Local advocates pushing changes in health care.

Michael L. Wall

President Northridge Hospital Medical Center

Mike Wall has led Northridge Hospital Medical Center to become one of the strongest high-tech hospitals in the San Fernando Valley. He has taken the Catholic Healthcare West facility from a position as a money-losing operation in 2000, to one that netted a $10 million profit in 2004.

Wall grew up in Michigan and earned a science degree from Eastern Michigan University, as well as a master's degree in hospital administration, from the University of Minnesota at Minneapolis, including a 12-month residency in Hospital and Health Care Administration. He has spent 25 years in healthcare leadership roles, including 12 as CEO of Mt. Diablo Medical Center in the San Francisco Bay area.

As president of Northridge Hospital, Wall oversees a 425-bed, acute care teaching and research hospital with 835 physicians as well as 1,800 employees and 435 volunteers.

His institution impacts the broader regional and national healthcare community through its affiliation with the David Geffen School of Medicine at UCLA. In addition, medical school graduates can spend three years in family practice training at Northridge's Family Residence program.

In a time when a nursing shortage has thrown the health care delivery system into what some call a crisis, under Wall, Northridge Hospital Medical Center has seen a decrease in nursing staff turnovers from 22 percent in 2000 to 9.8 percent this year.

Wall is an active board member of both the Valley Industry and Commerce Association (VICA) and the Economic Alliance of the San Fernando Valley. And, although Northridge Hospital is a non-profit organization that is part of a larger faith-based charity, which is ultimately pall of the Roman Catholic Church, he has a businesslike approach to managing the facility. which he sees as an important part of the local economy.

"It is important to understand that we are more than just an acute care hospital," Wall says. "We are a community resource, educator, researcher, and employer."

In the education arena, Wall is a faculty member of Cal State Northridge's Health Care Administration program. At CSUN, Wall and his colleagues say they are working to make the university's Health Care Administration program the best in the state.

Wall is no stranger to bold plans. Under his direction, Northridge Hospital plans to open the first and only Gamma Knife/Neuroscience Institute in the Valley, which treats brain tumors using 201 beams of gamma radiation--without a single cut. Other trailblazing plans for the hospital and medical center include:

* Opening a comprehensive "Center for Weight Loss Surgery," or "bariatrics" program.

* Instituting a diabetes and obesity community outreach program to educate and try to improve the epidemic of diabetes in targeted population groups.

* Maintaining a staff retention rate of 92 percent.

Says Wall, "We believe we have created an outstanding reputation that Northridge Hospital is a great place to work."

David Leuinsohn,

President and CEO Sherman Oaks Hospital

When David Levinsohn talks about the issues facing California's health care system today, he sounds like the William Shatner character in the classic Twilight Zone episode, knowing that the plane is going down, but finding no one willing to look through the window at what's causing the problem.

"One of the most important things facing us, to be sure, is that providers--hospitals, doctors--aren't getting paid for their services," says Levinsohn, the president and CEO of Sherman Oaks Hospital. "They need to get paid so they can continue to stay open and serve the community."

He believes that the entire health care infrastructure in California is teetering on the brink of disaster, while few leaders are willing to do much about it.

"The Richman/Nation proposals are promising," he says. "I think they need some fine tuning, but there are a lot of important things there that make sense. But also, someone needs to tell the health plans that they take an awful lot of money out of the health care system, and they need to start putting some of it back."

In addition to hosting the Valley Industry and Commerce Association's (VICA) Healthcare and Insurance Committee's meetings at Sherman Oaks Hospital, Levinsohn participates in the VICA group's advocacy efforts in promoting legislation affecting health care access, quality and costs.

Currently, he and his committee peers are working on promoting passage of AB 702, which would establish an educator scholarship fund, aimed at alleviating the shortage of R.N.'s in the state. Other efforts include opposition to un-funded mandates, like one that requires greater nurse-to-patient ratios in hospitals while the state is experiencing a nursing shortage crisis.

Clearly, he believes that equalization of the revenue ratios of insurers-to-providers is paramount to any other issue the system faces now.

"Premiums are too high," Levinsohn says. "And reimbursements are too low."

Levinsohn is a prime contributor to the dialogue surrounding health care issues in the region. He runs a hospital with a prestigious specialty component, the Grossman Burn Center, which is well recognized nationally and internationally. But, as with its emergency department, the center is overburdened because of its treatment of uninsured patients.

In the case of Sherman Oaks Hospital's Emergency Room, the burden of paying for uninsured patients often results from conditions that could be averted with regular health maintenance. He worries that if the public doesn't get more engaged in the issues of health care access in California, emergency rooms at facilities like Sherman Oaks will continue to close their doors.

Keith Richman M.D.

California Assemblyman

State assemblyman Keith Richman, M.D. has been serving the 38th District since 2000, and he is co-author (with Assemblyman Joe Nation of San Rafael) of bipartisan legislation to provide universal healthcare for Californians.

"Our health care system is in a crisis," Richman said. "Not only do we have 6.4 million people who are uninsured in California, but we also have health care costs that are skyrocketing."

His legislative proposals are contained in a package of bills designed to fix the problems of shrinking access to health care, basic insurance coverage, high costs and quality of care. Although his universal health care bill did not make it through the Assembly Health Committee, a Richman spokesman said the Assemblyman will continue to include the idea in health care discussions and reintroduce the bill next year. Richman said he believes lives depend on it.

"Not only is lack of insurance a tragedy for the individual who doesn't have any insurance," he says. "Clearly their health status is worse; but it puts a severe financial strain on our healthcare system."

Richman's program is unusual because it would mandate universal coverage by forcing individuals to insure themselves, with enforcement through the State Franchise Tax Board. Refunds would be withheld if a taxpayer were unable to show proof of health coverage. It's unclear how the mandate would be enforced on those who have no tax refund coming or don't even file state tax returns.

Yet, the bills promise to deliver the Holy Grail: making coverage affordable to all California families. The bills propose various means for doing so, such as creating purchasing pools, which Richman says should lower premiums, the creation of a treatment data research and review center that would, in theory, develop best practices to avoid redundancy, cut waste and increase medical efficacy.

Practically a native to the San Fernando Valley, Richman has lived in Northridge with his wife and three daughters since 1979.

Prior to becoming a politician, Richman was CEO of Lakeside Healthcare Inc., a health care provider that grew under his leadership to serve 100,000 patients, and employ more than 200 people. His career with Lakeside began in 1988, thus having spanned some of the most intensely transitional years in American health care history.

Dr. Richman got his pre-med schooling at U.C. Davis and his M.D. degree at UCLA along with a Master's Degree in public health.

The most controversial, of Richman's and Nation's healthcare bills is one that would divert some of the private money that is now mandated for expenditure on earthquake retrofitting for hospitals and healthcare facilities for the purpose of creating an electronic medical records system.

"Public employee unions are opposed to it," said Richman. "But in exchange for (delaying) retrofitting, an electronic medical records system will not only will save money but will save lives ... hundreds if not thousands ... by eliminating medical errors."

Richman's health care proposals are just beginning to work their way through the legislative process.

DIANA M. BONTA

Kaiser Permanente

Diana M. Bonta R.N., Dr.P.H. is passionate about her job as vice president of public affairs for Kaiser Permanente's Southern California region. But she's known equally as well for being a consummate nurse--concerned first and foremost with the well-being of individuals.

The state Director of Health Services under former Gov. Gray Davis, Bonta's accolades include the Presidential Citation Award from the American Public Health Association, Hispanic Magazine's 100 Leading Latinas, the Annual Pursuit of Justice Award from the California Women's Law Center, not to mention the fact that she was an inaugural inductee into the UCLA Alumni Hall of Fame.

While she was director of the California Department of Health Services, Bonta created a better smallpox vaccination program, improved bio-terrorism readiness and created the California Health Alert Network.

She also designed the state's anti-fraud initiative, which is being duplicated across the country. And, as her Kaiser-issued bio says: "(She) ... established the nation's first hospital nurse-to-patient ratios, restructured the state's Vital Records system, and created a model pharmacy discount program for seniors."

She says her new job has given her access to the best team in the health care industry; one that she says is genuinely committed to sharing its resources with the broader community, not just with partners, members and employees.

"We're spending two billion dollars on electronic medical records sharing," Bonta said. "We want to share the good parts of our expertise with community clinics and help them avoid the hard parts of doing the job."

One of Bonta's current projects, the Kaiser Permanente "Healthy Eating, Active Lifestyles" campaign, is rich with components that she believes will make a difference in the lives of children by making them more aware of their own health needs.

"It's not enough just to insure people," she says. "It's our job to teach them that they should watch their health themselves, and to show them how they can do that."

Dr. Bonta believes that one of the most significant goals she is helping Kaiser Permanente to achieve is trying to reduce ethnic and racial discrepancies in the delivery of health care. She said Kaiser is targeting emerging markets with outreach to various ethnic and racial communities, including African Americans, Latino Americans, and Asian Americans, by providing resources that reach out and welcome everyone.