Dr. Timothy J. Coen, owner of Fallbrook Urgent Care, isn’t happy with Fallbrook Healthcare District (FHD).
Coen expressed his displeasure with FHD at the independent government agency’s board meeting Nov. 9. Coen’s beef: FHD providing funds to one of his competitors, A+ Urgent Care.
“I don’t think it’s fair for the healthcare district to continue to subsidize my competition,” said Coen when approached after the meeting. “I'm all for competition, I just want a level playing field. I pay taxes, and some of those taxes go to fund my competition. It's crazy.”
One of the “Discussion/Action Items” at the meeting was “extended hours urgent care support agreement.” In a memo to the board, FHD executive director Bobbi Palmer recommended approval of the agreement with A+.
“We do have a staff recommendation in front of you for consideration tonight, and that is to continue to provide financial assistance to A+ Urgent Care for extended hours not to exceed $10,000 a month for 18 months,” said board president Gordon Tinker. “They would be open Monday through Friday from 9 a.m. to 7 p.m.; Saturday, Sunday, and holidays from 9 a.m. to 2 p.m.”
Coen interjected, “Just a clarification, so the executive director is recommending that the board subsidize A+ Urgent Care for extended hours service at a lesser rate (less hours) that I am currently providing at no cost to the board?”
Extended hours are defined as hours open after 5 p.m. on weekdays and any hours open on weekends and holidays. A+ Urgent Care would be providing 20 hours of extended care hours (10 total on weekdays, 10 on weekends) based on the proposal.
Fallbrook Urgent Care currently operates the following hours: 10 a.m. to 7 p.m. weekdays, 10 a.m. to 6 p.m. Saturdays, and noon to 5 p.m. Sundays. That translates to 23 extended care hours (10 total on weekdays, eight hours on Saturday, and five on Sunday).
Board members discussed the motion, and Stephen Abbot and Dr. Frank Winton expressed concerns about approving the agreement. During the discussions, Abbot noted the absence of a written contract to be reviewed, stating, “So, we’re talking about voting on a contract we don’t have.”
After several minutes, it was ultimately decided that the board’s legal counsel, Blaise Jackson, would put the contract in writing for review at the December meeting.
Public comments at board meetings are limited to five minutes and Coen used all of his time at the podium. He started his speech with some history.
“In 2014, with the closure of Fallbrook Hospital, the district offered an out-of-town urgent care chain (A+) a contract to provide urgent care services at a rate of $39,500 per month,” said Coen. “No RFP (request for proposal) or competitive bids were obtained.”
Coen went on to say that was the start of a long relationship between FHD and A+.
"It is not my belief that Fallbrook Healthcare District intended to create a new business to directly compete with my business," said Coen. "I think you really intended to create extra hours for urgent care to replace the absence of the hospital. But, instead of a level playing field, A+ has been provided with tax revenues over the past 18 months which favors their success not merely as an extended care facility, but as a full-time daytime facility as well."
FHD did issue an RFP in August for extended care hours and Coen participated in the bidding process. Near the end of his speech to the board, Coen stated reasons why FHD should choose Fallbrook Urgent Care. Coen stated he operated a local business that has been serving the community for 11 years, and that he was offering a significant savings of tax dollars with his low bid.
Coen wrapped up his talk by saying, "Finally, if you decide not to chose the lowest bid with the highest level of staffing, then level the playing field by allowing market to dictate the needs of the community. Stop competing with local established business by stopping the subsidy for an out of town urgent care."
Coen, in addition to owning Fallbrook Urgent Care, also owns and operates Mission Family Care, a family practice in Fallbrook. He said the RFP represents only Fallbrook Urgent Care – not Mission Family Care.
"We have had some conversations with our legal council about our ability to provide any sort of financial support to a business that mixes both family practice and urgent care," said Tinker after Coen completed his comments. "We can’t tell the difference where your expenses are for the two businesses."
“That’s been a concern, doctor, as you and I have talked about in the past," said Jackson. "There’s another advantage that A+ offers the community that you currently can’t offer, and that is Medi-Cal managed care patients, and you’re not in a position to do so, isn’t that correct?"
"We did speak with Medi-Cal HMO, Molina, and they did offer us a contract to see those patients," responded Coen.
Since the extended care hours item was carried over to December, Coen said after the meeting he might make a new offer.
"I may make an offer for $1 just so they can't say I didn't make any offer," said Coen. "I already provide longer extended care hours than what they are trying to subsidize with A+."