Sunday, October 17, 2004

Charlie’s Place

Why does the Alameda county board of supervisors dislike the medical center so much? Excellent question. Well, county supervisors have a huge budget (1,944,765,581 dollars) a bigger bureaucracy (8,658 budgeted positions) and hopelessly frustrated personal political careers. The supervisors don’t run the county the bureaucrats do: Chief Administrator Susan Muranishi, Director of Health Care Services Dave Kears and Sheriff Charlie Plummer. Every year Dave, Susan and Charlie divide up the tax dollars and throw a few crumbs to politician’s pet projects. So Gail Steele, Alice Lai-Bitker, Keith Carson, Nate Miley, and Scott Haggerty get to cut a few ribbons, do a few opening ceremonies, and fund a few non-profits. The county government has a responsibility to take care of the underserved, this means healthcare (for the uninsured and underinsured), behavioral health (the mentally ill), public assistance (welfare), public protection (courts and prisons) and general government in the unincorporated areas (this means municipal programs: schools libraries, sheriff’s and such.) They also do transportation, buses ect.

Here’s the rub, the poor, the sick, the incarcerated and the needy don’t vote much and they are not big donors to political campaigns either. So county supervisors spend most of their time sucking up to corporations, developers and non-profits that provide the services. Telecare, the biggest for profit mental health contractor in the county is a generous donator. Non-profits, lawyers, and consultants, now all of these people understand how county government works. They know how to support a campaign. Special interest groups and voter rich unincorporated areas also have lots of suction with the sups.

Every year Sheriff Charlie and Dave Kears duke it out over money and every year Charlie wins. Susan Muranishi’s primary contribution to the county is to create a budget and budget process so boring, complicated and convoluted that it would take a team of forensic accountants ten years to find an extra fifty cents. Meanwhile Dave or Susan can always find a little cash in the other shoe, should the need arise. So when political insiders need to get something done, they don’t go to a county supervisor, they go to Dave, Susan or Charlie.

Ok, enough of the civics lesson why don’t Dave and the Sups like the medical center. Well, Dave feels the county should be “purchaser not a provider” of healthcare services. It’s the greed is good philosophy. Besides bureaucrats prefer tidy little contracts with non-union organizations, keep the healthcare providers without a voice and employment protection.

Still what’s wrong with taking care of sick people? Well, here’s the real problem, you know those tidy contacts and neat little focused lean county programs: they don’t work. When someone doesn’t get enough general assistance to buy their medications and has a stroke, where do they go? The medical center. When Adult Protective Services fails to get a senior out of an unsafe home and they get hurt, where do they go? The medical center. When the Sheriff decides to compassionately release a felon who has cancer and can no longer walk, talk or take care of themselves, where do they go? The medical center. When a mental health case managed client has a psychotic episode and then withdraws, where do they go? The medical center. As Dave and Susan improve efficiency (cut services and ration care) more and more people fall through the cracks, the medical center catches them. The county supervisors and bureaucrats hate the medical center because it reminds them how miserably they have failed the people they are supposed to serve. They also hate the medical center’s staff who refuse to dump these clients back out on the streets without first addressing their needs, this costs.

So when the supervisors close the medical center where will people go? Well, for years the county prison system has enjoyed fat funding, infra-structural upgrades and political support. If the sick and needy become a nuisance or a political liability the police can just pick them up and take them to Charlie’s place, Santa Rita Prison.


Dan said...

Ann, you rock. This is the sharpest and most succinct explanation I've yet seen of what's behind the ongoing disaster at ACMC.

Deborah said...

Thanks for the civics lesson.

Although I agree with you on all other points I'm afraid I have to question the idea of the sick and indigent being provided chauffers to "Charlie's Place" if the County Bored of Supervisors, Dave and Charlie succeed in their desire and plan to close the medical center. Charlie's Place is the LAST place they will be welcomed. It's kinda of that "no room in the INN" doctorine. You see Charlie only wants healthy "guests", that will bring in the maximum tax/bond dollars and image building, good PR, while requiring minimal maintenance costs and care, at his place. ( The sickly and punky, pale look just isn't going to scare tax-payors of Supervisors enough that they are going to give you unlimited money and power) But, more importantly the sick one's eat into the profit, they require that Charlie actually pay out more than he takes in. I know of which I speak.
You see as a ACMC employee for over 15 years I have watched as Charlie's Place continuously and intentionally "dumps" it's aging, suddenly ill and chronically ill into the ACMC. Magically once "Charlie's (death) Angel's realize that their ill and indigent guests will require long term healthcare (ie.,the HIV +, SNF level...etc) then suddenly these guests that were moments earlier in shackles with armed guards because they were a "threat for escape"--( I have vivid mental images of their butts flapping in the breeze as they make a break for it while attached to a dialysis machine and by tracheostomy to a venilator)--These guests are suddenly "no longer in custody". By some miracle they no longer need to be in prison all they need is a good Skilled Nursing Facility and by the way they have no resources and Charlie is not paying for the SNF or the ACMC care because these guests are no longer his responsibility.
So Ann, although I understand the difficulty of the problem for the people I doubt Charlie is going to open the doors to the INN for these folks if the medical center closes. You see Charlie knows it is very difficult to run a top quality profitable prisonal industrial complex if you accept just everyone you might pick up off the street. One has to be very selective if one is going to be able to really enjoy any of that fat-funding. You wouldn't want all those quality upgrades to get all spoiled by some sick people ........would you?