CARE, YES, BUT THE COST? UNIONS AN ISSUE IN HOSPITAL BOARD RACE.

Byline: Karen Maeshiro Staff Writer

LANCASTER - While the two incumbents in the Antelope Valley Hospital board race are touting a record of progress and accomplishment, challengers are criticizing them for long emergency-room waits, a divisive battle over unionization of nurses and wasteful spending.

Incumbents Dr. Don Bean and Gary Hill are seeking second four-year terms. They face five challengers: marketing manager Lawrence Caird, business development manager John Misurek, physician Dr. Don Parazo, retired registered nurse June Snow, and business owner Ronald Tisbert.

The campaign has been marked by sparring between Hill and Parazo and representatives from High Desert Medical Group, where Parazo works. Hill in a radio campaign advertisement accused Parazo of being an HMO doctor and criticized HMOs. Parazo and High Desert Medical Group vehemently disputed Hill's assertions.

Hill further accuses the medical group of pushing one of its own to secure more favorable contracts with the hospital. The medical group was not pleased when the hospital increased the group's rates last year, Hill said.

``They literally have millions of dollars at their disposal to throw at this, and they are denying that they are an HMO. For them to deny they are an HMO is out and out wrong,'' Hill said. ``I think they are trying to buy the election because they are not pleased with the contract negotiations that they had last year. I feel this is a way for them to make a better deal and contract and make more money.''

Parazo responded by saying that Hill accepted campaign contributions from High Desert Medical Group. ``I will recuse myself from any contracting issues that involve HDMG. I seek more corporate transparency, which is not the current environment of the current board,'' Parazo said.

The election also comes amid a hotly disputed drive by the California Nurses Association to unionize registered nurses. A judge sided with the CNA, ruling that hospital officials unlawfully refused to take part in a count of authorization cards that the union says allows it to represent nurses.

The hospital is appealing the ruling. The hospital has so far spent more than $166,000 on labor consultants and attorneys, hospital officials said.

The CNA initially endorsed Caird and Snow, paying each candidate's $2,100 filing fee, but according to Caird, local union organizers have withdrawn their support of him and are now backing Parazo as a more viable candidate.

The campaign also has seen accusations of violations of the state's open meeting law and of election-eve changes to hospital administrator Mathew Abraham's contract that make it harder to fire him. The changes require a ``super majority,'' or four-fifths of the vote, to terminate him without cause.

Snow filed a complaint with the District Attorney's Office, saying the board violated the Brown Act by failing to make sufficiently available for public review a notice of the Sept. 30 special meeting at which the board in a 3-2 vote revised Abraham's contract.

Hospital attorneys said they don't think any violation occurred, but the hospital has since changed the location of where it posts meeting notices from the administrative wing, which is closed at nights and on weekends, to the hospital's main lobby, which is accessible all the time.

Dr. Don Bean

Bean, 63, is a physician who lives in Lancaster. He said he and the current board have accomplished much during the past four years, and the work is not done.

The hospital has increased the availability of medical care in Palmdale and surrounding communities, improved employee salaries and benefits, reduced legal and consulting fees, increased the hospital's bond rating, and established a better financial result than almost any other district hospital in California, Bean said.

``All outside agencies that come to make an objective evaluation of the hospital have said we are doing very well. That includes the Joint Commission for Accreditation of Healthcare Organizations, which gave the hospital a (score of) 94. The previous high was 91 in California,'' Bean said.

``Most of the problems facing Antelope Valley Hospital are problems facing other hospitals: a nursing shortage, bed shortage, money shortage. In truth, the only thing we have in excess are patients. We need to meet that challenge by the ... efficient allocation of resources,'' Bean said.

Bean said he is opposed to unions in the public service sector and defended the board's decision to appeal the PERB ruling. ``We have the only full-service hospital in the Antelope Valley. I don't think it should have to operate under the threat of a strike,'' Bean said.

Bean also supported the four-fifths vote provision added to Abraham's contract, saying it will lend stability to the hospital, especially in view of the fact that the board could change three directors in one election year, and then two in the next.

``If somebody thinks he screwed up or doesn't like his style, you don't want to lose a competent CEO over something that may be a frivolous issue,'' Bean said. ``To have it done on a whim is wrong.''

Lawrence Caird

Caird, 53, lives in Palmdale and is marketing manager for Valley Child Guidance Clinic. He previously worked 28 years with the Veterans Administration in various capacities, including regional director of public affairs, health systems specialist and administrator for a psychiatric training program.

``My sense of a well-run hospital is a balance between the bottom line and quality of care. If you focus simply on making a profit or balancing the budget, bad things can happen to the quality of care. If you give Rolls Royce quality of care regardless of the circumstances, you can go in the red,'' Caird said.

``It appears to me the hospital administration has been successful in the bottom line. You can't criticize the current fiscal status of the hospital. However, people brought to my attention that nurses who almost always are the keepers of the gate in terms of quality of care were under some pressure based on their intention to organize. They were feeling as if their jobs might be threatened,'' Caird said.

If elected, Caird would work to create a worker-friendly environment where employees would be recognized as equals and where the hospital would be seen as an employer of choice rather than one of convenience. He would also work to make sure meetings are properly noticed and accessible to the public.

Caird said the unionization of nurses would give them equity and parity with management and an ability to work without fear of retribution if they put the interests of patients first, Caird said. Caird added the appeal of the PERB decision was a waste of money that could have gone into patient care or bonuses to attract more nurses.

``To waste more money to appeal the PERB decision is simply that, a waste of money. It doesn't seem to be warranted. I don't know if they think they are buying time. It seems they are following a pattern of putting up roadblock after roadblock,'' Caird said.

Caird was critical of the four-fifths vote in Abraham's contract. ``Why should Mr. Abraham have better odds than say the president for impeachment? It was done out of fear that a change in the makeup of the board might stack things against Mr. Abraham. The four-fifths was wrong. The timing was wrong,'' Caird said.

Gary Hill

Hill, 53, is a resident of Lancaster and is Lancaster's finance director. He was the chief accountant for the hospital between 1977 and 1981.

In seeking re-election, Hill pointed to actions by the hospital in the past four years, including the opening of health clinics in Palmdale and surrounding communities, completion of the skilled nursing facility, the start of construction of a radiology center, the hiring of more nurses and the installation of new medical technology.

The hospital has adopted a long-range master plan that calls for expanding the emergency room and, instead of spending $55 million to remodel older areas of the hospital to meet earthquake seismic standards, building a multistory tower that would add more beds. Hill said another goal is to convert the skilled nursing facility to a women-and-infant center.

``When I first got on board, the hospital was approaching bankruptcy, losing $5 million to $6 million a year. We had contracts, sweetheart deals, with some of the HMOs. ... In the last four years we have been able to restructure fair contracts with HMOs,'' Hill said.

Hill believes the issue of a union for nurses should be decided by a secret ballot election among the nurses. That's why the board decided to appeal the PERB ruling, he said.

``We have an obligation to provide health care to the community. All of the employees should be paid an appropriate wage, and that's what we have done over the last four years,'' Hill said. ``My goal is to expand the quantity and quality of health care. The promises I made four years ago have all come to fruition.''

Hill said the four-fifths vote provision grants Abraham a protection that other workers have. ``We don't want to change the administration for 'light and transient' causes,'' Hill said, citing words from the Declaration of Independence. ``Just like a janitor or nurse has protection against wrongful discharge, everyone should have that protection.''

Dr. Don Parazo

Parazo, 49, is a Palmdale resident and a family practice physician and geriatrician. He has been a member of the hospital's medical staff for 15 years.

Parazo said he is running to give back to the community that he has had the privilege of caring for as a family physician. ``Even before entering the race, I asked one of the present board members if I would be able to contribute to the board. The response was that I was well-qualified and would make a fine addition to the board,'' Parazo said.

Parazo's goals are to have a more efficient access to the hospital, decrease the waiting time in the emergency room, promote better communication between the providers and nurses, and use his 15 years of working in the hospital to improve overall patient care.

He said one of the main issues is that the two present incumbents lack the current medical expertise to help the CEO make wise decisions. ``Also, we need to increase the communication between the hospital staff and the board,'' Parazo said.

Parazo said the hospital should work with nurses if they want to form a union. ``Why are health professionals seeking to unionize? Is it because the present board has not listened to them in the past? From the beginning, my platform is that if the nurses genuinely want the union to represent them, then we should work with them,'' Parazo said.

As for the board's decision to appeal the PERB ruling, Parazo said, ``If the hospital's position is a stall tactic, then I am not supportive of using patient dollars (to) support this tactic,'' Parazo said.

Parazo was critical of the board changing Abraham's contract. ``The board has an obligation to protect the checks and balances of the system. They put the CEO's interest above the public's interest,'' Parazo said.

June Snow

Snow, 56, is a resident of Lancaster and a retired registered nurse. She worked at the hospital for more than 20 years, 15 of those as administrative coordinator. She now runs a business that teaches diabetic self-management.

``I'm really not a politician, truly not. I just have a heart and a passion to make our health care services better than they are here in the Antelope Valley,'' Snow said.

Snow said she would shorten the wait in the emergency room by using all the beds in the hospital. She said the hospital is not using all the beds available to it. ``That's the plug-up. They have 28 patients waiting for beds and no place to put them. That's a big chunk of what's slowing everything down,'' Snow said. ``They have 30 beds on 5 Tower that are not open and not properly licensed but they can be.''

Snow said she would work to keep county-run High Desert Hospital open. ``The impact that (High Desert closing) would have on Antelope Valley Hospital is horrible because we are already so overloaded. We need to keep those beds open,'' Snow said. ``When we have all of our beds full, and have patients waiting in the emergency room, it is reasonable to look at transferring funded patients to High Desert to get them into bed rather than leave them in the ER for four days. That may help High Desert's bottom line.''

Snow said she objected to the hospital appeal of the PERB decision. ``As a nurse, I truly object to the hospital spending funds on fighting the union further. They have done what they needed to do; they have a ruling. I don't think one more dime should be spent on fighting something that is ruled legal and is a done deal. It's costing phenomenal amounts of money,'' Snow said. Snow said she was not for or against unionizing nurses but was in favor of following the law.

She was critical of the board's decision to change Abraham's contract, saying it was not right to do it four weeks before the election, and of the way the meeting was noticed.

``If you can put a public notice behind closed doors, I don't know why you can't paste it on the bottom of a desk drawer. I have real questions about the legality of what they did,'' Snow said. ``To extend someone's contract beyond newly elected board members, to extend it beyond their four-year term of service is really a disingenous thing. It's doing something to the people who follow you that does not allow them to respond to their constituency at all. You've locked them in.''

Misurek and Tisbert could not be reached for comment.