It’s odd enough when a local resident can’t legally set foot in a hospital’s main building unless she needs emergency care. It’s an entirely new level of unusual when she’s one of the elected people who oversees the place.

Then again, people have gotten used to strange things happening at Oceanside’s Tri-City Medical Center.

Earlier this year a judge temporarily issued a restraining order against a Tri-City board member, banning her from the hospital property. The board member stands accused of felony vote-swapping and faces a $100,000 lawsuit filed by the hospital she helps run.

The restraining order has since been lifted. But now the board has censured her for the umpteenth time. The board is pushing authorities to remove her and another board member who’s also been censured from office. Meanwhile, the board president suggested in public that the judge may have been bribed.

Amid a blizzard of accusations, the hospital that one local columnist called “pretty much the laughingstock of North County” continues to fight for its life.

To help you catch up, here are some answers to questions about Tri-City’s troubles.

What on earth is going on up there?

Tri-City has had a galaxy of troubles over the past several years: defecting patients, leadership battles, a continuing failure to get voter support to borrow money and a patient privacy scandal. Much of the fuss centers on two intertwined issues: The management of the hospital and its struggle for survival as North County rivals vacuum up its patients.

In a 2009 report, the North County Times noted that Tri-City was in a “fierce business struggle” against the hospital district that serves the Escondido-Poway area, with Tri-City losing more than 2,100 potential patients to it. Tri-City has also been trying to fight off the Scripps hospitals (including one in nearby Encinitas) that began serving some 60,000 coastal North County residents in 2008 after a merger with an Oceanside medical group. (Some residents later returned to Tri-City.)

Now the Escondido-Poway hospital district is building a new hospital in western Escondido that could draw patients from Tri-City, which serves Oceanside, Carlsbad and Vista. Meanwhile, Tri-City is “on a serious lawsuit binge,” as a NCT editorial puts it, accusing the Scripps chain and Escondido-Poway hospital district of trying to poach its patients.

As all this has been going on, the board that oversees the hospital continues to be ensnarled in an epic bout of anger and bad feelings.

So Tri-City is a public hospital? What’s up with that?

It’s a tradition for hospitals in North County to be managed by publicly elected boards: the hospitals in Oceanside, Escondido, Poway and Fallbrook are all government-run. (North County also has at least a couple publicly operated cemeteries. With the government-run hospitals, that’s cradle-to-grave service!)

Union-Tribune columnist Logan Jenkins writes that the public hospital districts are a product of the middle of the last century, when rural areas — as North County was at the time — had too few hospital beds. “In practice, public health districts can be awkward hybrids. They’re expected to compete like a business but be run at the top like a city,” Jenkins writes. “It’s a balancing act some districts perform better than others. Tri-City would have to be rated at the bottom of the list.”

In 2009, doctors tried to convince the board to appoint a task force to examine how the hospital was run; there was talk of converting the hospital from public to private. The board refused to appoint a task force.

Who’s in charge at the hospital?

It depends.

Tri-City’s ongoing mess has roots at the top, where there’s been significant tension between the board and the hospital’s different CEOs:

• In 2008, the board put eight top administrators on leave and ordered an investigation of the hospital’s finances.

• In 2009, the board sacked its CEO, a man who’d run the hospital district since 1998. He got a severance package worth more than $1 million; seven other top administrators were also fired.

The board stayed mum about exactly what prompted the firings, declining to explain what the board members discovered during the financial probe and why people needed to lose their jobs, the NCT reported.

• A year ago, the board fired Tri-City’s CEO then unfired him.

Have other problems arisen at the hospital?

A privacy scandal erupted in 2010, when the hospital sacked five nurses and disciplined others “because they posted on Facebook unspecified information about Tri-City patients,” the U-T reported.

Voters, meanwhile, have repeatedly failed to provide enough support to allow the hospital to pass a bond measure. The third attempt, which would have allowed the district to borrow $589 million to expand the hospital and improve the building’s earthquake safety, failed in 2008 when it didn’t reach the required two-thirds majority vote.

Has all the mess surrounding the hospital affected the quality of its medical care?

According to the CalHospitalCompare.org website, Tri-City’s care ranks superior in measurements of heart attack and heart failure care and average in areas such as critical care and pneumonia care. Most of its ratings are average for patient safety; it gets a “below average” rating in several ratings of “patient experience.”

In an interview, board member and registered nurse Charlene Anderson said the care at the hospital is “fantastic.”

What has that board member done to deserve a restraining order?

Kathleen Sterling’s board colleagues have repeatedly censured her, accusing her of being disruptive. Sterling, who’s been critical of hospital bosses, says she’s being persecuted.

Three board members and three employees claim Sterling, who’s in her 60s, became violent during a Feb. 24 meeting. “The witnesses said Sterling injured hospital security guards while trying to push her way into the board room, from which she had been barred after being censured six times by her colleagues in the past several months,” the NCT reports.

Sterling denies the allegations, telling a judge “I’m very respectful of people’s space.” She claims she’s allowed to be in the room before and after board meetings. The board allows her to attend the meetings remotely but not in person.

A security guard and the hospital have since sued Sterling for $100,000. Her lawyer wants Tri-City to kill the lawsuit and pay attorney’s fees.

In April, a judge declined to make the restraining order against Sterling permanent.

Sterling has long been a lightning rod on the board and has particularly been a critic of the hospital administration. In 2008, the U-T reported, her election platform included the elimination of management bonuses and stipends for doctors. She also accused the board of delegating too much to the hospital’s CEO.

She’s been censured multiple times, going back as long as a decade ago. Things have gotten bizarre at times: “After accusing fellow board members of acting like Nazis, she’s been ordered to attend a workshop on the Holocaust — and report back. (That should be rich.),” wrote the U-T’s Jenkins last year.

Since the temporary restraining order has been lifted, can she go into the hospital even if she’s not seriously sick or injured?

Yes, she can go to the hospital. However, the edict banning her from board meetings is still in effect; she must attend them remotely from another room.

She’s facing a felony charge too?

The District Attorney’s Office charged Sterling with soliciting a bribe, which is a felony, and a misdemeanor count of wrongful influence, the NCT reported. She pleaded not guilty.

The bribery charge refers to a meeting in which she is alleged to have “offered to support unspecified future board business in exchange for being made vice chairwoman of the hospital board and chairwoman of the hospital’s Human Resources Committee,” the NCT reported.

So what exactly is at the crux of all the fighting over Tri-City?

This one’s a toughie. Here are some theories:

Mutual disregard: Jerry Salyer, a local insurance broker who unsuccessfully ran for the board in 2002, blames the unusually large size of the board for some of its dysfunction. (It has seven members instead of the usual five.) He also points to a toxic atmosphere of disrespect. “They don’t respect one another,” he said in an interview, adding: “I think they’re fighting to fight.”

A single board member: Anderson places the blame for the ongoing mess on one person, Sterling. “All the public sees is that crazy board at Tri-City instead of that one crazy board member,” she said. “The rest of the board, we’re very functional, literate, capable people.”

Public hospital tensions: Monte Dube, a Chicago attorney who worked with the Tri-City physicians who unsuccessfully pushed to change how the hospital is governed, said in an interview that “dinosaur” public hospitals face unique challenges.

Their numbers are dropping, he said, as they get bought out or convert to private non-profit entities. Those that still exist, he said, face a tough time because the openness required of government agencies can make it tough to compete in areas like bidding: “You’re subject to open meetings, public records, and all the rules that apply to you but not your non-governmental competitors.”

As for leadership, “hospitals are extraordinarily complicated beasts, and you need to have very highly functioning boards of directors,” he said. “In many situations — and I can’t speak to Tri-City — board leadership is challenged because of the political process. The question is: Are they competent? Do they have the appropriate backgrounds to do what they do?”

Is there any way to fix the Tri-City mess?

The U-T’s Jenkins suggests that the hospital district get rid of government control and become a nonprofit or merge with the hospital district that serves the Escondido-Poway area.

Neither seems like a likely move at the moment. Anderson, the board member, said she doesn’t think the way the hospital is governed is a problem. There’s “one bad apple,” she said, “and occasionally people react badly to that.”

The NCT says Sterling she can only be removed from office if she’s convicted of a felony, recalled by voters or found guilty of election fraud.

The board censured Sterling and another board member, Randy Horton, at a meeting on May 26 and called upon the district attorney to begin the process of removing them from office, the NCT reports.

Horton, among other things, stands accused of sending an inappropriate letter to the editor of the North County Times, in which he complained that the board and hospital management “want complete agreement and unanimous support on anything and everything. As Buffalo Springfield once sang, ‘Step out of line, the Man get you and take you away.’”

Please contact Randy Dotinga directly at randydotinga@gmail.com and follow him on Twitter: twitter.com/rdotinga.

Randy Dotinga

Randy Dotinga is a freelance contributor to Voice of San Diego. Please contact him directly at randydotinga@gmail.com...

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