CVIndependent

Tue10222019

Last updateTue, 18 Sep 2018 1pm

The last few years have been quite transformative for the Desert Healthcare District (DHCD).

First, there was the need to change the board of directors election process from an at-large standard to a district-based approach, in order to comply with the California Voting Rights Act. As that process moved ahead, voters in the eastern Coachella Valley last November approved the district’s expansion beyond its antiquated Cook Street boundary, creating the potential for improved health-care access and services in the eastern valley—while necessitating that the district figure out how to fully fund services in the expanded district. That voter edict resulted in the launch of yet another rezoning process, which is currently under way.

Through these administrative and organizational challenges, the DHCD has continued to provide support to local health-care providers and community-service programs, addressing needs such as homelessness, public health and behavioral health.

It was against this backdrop on July 31 that the DHCD welcomed its new CEO, Dr. Conrado Barzaga. He brings some 20 years of experience ranging from health-care management and fund development to public-health and public-policy work. After completing his education as a physician and working in his native Cuba, Dr. Barzaga’s career path took him to Argentina, Bolivia and the United States.

Since coming to the U.S., he has held positions as a senior program officer for First 5 LA (2008-2012) and vice president for Planned Parenthood Los Angeles (2006-2008), among other work in health education and public health. Most recently, he spent more than seven years as president and CEO of the Center for Oral Health, where he was instrumental in expanding programs to under-served communities.

During a recent phone interview, Dr. Barzaga talked about the challenges and responsibilities facing the district.

“I believe that addressing health-care needs requires information, intervention and ideas from different sectors,” he stated. “Of course, we need the ideas of those who are the recipients of health-care services, but we also need to understand and listen to the providers of health-care services. So we will inform our work by working with all the sectors of our society that are engaged in health care in one way or another, from the recipients, to the providers, and to the systems.”

Barzaga spoke about the value of data aggregation and analysis in identifying and understanding the health-care needs and desires of the valley’s residents.

“I want to engage our community (in order) to listen and to learn,” he said. “Our board is elected by the people, and therefore, it must respond to the people. They will tell us what they perceive to be their priorities. From a data-gathering perspective, it is important that we gather as many indicators as we can. There are different sources (from which) we can get that data, including California’s Department of Health Care Services and the federal government’s Centers for Medicare and Medicaid Services—you name it. But it is the community’s participation which is going to provide the best intelligence and the best approach to addressing the needs of the district.”

Barzaga addressed the expansion of the district into the eastern Coachella Valley—including some of the area’s most under-served communities.

“We need to understand how the health inequities manifest in the health disparities in the district,” he said. “We need to quantify and qualify those disparities. That will help the district understand where it can have a more profound impact, what the best approach will be, and how the limited resources that we manage can have the best outcome and the best return on the public-dollar investments in the district.” Barzaga wants to utilize surveys, town-hall meetings, focus groups and individual interviews to, in his words, “distill and construct a cohesive long-term approach to how we’re going to foster a healthy one Coachella Valley 2030/2040/2050 (strategic plan).”

Lightheartedly, he added, “I’m in it for the long run.”

The Independent asked Dr. Barzaga how he views the collaborative effort involving the DHCD, the Coachella Valley Association of Governments (CVAG) and the office of Riverside County Supervisor V. Manuel Perez to address the homelessness situation in a number of our desert’s cities.

“Homelessness has important public-health implications,” he said. “At the same time, it’s a very complex issue that requires a collaborative approach to have a collective impact. Thus far, the district-commissioned report (on homelessness in our region) has been the framework for how the community can approach the issues of homelessness in the Coachella Valley.”

The district has committed $3 million to go toward addressing homelessness in the Coachella Valley.

“There was a request for proposals released very recently to invite different providers in the community to come up with ideas and plans on how to help solve the challenge of homelessness in the Coachella Valley,” Barzaga said. “I think the district has been active and has been a significant force in catalyzing and providing resources to our community partners to address homelessness.”

Does Dr. Barzaga feel the DHCD’s expansion of service into the east valley is producing desired results yet?

“From my perspective, the board is deeply committed to the expansion,” he said. “We held six community forums in the first half of this year in Mecca, North Shore, Coachella, La Quinta, Palm Desert and Indio. We’re sharing information with the community about the work of the district, and raising awareness about who we are, what we do, and how we can work together to make the district better. We had very good feedback from the community, and it was made clear through that process that, because of the expansion, some of these priorities are going to shift.

“The realities and the needs of the eastern Coachella Valley are different from the needs of the western Coachella Valley. One of the public-health functions of a health-care district is to address health-care disparities. We believe that there are many, and to address them, we need to understand and apply the lens of the social determinants of health, (in order) to make investments that are long-term, transformational and help to create a healthy Coachella Valley.

“Part of our community outreach effort is the platform we created called the Coachella Valley Health Information Place (CVHIP). It’s an online resource that any social-service workers, health-care providers, community health workers and community members can have access to. It connects different resources with the people who need access to those resources, like housing, food, health care, health insurance, day care, etc.

“To give you some examples, fire departments and police departments are using that (online) resource when they encounter people who need access to services—whether it’s behavioral health, housing, food, you name it. They are using this tool daily to provide solutions to the people they encounter in their daily work. Still, we’re promoting it everyday.”

We asked Barzaga if he had a message that he wanted to communicate through this interview—his first since assuming the new position.

“Rezoning is another topic which is now a priority for the district,” Dr. Barzaga said. “So far, we have had two public hearings this year, and we have two more coming up, and like the municipalities that have gone through the rezoning process, our aim is to have a board that reflects the various communities in the Coachella Valley. So we are really encouraging the public to come out and help us.”

Those hearings will be held during the district’s board meetings on Tuesday, Sept. 24, and Tuesday, Oct. 22. To view the initial set of proposed maps, visit www.dhcd.org/zoning.

Published in Local Issues

An Election Day decision by eastern Coachella Valley voters could have a positive impact on all valley residents’ access to quality healthcare moving forward.

Voters overwhelmingly approved Measure BB—written by the Desert Healthcare District in conjunction with the Riverside County Board of Supervisors—as the final step required in the DHCD’s efforts to expand its borders east beyond Cook Street. While the expansion of services to some of the valley’s most underserved communities may have seemed like a no-brainer during the run-up to the election, the process did not get this far without a lot of work.

“I think it’s important to note that this has been an extremely robust, kind of overwhelming process just to get to this point,” said interim DHCD CEO Chris Christensen during a recent phone interview. “There were times when there was concern whether the public would potentially (be able to) vote for passage of the measure. With all of the polling, the focus groups, the negotiations with the county board of supervisors and all the effort that has gone into this over the last year and a half, it was extremely close that this would not have made it onto the ballot this year. … I was told that no other health-care district in the state has ever had to go through this process of expansion, so it’s unprecedented. Our next step is to get the funding and continue the good things the district does.”

The Desert Healthcare District was created by the state of California in 1948. Today, the DHCD provides support to a variety of organizations (such as Find Food Bank, Volunteers in Medicine, Coachella Valley Rescue Mission, etc.) that provide health and wellness services to residents. However, the district’s boundaries stopped at Cook Street—until the passage of Measure BB finally expanded the district valley-wide.

The fundraising challenge ahead for the DHCD is daunting—more about that later—and a number of milestones need to be achieved soon to keep the bureaucratic end of this process on track and on time. One of the first requirements stemming from the voters’ expansion approval is the appointment of two new DHCD board directors who live in the annexed areas. According to a current DHCD timeline, the board must adopt a resolution to increase the number of its members from five to seven by no later than Jan. 2, 2019. Once that commitment is confirmed, the board will start to accept applications from east valley residents who would like to serve. Any interested residents will have until Jan. 8 to submit an application. During this same period, the DHCD staff will be managing a multi-pronged information-outreach effort to the annexed communities.

This candidate search will culminate at a public meeting of the board on Jan. 15, where applicants of interest to the board will be interviewed and considered. By the meeting’s conclusion, two new board members will be appointed, with one serving a term ending in December 2020, and the other serving until December 2022.

“Obviously, we’re looking for individuals who have a passion for our mission and what we’re doing,” Christensen said. “We’re willing to hear from anyone. But whether the board chooses to hear from all the applicants during the meeting interview opportunity will be at its own discretion. There are some limitations where a candidate cannot have worked in management, or as an executive, at the Desert Regional Medical Center or other hospitals in our region.

Doug Morin, the executive director of Coachella Valley Volunteers in Medicine in Indio, welcomed the forthcoming expansion, while taking a realistic view of the overall process.

“Though this has passed, I don’t know that the district really understands fully yet how they’re going to proceed,” Morin said. “Nobody has come to us to say, ‘Hey … you’re going to get access to more money.’ None of that has happened yet. For many of us agencies, we’re all very pleased and excited, because the valley is the valley. It shouldn’t be eastern valley and western valley; it’s one valley. … It certainly is the beginning of treating everyone in the valley equally regardless of where you live.”

A first step toward that end will be the creation of two new zones of service, which will get under way in February 2019. It will require the redrawing of boundaries for the existing five districts, as well as the establishment of new boundaries for the annexed area zones. According to the DHCD informational materials, a resolution to be passed in February will call for the new zones to be properly established; outline a public-outreach process; explain the zone-creation process and encourage public participation; and offer a schedule of public hearings regarding the new maps. A vote to adopt a final map of the seven new zones is set to take place sometime in October.

“We will be making concerted efforts in community relations in the expanded areas to better understand what the needs are, and how to provide access, program services, facilities or whatever options there are that make the most sense relative to the resources we have available,” Christensen said. “Obviously, we’re planning to increase those resources to provide additional opportunities. We’ll establish an office presence in the expanded area. We’re currently looking at a property where we would set up a satellite office so that we can have access to the community members there. We don’t want them to feel that they have to go all the way to Palm Springs to talk with staff or communicate with the board.”

As for that aforementioned fundraising challenge: The DHCD is currently facing an estimated budget shortfall of roughly $3 million in order to service the new zones completely and in their entirety.

“At the end of the day, it’s certainly our goal to match the funds currently available in the existing districts (roughly $3.5 million) to provide services in the new districts,” Christensen said. “Ideally, it would be nice if we could hypothetically receive the same allocation of property taxes from the expanded district residents as we currently get from district residents. That would be neat and simple.”

Last summer, the Riverside County Board of Supervisors turned down a request from the DHCD to receive a portion of county property taxes collected from the annexed zones’ residents, as has been the case in the previously existing districts. The Board of Supervisors may re-examine the question now that Measure BB has passed.

“We’ve got our backs against the wall in the sense of developing funding,” Christensen said. “First and foremost was to get the measure passed to approve the expansion. Now we have to address additional funding sources. It’s not going to be easy, but it will be up to the new board. We’ll have three new board members come January, with new thoughts and ideas that might come to play in helping to further the fundraising.”

Published in Local Issues

When most residents of the Coachella Valley go to the polls on Nov. 6, for the first time, they will be able to either cast a vote directly impacting future access to important health care services, or elect a representative to champion their specific community needs.

Some voters living in the current, long-established Desert Healthcare District (DHCD)—which begins in Palm Springs and extends east to Palm Desert’s Cook Street—will be casting votes to elect representatives in two newly formed districts: District 2, primarily covering Desert Hot Springs; and District 4, mostly made up of Cathedral City.

At the DHCD board’s public session on June 26, a final zoning map was adopted that defines the boundaries of the five new districts created within the current DHCD. Previously, the five-member board was elected at large by the entire district; two of five seats are up for election this year.

The move to district-based elections should mean better representation for minority populations; one of the most outspoken advocates for this is Alexis Ortega, the director of community outreach for the LGBT Community Center of the Desert.

“Cathedral City has pockets where … some 70 percent of the folks living in that one area are Latino,” Ortega said in a phone interview. “So, when you have districts (created) where the minority group becomes the majority in that neighborhood, like what we’ve been advocating for in the DHCD districting process, there’s the potential to strengthen that (minority) voting block and get their preferred candidate elected.”

As for Coachella Valley residents living east of Cook Street: They will be casting their votes on whether the DHCD and its important healthcare support services will be expanded into their communities, beginning in 2019.

“As we know, there’s a great disparity between services provided to residents of the east valley as opposed to the west—whether it’s the number of providers or the number of resources and things like that,” said Dr. Les Zendle, president of the Desert Healthcare District and Foundation board of directors, during a phone interview. “But with our ‘One Coachella Valley’ approach, we really believe that—just like with transportation or other issues that can’t be handled by one city at a time, or half the valley at a time—(we’ll be able) to take a collective look at health care.”

Assuming that the majority of the valley’s east side voters approve the DHCD expansion in November, the DHCD will need to start the process of again redistricting and then electing representatives to those new districts—a process that will take place through 2022.

“This November, there will be the first two elections in the new districts, so it will be interesting to see who pops up to the forefront (to run),” Ortega said. “Moving forward, the biggest thing will be informing folks of the importance of the role that the DHCD plays in setting their health-care priorities and in funding for our region. Also, in November, folks in the (proposed) annexed areas will be voting to approve the expansion of the DHCD into their communities, so our role at the LGBT Community Center of the Desert will be to make folks aware of everything that’s happening and how it affects our community, and how our center works with LGBT folks of color to make sure that their needs are met.”

Zendle said he and his fellow board members have a lot of work to do.

“We will certainly continue to do what we have always done, which is trying to educate the public about what the Desert Healthcare District and its foundation does,” he said. “To be frank with you, it’s something not a lot of people in the community are familiar with. I think that the political people and the stakeholders who receive our funding are aware of it, but the general community isn’t necessarily aware of what we are.”

The DHCD provides support to a variety of organizations (such as Find Food Bank, Volunteers in Medicine, Coachella Valley Rescue Mission, etc.) that provide health and wellness services to residents.

How can a valley resident within one of the new districts become a candidate for a board seat? “Basically, a person has to be a registered voter in the district or the zone in which they want to run,” Zendle said. “They have to get the forms and a handbook and instructions on how to get on the ballot and conduct their campaign. They can pick up these materials either here at our DHCD offices in Palm Springs or through the County Registrar’s Office.” Candidates must also pay $1,150; the nomination period runs through Aug. 10.

As complex, problematic and underappreciated as the DHCD seems to be, its potential to provide valuable services to all communities is evident.

“I currently live in Palm Springs,” Ortega said, “so I’m a Palm Springs resident who wants to see Palm Springs represented (on the DHCD board), but I also understand that maybe Palm Springs has been a bit over-represented on the DHCD board. So, how can we bring in other voices that may stem from communities that are more heavily majority-minority, and how can we make sure that those voices are included? I think this (district-creation effort) has been a good first step, but the process is imperfect. No one is ever going to be completely happy, but I think it’s a good first step.”

For more information on the DHCD’s new districts and proposed expansion, visit www.dhcd.org.

Published in Local Issues

In 1948, the Desert Healthcare District was created by the state of California. Health-care districts were intended as a “response to a shortage of acute care hospitals as well as minimal access to health care in rural parts of the state,” according to the DHCD website.

In the ensuing 70 years, the service portfolio of the DHCD has evolved and expanded. Today, with an annual operating budget of roughly $7 million, the DHCD provides support to a variety of organizations (such as Find Food Bank, Volunteers in Medicine, Coachella Valley Rescue Mission, etc.) that provide health and wellness services to residents in the current district—some 515 square miles of the western Coachella Valley, including Palm Springs, Desert Hot Springs, Cathedral City, Rancho Mirage and the portion of Palm Desert west of Cook Street.

While a Riverside County property-tax allocation paid by all county residents helps fund the DHCD, it serves only this relatively limited portion of the county’s population. However, that is about to change.

In February 2016, Assemblymember Eduardo Garcia—representing his eastern Coachella Valley constituency—introduced legislation, Assembly Bill 2414, mandating the DHCD to annex an additional 1,760 square miles of territory—and to provide health-care support to residents of eastern Palm Desert, Indian Wells, La Quinta, Indio, Coachella, Bermuda Dunes, Mecca, Thermal, Oasis, North Shore and Vista Santa Rosa. The bill passed and was signed into law by Gov. Jerry Brown in September 2016.

Today, a concerted effort is underway to bring the vision of an expanded DHCD to fruition. The next important milestone: Having the voters of Coachella Valley approve the expansion by passing a measure. Spearheaded by DHCD CEO Herb Schultz and the health district’s board of directors, the “One Coachella Valley” approach, as CEO Schultz calls it, did not arrive at this point without struggle against resistance.

“This has been (the subject) of an ongoing conversation for about 15 years that, finally, required us to pass legislation to get to this point,” Garcia said. “Are you aware that this effort now underway could have been accomplished by the DHCD taking the initiative and applying to the Riverside County Local Agency Formation Commission (LAFCO) to expand their territory? I hate to say this, but we almost had to force this issue via the legislation in order for us to get to where the voters can approve it in November.”

That struggle seems to have given way to a new spirit of mutual cooperation.

“The (DHCD) board’s focus, and the advocates’ focus, is squarely on getting this) on the ballot this year,” said Schultz, who has been the district’s CEO since late 2016.

But in order to accomplish that goal, a resolution offered by the Riverside County Board of Supervisors must be approved by LAFCO—and, LAFCO has indicated to the DHCD board that it would only support a proposal that was accompanied by a list of potential quantifiable funding sources.

The district has estimated it will need to increase its yearly budget by about $4 million in order to provide the new expanded territory with the same level of services it delivers to its current, smaller district. But so far, in the district’s search for increased revenue sources, it can only point to a generous, but limited, self-funding commitment: In late February, the DHCD board announced a $300,000 per year donation, which would last for a period of 20 years, equaling a total investment of $6 million. Will that be enough for LAFCO to sign off and allow the initiative to be placed on the ballot? “I can’t conjecture at this point what the LAFCO staff is going to say in its analysis,” Shultz said. “I can’t conjecture what the LAFCO commission is going to say when it gets to vote on that staff report.”

Garcia said the LAFCO commission’s opinions may not matter.

“In the law, LAFCO was stripped of its (ability) to deny the actual application,” Garcia said. “Therefore, their process is very procedurally driven. There is nothing in that process that can cause this application to be declined. So, what the job of both the Desert Healthcare District and Riverside County has been, is to identify a (single) funding source to get the DHCD expansion up and going. Given those circumstances, we believe now that, with the recent action taken by the DHCD (to allocate and accrue a self-funded total of $300,000 annually for 20 years), they’ve done that. They’ve identified a funding source—perhaps not the total amount that would be the ultimate operating budget of the expanded health care district, but it certainly is enough to get some programs up and going. And they’ve identified a series of other funding sources that would be able to augment the level of commitment that they’ve made. So, from all perspectives on this end, we are on track to meet the goals of the bill and to be able to give the voters of eastern Coachella Valley the opportunity to expand the health care district.”

Riverside County Supervisor V. Manuel Perez said he expected the forward momentum toward the expansion to continue.

“We’re taking it step by step, or bite by bite, if you will,” Perez said. “The first thing we have to do is get this resolution through LAFCO. We’ve finally got the language down for the resolution. It’s going to go to LAFCO when they meet (potentially on April 26). We’re very committed to this effort. This is an ongoing struggle that goes back many years—and as a person growing up on the eastside (of Coachella Valley), I can say that obviously, the time has come.”

With all the parties coming together, it appears the objective of providing more inclusive health-care services throughout Coachella Valley may be within reach.

“There are no guarantees, obviously,” Schultz said. “But the important thing is that this process has brought together what we call the ‘One Coachella Valley’ approach. It’s not about the west, and it’s not about the east. It’s about the valley.”

Garcia said he’s confident things will work out.

“The reality is that, if and when the voters approve this expansion, the DHCD’s entire (current) $7 million annual operating budget will become part of the (new overall) DHCD operating budget. So it isn’t going to be that $7 million will be only for the west valley, while $300,000 is used for the east valley. It will be a budget that encompasses everything. … The desire to increase the budget in order to reach more people is the goal that’s on the minds of the DHCD leadership. I believe we’ll get there.”

Published in Local Issues