"Plans for upgrading the Health and Wellness Center are not well financially," the Village News reported in its Feb. 16 edition. Finally, somebody noticed.
Over the past several years, empire building along with large payouts to consultants, demographers, architects, and lawyers, have left precious little money to go to programs that might improve public health in the Fallbrook area, which is the Fallbrook Regional Health District's core mission.
A series of questionable decisions has resulted in a severe drop in community health contracts grants. It’s a common-enough tale: a small town receives a large sum of money, and the locals eventually fritter it away with their own pet projects or by being wowed by big-city types in suits who promise all kinds of wonderful things.
The FRHD collects more than $2 million annually from property tax allocations. In 2020, community grantees were awarded $1.2 million of this. In 2021, this amount fell to $789,000. In 2022, these programs were given just $541,000. Where has the money gone? It's a long and quite sad story.
My wife Jeanne (who worked in clinical trials for 10 years and is also a licensed forensic accountant) and I attended numerous board meetings over the years. Often, we've been the only "civilian" attendees. The visitors’ seats are generally filled with employees, grantees, vendors, consultants, and anyone else looking for money.
We've spent many, many hours poring over the district's financial statements and examining their decisions and have offered many recommendations and suggestions. Mostly, we’ve been looked at as meddlesome gadflies. While the board members and the executive directors have been cordial enough to us personally, the mismanagement has generally proceeded on pace. Due to our own worsening health problems, we decided last summer to stop devoting time to what has been a stressful and often fruitless enterprise. Some background:
Fallbrook Hospital closed in 2014 after Community Health Systems of Tennessee ceased its lease of the facility. The FRHD could have spent perhaps $1 million to retrofit it for community use as a health center, but instead decided to sell it. After spending roughly $400,000 on maintenance and security of the building after the closure, the district sold it for $4,265,053 in 2017. Millions more have come from property taxes in the ensuing years.
In 2017, Bobbi Palmer was the executive director, having replaced the retiring Vi Dupre in 2016. Her plan, approved by the board of directors, was to create a new Health and Wellness Center which would partially replace the hospital. So in early 2018, the FRHD paid a reported $1.8 million for a property which had been zoned as a church.
Rezoning, permits, repairs, landscaping, insurance and maintenance, among other costs, ballooned the original cost by several hundred thousand additional dollars, including $155,108 for a new roof on one building along with $27,089 for a roofing consultant. Finally, in 2022, after delays caused by a combination of the COVID-19 pandemic and the large amount of work necessary to bring the facility up to standard, the Wellness Center opened after having sat idle for four years.
In the interim, the FRHD had only the most nebulous plans for what to do with it. That vacuum would soon be filled by consultants. There was survey after survey – local advisory committee meetings, use of the San Diego Community Health Needs Assessment, and checks paid to CentraForce ($82,500) and Galvanized Strategies ($129,533), before the district spent $256,135 on recommendations from Catalyst Consulting.
(While this was going on, the board wasn't exactly reining in its other spending, including approving such pie-in-the-sky programs as Blue Zones, blowing $95,921 before the board finally canceled it in 2019.)
A serious problem with the Wellness Center is its location at 1636 E. Mission Road. The Fallbrook area (which includes Rainbow, De Luz, and Bonsall) has a population of more than 56,000, with roughly 50% whites (many of them older retirees, who mostly live on the outskirts) and 40% working-class Latinos (who mostly live near downtown).
The town’s health clinics, urgent care center, food pantry, and lab are all located in or near downtown, within walking distance of the population that makes most use of these facilities. The Wellness Center, however, is too far from downtown to walk or push a stroller (and there are no sidewalks there, anyway), too dangerous to reach via bicycle, and if you’re driving from town you have to either go out of your way or make a risky left turn across a double line on Mission to get to the center.
In 2019, Palmer was replaced by Mason, who previously had worked for several nonprofit agencies and who had been running the local Foundation for Senior Care. But those who hoped that she might put the brakes on the FRHD's runaway spending would be disappointed after she told the Village News, “The development of the Community Health and Wellness Center will be the focus of our board for the next few years.”
She hired a full time Wellness Center administrator, along with another admin officer. An experienced grant writer, Mason also set up a new entity, the Fallbrook Regional Healthcare District Foundation, in March 2021; its purpose was to obtain grants for local health care, though thus far not a single dollar has been collected.
Meanwhile, developing the property will cost millions more. An architectural firm, Taylor Design, requested $965,946 for designing the property, as well as another $237,171 for construction management and $150,000 for legal services. Mason estimated that the construction costs would come to an additional $7.9 million, which would include a new pavilion for outdoor events and the transformation of the sanctuary into a new conference center.
The board, not committing to the full $9.2 million proposal but instead agreeing to phased construction, approved an initial payment to Taylor Design even though its proposal was rife with duplicative items (such as a demo kitchen, which already is available at the Fallbrook Food Pantry) and dubious other recommendations: a Wellness Center classroom labeled “Financial Literacy” (surely a need for many residents, but why is the healthcare district involved?) and a multi-purpose room that could be set up for 120-guest banquets (more suitable for a wedding venue than a cash-strapped health organization).
As of this month, the proposed cost has jumped to $10.9 million. According to the FRHD's own report, "The Board is stunned about the construction cost estimate." Presumably the most stunned were the two new directors, Terry Brown and Mike Stanicek.
The Wellness Center remains mostly, though not entirely, a ghost town, a white elephant unnoticed by most residents. The most popular event is chair yoga. While there are group gatherings on such health-related subjects as mental health first aid, hands-only CPR training, and blood drives, a few groups having nothing to do with healthcare (such as some local homeowners associations and the Encore Club's card game groups) meet there as well.
Only one nonprofit has moved into permanent quarters (10 hours a week) – Michelle’s Place, a cancer resource center which just opened its new $2 million-dollar building in Temecula in November and for months did not even list its new Fallbrook location on its website. According to its Form 990, every one of its 13 listed major contributors comes from Riverside or San Bernardino counties – except for the FRHD.
Mason has worked as a volunteer, support group facilitator, and advisory board member for Michelle’s Place since 2004. And while the board alone did the scoring and voting which would determine which organizations should get community grants, Michelle’s Place was able to secure 100% of its grant application of $47,406.
Some other grantees, while no doubt doing good things, seem to have only a tenuous connection to healthcare, or to Fallbrook, and should look for funding from social service organizations, the California Department of Rehabilitation, or to benefactors from other areas.
Meanwhile, the FRHD admin office remains at 138 S. Brandon Road, which the district still owns and operates. Thus each month there are two bills for maintenance, two for utilities, two for insurance, etc. The 2023 budget allocated $756,730 to the Brandon property and another $379,004 to the Wellness Center.
The FRHD also owned MedPlus Urgent Care on Alvarado before selling it three years ago to the doctor in charge, after having subsidized the clinic to the tune of as much as $10,000 a month. But the transaction was not an all-cash sale or financed by a bank loan. Instead, the FRHD loaned the money for the purchase. So, in effect, the FRHD became both a banker/creditor and a real-estate landlord, two descriptions far removed from the organization's core mission.
The transaction was listed on the FRHD’s 2021 monthly financial statements as “Deferred Inflows of Resources” for $487,500; at the close of 2022 it was listed as “Note Receivable – East Alvarado” for $465,678. In any case, it's open only five days a week, until 4 p.m., and is closed on weekends – hardly “urgent care” hours. (The FRHD does not appear to have any relationship with the other urgent care center in town, the Fallbrook Medical Center.)
Even though the board is supposed to set the agenda with the director and staff under its command and guidance, the board has mostly gone along willingly with whatever Palmer and Mason proposed. Serving on the board is a thankless task –the director and staff are full-time employees, while board members receive only a $110.25 stipend for each meeting, with a limit of six meetings (including committee meetings and training programs) per month.
The agenda packet for the main board meeting each month runs dozens of pages. And the forms filled out by prospective grantees in 2022 totaled more than 1,400 pages. (I know, I printed the entire collection.) For diligent board members, it's hours and hours of studying and attending meetings for scant rewards. Hardly anyone wants the job. One board member was appointed in 2008 and has spent nearly 15 years on the board without once facing an election.
Another was appointed to a Latino-majority district which was established to ensure that a Hispanic would be placed on the board, but after Stephanie Ortiz resigned, not a single community member applied, and the position went to someone who lives outside the district. Thus the opposition to further Wellness Center spending at the Jan. 21 board meeting, in contrast to the usual mode of rubber stamping, came as a huge surprise to many observers.
Certainly the Fallbrook Regional Health District has done some good things in recent years – vastly increased its outreach to the Latino community, upped the level of partnership with the North County Fire District, collaborated on programs with other healthcare organizations, improved its website, and provided free COVID-19 tests, among other accomplishments. And for this upcoming year, a new system of deciding who gets what grants is due to be implemented.
Unfortunately, though, the FRHD has a finite amount of money to spend to support and improve the health of the local population, but much of it has been wasted on its white elephant. How much of the millions it’s received might have been better spent – and could be spent in the future – to provide food for more low-income families? Or free eye exams for poor kids? Or help with dental bills for those who can’t afford them? And so much more...
Now it’s possible that the Wellness Center will someday be a roaring success. I could be dead wrong, and hope I am. But if I’m right, the FRHD has been squandering millions of dollars that would much better be spent on the health of our local residents. Meantime, the next board meeting is scheduled for March 8.