Amid a historic health care crisis that threatens to bleed into next year, the El Camino Healthcare District has taken on an unusual level of importance this election season -- even if the agency's purpose remains obscure to some.
The district, tasked with meeting the public health needs of its residents, is now faced with the daunting task of taking the edge off a global pandemic that has destabilized the economy, sickened thousands and has blown a hole in El Camino Hospital's previously healthy budget.
Five candidates are vying for a seat on the health care district's board of directors, each with their own take on the district and the hospital's performance to date, and each with differing health care priorities as the pandemic progresses. Two of the three incumbents whose terms expire this year, Julia Miller and John Zoglin, are seeking reelection for their second and third terms, respectively, and are largely running on the successes of El Camino Hospital -- an organization that has since been rebranded as El Camino Health.
The third incumbent, Gary Kalbach, declined to run for reelection.
Challengers seeking a seat on the board are three doctors: Dr. Jane Lombard, a cardiologist and Los Altos Hills resident; Dr. Carol Ann Somersille, an obstetrician/ gynecologist and Mountain View resident; and Dr. Meghan Fraley, a psychologist and Mountain View resident. Each brings a different perspective on health care, but all three said they value both the accomplishments and the raw potential of having a public agency solely focused on public health.
The El Camino Healthcare District is a tricky agency from an outsider's perspective, in part due to its historically complex relationship with the hospital. The public agency collects taxpayer money and has five elected board members, who make key decisions on how that money gets spent. Part of that money goes towards paying for hospital construction and facility upgrades, but the majority gets funneled back into the community in the form of "community benefit" grants.
What sets El Camino Healthcare District apart from other health care districts is that it retains oversight of El Camino Health, the nonprofit, private corporation that encompasses El Camino Hospital, a network of clinics and a roughly $1 billion annual budget. Elected district board members typically choose to also serve on the hospital's board of directors, giving them significant control over El Camino Health.
In other words, district voters are empowered to directly influence the actions of an independent hospital nestled within their community.
The district has been hammered over the years for a lack of transparency, and has been criticized for making major financial decisions without soliciting public input -- decisions ranging from buying clinics to a $103 million purchase of an entire satellite campus in Los Gatos. Candidates have mixed feelings on the issue, with some arguing that more work needs to be done to keep the public informed.
Candidates generally agreed that the district's COVID-19 response has been strong, but the three challengers said more work needs to be done. Candidates' assessments of the current state of the hospital's labor relations range from positive to deeply strained.
The district's methods for reinvesting taxpayer funds into the community were largely praised by the incumbents, while challengers in the race wondered whether more can be done to create an overarching strategy guiding the dozens of grants to nonprofits, school districts and other agencies.
Occupation: Digital marketing executive
Education: Harvard university, B.A.; Stanford University, M.B.A.
Years in the district: 40
Campaign website: zoglinforelcaminohospital.org
John Zoglin, the longest-serving incumbent on the El Camino Healthcare District, said he's proud that El Camino Hospital has grown into a high-quality institution that has broadened its presence across Santa Clara County under his leadership.
During his tenure, the hospital purchased a satellite campus in Los Gatos and has since built and acquired a network of clinics spanning all the way south to Gilroy. With the expansion of services from three sites to 13 in just four short years, coupled with the expanded role outside of the hospital campus, the organization has since rebranded itself as El Camino Health.
Zoglin called the strategy a battle against institutional inertia, charting a course that he believes has led to higher quality services and financial security in an uncertain health care market.
Zoglin is seeking reelection on a platform of keeping up the good work, maintaining the district's local control of El Camino Health and improving access to quality health care services. While he believes the hospital itself has benefited from the oversight of a diverse field of experts, it should be balanced with people who can serve as a voice for the community. The five members of the El Camino Healthcare District must fill that role.
"Marin General has separated its hospital board from its district board -- in my belief to the detriment of the institution's engagement with the community," Zoglin said.
A long-time Los Altos resident, Zoglin has previously been a small business owner -- a Sylvan Learning Center franchisee -- and has worked in tech companies ranging from startups to large corporations, including Hewlett-Packard, Dell and IBM. Since his appointment to the health care district's board of directors in 2007, Zoglin has served in pretty much every capacity, including committees overseeing finance, investment, governance and executive compensation. He pointed out that there's a lot to manage in a $1 billion annual budget, which eclipses the combined budgets of numerous cities and school districts throughout the health care district.
Zoglin refers to the coronavirus pandemic as the "greatest threat" to global health in more than a century, and said that the district has an obligation to aggressively respond to COVID-19. Along with his vote to pour $2.4 million into free testing for district residents, he said the district has partnered with local schools to ensure teachers and school staff have an easily accessible place to get tested. Though El Camino is not a research hospital and lacks the capacity for developing tests, he said it can work to its strengths and ramp up testing and prevent the spread of the virus.
Looking beyond the pandemic, Zoglin said he would advocate for easier access to health care services and more convenience for patients, particularly through patient services off of the hospital campuses. He said he would also prioritize mental health services, building on things like the ASPIRE program and the hospital's newly built mental health facility. This should be a priority if it is a money-loser for the hospital, he said.
"Mental health is an area consistently under-reported, under-discussed and under-supported across the U.S.," he said. "Possibly because of lingering stigma around people suffering from mental issues, the compensation provided by the federal government and insurers if often and unfortunately inadequate to provide the care needed."
Though price transparency is a tricky problem, dependent on state and federal-level decisions, Zoglin said he is an advocate for making the cost of services as clear as possible to consumers prior to getting a bill.
Zoglin said he is sensitive to the concerns over transparency in governance, and that he would consider surveying district residents on how well the district communicates its actions and supports public participation in open meetings. He believes the use of Zoom even after the pandemic could give more members of the public a chance to get involved, as evening meetings can tough to attend.
Over the years, Zoglin said he has been a champion for the district's community benefit program as it looks today: largely maximizing how much taxpayer money can be redirected to public health grants for nonprofits, school districts and other agencies. He believes the process puts the grants in line with the public health needs of residents both within and near the district, and that he supports the firewall that separates individual board members from the grant-making process.
"If we have the El Camino Healthcare District board, not comprised of public health experts, make individual allocation decisions, the result could be a dynamic we have seen in other institutions whereby elected officials earmark funds for personal or political biases versus public health needs," he said.
Education: Duke University, B.S.; Stanford University, M.D.; Santa Clara University, MBA
Years in the district: 37
Campaign website: lombard4communityhealth.com
Jane Lombard has spent much of her career fighting heart disease on the ground level, working as a Bay Area cardiologist for decades with a recent emphasis on women's health. But to truly curb heart disease, she said it's going to take a broad public health response that tackles the problem early.
Lombard, 63, is vying for a spot on the El Camino Healthcare District's board of directors this November, in part to leverage its power as a government agency to solve health crises that start long before surgery is needed. Obesity, high blood pressure and diabetes are all problems that go unaddressed, particularly for the young and the medically disenfranchised.
"Great health is more than just good medicine," Lombard said. "We need to explore and remedy the social determinants of health, which includes education, good nutrition, water, and access to exercise and care. None of these are addressed by conventional medical institutions."
Lombard said she believes she is a strong fit for leading the healthcare district and, by extension, El Camino Hospital. She has experience as a physician with the heavy hitters in the world of health care, including Kaiser, Stanford and Sutter, and has volunteered with nonprofit organizations including AVID, which supports first-generation college students. Combined, she said, she observes health care through the lens of both clinical and community needs.
Most of the hospital's needs as a private corporation and the priorities of the health care district, ideally, will be aligned and create a symbiotic relationship, Lombard said. But she acknowledges there are times when the district must set aside its fiscal priorities in order to finance community needs. She pointed to care for the medically indigent, which is provided by the hospital at a loss, but nevertheless should be supported by the district.
Lombard said she lauds the district's decision to spend millions on COVID-19 testing for patients in the health care district, but believes the pandemic response can go beyond just diagnostics. There's a big unmet need for tracking the contagion, COVID-19 education and mental health services that the district can support in the coming years.
Outside of COVID-19, Lombard said she would advocate for a national public health campaign against obesity and diabetes, leading causes of cardiovascular disease. She said she would also seek to create partnerships with local organizations to get to the core problem behind many health problems, particularly housing, access to good nutrition and access to transportation.
With lack of transparency being a common critique of the health care district, Lombard said the district could do much more to make the district's meetings and materials easier to digest for the public. Even she finds it difficult to follow what's going on without more background information, she said, and a combination of better outreach and user-friendly reports could make meetings more accessible.
On the district's community benefit spending, Lombard said the grant recipients all seem equally deserving of the taxpayer funds, though she wonders if it's all being done on a case-by-case basis. If elected, she said she would examine whether the community benefit program could use a more coordinated, systematic approach.
Carol Ann Somersille
Occupation: Obstetrician and gynecologist
Education: Harvard College, B.A.; John Hopkins University, M.D.
Years in the district: 20
Campaign website: carolsomersille.com
Carol Ann Somersille has had a close relationship with El Camino Hospital for years, working as a physician on the Mountain View campus for years and living practically in the hospital's backyard. As a Cuesta Park resident, she said she walks to work and her kids -- now adults -- attended the nearby Bubb Elementary School.
Somersille said she is seeking to take her experience managing an independent medical practice to the health care district's board of directors, bringing with her both pride for the district and lofty goals for improvement.
She said she believes one of El Camino Hospital's greatest strengths is that it is one of the last remaining hospitals in the Bay Area that is still owned and operated by the community, rather than a corporation or outside group. As a board member, she said her priority is to keep it that way, and ensure that the health care needs of local residents are prioritized in the district's actions.
And as an African-American woman and an obstetrician and gynecologist, Somersille said she is committed to social justice issues as it relates to health, addressing the inequities of health care for women and people of color. The district should prioritize diversity and inclusion and ensure that all voices are heard, she said, and all of this can be done while retaining the hospital's strong financial picture.
"As one of the few remaining independent physicians who has run a successful private practice -- with patients from all walks of life -- I know how to run a medical practice in the black. I intend to bring over two decades of experience in this area to the hospital board."
On the pandemic response, Somersille said the district's response to date has been "exemplary," particularly in the realm of free testing and education -- despite an inept pandemic response from the federal government. Still, she said, the district should work towards greater access to rapid COVID-19 tests and ensure that patients are safe.
Unlike other candidates, Somersille said she was reluctant to say which public health issues she would prioritize as a district board member. She said top health concerns vary from one patient to another, and she preferred to take a holistic approach.
"My goal is to ensure that the district maintains an excellent standard of healthcare for all," she said. "Our job is to ensure that the needs of all -- whether cancer, diabetes, mental health, hypertension -- are met with excellence."
Somersille acknowledged that the district has challenges with transparency and communicating decisions to the public in the past, particularly with regard to the district's land purchases and acquisition of South Bay health care clinics. Those kinds of decisions need to be reported to the community with a clear rationale.
"The plans for property located outside of our district should be thoroughly vetted by district community leaders before implementation," Somersille said.
Though labor relations have been strained in recent years, Somersille said she would be a passionate advocate for a strong working relationship with El Camino's employees. She has been a member of a union herself, the Union of American Physicians and Dentists, since 1997, and said she understands the needs for contracts that support safety, training and fair wages. She vowed to be a liaison between the district and its labor groups.
Somersille has also stressed the importance of having a hospital that has a strong working relationship with its physicians, and that her direct experience in the field would be a helpful addition to the board. She has been a member of multiple groups, including the El Camino Medical Group, composed of independent physicians working at El Camino Hospital.
On community benefit spending, Somersille said she believes the hospital could tap deeper into the budget and draw a percentage of its surpluses, potentially 3% or 4%, to be spent on more grant funding.
Age: Declined to state
Occupation: director of El Camino Hospital and El Camino Healthcare District
Education: De Anza College, San Jose State University
Years in the district: 50
Campaign website: juliamiller.net
The El Camino Healthcare District was in a precarious place when Julia Miller joined the board in 2012. The district had been blasted in a recent investigation by little-known Local Agency Formation Commission of Santa Clara County (LAFCO).
Among other things, LAFCO found the district acted in an unaccountable manner, lacked transparency and blurred the line between district taxpayer funds and the hospital's finances. Unless things changed, LAFCO sought to dissolve the agency that was created, primarily, to build a hospital that no longer needs help.
Miller, at the time, ran on a campaign of fixing the myriad problems brought up by LAFCO, and believed her long experience managing budgets and serving on the Sunnyvale City Council put her in position to steer the district in the right direction. Now seeking reelection for her third term, she said her track record shows she is a relentless advocate for transparency -- including her push to webcast board meetings.
Along with decades of civic engagement, Miller said she has spend years as a booster for the hospital's foundation, and touts $10 million in philanthropic donations for support services at El Camino. During her tenure, she also oversaw a massive reconstruction of the Mountain View hospital campus, which now has a state-of-the-art mental health facility.
Miller said she wants to serve on the board again because health care is a complex, changing and competitive environment, now made even more complicated by the pandemic, and her experience would be an asset to the board. She said that she and her colleagues have already shown a strong response to the pandemic, with free COVID-19 testing for all who live in the district, and that the district's community benefit grants will help subsidize health services during the crisis.
But COVID-19 has resulted in numerous public health challenges that go well beyond hospital visits and diagnostic tests. She said she worries about increased homelessness, food shortages and mental health needs, particularly the elderly suffering from isolation and loneliness.
Looking beyond the pandemic, Miller has called for a greater focus on improving services for cancer treatment and mental health and substance abuse. She also advocated for an expansion of the district's stroke center and neuroscience program.
Miller said her experience and relationships built up over the last eight years will help her strike a balance between the needs of district residents and the goals of the private hospital corporation. In 2017, she and former director Dennis Chiu felt strongly that the health care district should not cede too much of its oversight of the hospital, and opposed the idea of having fewer elected district board members serving on the hospital's board of directors.
Though the health care district has had standoffs with labor unions multiple times during her tenure, Miller said the hospital is in a good spot with labor relations, and that "all is well" with open communication from the hospital's leadership.
"El Camino Heath's new CEO is very seasoned in dealing with labor contracts and we settle quickly, effectively and smoothly," Miller said.
If elected, Miller said she would continue her work streamlining and increasing the funding for the Community Benefit Program, which she said is "excellent" as a vehicle for meeting the health care needs of district residents.
Occupation: Psychologist, clinical director
Education: Oberlin College, B.A.; University of Chicago, M.A.; Sofia University, Ph.D
Years in the district: 14
Campaign website: votedrmeghan.com
To Meghan Fraley, the El Camino Healthcare District is a rare but potent community asset that can remedy chronic unmet health needs and improve access to health care. But it takes the right people to deliver on that potential.
Fraley, an outspoken community activist and mental health care professional, believes her background is exactly what's needed. Neither the district's board nor the hospital corporation's board of directors has a member with mental health expertise, which she said gives her frontline experience facing the mental health crisis. She currently has a private practice in San Jose, and is the clinical director an eating disorder clinic called the Cielo House.
Outside of the workplace, Fraley is better known for her grassroots activism, pushing in past years for a higher minimum wage and Mountain View's recent progressive business tax. The district's board has historically consisted of physicians, business leaders and former council members -- in contrast with Fraley's background.
"I'm running for the healthcare district to bring my skills in effective civic-community leadership and behavioral health expertise to a board where these essential skills are profoundly missing," Fraley said.
Fundamentally, Fraley said the district needs to reexamine its core mission and go beyond overseeing the hospital's corporate operations. The district was formed to construct a hospital in the 1950s -- and succeeded in creating an "incredible" community hospital -- and now it's time to hone its focus on meeting the critical health care needs of all district residents, she said. To do that effectively, it needs a clear line of communication with the public it seeks to serve, which she said must be improved.
With the pressing challenge of COVID-19, the district has a clear path for supporting that public health mission. Fraley said she would advocate for a strategy that not only treats patients who contract the virus, but prevents the spread of the COVID-19 in the community. She also cautioned that the the problem is going to linger for years, and that El Camino should be prepared to support those facing long-term health impacts of the virus and the significant mental health affects of the pandemic.
Fraley said she believes the health care district can be a leader in championing mental health care in the community, for which funding is limited and services are expensive and difficult to find. She called for an outreach campaign to help residents access mental health services, and a cross-agency collaboration to ensure diverse populations -- particularly the Latino community -- can get the help they need.
In order to accomplish these goals, the board has got to step up its presence in the community and be more transparent about its actions, Fraley said. For many, it's not clear what the health care district does and how its role is distinct from the hospital's day-to-day operations. The district could benefit from a website redesign that better fosters civic engagement, and could use trainings on the Brown Act to keep in line with the state's open meeting laws.
Fraley said she worries about the hospital's relationship with labor unions in recent years, which have been strained by troubled negotiations and disputes with hospital leadership. In 2019, the hospital sparred with SEIU health care workers and was on the cusp of a nurses' union strike. She believes these conflicts are a sign that the district needs new leadership that can foster a trusting relationship with employees and provide fair treatment and wages for workers.
On the campaign trail, Fraley said she would aim to heal the injuries of the past, improve communication between unions and hospital administrators and try to reach resolutions before things boil over.
"We need to show this gratitude to our frontline workers facing danger and trauma day in and day out by ensuring that they feel and are supported and protected at their workplace both physically, emotionally and financially," Fraley said.
With regard to the district's spending of taxpayer money on community grants, Fraley said she believes there needs to be a stronger strategic vision and objectives for how the money will address the pressing health care needs of the community, rather than a scattershot approach. Each grant should be weighed against the unmet health needs in the community that need patching up, she said.
"While the organizations that receive money from the taxpayer district dollars are each worthy in their own right, there needs to be a more holistic and strategic vision that guides the allocation of these funds," she said.