February 16, 2005 - Top Stories
By DAVID ROSS
Dr. Paul Milling first made, and then cancelled an appointment to be interviewed for a story about his allegations that Palomar Medical Center’s OB department is being shortchanged in favor of Pomerado Hospital.
“I’ve been told to keep my mouth shut on this,” he said over the phone.
At that time he had relieved a lot of negative comments over a speech that he gave to the hospital board and petition signed by 75 physicians and 79 operating room personnel that he presented at its Feb. 7 meeting.
Later, when this reporter went to his office in Escondido, Dr. Milling said, “What the hell?” and consented to be interviewed.
The longtime orthopedic surgeon and former controversial hospital board member points out that the Palomar Pomerado Health system is running a birth center in Poway that is luxurious and spa-like, almost like a five star hotel. It even includes a concierge and three special food servers and an exclusive restaurant style menu.
It probably doesn’t include a piece of wrapped chocolate left on the pillow.
It does have crown moldings on the walls, an in-room Jacuzzi and a built-in entertainment center with a TV, VCR and DVD.
This compares to the much less luxurious OB department at the much larger and older Palomar Medical Center. At that birth center there is no Jacuzzi. Entertainment is limited to a TV on the wall. The menu is the regular hospital menu.
However, the differences in the program are much more than cosmetic, he says. They are potentially dangerous.
In his comments to the board Feb. 7, Milling noted that he was going public after sending a letter in January to hospital district CEO Michael Covert.
The petition states, “We believe Palomar OR needs increased staffing to provide better patient care, safety, increased staff retention and improvement of hospital and medical staff morale,” he said.
“The OR and recovery room staff in particular, are acutely attuned to the problems and the potential of a fetal catastrophic event to occur. They are afraid of losing their jobs if they speak out publically. Privately, they are very concerned, particularly regarding the c-section issue.”
County trauma guidelines, he said, call for an OR crew to be “immediately available” that is, in house. “This does not happen at night and on weekends. This doesn’t happen so the hospital can save money. Administration has told the employees that. The crews have a 30-minute response time which is impractical to expect when they live as far away as Oceanside and Temecula. No audit has ever been done to see how often that is administered.”
Dr. Milling added, “We are understaffed for the large volume of work that is done, especially in the evenings with the large add-on schedule. We have twice as many add-on cases as other hospitals our size.
“Since the block time during the week is full and the add-on schedule is so large, surgeons cannot get their semi-emergent cases on the schedule at a reasonable working hour. This causes them to schedule their cases on a Saturday or Sunday add-on schedule.
“The ORs are again full during the day and emergencies from the ER (emergency room) on weekends and during the week have to wait in line to get into surgery, usually not until later afternoons or early evening. These cases then run into the later evening and early morning hours.
“In addition, they are often bumped by c-sections because we have no dedicated in-house OB crews and anesthesiologist after 7 p.m. during the week and not on Saturdays and Sundays.”
Dr. Milling provided some other comparisons between Pomerado and Palomar.
• Palomar did 3.3 times more deliveries and 3.8 more c-sections than Pomerado in fiscal year 2004.
• At Pomerado there is a 24/7 dedicated in-house OB anesthesia and OB special crew, instant attention and care 100% of the week.
• At Palomar, there is a 12/5 dedicated in house OB anesthesia and any surgical crew 35.7% of the week in the surgical department— not in the OB department.
• Pomerado does have dedicated in house anasthesiologists and surgical crews 7 a.m.- 7 p.m. Monday-Friday. The rest of the week anasthesia and crew are available within 30 minutes call.
• At Pomerado the standard of care is no. 1 in the county and on par with other county hospitals, such as Tri-City, Sharp, Scripps, Mercy, Kaiser and UCSD.
• At Pomerado there is instant epidural service for mother’s pain relief.
• At Palomar there is variable epidural service. Mothers may have to wait in pain for hours during delivery, waiting on an anesthesiologist who is in surgery.
• At Pomerado there is instant bonding between the mother and baby.
• At Palomar the bonding is delayed for two the three hours because the mother is in the surgical recovery room and the baby is in the OB department.
At the Feb. 7 meeting, Milling stated that “Pomerado is referred to as the ‘country club hospital’ by hospital and department medical staff. There is a reason for this comment. It appears Pomerado has historically been given a higher priority. Why?”
He provided other comparisons:
The total expenses at Palomar are 2.46 times that of Pomerado and its total net income is 11.349 times that of Pomerdo.
The hospital district so far has limited its comments to criticisms of Dr. Milling for not going through proper channels to present his critique of the system.
It has not yet challenged Milling’s statements or his statistics.
A dozen drivers or more ended up with flat tires on the northbound lane of Valley Center Road Saturday night, causing the road to be closed for several hours while road crews did quick fix.
This greatly complicated matters for motorists going from Escondido to Valley Center that night since Lake Wohlford Road was also closed due to torrential rains.
About 6:35 p.m. the CHP responded to about half a dozen potholes and vehicles to the side of the construction area fixing tires. About 15 vehicles were caught and the road was closed while County road crews rushed to the scene (for how one woman’s evening was messed up by this experience, see our story inside).
According to Dept. of Public Works spokesman Bill Pollick the department has road crews on storm patrol 24/7 in case something like this occurs.
They arrived about 8:30 p.m. and finished applying an asphalt patching material designed for cooler weather by 10:30 p.m. They monitored the patch for about an hour to see if it held.
This took about 60 bags of asphalting material, according to Pollick.
Because another storm is expected later this week, the County announced that it had decided to close the lane again on Tuesday morning and early afternoon to apply a more permanent “hot patch.”
This was to done with heavy equipment, so they had no choice except to shut down the lane again.
They are also going to look at the southbound lane to see if that needs to be fixed.
Pollick told The Roadrunner, “Whenever we get rain we tend to get potholes all over the country. We have our crews out on storm patrol, where they are on 12 hour shifts, available 24 hours a day.
“For example the Valley Center road crew has one or two people driving around during a storm. If it’s something small they can handle it with a shovel. If it’s something larger they can call in heavy equipment, or a dump truck with a bucket to scoop up the debris.”
You are encouraged to report potholes or rocks in the road or mud slides to the following number: 877-684-8000.
Persons who may have damaged their autos on the potholes are advised to call County Claims at 619-531-4899. You can also report road hazards on this web site: www.sdcdpw.org/roadservice
By DAVID ROSS
‘Don’t worry!” the County is telling the Bates family, owners of Bates Nut Farm.
However the Bates family and their spokesman Bob Hunsaker are not so sure. They think the County’s reply that the 40-year old business is not in danger amounts to: “Trust us.”
Although the recommended land designation that is part of the GP2020 process for the 40-year old business leaves open the possibility that it could eventually become a legal non-conforming use, the County Dept. of Planning & Land Use representative is telling the local planning group that there is no intention to change what the Bates family already has.
In fact, there is the possibility that a new zoning designation could be created that would apply to agricultural commercial uses such as Bates and the Lavender Fields, according to the County.
However, the Bates family will have to wait until GP2020 is adopted to find out whether the problem is fixed or not.
In an email to VC planning group Chairman Andy Washburn, Bob Citrano, the planner in charge of the VC Community Plan wrote:
“There has been much confusion and concerns raised on all sides, including the local paper, over the staff recommended designation for Bates Nut Farm. The existing general plan designation for the Bates property is (17) Estate Residential. Under GP2020, a residential designation has also been recommended (SR-4 Semi-Rural: 1 dwelling unit per 4 acres). Therefore, GP2020 proposes no changes in land use designations for Bates Nut Farm.”
Citrano adds, “Since 1975, Bates Nut Farm has been operating under a Use Permit. This Use Permit identified the type of operations, along with the scale and site plan for the supporting facilities. At the time the Use Permit was issued, the property had an A70 (Limited Agriculture) zoning, although a portion of the property's zoning has since changed to C40 (Rural Commercial). Both the current and planned uses for the Bates property are allowed in both zones under a Use Permit.
“Once GP2020 is adopted, the zoning designations will be addressed. The zoning designations will determine the uses that will be allowed, either by right or with a Use Permit. In general, the County has no intention of recommending new zoning designations that will not enable existing legal businesses to continue. In addition, a revision to the zoning ordinance will enable communities to craft new zoning designations that are more appropriate for the community and its specific businesses.
“For example, we could create a new zoning designation for Valley Center that applies to agricultural commercial uses. This designation could help Bates Nut Farm, as well as other local businesses such as the Lavender Fields.”
Citrano concludes: “I hope this will allay some of the concerns that have been raised over the past few weeks. Please feel free to share this information with the rest of the planning group.”
Bob Hunsaker, a local Realtor who is representing the Bates family “pro bono” is disappointed in DPLU’s response to the Bates family’s concerns.
Hunsaker told The Roadrunner Monday, “Having reviewed DPLU’s recent email stating their position on Bates Nut Farm's land use designation, I can offer two observations:
“1. Even though they refer to ‘confusion’ on the subject (as if to say The Roadrunner printed wrong information), your article and editorial were both factual. Nothing that DPLU says in their email indicates otherwise.
“2. Their stated position is a huge disappointment. In short, in spite of repeated requests from Bates Farm and from planning group members for help in resolving this, they have provided no new options for Bates Farm at all. Nothing has changed.
“In short, they just say ‘trust us’ later in the process - long after the land use designation is etched in stone.
“I take exception to DPLU's matter-of-fact tone that (perhaps) a use permit will allow Bates to keep their commercial zoning. First of all, we have absolutely no assurance that this will / can occur in the future. Second, another round of use permits is no trivial matter! A major Use Permit can run $50,000 to $75,000. Environmental studies can add another $150,000. New requirements can add thousand and thousands more. Is this a burden we want placed on Bates Farm?”
Hunsaker adds, “The biggest problem we have is the County’s solution! Best case it’s crushingly expensive and time-consuming, putting Bates Farm's future in serious trouble. Worst case it doesn't work, putting Bates Farm’s future in serious trouble.
He concludes, “Once again, what’s so terrible about the safe alternative - designating Bates Farm ‘what it is’? The Bates family has earned this community’s respect for four generations. No one in this community should be satisfied with the County’s treatment of a real and substantial threat to Bates Farm. I encourage anyone who cares about this farm and family to rally to their side.”
Sherrie Ness of Bates Nut Farm added her own comments and was annoyed at comparing Bates Nut Farm with the Lavender Fields.
“We’re not on the same page with The Lavender Fields. Our business has become as much resale and industrial manufacturing and packaging. The only thing we really grow anymore are the pumpkins.
“So for all purposes we need to be zoned commercial in the sense that that is what we are doing here.”
Mrs. Ness said she was grateful for the outpouring of support that Bates has gotten from the community since the planning group took its vote last month.
“I appreciate the community support. The single family business is almost non-existent anymore. The small business person is going to be in the future, very rare. It’s tough to compete with the big guys.”
Although the planning group failed by one vote to support Bates’ request for zoning commensurate with what it does, Mrs. Ness said, “Really, the majority of the planning board is in support of what we are doing.”
She said some members who didn’t support Bates in the January vote have approached her and said they support what it does.”
Apparently there was some confusion at that meeting what the designation that the County was proposing would actually do to the Bates business.
“If some of the people who voted no who actually support us would show up at the planning commission and take it back, I would appreciate it.”
* * *
The planning commission is tentatively scheduled to hear Valley Center’s general plan update on March 4.
Those who wish to speak about the Bates property can address it at that meeting.
The San Pasqual Band of Mission Indians has committed to provide $50,000 a year to maintain a landscaped median along Valley Center Road as long as the County agrees to build the median.
Jim Quis Quis, representing the band which operates Valley View Casino, spoke in open forum at Monday’s VC planning group meeting. He read a letter stating the tribe’s commitment to the process in return for the right to plant signage in the median.
“Particular interest was expressed concerning Design Objective No. 1: Designate Valley Center Road as a special parkway serving as focus and unifying element of the community. Planted median of trees, shrubs, grasses and boulders native to the valley,” said Quis Quis, quoting the letter that was signed by the newly reelected tribal chairman Allen Lawson.
The tribe’s promise to work with the County to fund the landscaped median is the culmination of many months of work by a group of private residents calling themselves Citizens for Valley Center Parkway, chaired by resident Jon Vick.
The committee formed about two years ago to try to find a way to fund the landscaped median.
The median is called for in the Valley Center Design Guidelines, however the County Dept. of Public Works has said it may not have funding for it. It won’t know until it learns whether the road widening will come under budget.
Quis Quis noted that his tribe has been informed that the median can only be built if funding was found to maintain it. The tribal council has voted to provide that funding, he said.
The next step is for the tribe to negotiate, government to government, with the County.
Planning Chairman Andy Washburn noted that “a lot of people are interested in a landscaped median as opposed to a concrete road.”
Some members of the planning group were apparently nonplussed that they had not been consulted by this private effort to obtain funding, although all said that they support a landscaped median.
Planner Keith Simpson asked if there has been any discussion of the size of the signage.
“There has been some discussion with certain individuals,” said Quis Quis. “The letter mentions that it is subject to the design guidelines. It would be in good taste. We’re not contemplating dictating anything in terms of signage.”
The Valley Center post office has a new officer in charge, Andree’ Sauls. He’s joined an organization where the employees think of each other as “family.”
He has taken the position formerly held by Candy Watson, who is now postmaster of Bonsall.
Sauls, who took over in Valley Center about a month ago, has, most recently, been acting station manager at Orange Glen Post Office, and officer n Charge in Solana Beach and Bonsall. All within the last year.
Sauls is a 17-year veteran of the USPS who has actually spent most of his career in customer service at the Ramona Branch.
Sauls is married, with a 2 year old boy and 9 year old girl.
“My wife, Berena, works twenty times harder than me. She’s a homemaker.”
In Valley Center he oversees about 30 employees, most of them delivery people.
Friday he told The Roadrunner, “The thing I’ve noticed right away here is that the employees are a very close knit group, almost a family oriented atmosphere.”
Working in a small community like Valley Center is something of an awakening for the Escondido resident.
“The delivery is not as dense,” he said. “So when you are trying to find addresses, you have to drive up a few mountains before you find it. That was a little culture shock. It’s rural. Interesting, how far some people live away from the road, up a ways.”
Another thing he noticed is that the customers all seem to know each other.
“As soon as you get here it gives you a warm feeling. Which I think is good. You have a good communication with them, whether it’s good or bad.”
And that’s OK with him.
“The foundation of my philosophy is that I want open communication. I want to know how they feel about their service, delivery, and post office box.
“Call or stop in any time and we’ll talk. I want to hear the good and bad. I want to hear some of the issues and see if we can resolve them.”
He adds, “Any time communication is going I see it as a good thing,m as long as it’s progressive, positive and looking for solutions. At the least it should be talked about, even if the request is impossible.”
Sauls says he is coming at a challenging time at the VC post office. They are in the middle of rural route inspections, which he is conducting.
“That’s a lot of work, but it’s giving me a good idea of what Valley Center is like,” he says.
The Valley Roadrunner
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