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ACHD cites "Mandate" of Healthcare Districts

Original post made by Jack Hickey, Woodside: Emerald Hills, on Sep 15, 2015

What is the mandate under which Hospital District morphrodites(a.k.a. Healthcare Districts) operate?
In it's latest "Executive Director Update" Ken Cohen, Executive Director of the Association of California Healthcare Districts(ACHD) congratulates Alta Healthcare District for finally paying off its creditors from a decades old bankruptcy. Numerous Healthcare Districts have closed their hospitals and declared bankruptcy, but it is rare for a District to pay off all creditors in full. With this landmark achievement, the District will continue on in existence to provide the legally mandated services to the residents of the District. Web Link
I sent the following to Mr. Cohen:
"As an elected Director of the Sequoia Healthcare District, I am unaware of
any “legally mandated” services applying to districts. Please enlighten me."
His response:
"Regarding legally mandated services, the term was used to describe that the District will now continue to exist to provide Healthcare services (this is the legal mandate) to the district. The specific array and range of services within the broad healthcare district legal mandate is

This is the mandate:

“To establish, maintain, and operate, or provide assistance in the operation
of, one or more health facilities or health services, including, but not
limited to, outpatient programs, services, and facilities; retirement
programs, services, and facilities; chemical dependency programs, services,
and facilities; or other health care programs, services, and facilities and
activities at any location within or without the district for the benefit of the district and the people served by the district.”
To which I responded:
Ken,districts ostensibly have been given powers by the Legislature. They
are not mandated to use those powers. The only mandates I can think of,
occurred when voters approved creation of the Districts for the specific
purpose of establishing hospitals.
32121. Each local district shall have and may exercise the following
powers(no mandate here): See:Web Link
Ken responded:
I think we may end up with a difference of opinion on this. Technically, a
mandate is the authority to carry out a policy or course of action, regarded
as given by the electorate. This is my view but it is shared by others, when
the electorate establishes a District, the give the District a mandate to
provide healthcare services with certain powers granted by the legislature.
The type and/or level of service is discretionary. A healthcare district
has a mandate to provide healthcare services and facilities (as determined
by the Board) to benefit the district. They do not have a mandate to provide
"water, sewer, roads, etc", this would be operating outside of their

If the District elects to provide zero service, they are not meeting their
mandate. It might then be up to the voters to determine if the district
should continue to exist, collect taxes or revenues, and provide no

In this instance, mandate and obligation are nearly identical.

For CA law, mandate / obligation are different from judicial mandates or
court orders.

Anyway, I hope all is well. Look forward to seeing you/Sequoia Healthcare
District in the near future. Your questions, as always, are provocative and
My response:
Ken, see: Web Link for the electorate mandate
for Sequoia Healthcare District.

I also sent this dialogue and the following, to Martha Poyatos(LAFC0) and cc'd Marianne O'Malley, Managing Principal Analyst, State and Local Finance Section, Legislative Analyst's Office
"Martha, doesn't this "mandate" question arise when determining whether an
activity of the District, (all of it discretionary IMHO) needs to be
continued by a successor agency? I see no mandate for a successor agency of Sequoia Healthcare District to continue the Nursing Program. Or to
subsidize schools, Ravenswood Clinic, Samaritan House, etc."

Comments (5)

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Sep 15, 2015 at 3:13 pm

Jack Hickey is a registered user.

ACHD is a lobbying and PR organization supported by Healthcare Districts. See:Web Link and, Web Link and, Web Link

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Sep 15, 2015 at 4:28 pm

Jack Hickey is a registered user.

Point of information: I received this e-mail from Marianne O'Malley, Managing Principal Analyst, State and Local Finance Section, Legislative Analyst's Office on Sept. 1, 2015:

"I read about your interest in eliminating property taxes for Sequoia Healthcare District and watched your campaign video. My colleagues and I are working on a project related to the allocation of California property tax revenues. We are interested in learning more about your experience, as well as any feedback you may have gotten regarding the Grand Jury’s suggestion that local property tax rates be lowered to eliminate funding for the district. Would you have time this week to talk with us?"
I sent her this response:
"Marianne, the 2012-2013 SMC Civil Grand Jury Web Link recommended that LAFCo contract out MSR’s for the Healthcare Districts.

The Grand Jury found that the service review of SHD conducted by the County Local Agency Formation Commission (LAFCo) would have had more substance if a consultant knowledgeable about health care districts had assisted in its preparation. The Grand Jury noted that SHD gives funds to the Ravenswood Clinic, even though the clinic is not located within its boundaries. The
Grand Jury also noted that the San Francisco State University (SFSU) Nursing Program supported by SHD needs careful monitoring to ensure that future graduates become and remain employed at Sequoia Hospital, or at least elsewhere within the County.
LAFCo staff conducted the 2007 service review of SHD and PHD. In contrast, an outside consultant conducted the 2012 Santa Clara County LAFCo Audit and Service Review of the El Camino Hospital District (ECHD).9 The consultant’s report was 94 pages long and was, by far, a more detailed analysis of the district’s operations. The report included an Executive Summary,
an Introduction, a section on ECHD and its affiliates, a section on Hospital Districts in California, an audit of ECHD, a service review of ECHD, and a section on governance and organizational alternatives. In addition, the report addressed two key questions:
1) Is ECHD providing services outside of its boundaries.
2) Should ECHD continue to exist and/or continue to receive public funds or could another entity provide ECHD’s services more efficiently.

I read the El Camino MSR and also discussed it with the firm which prepared it."

Her response:
"Thank you very much. We will be following up with LAFCO. Best, Marianne"

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Sep 15, 2015 at 4:30 pm

Jack Hickey is a registered user.

I also spoke with Marianne and her colleague for 20 minutes.

Like this comment
Posted by Jack Hickey
a resident of Woodside: Emerald Hills
on Nov 11, 2016 at 9:28 am

Jack Hickey is a registered user.

Contract for MSR is on the agenda for LAFCo's November meeting.

Regular LAFCo Meeting Web Link

Wednesday, November 16, 2016
2:30 pm

Board of Supervisors' Chambers
Hall of Justice and Records
400 County Center
Redwood City, CA 94063

Agenda Item 4. Consideration of Authorization of Contract with the Consulting Firm of Harvey M. Rose Associates, LLC, for Preparation of a Municipal Service Review and Sphere of Influence Update for the Sequoia Healthcare District and the Peninsula Health Care District

Web Link

Like this comment
Posted by Little state bucks
a resident of Menlo Park: Belle Haven
on Nov 11, 2016 at 1:54 pm

Looks like your guys got smoked again. There mistake? Hiding their background.

Sorry, but further commenting on this topic has been closed.

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