Fix it…

The Borrego Sun investigation into the Borrego Community Health Foundation (BCHF) began as an attempt to understand what was going on at the Borrego Springs clinic with the dismissal of critical resident providers. The concern extended to the three-month absence of the resident doctor. The community was upset with the firing of the only, full-time personnel serving Borrego Springs, and questioned why such popular providers had been let go.

Digging into the Foundation’s activities through public documents, the Sun began to identify many aspects of the BCHF management that were worrisome and questionable, and possibly, illegal for a federally qualified non-profit. Sources confirmed troubling facts that lead to further investigations. After months of attempting to reconcile facts with explanations from the BCHF executive team without success, the Sun remains concerned with red flags in past IRS-990 tax filings that, surprisingly, have not caught the attention of federal and state regulators. Many have been covered in previous articles.

Facts are facts. However, how facts are interpreted often depends on the perspective of the observer. One problem is interpreting the activities of the foundation from two-year-old IRS filings. This year, Borrego Health will post its 2019 tax filing, which covers the year 2018. Hence, in fairness to the foundation, a real time picture of activities and income is not available. Perhaps, changes are being made with transfer of the CEO position from Bruce Hebets to Mikia Wallis.

However, past 990-tax disclosures combined with information from former employees seems to reveal a pattern of questionable practices employed by Hebets. There’s a pattern of manipulating federal and state regulations and operating as a for profit business, exploiting the BCHF status as a non-profit to benefit friends and families through salaries and contracts.

The non-profit’s cash-to go-culture, shaped by former the police sergeant, seems to be about spending taxpayer’s money on enriching a select few, many unqualified for a high level positions; questionable purchasing practices; poor auditing; hiding or misappropriating funds; and entering into sketchy contract services with private sector corporations, created with friends to garner financial perks. Also creating perceived if not, real personal and organizational conflicts of interest.

The truth of how the money is actually spent, or source of all the Foundation’s profits, are not properly disclosed in the tax filings. The non-profit status, sadly, appears to be masterfully manipulated for private gain.

The Borrego Sun has uncovered some serious issues. Many of BCHF’s problems may stem from a lack of experience and expertise by the administrators and managers, or the rapid expansion from one clinic, to 27, and soon to be 28 clinics. What else to do with a giant windfall of cash, except spend it indiscriminately? The overall impression, without any attempt at transparency by the foundation’s management, is that Borrego Health operates as a free-wheeling business, flush with cash, managed by amateurs, generously sharing federal and state revenues in ways that, often, do not reflect the goals of a regulated, non-profit, healthcare provider.

There’s legitimate concern that the foundation’s money, which consists of government grants, federal and state Medicaid/Medical and Medicare insurance, and other prescribed programs, including clinics, dental, pharmacies, and numerous partnerships, receive funds that are not always serving legitimate health needs of real people. As a federally qualified health clinic, these funds are intended for those who can’t afford otherwise afford healthcare, or are geographically dependent on BCHF as their only medical alternative.

An example, are Borrego Springs residents that qualify to receive government-subsidized services for everything from prescriptions, to children and adult prevention programs, pregnancy, dental care, emergency interventions, and case management of serious and life-threatening medical conditions. In addition to pharmacies, infectious disease treatment clinics that also focus on gender and HIV, urgent care and mobile medicine are available at some of the 27 clinics. But not Borrego, despite the need. The foundation claims each clinic is focused on the particular needs of each community it serves. Borrego’s needs for the past number of years have, apparently, fallen out of focus.

From a distance, it appears the non-profit state and federally-funded status is viewed by many in the BCHF’s administration as a cash cow to benefit friends and family, rather than as a dedicated healthcare provider. However, despite shortcomings by management, it’s important to keep in mind that the Foundation employs thousands of dedicated and caring providers. These hardworking and talented people make a real difference in the communities they serve.

Given the research and facts uncovered by the Sun, there’s an important question facing the community and BCHF. That question is, “What to do about the apparent abuses and problems, short of initiating state and federal investigations?” An investigation could have serious consequences for many innocent people, honest employees just doing their jobs, and others naively caught up in the foundation’s practices.

In all fairness, the pandemic will have impacted the foundation’s cash flow. However, from past extraordinary expenses such as the $1.8 million retirement gift given to Hebets, and an unspecified amount of expenses of $11 million in 2017, it would seem the BCHF should have the cash, or at least saleable assets to make reparations to the Borrego Springs clinic and community.

To discover what those reparations might look like, the Sun asked former and current employees, managers, and experienced healthcare professionals, not associated with the foundation, for recommendations on what should be done to provide more than “adequate” healthcare at Borrego’s clinic.

The following suggestions would move Borrego Springs clinic from, “left behind,” to “head of the class.”

Staff the Borrego clinic with one full-time, on site, certified medical doctor; a backup doctor; one family practitioner; an additional RN, and two LVNs; or one LVN and a physicians assistant. Replacement of the in-house psychologist along with an assistant behavioral therapist is critical. Growing the social services support staff from one to two seems only reasonable given the economic and health crisis. Add clerical as needed. Also, according to a real dreamer, a bonus would be an in-house lab and lab tech.

In addition to a backlog of health needs not met due to the Corona Virus, the pandemic is creating a wave of mental health disease, due to economic anxieties, fear of the unknown future, existing health issues, and isolation. Firing the one psychologist, serving the Borrego Clinic at this critical time, was a step backward, not forward. A review of the current BCHF contract with a psychiatry group for referrals, like the foundation’s other private contractors, should be investigated for re-numeration agreements, and for competent certification of the providers’ expertise in their field.

Someone opined, ”Borrego Springs is the wrong place to have a mental health problem.” This needs to be corrected for the sake of those who suffer.

Due to the marginalized income of many residents, geographic distances from health services, and a large aged-population of Borregans, rotating specialty services should include a pediatrician, dermatologist, allergy specialist, cardiologist, nutritionist and a doctor, certified in the field of pain therapy and relief.

Currently, at the clinic the visits from specialists have been slowly eroding from monthly, to two or three months between visits.

Highly recommended is an urgent care facility, with 24/7 response capability appropriately staffed. People have suggested, there are economical ways this can be done. The foundation has often stated that the explosive expansion was needed to subsidize clinics that are not financially sustainable. Borrego Springs may be one of those clinics, needing to be subsidized.

Yet, some sources believe, the Borrego clinic sees enough patients, bringing in enough government funding that the clinic could and should be sustainable, and providing a higher quality of service. If so, these funds went elsewhere. Hopefully, not into salaries or newly created employment positions for BCHF friends, and family. It would be a shame if Borrego funds were used to upgrade clinics in other more populated areas simply to stimulate administration funds for overly generous benefits, extravagant events and parties, car allowances and personal car maintenance, and so much more.

A mobile unit, appropriately staffed for school visits, and offering services to adjacent rural populated communities, such as Ranchita, Shelter Valley, and other nearby, rural communities should be evaluated as a possibility. Mobile service from the Borrego Springs clinic to Salton Sea residents would be more practical than having a clinic there. Assuming, there’s still a BCHF clinic operating at the Salton Sea site.

Questions about what clinics are operating, and which have closed, or been newly added, is part of the outdated website information and transparency problems that create confusion about the Foundation. Dr. Alfredo Ratniewski, the Executive Chief Medical Director, who the Sun disclosed as a problem for the foundation, disappeared from all BCHF websites in a week. It seems updating information on clinics should be a cakewalk in comparison.

Speaking of transparency, it would be valuable to know the exact count of Borrego Springs’ patients, receiving services from the clinic that include dental, pharmacy and assisted living facilities profits. Added to the count, the Sun would like to know the total amount of reimbursements received for these Borrego services. In plain English, what is the budget for Borrego Springs, and why can’t the community view it?

Getting back to ideal services at Borrego Springs clinic, one source suggests, Identifying “at risk populations,” living alone, with serious illnesses, and maintaining an intern or volunteer for the purpose of making weekly contact and social assessments.

A common chord was to replace the current clinic manager with someone willing to requisition equipment and supplies desired by medical providers, and buy equipment, like wheel chairs, which are the general staple of a health clinic. Old equipment such as the outdated EKG needs to be replaced regularly. Another suggested, with so much money at their disposal, the foundation should create a position in the Purchasing Department to regularly visit clinics for purposes of identifying facility and equipment needs, along with purchasing responsibilities. This would be opposed to each clinic ordering its own supplies and equipment. Who knows such a move might lead to an equitable distribution of equipment and even save money?

Moving into Telehealth, many of the Sun’s responders felt there is an immediate need for upgrading the foundation’s electronic filing and data production. Telehealth requires training for personnel, as well as assistance for patients for whom the experience is frightening or too complicated. Recognizing some patients require a personal one on one with the medical providers, either due to mental problems, age, or seriousness of disease under case management, the clinic must accommodate these patients, regardless of the COVID-19 impact. If only, in Borrego, improvements and upgrades had been prior to a community crisis.

Another suggestion, is to do a better job of educating the community and visitors of what is available at the clinic, and promote staff expertise. Reduce overhead costs, including administrative salaries, to pay and keep good people on the frontlines, is another recommendation. One wonders, how to find the ratio of BCHF overhead costs in relation to individual medical services.

Speaking of alerts, when a regular provider is on leave, absent, dismissed or being replaced by a substitute, alert the patients. Don’t repeat the poor communication evidenced in the recent the Borrego Springs dismissals by telling patients, “so and so retired,” when, in fact, they were fired.

Finally, be transparent with the community about problems and achievements. The public will forgive mistakes, but not deceptions. The BCHF is required to make public its IRS990-tax filings. The foundation chooses to make it difficult to acquire this and other public information by making a request of the Financial Director. Why not make the taxes available on the website, as so many other non-profits do, rather than forcing anyone interested to seek permission, or to dig through obscure federal and state government websites?

The initial goal of the Sun reporting was to uncover reasons for the dismissals at the Borrego Springs clinic, and the general drain of services. However, investigations took a life of their own, growing to uncover and disclose a number of serious, if not possibly, fraudulent practices.

Solving problems within BCHF needs to be focused at the top. Changing the corporate culture, or correcting years of inappropriate practices, belongs to those with a high level of expertise in managing large non-profits such as BCHF. It also requires an intimate look at the people and the books, by professionals, who knows what to look for, and how to address, or fix a pattern of questionable behavior and expenditures.

There seems to be only one solution that works for everyone, BCHF, its employees, and consumers. The recommendation: The BCHF Trustees hire a respected and credible outside legal counsel, experienced in government funded, non-profit healthcare providers, to review and address, if necessary, any misappropriations, for profit practices, hiring contractors without appropriate credentialing and auditing, and unethical, disallowed expenditures and purchases.

There’s an old saying, “don’t throw the baby out with the bath water.” Fix it BCHF.