$100 PER TEARDROP
This summer, my daughter returned from summer camp with an ear infection.
Of course, the infection was downplayed until it wasn’t.
And she had another camp starting right away.
So her mother takes her to the E.R.
They look in her ear, give her a few drops and send her on her way.
While I stay home and sit in a dark corner, muttering to myself, rocking, arms hugging knees, wondering what the bill is gonna be.
Most folks around here are either on Medi-Cal, Medicare or have employer-based health plans. But about 5-10% of locals have private insurance.
In my case, a Blue Shield Bronze plan. Which carries a $5,800 individual deductible ($11,600 family) and costs a mere $1,800/month for my daughter and myself.
The bill comes back a month later. After Northern Inyo Hospital and the insurer have done all their number-crunching voodoo, they tell me I owe $1,400.
Which was initially about $2,140 until some deductions were graciously tossed in.
Before deductions, the E.R. visit was pegged at $669.
The healthcare provider charge was $394.
But the medication! That was $1,077. Or what I would estimate as $100 per eardrop.
Per teardrop.
So now I’m left in a moral quandary. Will I pay this bill in its entirety? No.
Will I make up a number I deem fair and pay that? Yes. Which will still be something absurd. $600? $700?
I already pay them that much in property tax for the 2009 GO bond.
I know this appears like a non-sequitur of a lead-in to talk about the upcoming Southern Mono Hospital District Board (SMHD) election, but the issues facing rural hospital districts of any stripe are not dissimilar.
Local attorney Sophie Bidet is one of five people running for two available seats.
Why is she running? “I want to advocate for the local community members who don’t have Medi-Cal or employer-based insurance,” she says.
“I’m not alone in my belief that they’re not putting patients first. To me, it appears the district is run for its administrators as opposed to the taxpayers. The hospital is happy [financially very healthy] right now. But many of its constituents are struggling. I’m asking for balance.”
She cites the hospital’s elimination of prompt pay as one example (you used to be able to receive a sizable discount if you paid within thirty days).
“Show me the law which says you can’t offer it [prompt pay].”
Bidet is a French native and carries dual citizenship. She is married to Tim Gallagher, who is the General Manager at Wave Rave Snowboard Shop. They have one daughter.
She also has a few personal stories about a broken system and soaring costs.
For example, her migraine medication. It is cheaper for her to fly to France and pay out-of-pocket to refill her prescription than it is for her to refill it here. 12 Euros (about $14) versus $600/month.
Then there was her husband’s colonoscopy.
Five years ago, he had one done in Mammoth by Dr. Fru.
This year, he was due for another. The cost of the procedure at Mammoth, said Bidet, has increased 400% over the past five years. So they went shopping out of the area for a different provider.
“We have an incredible opportunity to lead by example,” says Bidet. And that example would be in operating a hospital which serves the broader population.
As she states on her campaign website (sophieformammothhospitalboard.com), “I have spent my career standing beside people who needed someone in their corner. That is exactly what I will do on the SMHD Board – for every uninsured patient, every working family, every local resident who deserves a voice in how their community hospital is run.”
Let’s run now through the rest of the slate of candidates. They are Daniel Ranson, Matt Hall and incumbents Dr. Yuri Parisky and Joanne Hunt.
Daniel Ranson, 48, is the owner of Eastern Sierra Counseling with his wife Sarah Vigilante. Over the past decade, the couple has grown its practice (which provides mental health services) to include five locations in Mammoth, Bishop, Ridgecrest, Truckee and South Lake Tahoe.
They have also grown a family (three children).
They are in the process of opening a second location in Truckee and have created sixty healthcare jobs within the past three years.
Both, also, are former employees of Mammoth Hospital.
As Ranson says, when he decided to spread his wings and open a private practice, “I was told psychiatry wouldn’t work here.”
But like many an entrepreneur, Ranson says, “When you tell me I can’t do something … “
Ranson and Bidet agree on a central tenet. The need “to strike a balance” between the bottom line and patient care.
“The CEO [Melanie Van Winkle] is a numbers person,” he observes. “So we need board members who are care-focused.”
The biggest reason he’s running for office: “I’m doing this to bring attention to the fact that Labor and Delivery closed. Voters passed a bond in the early 2000s, and part of the rationale for that bond was to provide Labor and Delivery services. So I’m paying that tax and not getting the service. My passion is about access to care. And I believe this financially stable hospital district is passing the buck … orthopedics is super-profitable. Delivery of community services not so much.”
Some initiatves he’d like to see:
*A community pharmacy. A lot of Mammoth residents at this point are heading to Dwayne’s in Bishop for pharmaceutical services.
*Physician retention. “We’re not flexible. We want doctors to work certain hours, certain days versus catering a bit more to the specialists and their needs and schedules.
In his practice, Ranson says, “My licensed clinicians don’t go anywhere.”
*Women’s health. He is critical of women’s health being relocated within family medicine versus being a stand-alone department.
Closing out her second term on the Southern Mono Healthcare District Board, Joanne Hunt “doesn’t want to stop.”
“I enjoy working with my fellow board members and the community, gathering everyone’s ideas about what our needs are,” she said.
Hunt is a longtime local and, though now retired, a longtime healthcare worker.
She started as a nurse and ended up becoming director of nurses for a while, giving her some administrative experience. She then decided to go back to working in the emergency department, her favorite.
“I loved the ER because you never knew what was going to walk through the door,” she said. “We joke that we’re kind of ‘adrenaline junkies,’ but there was always that excitement of not knowing what was coming in next.”
She’s worked in pretty much every area of nursing, outside of labor and delivery, and ran for the board upon retirement.
“I felt like I had a good background and a good understanding of how the hospital runs, so I decided to go for it,” she said.
It’s been eight years since then. In that time, she said her proudest accomplishment is getting departments to stop working in silos and collaborate to keep the focus on patients.
“It’s really been neat to see how different departments now work together, whether it’s nurses getting cross-trained to work in the ER, in the clinics, in Med/Surg, in PACU, so they get a full perspective of each area’s needs and how they can support each other. It really works well.”
Looking forward, she’s most excited about the district’s new collaboration with Northern Inyo Healthcare District (NIHD) board.
“Women’s services is the biggest piece,” she said. “If we can bring in more OB-GYN positions, we can provide the best care so patients can be seen here in Mammoth for prenatal care, and then go down to Bishop for delivery. That’s worked out really well, and it’s one of the things we need to keep building on to make the overall system as good as it can be.”
She’s also excited about the education opportunities possible, training both hospitals simultaneously to reduce redundancy.
Hunt is a fan of CEO Melanie Van Winkle’s leadership, and said she’s looking forward to another term working alongside the current board.
Fellow incumbent Dr. Yuri Parisky can safely be characterized as a “live wire.” One never quite knows what truth he may deliver, or how he may deliver it.
And though Parisky, a recently-retired Radiologist, is a two-term incumbent, that doesn’t mean he marches in lockstep with the board and administration.
In fact, he is in agreement on more than a few points with challengers Bidet and Ranson.
He says of current CEO Melanie Van Winkle, “She has too much glee in making money.”
And he thinks it’s no coincidence that the number of CT scans ordered has skyrocketed of late. Because there’s a financial incentive for doctors to do so.
“As a humanitarian,” he continues, “I think we ought to provide some sort of [financial] relief to locals. I’ve challenged the notion as to why we can’t give the 25% [prompt pay] discount.”
The reason he’s running is based upon his belief that the job isn’t quite finished. “There are several balls in the air,” he says, alluding not only to the ongoing $150 million expansion project, but also to the hospital administration’s recent push to adopt the Virginia Mason management system.
Let’s just say he’s not a fan of the initiative.
“We’ve spent a half-million dollars on this [Virginia Mason]. They call it a patient-first initiative. Then what the hell have we been doing for the past thirty years?”
The goals are nice, as are the platitudes, but Parisky can’t help but see it as a waste of time and resources. “I worry about field trips, kumbaya and meetings with talking sticks … call me a cynic.”
Parisky is encouraged by recent efforts to strengthen the relationship with Northern Inyo Hospital District, and opportunities to expand services for the entire community which are best performed at NIHD.
He also thinks it’s a no-brainer for the hospitals to share ICU space. “Why automatically fly a patient to Renown when we can just drive them 3,000-feet in elevation down the hill?”
And a revelation from a recent joint workshop: They can do our laundry!
Things Parisky cares about: Implementing an Eastern Sierra Women’s Health Initiative. Making a concerted, professional effort at physician recruitment (versus counting on casual referrals by existing staff).
Why return him to the board? “I understand how medicine should be administered. I can lobby effectively. And I’m a physician with a long history of honorable practice.”
Matthew Hall threw his hat in the ring for the SMHD board as…. a career landscape architect?
It’s a better fit than you might realize, or at least that’s what he argues.
Hall grew up in Ohio, and then came out to Southern California’s sunny beaches immediately upon his graduation from Ohio State University. Laguna Beach, where he landed, was a “mecca” for landscape design. Which can mean, he said, many different things.
“A lot of people think landscape architecture is just residential design, like, ‘can you look at the brown spots on my lawn?’ But it’s a huge field. You can graduate and work for the Forest Service, work on large-scale master plans, multifamily residential projects, urban projects.”
For Hall, this meant he learned to get on the job site quickly and learn a lot about whatever he was designing for, then communicate that need to the public. His career was ultimately a lot of board meetings, large projects with a lot of stakeholders, public meetings, public speaking, he said.
“We’re designers at heart, but we’re creating environments for the public, and that was the most satisfying part. After all the design and coordination, walking the finished space.”
As he progressed in his career, that became increasingly important to him. And eventually, it was all that mattered.
“I had an epiphany after almost a 35-year career,” he said. “I just wanted to do more for the community. I was on the hamster wheel of big clients and big projects and decided I needed a change.”
He retired and moved to Mammoth Lakes in 2019, where he was a second-home owner for a long time. Of course, a lot of the pull to the mountains was lifestyle related, but it was also community oriented.
He started volunteering as an instructor for Access Mammoth, in both mountain biking and skiing. His wife, Annemarie Hall, works for the Mono Arts Council as the artist liaison and teaches art at the elementary school.
Looking at the three open seats on the SMHD board, he knows he’s not walking in as a healthcare expert.
“I’ll never claim to know everything about health; that’s what the CEO and her team, and the physicians, are experts in. The board’s job is to take in all that expert information and develop consensus on what’s right for the community.”
Still, he has some ideas for where the district should focus next.
Top of the list is the hospital’s new collaboration with Northern Inyo Healthcare District (NIHD) on making maternity care more accessible.
“There’s no pregnant woman who wants to be in an emergency situation,” he said.
He’d also like to see Mammoth borrow a page from NIHD’s own playbook and create something like the rural clinic in Bishop.
“I’d love to see Mammoth have more of that. I’ve talked to a lot of people in town about confusion over urgent care here. There isn’t true urgent care, so people default to the ER, but then there’s a stigma that the ER will be too expensive, so people just don’t go at all.”
He’s also watching the district’s independent pharmacy situation. He doesn’t know the staff personally, but he’s heard they’re short-staffed and struggling to hire.
