospitals are in the process of exploring how its District Critical
Access Hospital could convert to a Non Profit Hospital Board so it could receive the
higher amount of Provider Tax reimbursement. Changing to a Non Profit Hospital
Board would be addressing how changing the oversight of MCDH would improve
financial viability, plus it would be able to retain local control.
“FACT: An annual three million dollar improvement could be made to MCDH if we
became a Non Profit Critical Access Hospital.
“FACT: To change the oversight of MCDH to a Non Profit Hospital, would take a
vote of the people.
“FACT: It is possible to have the District Board remain in place, thus having the ability to receive Parcel Tax Revenues.
“MCDH would propose that if MCDH would be managed by a Non Profit Board, after
a vote of the people, that the difference in monies, for rounding purposes of three
million dollars per year, would be used to design, fund, and construct a replacement
facility. We believe that one-hundred-twenty million dollars (or more) could be set
aside for these purposes.”
Readers may want to keep in mind that some of the things CEO Edwards calls a “FACT” could well be called subjective allegations by others. In a document passed out in support of a $150 - $250 per parcel tax (!) Edwards claims “a strong partnership with our Labor Union, resulting in zero wage increases for this year.”
If you want to know if someone is reliable, sometimes it is important to check out history, especially when that history is less than a year old. Here's what was reported in the AVA about last summer's contract negotiations between hospital administration and MCDH's employee union: “The union ratified the contract proposal, with approximately 85% of its voting members in favor. The contract thus agreed upon is a one year extension of the existing contract. The idea to continue under the old contract for one more year came from the union. The bigger story lies in what the hospital administration had previously offered the employees union. According to a source familiar with the situation, initially MCDH offered a proposed contract that would have 'trashed' the health insurance benefits of the employees, greatly increasing what employees would have to pay out of pocket for less coverage in order to maintain any health benefits whatsoever.
The union flatly refused that offer. Next, MCDH apparently attempted a divide and conquer strategy by offering the hospital's nurses, lab technicians, and X-ray techs a 10% raise. The flip side of that offer: every MCDH employee below the nurse and tech salary level would end up paying for their own insurance... The best guess is that the contract proposals to the employees union came directly from Mr. Edwards, considering that at least one member of MCDH's Board of Directors was not fully aware of the negotiation tactics.”
This is what Edwards describes as “a strong relationship with our Labor Union.” I have no idea why he chose to capitalize “Labor Union.”
At the February MCDH Board meeting Dr. Glusker said he and Dr. [William] Rohr had received an email from a company that purports to do the same thing as the attorney Edwards wanted to bring on board. According to Dr. Glusker, Dr. Rohr would like to make a presentation to the Board regarding the company (possibly Med First Partners) with whom he has spoken. Dr. Rohr, Dr. Glusker and another Planning Committee member have seemingly been pursuing this notion for some time.
After Glusker's statements, attempts to bring Edwards' plan to a motion were tabled. However, a glance at the March 31st MCDH Board agenda shows a presentation by Edwards' man, attorney Lloyd Bookman.
Which brings us back to the MCDH Planning Committee meeting of March 22nd. Presumably, the letter that Edwards slammed the door on was one from an alternative attorney to Mr. Bookman since the letter in question was apparently brought to the Planning Committee by the civilian committee member working with Drs. Glusker and Rohr. This might make readers wonder, is this is all part of an ongoing power play between Edwards and certain members of the MCDH Board (most obviously, Drs. Rohr and Glusker)?
Edwards putting the kibosh on public access to the letter should make any member of the public question why Edwards doesn't want the public to see or read possible alternative moneymakers for MCDH. Or, in a more sinister motive, did Edwards quash the alternative letter because its details show that his plan won't actually benefit MCDH all that much? Citizens within the Mendocino Coast Hospital District might want to consider attending not only the March 31st MCDH Board meeting, but, also, meetings of its Planning and Finance Committees. Members of the public might want to ask what happened to the planned mediation (recommended by the Board's attorney) between the Medical Executive Committee of MCDH, the Board of Directors, and hospital administration. The outside mediator offered up meeting dates of March 21,22, and 23, but those days have come and gone without any mediation.
For some reason a line from the classic late '60s film Cool Hand Luke keeps popping into my head, “What we have here is failure to communicate.”

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