Health Hosp

MUNICIPAL SERVICE REVIEW AND SPHERE OF INFLUENCE UPDATE FOR: HEALTHCARE AND HOSPITAL DISTRICTS IN STANISLAUS COUNTY Prepared By: Stanislaus Local Agency Formation Commission 1010 Tenth Street, Third Floor Modesto, CA 95354 Phone: (209) 525-7660 Adopted: August 26, 2020 STANISLAUS LOCAL AGENCY FORMATION COMMISSION COMMISSIONERS Amy Bublak, City Member Michael Van Winkle, City Member Jim DeMartini, County Member (Chair) Terry Withrow, County Member William Berryhill, Public Member (Vice Chair) Richard O’Brien, Alternate City Member Vito Chiesa, Alternate County Member Brad Hawn, Alternate Public Member STAFF Sara Lytle-Pinhey, Executive Officer Javier Camarena, Assistant Executive Officer Jennifer Vieira, Commission Clerk Alice E. Mimms, Legal Counsel TABLE OF CONTENTS Introduction ..........................................................................................................1 Municipal Service Review Factors to be Addressed ........................................................ 1 Sphere of Influence Update Process ............................................................................... 2 Sphere of Influence Determinations ................................................................................. 2 Background ..................................................................................................................... 2 Authority .......................................................................................................................... 3 Purpose ........................................................................................................................... 3 Classification of Services ................................................................................................. 3 Del Puerto Healthcare District .............................................................................4 Formation ........................................................................................................................ 4 Services .......................................................................................................................... 4 Location and Size ............................................................................................................ 4 Sphere of Influence ......................................................................................................... 5 Governance ..................................................................................................................... 5 Personnel ........................................................................................................................ 5 Mission Statement ........................................................................................................... 5 Partnership Agencies ...................................................................................................... 5 Funding Sources ............................................................................................................. 6 Municipal Service Review Determinations ....................................................................... 7 Growth and Population Projections .................................................................................. 7 Location and Characteristics of Disadvantaged Unincorporated Communities ................ 7 Present and Planned Capacity of Public Facilities, Adequacy of Public Services ............ 7 Financial Ability of Agencies to Provide Services ............................................................. 7 Status of, and Opportunities for, Shared Facilities ........................................................... 8 Accountability for Community Service Needs .................................................................. 8 Any Other Matter Related to Effective or Efficient Service Delivery ................................. 8 Sphere of Influence Determinations ................................................................................. 9 Present and Planned Land Uses ..................................................................................... 9 Present and Probable Need for Public Facilities and Services ......................................... 9 Present Capacity of Public Facilities and Adequacy of Public Services ........................... 9 Communities of Interest in the Area ................................................................................. 9 Need for Public Facilities in Disadvantaged Unincorporated Communities .................... 10 Del Puerto Healthcare District Summary Profile ............................................................. 11 Map: Del Puerto Healthcare District Boundary & SOI .................................................... 12 Westside Community Healthcare District ....................................................... 13 Formation ...................................................................................................................... 13 Services ........................................................................................................................ 13 Location and Size .......................................................................................................... 13 Sphere of Influence ....................................................................................................... 13 Governance ................................................................................................................... 13 Personnel ...................................................................................................................... 13 Partnership Agencies .................................................................................................... 13 Funding Sources ........................................................................................................... 14 Municipal Service Review Determinations ..................................................................... 15 Growth and Population Projections ................................................................................ 15 TABLE OF CONTENTS (Cont.) Location and Characteristics of Disadvantaged Unincorporated Communities .............. 15 Present and Planned Capacity of Public Facilities, Adequacy of Public Services .......... 15 Financial Ability of Agencies to Provide Services ........................................................... 15 Status of, and Opportunities for, Shared Facilities ......................................................... 16 Accountability for Community Service Needs ................................................................ 16 Any Other Matter Related to Effective or Efficient Service Delivery ............................... 16 Sphere of Influence Determinations ............................................................................... 17 Present and Planned Land Uses ................................................................................... 17 Present and Probable Need for Public Facilities and Services ....................................... 17 Present Capacity of Public Facilities and Adequacy of Public Services ......................... 17 Communities of Interest in the Area ............................................................................... 17 Need for Public Facilities in Disadvantaged Unincorporated Communities .................... 17 Westside Community Healthcare District Summary Profile ........................................... 18 Map: Westside Community Healthcare District Boundary & SOI ................................. 19 Oak Valley Hospital District .............................................................................. 20 Formation ...................................................................................................................... 20 Services ........................................................................................................................ 20 Location and Size .......................................................................................................... 20 Sphere of Influence ....................................................................................................... 20 Governance ................................................................................................................... 20 Personnel ...................................................................................................................... 20 Partnership Agencies .................................................................................................... 21 Funding Sources ........................................................................................................... 21 Municipal Service Review Determinations ..................................................................... 22 Growth and Population Projections ................................................................................ 22 Location and Characteristics of Disadvantaged Unincorporated Communities .............. 22 Present and Planned Capacity of Public Facilities, Adequacy of Public Services .......... 22 Financial Ability of Agencies to Provide Services ........................................................... 22 Status of, and Opportunities for, Shared Facilities ......................................................... 23 Accountability for Community Service Needs ................................................................ 23 Any Other Matter Related to Effective or Efficient Service Delivery ............................... 23 Sphere of Influence Determinations ............................................................................... 24 Present and Planned Land Uses ................................................................................... 24 Present and Probable Need for Public Facilities and Services ....................................... 24 Present Capacity of Public Facilities and Adequacy of Public Services ......................... 24 Communities of Interest in the Area ............................................................................... 24 Need for Public Facilities in Disadvantaged Unincorporated Communities .................... 25 Oak Valley Hospital District Summary Profile ................................................................. 26 Map: Oak Valley Hospital District Boundary & SOI ........................................................ 27 References .............................................................................................................................. 28 Municipal Service Review and Sphere of Influence Update For the Del Puerto Healthcare District, the Westside Community Healthcare District, and the Oak Valley Hospital District Introduction The Cortese/Knox/Hertzberg Local Government Reorganization Act of 2000 Act (CKH Act) requires the Local Agency Formation Commission (LAFCO) to update the spheres of influence (SOI) for all applicable jurisdictions in the County. A sphere of influence is defined by Government Code 56076 as “...a plan for the probable physical boundary and service area of a local agency, as determined by the Commission.” The Act further requires that a municipal service review (MSR) be conducted prior to or, in conjunction with, the update of a sphere of influence (SOI). The legislative authority for conducting a municipal service review is provided in Government Code Section 56430 of the CKH Act. The Act states, that “in order to prepare and to update spheres of influence in accordance with Section 56425, the commission shall conduct a service review of the municipal services provided in the county or other appropriate area...” MSRs must have written determinations that address the following factors in order to update a Sphere of Influence. These factors were recently amended to include the consideration of disadvantaged unincorporated communities within or contiguous to the sphere of influence of an agency. Municipal Service Review Factors to be Addressed 1. Growth and Population Projections for the Affected Area 2. The Location and Characteristics of Any Disadvantaged Unincorporated Communities Within or Contiguous to the Sphere of Influence 3. Present and Planned Capacity of Public Facilities, Adequacy of Public Services, and Infrastructure Needs or Deficiencies Including Needs or Deficiencies Related to Sewers, Municipal and Industrial Water, and Structural Fire Protection in Any Disadvantaged, Unincorporated Communities Within or Contiguous to the Sphere of Influence 4. Financial Ability of Agencies to Provide Services 5. Status of, and Opportunities for, Shared Facilities 6. Accountability for Community Service Needs, Including Governmental Structure and Operational Efficiencies 7. Any Other Matter Related to Effective or Efficient Service Delivery, as Required by Commission Policy This MSR will analyze the Del Puerto Healthcare District, the Westside Community Healthcare District, and the Oak Valley Hospital District. It will also provide a basis for LAFCO to reaffirm the Spheres of Influence for the Districts. MSR & SOI Update – Healthcare and Hospital Districts Page 1 Sphere of Influence Update Process A special district is a government agency that is required to have an adopted and updated sphere of influence. Section 56425(g) of the CKH Act calls for spheres of influence to be reviewed and updated every five years, as necessary. Stanislaus LAFCO processes municipal service reviews and sphere of influence updates concurrently to ensure efficient use of resources. For rural special districts, which do not have the typical municipal-level services to review, this document will be used to determine what type of services each district is expected to provide. For these special districts, the spheres will delineate the service capability and expansion capacity of the agency, if applicable. The most recent sphere of influence update for the Healthcare and Hospital Districts was adopted in 2015 and proposed no changes to the Districts’ SOIs. The current update serves to comply with Government Code Section 56425 and will reaffirm the SOIs for each district. Sphere of Influence Determinations In determining a sphere of influence (SOI) of each local agency, the Commission shall consider and prepare determinations with respect to each of the following factors, pursuant to Government Code Section 56425: 1. The present and planned land uses in the area, including agricultural and open-space lands. 2. The present and probable need for public facilities and services in the area. 3. The present capacity of public facilities and adequacy of public services that the agency provides or is authorized to provide. 4. The existence of any social or economic communities of interest in the area if the commission determines that they are relevant to the agency. 5. For an update of a sphere of influence of a city or special district that provides public facilities or services related to sewers, municipal and industrial water, or structural fire protection, the present and probable need for those public facilities and services of any disadvantaged unincorporated communities within the existing sphere of influence. Background Healthcare/hospital districts originated during the aftermath of World War II. American soldiers returned from the war in need of extensive medical treatment and often hospitalization. California was in the grip of an acute hospital bed shortage. Significant portions of the state had no access to necessary healthcare services. The Legislature responded to this hospital shortage by enacting the Local Hospital District Act, which later became the Health Care District Act. The creation of these types of districts was intended to provide hospital facilities in areas needing them, but where it was not economically feasible for other institutions to provide them. The districts, have, or prior to Proposition 13 had, taxing powers, authority to issue general obligation bonds, and authority to receive federal hospital construction grants. MSR & SOI Update – Healthcare and Hospital Districts Page 2 There are three healthcare/hospital Districts in Stanislaus County: 1) Del Puerto Healthcare District, located in the Patterson area; 2) Westside Community Healthcare District, located in the Newman and Gustine area; and 3) Oak Valley Hospital District, located in the Oakdale area. In addition, these three Districts are among those whose service area, or sphere of influence, can be determined by where their patrons come from, as indicated by patient-origin records kept by the Districts. Authority The three Districts in this review were organized under the Local Hospital District Law, Health and Safety Code, Section 32000 et. seq. In addition, the Districts are considered to be a “registered voter districts,” as the board members are elected by registered voters residing within each District’s boundaries. Purpose Healthcare/Hospital districts may exercise numerous powers, including the following: establish, maintain, and operate, or provide assistance in the operation of, one or more health facilities or services, including but not limited to, outpatient programs, services and facilities; retirement programs; chemical dependency programs, services and facilities; or other healthcare programs, services, facilities, and activities at any location inside and outside the district for the benefit of the district and people served by the district; acquire, maintain, and operate ambulances, or ambulance services inside and outside the district; and establish a nurses’ training school, or child care facility for the benefit of employees of the hospital or residents of the district (Health and Safety Code Section 32121). Classification of Services As part of the original MSR completed for the Districts, each District provided a listing of the services provided within their boundaries. The Districts are authorized to provide the functions or classes of services (e.g. community hospital with acute care, skilled nursing, and ambulance services) as identified in this report. State Law requires that the Districts seek LAFCO approval in order to exercise any other latent powers not currently provided. MSR & SOI Update – Healthcare and Hospital Districts Page 3 Municipal Service Review – Del Puerto Healthcare District Formation The Del Puerto Healthcare District was formed on July 1, 1946. Services The District provided hospital services until 1998 when, for economic reasons, the hospital was forced to close. The District has maintained ambulance services (Patterson District Ambulance) since 1986, paid all outstanding debts, and as of June of 2003, provides outpatient care through the Del Puerto Health Center. Current services and programs include the following: • Patterson District Ambulance provides pre-hospital emergency medical services within the District. Ambulances are staffed with Paramedics and EMTs. Currently, two 24-hour ambulances serve the District, as well as provide mutual aid to surrounding areas. Patterson District Ambulance provides a third ambulance for 12-hours on occasion Mondays through Fridays as needed. • Del Puerto Health Center provides primary care 6-days a week to western Stanislaus County. The Center is open Monday through Friday 8:30 a.m. - 6:30 p.m. and Saturday 8:30 a.m. - 12:30 p.m. Services include primary care, women’s health exams, family care, industrial medicine, drug screenings, physicals, workers compensation care, etc. Specialized pediatric care is provided Monday through Friday 8 a.m. - 5 p.m. Other visiting specialists include cardiologists and neurologists. The Center also provides lab and x-ray services. • The District promotes community education through outreach on topics such as women’s health, diabetes, and stroke information. The District also participates in community events (e.g. Patterson Apricot Festival and health fairs). Other sponsorships or collaborations include women’s health events held twice a year (for breast exams, pap exams, and cholesterol screenings), and a heart healthy screening program in the Spring. • Patterson District Ambulance staff provides CPR and first aid classes. This low-cost service targets individuals, businesses, and those whose job requires certification. Several employees are trained to teach these skills. • The District is designated as a teaching facility. Staff training is not only provided, but periodically, the District partners with the Patterson Fire District and Westside Ambulance to provide mutual training and has hosted EMS Agency training. Senior paramedics train paramedic and EMT interns. The District assists with the emergency medical system by training approximately 8 Paramedics a year. • Patterson District Ambulance provides standby emergency support for local and state fire agencies, and ambulance standbys at sporting and other local events. Location and Size The District boundaries are comprised of approximately 234,000 acres, serving a significant portion of western Stanislaus County. While not heavily populated, the District covers an area that generally extends from Highway 132 south to Crows Landing, the San Joaquin River to the MSR & SOI Update – Healthcare and Hospital Districts Page 4 east and the County line in the hills beyond Interstate 5 to the west. The District serves the City of Patterson, as well as the unincorporated communities of Crows Landing, Grayson, and Westley. The District also serves the unincorporated community of Diablo Grande, located in the western foothills of Stanislaus County, west of Interstate 5 and approximately 5 miles southwest of the City of Patterson. The District’s administrative office is located at: 875 “E” Street, Patterson, California. Sphere of Influence The District’s Sphere of Influence (SOI) encompasses approximately 249,000 acres and includes a potential expansion area of approximately 15,000 acres located in San Joaquin County. This area was included in the SOI because the District also draws patients from the Vernalis area in San Joaquin County, which, although not currently within the District’s boundaries, is closer to Patterson than the healthcare services available in the Tracy area. It should be noted, however, that the District’s SOI does not limit its service area, as the District also receives patients from areas outside this boundary, including the cities of Newman, Gustine, Modesto, Ceres, Turlock, and from as far as Tracy and Stockton. Governance A five-member Board of Directors governs the District. Meetings are held on the last Monday of each month at 7:00 p.m. at 1700 Keystone Pacific Parkway, Unit B, in Patterson. All meetings are open to the public. Personnel The District employs 48 persons: 39 full-time, 9 part-time. In addition, due to the small size of the District, some support services are outsourced. These include, biomedical, housekeeping, and preventative maintenance. Legal services and annual audit professionals are also used. Consultant groups are used for feasibility studies on an as-needed basis. Mission Statement The Del Puerto Healthcare District’s mission statement is as follows: “The District’s primary mission is to provide the highest quality healthcare services through Patterson District Ambulance and the Del Puerto Health Center, while expanding the healthcare availability to the citizens of the Del Puerto Healthcare District.” Partnership Agencies The District maintains positive and collaborative relationships with local, state and federal agencies, such as: the City of Patterson, Stanislaus County, local area hospitals, the Patterson- Westley Chamber of Commerce, and the unincorporated communities of Crows Landing, Grayson and Westley. The District also maintains a strong working relationship with the Westside Community Healthcare District (Westside Ambulance), West Stanislaus Fire Protection District, the State Department of Health Services, Mountain Valley Emergency Medical Services, California Ambulance Association, California Special Districts Association, and Association of California Healthcare Districts. Additionally, in 2007, the Westside Healthcare Advisory Taskforce was formed. The taskforce is a public/private/non-profit consortium of interested healthcare proponents on the Westside of Stanislaus County and Merced County. The mission of the taskforce is to foster a richer MSR & SOI Update – Healthcare and Hospital Districts Page 5 communication between Westside healthcare providers and communities, and by doing so, better identify service gaps and potential opportunities to improve. Funding Sources The District’s source of revenue is derived from the following: a share of the County property tax revenues, special assessments, health center revenues, ambulance service fees, developer/mitigation fees collected from new development, and interest income. MSR & SOI Update – Healthcare and Hospital Districts Page 6 Determinations - Del Puerto Healthcare District The following provides an analysis of the seven categories or components required by Government Code Section 56430 for a Service Review for the Del Puerto Healthcare District: 1. Growth and Population Projections for the Affected Area The District estimates that its current population is approximately 30,000 people. During the 2018-2019 fiscal year, the District had 15,044 health center visits and responded to 2,338 ambulance calls. Of the District’s 30,000 people, approximately 22,524 reside in Patterson. The City of Patterson is likely to see significant growth in the future, including a development known as The Villages on the northeast end of the City. The development is planned for 692 gross acres of residential, commercial, industrial, public uses. While there are other communities within the District (Westley, Grayson, and Vernalis), it is unlikely that there will be major growth in these communities in the near future. 2. The Location and Characteristics of Any Disadvantaged Unincorporated Communities Within or Contiguous to the Sphere of Influence The communities of Grayson and Westley, which lie within the boundaries and Sphere of Influence of the District, are both considered disadvantaged unincorporated communities, as they have median household incomes that fall below the 80% statewide median. 3. Present and Planned Capacity of Public Facilities and Adequacy of Public Services, Including Infrastructure Needs or Deficiencies Related to Sewers, Municipal Water and Industrial Water, and Structural Fire Protection in Any Disadvantaged, Unincorporated Communities Within or Contiguous to the Sphere of Influence The District has created a Strategic Plan which covers all aspects of future medical care needs for the Westside. In 2008, it was determined that the Health Center had outgrown its existing facility on Ward Avenue. In 2012, the District relocated its Health Center to a newly remodeled, 11,000 square foot building in the Keystone Business Park. The District owns and maintains four ambulances and equipment necessary to place the ambulances in service. The District also owns all equipment necessary to provide services to the Health Center. As the District is not a provider of water, sewer, or fire protection services, it is not responsible for assuring that these services are adequately provided to disadvantaged unincorporated communities within or contiguous to the District. 4. Financial Ability of Agencies to Provide Services Overall, the District appears to be in stable financial shape and has in place the necessary financial mechanisms to support continued services to existing and future residents. The District uses surveys and input from its billing company to establish rates. Additionally, the District was successful in obtaining a Rural Health designation in 2004 that allows the Health Center to receive a cost-based reimbursement from the government for MediCal and Medicare patients. MSR & SOI Update – Healthcare and Hospital Districts Page 7 As is common with agencies that provide ambulance services, it is difficult to fully recover costs related to emergency service calls. Thus, the District’s ambulance service is subsidized through property tax support. The District also collects mitigation fees from new developments based on its 2006 Impact Fee Study and continues to collect fees on approved projects under fee agreements. The District is currently evaluating future facility needs and improvements and will update its impact fees when completed. 5. Status of, and Opportunities for, Shared Facilities In the spirit of cooperation, the District shares facilities and/or equipment with agencies and organizations within the area when opportunities arise. For example, the District allows access to their quarters when the Westside Ambulance posts for the District. Since the West Stanislaus Fire Protection District assists with medical aids, their supplies and oxygen are restocked. From time to time joint education or meeting space is provided. Through a joint grant, space, equipment and supplies for diabetes education and screening is also provided. 6. Accountability for Community Service Needs, Including Governmental Structure and Operational Efficiencies A five-member Board of Directors governs the District. Registered voters within a geographical area or division elect the board members. The Board is subject to provisions of the Brown Act requiring open meetings. It is reasonable to conclude that the District has the organizational capability to adequately serve the areas under its jurisdiction. The District has the necessary resources and staffing levels to operate in a cost-efficient and professional manner. 7. Any Other Matter Related to Effective or Efficient Service Delivery, as Required by Commission Policy None. MSR & SOI Update – Healthcare and Hospital Districts Page 8 SOI Update – Del Puerto Healthcare District The following determinations for the Del Puerto Healthcare District Sphere of Influence update and are made in conformance with Government Code Section 56425 and local Commission policy. Determinations: 1. Present and Planned Land Uses in the Area, Including Agricultural and Open-Space Lands The present and planned land uses within the District’s Sphere of Influence (SOI) consist of agricultural, rural residential, suburban and urban areas. The District does not have the authority to make land use decisions, nor does it have authority over present or planned land uses within its boundaries and SOI. The responsibility for land use decisions within the District boundaries is retained by the City of Patterson, Stanislaus County, and San Joaquin County. 2. Present and Probable Need for Public Facilities and Services in the Area The present and probable need for public healthcare facilities and services in the area is not likely to diminish. On an annual basis, the District draws thousands of patrons seeking localized healthcare services. Portions of patients travel from all communities on the Westside (including Patterson, Newman, and Gustine) as well as the Modesto, Ceres, and Turlock areas. The District also receives a portion of its patients from as far as Tracy and Stockton. New development in these areas will continue to generate additional demand for healthcare and ambulance services. 3. Present Capacity of Public Facilities and Adequacy of Public Services that the Agency Provides or is Authorized to Provide Following an increased demand for healthcare services, the District’s Health Center outgrew its previous location and, in 2012, relocated to an 11,000 square foot building that provides sufficient area for procedures, stress and echo testing, colo-rectal screenings, and additional space for specialists and family physicians. The District operates two ambulances 24 hours a day, seven days a week, 365 days a year, and when needed will add a third ambulance to help cover calls. The District is faced with a shortage of space in existing crew quarters and has recently obtained additional attached land upon which to build a larger headquarters that will house the District administrative offices and ambulance operations. 4. The Existence of Any Social or Economic Communities of Interest in the Area if the Commission Determines That They are Relevant to the Agency The following jurisdictions can be categorized as Communities of Interest in the area: the City of Patterson, the unincorporated communities of Crows Landing, Grayson, Westley, Diablo Grande, and Vernalis (in San Joaquin County). Although outside the Districts’ current boundary and SOI, the cities of Newman and Gustine can also be considered communities of interest, as the District receives patients from these areas as well. MSR & SOI Update – Healthcare and Hospital Districts Page 9 5. For an Update of a Sphere of Influence of a City or Special District That Provides Public Facilities or Services Related to Sewers, Municipal and Industrial Water, or Structural Fire Protection, the Present and Probable Need for Those Public Facilities and Services of Any Disadvantaged Unincorporated Communities Within the Existing Sphere of Influence As the District does not provide services related to sewers, municipal and industrial water or structural fire protection, this factor is not applicable. MSR & SOI Update – Healthcare and Hospital Districts Page 10 DISTRICT SUMMARY PROFILE DEL PUERTO HEALTHCARE DISTRICT Formation: July 1, 1946 Services: Ambulance services, operation of a health center, education, and free community health outreach District Boundary: Approximately 234,000 acres, located west of the San Joaquin River, including the City of Patterson, the unincorporated communities of Crows Landing, Grayson, and Westley, as well as the Diablo Grande area Sphere of Influence: Includes approximately 15,000 acres beyond the District’s current boundary, extending out to the Vernalis area in San Joaquin County Population*: 30,000 (total service population estimate for 2020) Land Use: Agricultural, Rural Residential, Suburban and Urban Enabling Act: Local Hospital District Law, California Health and Safety Code, Section 32000 et. seq. Governing Body: Five-member Board of Directors, elected by registered voters within the District boundaries Administration: 48 Employees Total Revenues: $4,458,000 (Fiscal Year 2019-20 Budget) Revenue Sources: Share of County property taxes, special assessments, service fees, developer/mitigation fees, and interest *Source: District estimate, 2020 MSR & SOI Update – Healthcare and Hospital Districts Page 11 DEL PUERTO HEALTHCARE DISTRICT BOUNDARIES AND SPHERE OF INFLUENCE MSR & SOI Update – Healthcare and Hospital Districts Page 12 Municipal Service Review – Westside Community Healthcare District Formation The Westside Community Healthcare District was formed on November 18, 1957. Services Currently, the District provides ambulance services within its service area boundaries. The District originally operated a 22-bed hospital facility from 1938 until its closure in 1993. The hospital’s closure was a result of low utilization and declining reimbursements. The District has since sold the hospital but is currently still utilizing it while the District looks into purchasing a new location. The District continues to operate West Side Community Ambulance service. Location and Size The boundaries of the District are comprised of approximately 329,000 acres and serves approximately 20,507 people. The District serves areas in and around the City of Newman and the City of Gustine (in Merced County). The District office is located at 990 Tulare Street, Suite C in Newman, California. Sphere of Influence The District’s Sphere of Influence (SOI) is generally coterminous with its current boundaries, with the exception of approximately 2,500 acres in the Santa Nella area in Merced County that currently lies outside the District’s boundaries but within its SOI. The cities of Newman and Gustine and the unincorporated community of Stevinson (in Merced County) are all located within the District’s boundaries and Sphere of Influence. Governance A five-member Board of Directors governs the District. Registered voters within a geographical area or zone elect the board members. Directors from Zones 1 and 2 are representatives from and elected in Stanislaus County, whereas Directors from Zones 3, 4 and 5 are representatives from and elected in Merced County. Meetings are held the fourth Tuesday of every month at 7:00 p.m. in the City Chambers behind the Newman Police Department located at 1200 Main Street in Newman, California. However, current meetings are being held at the District office located at 990 Tulare Street in Newman, California due to COVID 19. Personnel The District employs 31 persons: 10 full-time and 21 part-time. The District currently contracts its billing, collections, accounting, and legal services. The District was formerly contracting management and administrative services until July of 2019. The District has since taken over these functions internally. Partnership Agencies The District maintains positive and collaborative relationships with local, state and federal agencies, such as: the Cites of Newman and Gustine, Stanislaus and Merced counties, California Highway Patrol, Gustine and Newman Fire Departments, West Stanislaus Fire MSR & SOI Update – Healthcare and Hospital Districts Page 13 Protection District, and local area hospitals (e.g., Doctors, Emanuel, Memorial, and Los Banos). The District coordinates with Riggs Ambulance Service and bordering service providers via mutual-aid agreements. The District is also a member of the Westside Healthcare Advisory Taskforce, formed in 2007. Funding Sources The District’s source of revenue is derived from the following: A share of County property tax revenues (Stanislaus and Merced), special assessments, and ambulance service fees. MSR & SOI Update – Healthcare and Hospital Districts Page 14 Determinations - Westside Community Healthcare District The following provides an analysis of the seven categories or components required by Government Code Section 56430 for a Service Review for the Westside Community Healthcare District: 1. Growth and Population Projections for the Affected Area According to the District, approximately 20,507 persons reside within the District’s boundary. Last fiscal year, the District ran 2,322 calls, made 1,976 patient contacts and transported 1,445 patients. Although significant growth is not projected in the unincorporated areas of Merced and Stanislaus County, growth potential exists in the cities of Newman and Gustine. 2. The Location and Characteristics of Any Disadvantaged Unincorporated Communities Within or Contiguous to the Sphere of Influence The unincorporated communities of Stevinson and Santa Nella, located in Merced County, are both considered disadvantaged unincorporated communities that are located within the District’s Sphere of Influence. Both communities have median household incomes that fall below the 80% statewide median. 3. Present and Planned Capacity of Public Facilities and Adequacy of Public Services, Including Infrastructure Needs or Deficiencies Related to Sewers, Municipal Water and Industrial Water, and Structural Fire Protection in Any Disadvantaged, Unincorporated Communities Within or Contiguous to the Sphere of Influence The District sold the hospital in 2015. As part of the sale, the District had an agreement to stay at the hospital for 5 years rent free until June 21, 2020 which has recently passed. Currently, the District is looking to purchase property within the City of Newman. The new property will allow the District to move out of the old hospital which is in need of repairs and costly to maintain. The District appears to be meeting the ambulance response expectations in the communities that it serves. As the District is not a provider of water, sewer, or fire protection services, it is not responsible for assuring that these services are adequately provided to disadvantaged unincorporated communities within or contiguous to the District. 4. Financial Ability of Agencies to Provide Services The District receives funding from charges for services, taxes and assessments. According to the District’s latest financial audit (FY 2017-2018), the District sets the rate of assessment annually for the special tax assessment that was passed by voters in 1984. The District also receives a portion of the general property taxes collected in the District by both Merced and Stanislaus Counties to support District operations. The District is currently experiencing a decrease in revenue due to a decrease in transports and has stated that the decrease is related to COVID-19. This fiscal year has seen a decrease of about 30% in the number of transports in comparison to last fiscal year. MSR & SOI Update – Healthcare and Hospital Districts Page 15 5. Status of, and Opportunities for, Shared Facilities The District does not currently share its facilities with other Districts. 6. Accountability for Community Service Needs, Including Governmental Structure and Operational Efficiencies A five-member Board of Directors governs the District. Registered voters within a geographical area or division elect the board members. The Board is subject to the provisions of the Brown Act requiring open meetings. The District has limited administrative staff, which it supplements with professional consultants to complement the District staff and improve productivity. At this time, there are two vacancies on the Board of Directors. However, four of the five seats are currently up for election. 7. Any Other Matter Related to Effective or Efficient Service Delivery, as Required by Commission Policy None MSR & SOI Update – Healthcare and Hospital Districts Page 16 SOI Update – Westside Community Healthcare District The following determinations for the Westside Community Healthcare District’s Sphere of Influence update are made in conformance with Government Code Section 56425 and local Commission policy. Determinations: 1. Present and Planned Land Uses in the Area, Including Agricultural and Open-Space Lands The present and planned land uses within the District’s Sphere of Influence (SOI) consist of agricultural, rural residential, and suburban areas. The District does not have the authority to make land use decisions, nor does it have authority over present or planned land uses within its boundaries and SOI. The responsibility for land use decisions within these areas is retained by the City of Newman, Stanislaus County, the City of Gustine, and Merced County. 2. Present and Probable Need for Public Facilities and Services in the Area As new development occurs, additional demand for ambulance services is generated; therefore, the present and probable need for ambulance services in the area is not likely to diminish. 3. Present Capacity of Public Facilities and Adequacy of Public Services that the Agency Provides or is Authorized to Provide As identified in the Municipal Service Review section, it appears that the District currently has adequate capacity to provide ambulance services within its existing Sphere of Influence. 4. The Existence of Any Social or Economic Communities of Interest in the Area if the Commission Determines That They are Relevant to the Agency The following jurisdictions can be categorized as Communities of Interest in the area: the City of Newman (in Stanislaus County), the City of Gustine, and the unincorporated communities of Stevinson and Santa Nella (in Merced County). 5. For an Update of a Sphere of Influence of a City or Special District That Provides Public Facilities or Services Related to Sewers, Municipal and Industrial Water, or Structural Fire Protection, the Present and Probable Need for Those Public Facilities and Services of Any Disadvantaged Unincorporated Communities Within the Existing Sphere of Influence As the District does not provide services related to sewers, municipal and industrial water or structural fire protection, this factor is not applicable. MSR & SOI Update – Healthcare and Hospital Districts Page 17 DISTRICT SUMMARY PROFILE WESTSIDE COMMUNITY HEALTHCARE DISTRICT Formation: November 18, 1957 Services: Ambulance services District Boundary: Approximately 329,000 acres including the western portion of Stanislaus County in and around the City of Newman, south of and adjacent to the Del Puerto Healthcare District. The District boundary also overlaps into Merced County, including the City of Gustine and the unincorporated community of Stevinson Sphere of Influence: Coterminous with the District’s current boundary, with the exception of approximately 2,500 acres in the Santa Nella area of Merced County Population*: 20,507 Land Use: Rural, Suburban and Urban Enabling Act: Local Hospital District Law, California Health and Safety Code, Section 32000 et. seq. Governing Body: Five-member Board of Directors, elected by registered voters within the District boundaries Administration: 31 Employees: 10 full-time and 21 part-time Total Revenues: $2,239,647 (Fiscal Year 2019-2020 Budget) Revenue Sources: Share of County property taxes, special assessments, and ambulance service fees *Source: Westside Community Healthcare District MSR & SOI Update – Healthcare and Hospital Districts Page 18 MSR & SOI Update – Healthcare and Hospital Districts Page 19 Municipal Service Review – Oak Valley Hospital District Formation The Oak Valley Hospital District was formed on June 18, 1968 as a not-for-profit, acute care, hospital. Services In 1973, the District constructed the Oak Valley Hospital, in order to provide area residents with access to convenient health care services. The District is licensed to operate and maintain a general acute care hospital, which includes 29 acute care hospital beds in use, and other services such as the following: a 24-hour basic emergency care, respiratory care services, surgical services, clinical laboratory, and diagnostic imaging services. The District also operates the 115-bed Oak Valley Care Center, a skilled nursing facility. In addition, the District operates rural health clinics located in Oakdale, Riverbank, Escalon and Waterford. Ambulance services are provided to the communities of Oakdale, Riverbank, and Waterford. Emergency Medical Technicians (EMTs) are on call 24-hours a day to serve the surrounding communities utilizing the Oak Valley Ambulance services. Location and Size The District boundaries are comprised of approximately 253,700 acres. The District serves Northern Stanislaus County, which includes the cities of Oakdale, Riverbank, and Waterford; and the unincorporated communities of Knights Ferry and Valley Home. The District also provides services to areas in the southeast portion of San Joaquin County including areas in and around the City of Escalon. The District’s hospital and administrative offices are located at 350 South Oak Avenue, Oakdale, CA 95361. Sphere of Influence The cities of Oakdale, Riverbank, and Waterford, along with the unincorporated communities of Knights Ferry and Valley Home are located within the District’s Sphere of Influence boundary. The Sphere of Influence includes additional acreage currently outside the District’s boundary in and around the City of Escalon (in San Joaquin County). Governance A five-member Board of Directors governs the District. Meetings are held on the fourth Wednesday of every month at 5:30 p.m. in the District’s Hospital Administration Building Conference Room located at 350 South Oak Avenue, Oakdale, CA 95361. All meetings are open to the public. The District also has established a website (www.oakvalleyhospital.com) that is user-friendly and provides information such as programs and services, physicians’ directory, annual reports, and visiting hours. Personnel The District employs 550 employees and additionally has over 40 physicians approved to practice medicine. MSR & SOI Update – Healthcare and Hospital Districts Page 20 Partnership Agencies The District maintains positive and collaborative relationships with local, state and federal agencies, such as: the cities of Oakdale, Riverbank, Waterford, and Escalon, Stanislaus and San Joaquin counties, Oakdale Rural Fire Protection District, Oak Valley Hospital Foundation, Mountain Valley Emergency Medical Services, local area hospitals, UC Davis, Children’s Medical Hospital, Fresno, Hospital Council of Northern and Central California, California Department of Health Services, California Children and Families Commission, Office of Statewide Health & Planning, and the Center for Medicare and Medicaid Services (CMS). Funding Sources The District’s source of revenue is derived from the following: reimbursements from Medicare, Medi-Cal, Self-Pay, PPO, Private Insurance, Oak Valley Hospital Foundation, charity/trusts, grants (First Five Program). The District does not receive a share of the County property tax revenues for daily operating needs but does receive funds for approximately 40% of the debt incurred for the new building. MSR & SOI Update – Healthcare and Hospital Districts Page 21 Determinations - Oak Valley Hospital District The following provides an analysis of the six categories or components required by Government Code Section 56430 for a municipal service review for the Oak Valley Hospital District: 1. Growth and Population Projections for the Affected Area Approximately 42,454 persons live within the District’s boundary and Sphere of Influence as of 2019. According to the District’s most recent Audit and Financial Statements (FY 2018- 2019) during the fiscal year ambulance runs continued to increase, but inpatient admissions and clinic visits decreased. Acute inpatient days decreased 4.02%. Skilled Skilled nursing days decreased 2.75%. The emergency department visits decreased by 5.7% and clinic visits decreased 7.43%. Total outpatient visits decreased 6.9%. Although significant growth is not projected in the unincorporated areas of Valley Home and Knights Ferry, growth potential exists in the cities of Escalon, Oakdale, Riverbank, and Waterford. 2. The Location and Characteristics of Any Disadvantaged Unincorporated Communities Within or Contiguous to the Sphere of Influence No known disadvantaged unincorporated communities are within or contiguous to the District’s Sphere of Influence. 3. Present and Planned Capacity of Public Facilities and Adequacy of Public Services, Including Infrastructure Needs or Deficiencies Related to Sewers, Municipal Water and Industrial Water, and Structural Fire Protection in Any Disadvantaged, Unincorporated Communities Within or Contiguous to the Sphere of Influence The District recently completed a hospital expansion consisting of 123,000 square feet which houses outpatient services, the emergency department and billing department for the District. As the District is not a provider of water, sewer, or fire protection services, it is not responsible for assuring that these services are adequately provided to disadvantaged unincorporated communities within or contiguous to the District. 4. Financial Ability of Agencies to Provide Services The District adopts an annual budget, which is used as the spending plan for the District. The budget provides a framework for the District to address budgetary issues such as: revenues, expenditures, reserves, fiscal management, investments, capital improvements, and rates and fees. Monthly financial reports are provided at the District’s board meetings. There is no overlapping or duplication of services within the District boundaries. The District participates in a variety of joint agency practices to maximize cost avoidance opportunities such as the District’s Management Agreement with BETA Healthcare Group for Risk Management services and Plan Alpha for Worker’s Compensation services. Rates and fees for services provided by the District are governed by the amount the District can charge for services rendered. The District charges all patients equally based on its MSR & SOI Update – Healthcare and Hospital Districts Page 22 established pricing structure. The rates and fees are established during the District’s annual budget review process. Factored into the budget are reimbursements from insurance programs, such as HMOs, PPOs, Medicare and Medicaid. The amounts of reimbursements are based upon contractual agreements and government obligations. The District’s annual budget process is designed to screen out unnecessary costs and is submitted to the Board of Directors for review and approval. Overall, the District appears to be in good financial shape, and has in place the necessary financial mechanisms to continue serving existing and future residents. 5. Status of, and Opportunities for, Shared Facilities In the spirit of cooperation, the District shares its conference facilities with agencies and organizations within the area, including, but not limited to the City of Oakdale, Family Support Network, and the State’s Women, Infant & Children (WIC) Program. 6. Accountability for Community Service Needs, Including Governmental Structure and Operational Efficiencies A five-member Board of Directors, elected by registered voters, governs the District. The Board is subject to the provisions of the Brown Act requiring open meetings. The District also has established a website (www.oakvalleyhospital.com) that is user-friendly and provides information such as: programs and services offered, visiting hours, and yearly reports. The District has the necessary resources and staffing levels to operate in a cost- efficient and professional manner. It is reasonable to conclude that the District has the organizational capability to adequately serve the areas under its jurisdiction. 7. Any Other Matter Related to Effective or Efficient Service Delivery, as Required by Commission Policy None. MSR & SOI Update – Healthcare and Hospital Districts Page 23 SOI Update – Oak Valley Hospital District The following determinations for the Oak Valley Hospital District Sphere of Influence update and are made in conformance with Government Code Section 56425 and Commission policy. Determinations: 1. Present and Planned Land Uses in the Area, Including Agricultural and Open-Space Lands The present and planned land uses within the District’s Sphere of Influence (SOI) consist of agricultural, rural residential, suburban and urban areas. The District does not have the authority to make land use decisions, nor does it have authority over present or planned land uses within its boundaries and SOI. The responsibility for land use decisions within these areas is retained by the cities of Oakdale, Riverbank, Waterford and Escalon; and Stanislaus and San Joaquin counties. 2. Present and Probable Need for Public Facilities and Services in the Area The present and probable need for public healthcare facilities and services in the area are not likely to diminish. On an annual basis, the Oak Valley Hospital District draws thousands of patrons seeking localized healthcare services. Realizing that the need for community- based healthcare services will continue, the District has adopted a Master Plan, which includes expansion of hospital facilities and services within the District’s Sphere of Influence. This expansion is expected to meet the local healthcare needs for the next 30 years. 3. Present Capacity of Public Facilities and Adequacy of Public Services that the Agency Provides or is Authorized to Provide The District outgrew its previous facility, built in 1973, and recently underwent a $69 million expansion of a new hospital facility. Financing for the expansion came from a variety of sources including hospital reserves, revenue bond financing, and donations. With regards to adequacy of public services provided, the District continually strives to implement new procedures to measure service levels, invests in information technology that gives physicians and other caregivers timelier access to data needed to provide effective care to patients, and completed a consumer preference survey and developed action plans to address areas of concern. The District states that it is committed to providing its communities with quality health care services with compassion, pride and excellence. 4. The Existence of Any Social or Economic Communities of Interest in the Area if the Commission Determines That They are Relevant to the Agency The following jurisdictions can be categorized as Communities of Interest in the area: the cities of Oakdale, Riverbank, Waterford, and Escalon (San Joaquin County), as well as the unincorporated communities of Knights Ferry and Valley Home. MSR & SOI Update – Healthcare and Hospital Districts Page 24 5. For an Update of a Sphere of Influence of a City or Special District That Provides Public Facilities or Services Related to Sewers, Municipal and Industrial Water, or Structural Fire Protection, the Present and Probable Need for Those Public Facilities and Services of Any Disadvantaged Unincorporated Communities Within the Existing Sphere of Influence As the District does not provide services related to sewers, municipal and industrial water or structural fire protection, this factor is not applicable. MSR & SOI Update – Healthcare and Hospital Districts Page 25 DISTRICT SUMMARY PROFILE OAK VALLEY HOSPITAL DISTRICT Formation: June 18, 1958 Services: Operation of a general acute care community hospital, skilled nursing facility, ambulance services, and rural health clinics District Boundary: Approximately 253,700 acres, located in the northern portion of Stanislaus County, including the cities of Oakdale, Riverbank, and Waterford; and the unincorporated communities of Knights Ferry and Valley Home Sphere of Influence: Extends into southeast San Joaquin County nearly 28,000 acres, including areas in and around the City of Escalon Population*: 42,454 (Service population estimate for 2019) Land Use: Rural, suburban, and urban Enabling Act: California Health and Safety Code: Hospital Districts, Sections 32000 to 32490.9 Governing Body: Five-member Board of Directors, elected by the registered voters within the District Administration: 550 Employees Total Revenues: $76,370,755 (Fiscal Year 2018-19 Audit & Financial Statements) Revenue Sources: Insurance Programs (Self-Pay, PPO, Private Insurance, Workers Compensation), Medicare, Medi-Cal, charity/foundations, and various grants *Source: District estimate, 2019 MSR & SOI Update – Healthcare and Hospital Districts Page 26 OAK VALLEY HOSPITAL DISTRICT BOUNDARIES AND SPHERE OF INFLUENCE MSR & SOI Update – Healthcare and Hospital Districts Page 27 REFERENCES 1. Association of California Healthcare Districts. Website (www.achd.org). Accessed July 10, 2020. 2. California Department of Water Resources. Disadvantaged Communities (DAC) Mapping Tool. Website (https://gis.water.ca.gov/app/dacs/). Accessed July 13, 2020. 3. California Special Districts Association (CSDA). Website (www.csda.net). Accessed July 7, 2020. 4. Del Puerto Health Care District. Adopted Budgets - Fiscal Years 2019-2020 Received May 4, 2020. 5. Del Puerto Health Care District. Website (www.dphealth.org). Accessed May 1, 2020. 6. Oak Valley Hospital District. Report of Independent Auditors and Financial Statements 2018-2019. 7. Oak Valley Hospital District. Website (www.oakvalleyhospital.com). Accessed June 16, 2014. 8. Sierra Medical Services Alliance and West Side Community Healthcare District. Agreement for Daily Management and Consulting Services. May 6, 2014. 9. Stanislaus LAFCO. Municipal Service Review and Sphere of Influence Update for the Healthcare and Hospital Districts. January 28, 2015. 10. Westside Community Healthcare District. 2020-21 Annual Budget Sheet. 11. Westside Community Healthcare District. Basic Financial Statements - June 30, 2018. 12. Westside Community Ambulance. Website (www.westsideambulance.com) – Accessed June 16, 2020. 13. West Side Healthcare Advisory Task Force. Website (www.westsidechoices.com). Accessed June 19, 2020. MSR & SOI Update – Healthcare and Hospital Districts Page 28