Richard Burruss, M.D.

In 1974, younger and in better shape than today, armed with binoculars, granola, and a parka, a high school senior hiked out onto a windy, cold, chaparral covered mountain in the Los Padres National Forest to catch a glimpse of one the few remaining 40-50 California condors. 10-20,000 years ago, the range of the California Condor extended from Canada to Central America. They were the largest bird in North America and they were everywhere. But over the ensuing 20,000 years, no longer able to compete, its territory dwindled, shrinking until the last half of the 20th century. Suddenly humans realized the use of lead shot, DDT and loss of habitat had decimated the bird's population and reduced them to the point of extinction. School kids were taught that human activity had reduced the great birds to near extinction, when in fact, the condor population had been dwindling for hundreds of centuries! Saving the largest bird in North America from extinction has been a heroic and expensive act, but its success still remains to be seen.

The Tri-City Healthcare District reminds me of the California condor. Although it is easy to think of TCMC's problems in isolation as a local issue, the truth is that Healthcare Districts across the country have been at a competitive disadvantage for decades and have seen steady erosion in their numbers that will continue into the future. In the recent March issue of Health Leaders this subject was addressed in an article entitled "SOS: Public Hospitals" and can be summed up in its opening line, "Public Hospitals are in trouble". According to AHA statistics, of the 1,761 public hospitals operating in 1974, only 1111 remained in 2007 (the California condor, on the other hand, has fared better with over 300 surviving today). Instead of DDT, lead shot, and loss of habitat, many would point to the recent credit crisis and the uninsured as threats to the District hospitals' survival but the real culprit is an increasingly competitive marketplace, public reporting laws, and legal restrictions on Board membership and activities. In other words District hospitals are forced to compete with one arm tied behind their back because of their governance structure.

On March 26, in a letter to the Board and later discussed in closed session, the Medical Staff took an unprecedented step to insure the future of TCMC and requested that the Board actively investigate any and all partnership opportunities and alternative governance structures so that the Hospital would remain viable and competitive while fulfilling its mission to provide high quality care to the residents of North County. The Medical Staff had only two pre-conditions: that all alternatives are placed on the table and that the Medical Staff participate in the considerations. The commitment to the future of the hospital as a high quality healthcare provider to North County remains.

In 1974, that teenager spotted two soaring condors over the course of three days, but by 1987 the population had dropped to 22 and the US took the bold step of capturing all of the remaining birds launching the most expensive species preservation program ever undertaken. At the time it was controversial. Many environmentalists argued that human intervention would fail, but the US took an unprecedented, brave step and the bird survives today. The TCMC Board needs to do the same, take the brave step for the good of the hospital, the patients and the North County community.