Residents living in the El Camino Healthcare District have a rare asset seen few places in the entire state of California: public power and control over its local hospital.

And this November, voters within the district's boundaries -- which includes Mountain View, Sunnyvale, Los Altos and portions of other nearby cities -- will have an opportunity to weigh in on how El Camino Hospital should chart its course during a swirl of uncertainty. Along with a challenging market and health care costs that threaten to spike, the tumult over national health care policy shows no signs of abating.

Four candidates are seeking two seats on the health care district's board of directors, and will have significant oversight of El Camino's Mountain View and Los Gatos campuses. They are Dr. Peter Fung, the sole incumbent in the race, former Sunnyvale council member James Davis, former Mountain View council member Mike Kasperzak and long-time physician George Ting.

Davis did not respond to the Voice's candidate questionnaire and attempts to contact him by phone and via the email address he provided to the Santa Clara County Registrar of Voters were unsuccessful. As of this week, his campaign has not filed any fundraising or expenditure reports, according to county records, and he doesn't appear to have a campaign website.

The three other candidates all made a strong case for the health care district and the hospital being on the right track, largely agreeing that the gloomy rhetoric about El Camino's financial survival against giant competitors is warranted. Expansion into Los Gatos, and actions like buying land and opening clinics in San Jose, didn't bother any of the candidates.

Candidates did differ, however, on the district's track record on transparency and openness, and whether it has followed the letter and the spirit of California's open meeting laws. This was a sore spot in a scathing 2011 Santa Clara County Civil Grand Jury report on the district, which prompted a series of significant changes to the way the district conducted business. There was also a divergence of opinions on what exactly the taxpayer-funded district should be doing with the millions of dollars it collected in property tax revenue, nearly all of which is dispersed to other organizations through the district's annual Community Benefit Program.

Peter Fung

Age: 70

Occupation: Physician, stroke and vascular neurologist

Education: M.D. from University of Hong Kong Medical School; M.S. and residency in neurology at University of Michigan, Ann Arbor

Years in the district: 35

Website: votePeterFung.com

When Dr. Peter Fung sought to join the health care district board in 2014, he billed himself as a practicing physician who could bring a much-needed level of expertise and on-the-ground experience to the hospital's governance. He joined just as the only physician serving on the board at the time, Patricia Einarson, bowed out.

Now, four years later, Fung said he believes his deep health care experience as a doctor -- now bolstered by four years of governance and oversight experience -- makes him well-positioned to continue serving on the board of directors. He said El Camino Hospital, and by extension the district, is headed towards uncharted territory, and needs a firm hand on the tiller.

"In this uncertain, complex and ever-changing health care market, you need a strong voice and a physician with many years of experience," he said.

Fung said he believes the hospital's performance is dependent on having a board of directors that has the expertise -- whether in running a business, treating patients or public health policy -- to make the right decisions for the hospital. He said he led the way on recent plans to de-emphasize having elected officials in charge of oversight in favor of appointments with "greater expertise." At the time, he questioned why there was public opposition to the proposal.

In the competitive health care market in the Bay Area, Fung said changes can occur at "lightning speed" and often have to be conducted behind closed doors, creating the appearance that the district and the hospital lack openness and transparency. Despite the handful of surprises, Fung said he believes his last four years show a track record of releasing information to district residents "as promptly and as complete as possible."

Fung said he stands firmly behind the district's strategy of investing taxpayer dollars in nonprofits and public agencies, much of which gets funneled into mental health programs and school resources like nurses. Many of the programs, he said, are targeted at families who lack essential needs like food, shelter and protection from abuse, and it's worth "every penny" that's spent.

"I personally had doubts previously before I joined the board," Fung said. "People who do not understand the dire needs of our community and the results of our effort may find ways to criticize it. I would be happy to speak and convince them."

Fung has maintained that the hospital must expand its services outside of the health care district's boundaries in order to stay afloat. He argues that managing costs and expanding will bring financial security to the hospital, which will benefit district residents in the long run.

If re-elected, Fung's top priorities include making sure the hospital provides top-quality services, improving access to care through free and subsidized health clinics, and working with "community leaders" on the best way to spend taxpayer money on public health grants.

Mike Kasperzak

Age: 64

Occupation: Consultant, former Mountain View City Council member

Education: B.A. from Lewis & Clark College; J.D. from University of California, Hastings College of the Law

Years in the district: 41

Website: kasperzak.org

Although best known for serving on the Mountain View City Council for more than a decade, Mike Kasperzak said he's had an eye on the city's local independent hospital since the 1980s. Kasperzak said he believes his public service background, along with his acute understanding of how the hospital affects those who live and work in the area, would add a valuable perspective to El Camino's leadership.

Kasperzak points out that none of the current elected officials leading El Camino Hospital are from Mountain View, despite the hospital's primary campus and the district's origins being firmly rooted within the city. He would be able to fill that missing niche, he said. And while the district's board doesn't get the same attention as the council, Kasperzak said the public ownership and oversight of the hospital plays an important role in safeguarding it from a for-profit takeover.

"What happened to Los Gatos Hospital when it was purchased and decimated by Tenant Healthcare cannot be permitted to happen to El Camino, but the risks are very real," he said.

While the health care district and the hospital have followed the letter of the law when it comes to transparency and open meetings, Kasperzak said he would follow the spirit of the law, and bring as much deliberation into open session as legally possible. While he concedes that the hospital has to deliberate on some strategies, purchases and acquisitions in closed-door meetings to avoid tipping its hand to competitors, he said the board needs to avoid even the perception that it's not transparent.

Kasperzak calls the district's community benefit program "awkward" as it exists today, essentially taking in tax money and redistributing it as philanthropic funds. He suggested that the millions in annual funding would be better spent in-house -- providing indigent care in local communities, for example -- rather than acting as a pass-through organization. That said, Kasperzak argues that a change in practice would need to be done in a way that doesn't leave out organizations that have come to depend on the grant money from the district.

Although some residents argue that expansion into Los Gatos, San Jose and beyond strays from the district's original purpose, Kasperzak said he supports the expansion strategy as a means for long-term stability and sustainability. Extending into other areas, he said, could focus on the creation of new, small clinics in underserved communities, and finding new ways to support its network of physicians in a changing health care environment.

Kasperzak top priorities as a board member would be to promote transparency, fiscal strength and preparing the hospital for an onslaught of changes in health care policy -- including the potential for a single payer health care system.

George Ting

Age: 71

Occupation: Physician

Education:B.A. from Columbia University; M.D. from University of Southern California

Years in the district: 31

Website: georgetingechd.com

George Ting has a long track record as a local physician immersed in the world of kidney health, working as a nephrologist for 40 years and serving as El Camino's director of dialysis services. During that time, Ting said he has built a strong understanding of what it will take for the hospital to build strong relationships with local physicians, which is essential for keeping El Camino alive an independent hospital.

"I know and love the hospital and the community," Ting said. "I know the history, weaknesses and strengths well. I am committed to keeping the hospital successful and independent."

Speaking broadly, Ting said he believes the board's physician-partnering plan as it exists today could use some adjustments, criticizing it as "high cost" and "high risk," and cautioned at a board meeting last year that the board doesn't have long to change course. He also raised concerns about reining in health care costs in the U.S. -- which he described as unsustainable -- and moving away from the standard fee-for-service model.

Ting said he believes the interests of the hospital, as a nonprofit corporation, and the health care district are one in the same, and that balancing those interests wouldn't be difficult. He believes both need to focus on strong partnerships and keep a close eye on finances as the health care market rapidly shifts, building off the work already done by the district and the hospital.

Transparency has been challenging in the past, and Ting acknowledged that the public, and even some top hospital staff, haven't been kept in the loop on the board's major decisions. Moving forward on big new initiatives cannot be done without both an ongoing dialogue, respect and "proper" disclosure.

"It is hard to maintain community support when they feel left out or in the dark," Ting said.

Ting largely approves of the use of taxpayer dollars for its community benefit program, which he said should be prioritized towards increased access to health care and services for low-income families. Whether that money goes to the hospital's programs or nonprofits doesn't matter so much -- "Whoever can do it better and at a more affordable price."

Ting's approach to expansion is cautious support of the status quo. That is, shifting services to meet patients closer to where they live in places like Los Gatos, San Jose and other regions of the county can amount to more geographical coverage and higher reimbursement for services. At the same time, however, Ting said he believes some of the recommendations from consultants may not be ready for wholesale adoption, and that it would advocate for a "careful review" of El Camino's new clinic, located at 828 S. Winchester Blvd. in San Jose, before trying to emulate it in other locations.

Top priorities for Ting, if elected, would be to foster strong clinical partnerships, keep a close eye on the budget -- including "relentless" cost management -- and put a high value on clinical initiatives by physicians.

James Davis

Age: N/A

Occupation: Former Sunnyvale City Council member

Education:N/A

Years in the district: N/A

Website: N/A