The Calaveras Enterprise asked Dr. Randall Smart, executive director of the Mark Twain Healthcare District (MTHCD), a series of questions this week regarding Measure A. Measure A, which is on the June 5 ballot, will approve a new lease between Mark Twain Medical Center and MTHCD and renew the affiliation with Dignity Health for the next 10 to 30 years.

Calaveras Enterprise: What are the alternatives you considered ​to renewing the lease with Dignity Health and why were none of those alternatives recommended​?

Randy Smart: The MTHCD contracted with several national consultants to advise us on what alternatives were available. We looked at other affiliations, such as Sutter Health, Adventist Health and Kaiser Health. Those health care firms chose not to provide proposals. The district also looked at independent operation. It was too expensive. We would need $30 million just to start. We don’t have that money.

CE: Which new terms in the recommended ​lease agreement are the most important and why? (See chart.)

RS: The most important aspect of the new lease is that our hospital will have a stable, long-term relationship with a nationally reputable firm. This offers our citizens tremendous security for health care access and quality. The lease also requires Dignity Health to maintain hospital bed numbers and specialty services. This is particularly important.

CE: If the lease is renewed for the next 10 to 30 years as proposed, how do you think it will affect health care in ​Calaveras County?

RS: If the new lease is approved as proposed, health care in Calaveras County will likely improve, and possibly expand under the management of Dignity Health. But equally important, the MTHCD will, for the first time, have a reliable revenue stream that will allow us to fill health care gaps in the county. This is huge and exciting.

CE: ​Will the proposed lease agreement have any importance to Calaveras County beyond health care?

RS: Yes. Mark Twain Medical Center is a countywide health care system encompassing eight clinics and a main campus in San Andreas where specialty services are available. That system has a significant economic impact on the county. The system has over 300 employees and has business relationships with many private businesses in the county, such as physical therapists, pharmacies, home health agencies and occupational therapists. If the Mark Twain Medical Center system fails because we don’t have a lease, the economic impact could be devastating.

CE: ​How will the role of​ the MTHCD change​ under the proposed new agreement​?

RS: The MTHCD will transition from a “hospital-based” health care district to a “community-based” health care district. This means that the district will be able to collaborate with other agencies, such as Calaveras County Public Health, Health and Human Services, schools and nonprofit corporations. These partnerships will create synergies to fill health care gaps and provide new services. This is very exciting.

CE: Will there be any tax increases or other additional costs imposed upon the citizens or government of Calaveras County if the recommendation is approved?

RS: Measure A, the new lease proposal, does not add any additional taxes and does not change your tax bill in any way.

CE: What choices does the MTHCD have available to it if Measure A does not pass?

RS: If Measure A doesn’t get 50 percent voter approval, then the MTHCD will have to either operate the hospital independently or continue to try to find another affiliate. It would be unlikely that we would find another affiliate; we’ve already looked. If we are forced to operate the hospital independently, we would probably have to file for bankruptcy. The hospital would then either close, like Tuolumne General Hospital did several years ago, or be sold to whoever is willing to buy it.

CE: Is there significant opposition to this agreement? If so, what have you observed to be the reasoning of those who oppose?

RS: We have conducted many town hall meetings throughout the county and listened to hundreds of citizens. We have encountered no opposition to the new lease.

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