So a bit of a fun little trip Exercise, how did we make that? What's up everybody? I'm EvilRabbit and we are here on Forza Horizon 4 to date for a little challenge to you guys So I decided to create a route that I Was not been eyeing up and trying to figure out how to do for a while So we are in our R34 skyline, which is tuned for basically grip racing I was using it. It is a a class car. It's a 799 So today we are going to take a look at the challenge that I'm bringing to you guys called stay in your lane challenge, so we're gonna go do that event here and Show you guys what I mean by the title. I think you guys can understand what the gist of the racing is gonna do So in order to get to this event you have to go to the Horizon Festival Sprint, which is located Which is located right? Left of the Horizon Festival So like I said, it is called stay in your lane challenge. So If you don't understand what it is by just the name of it, then well You're about to see it. So EvilRabbit presents stay in your lane challenge So retro sports car class, so we are gonna be using our skyline here today, but it is for any retro sports car This skyline this is tuned up on racing tires 799 a class car probably one of my favorite classes to race is a class cars and I Don't know if a super high powered car would be the best choice For this challenge. So we're gonna give it a shot. I did run it once on testing. So I haven't actually done it in The game to set my time or anything like that. So but basically it is Of course to set up where all the checkpoints are on the right side of the driving road where you should be driving So every checkpoint the entire race is meant to be on the correct side of the road There's small deviations where you can maybe pass some people and the drive cars tend to Move their self out of the way at one point of the race but we are going to do this here today and Just for the purpose of this we're going to knock down the difficulty just a smidge So I wanted to bring this to you guys It's and challenge you guys to do this and see what times people can get on this So if you guys want to give this a shot comment down below your times And me up on Instagram with picture of your times or what not very curious if you guys are interested in trying this a little bit of a Stay in your line challenge Stay in your lane. So here we go We are on our full logitech G920 900 degrees of rotation sequential shifter energy innovations wheel so in the beginning there's a bit of a open section where you can Kind of joggle for position, but you're gonna have to slide shop down And this is where the whole stain your lane begins Like I said, it is set up to where you will be driving in the correct lane of driving The entire race these guys are gonna be in my way I try to find a place to pass them So I did set it like these checkpoints are pretty small And they are all on the correct line of driving and I almost completely Went off course there so it's kind of a way to hone Precision driving I guess you could say and I'm having I had a lot of fun making this route and testing it and now We're just in a full full out race. So I mean technically if you were in a real street race Oh God you would be doing this anyways You would try to be staying on your side of the road So as you can see the checkpoints are very small and they're set perfectly on the correct side of the road so I chose my r34 because it is good for grip and it's all wheel drive and Kind of goes where I want it to But you can choose any other retro sports car. You want just a class cars are probably my favorite class of cars to race Try to stay in our lane because that's the whole purpose of this race is to stay in your lane the entire race It's a little bit of a section here. That's a little bit wider on the lanes Almost lost that this was a drive charge decide to go Miss that turn so that's your chance to get ahead and get some clean air but the whole Section is to try and stay in the lane not hit the walls like that So there is parts of the track that you can drift wide But you better make sure you Come back into the lane to get your checkpoints because I did set the checkpoints very close together And then you're gonna make sure you want to blow yourself down here because it's kind of a hard turn But you also got a state within the driving line and Try and stay on your side of the street So this was a challenge I've been thinking about doing for a while And I just thought about doing it and bringing it to you guys to see if you guys be interested in it I'm also very interested in doing this in almost like a drift car and do it in a drift race And see if I can't drift in my own line Which would be very interesting to try and do street drifting staying within the checkpoints. I Broke a little bit too much there. I didn't need to break that much So as you can see these checkpoints are pretty Pretty narrow and right there. We're gonna be able a little bit off our line, but we're gonna pretty much stay in our lane And we're gonna head back up the Little mountain section, but this time on the outside of the turns Given the correct driving roads So it's kind of a fun little challenge to do so I challenge you guys to give it a shot Let me know what you guys think that's probably not staying in my lane right there And I'd be very curious to see what type of Step of cars you guys chose in the retro sports car class and What kind of times you guys are getting on this little track?  I mean, it's it takes a little bit of a precision. I was able to play in 344 oh nine one so It's definitely a fun little challenge a challenge you guys to give it a shot stay in your lane challenge Try and do this challenge as quick as you can but make sure you know with staying within the lane But there are some spots where you can deviate like I said the majority of it You're gonna have to make sure you get back into your lane so that you can get your checkpoints because they're really close together and very narrow so Head to the festival give it a shot for yourself. Let me know what you guys think about it I think we should uh, maybe see if we can't get a little retro drift car, which I think I may have a Rotary a bit of a rotary in here, so we're gonna flip ourselves around I was going the right way I Head back to the festival and Change up cars and try this one more time. I think I need that for this on we may uh, I will be alright No worries. We'll get the forces on later, but we're gonna cut through here to get to Back to our little race section so that we can Try it maybe in a drift car out Maybe in a drift car and see how See how it works in the drift car so a bit of an interesting take on a street race because uh Well, if you were actually in a street race, you would definitely be trying to uh Stay in your lane through some of the sections. So that was the kind of the main purpose of that That didn't work Get wrecked on myself I thought I could e-brake this and slide it but then I realized this is all we'll drive with some really really grippy tires So I gotta remember I gotta go back to this event and uh Going to my custom event if I went to the right one I did Go to my event stay in your lane challenge Did I click it? I did click it Game's taking forever to love for there. We go What kind of cars we got? Oh, we got my z's and my 240s Oh, we have my a-class s 14 or a-class s 13 Mmm, and we got some z's too Alright, so I think we're going to uh We're gonna take the 240 out And uh, see if we can't do this little stay in your lane challenge in the drift car and uh, maybe uh Get our drift on in these sections without uh, actually going too far out of the track Do it in this kind of a drift race style because the car's set up to drift So I may not need handbrake although I may use it. Um, because it will just get sideways This is a fully built 240sx with um stock motor turboed Full drift suspension full drift spec and uh It's a little over 400 horsepower but it's 421 horsepower So, uh, this should be definitely a very interesting challenge. I'm definitely going to let those guys go ahead of me and uh Do this in the 240 hang back a little bit. See if I can't do this challenge sideways Oh, it looks like we've got Paul Walker over there So we are going to Do this thing sideways and uh See what happens. I'm gonna let them go Got a lot of little 240s going on here. So a little stay in your lane challenge In a drift car so we got to try and uh, basically be street drifting this car and racing it without uh deviating from our lane too much I'm gonna have to Try and pass that guy Oh and see that's where I'm deviating from the lane and I'm kind of Losing it there Oh, yeah, see I tried to get a little bit too aggressive and I missed my checkpoints So we're going to uh rewind that a little bit. So this is actually uh A bit harder if you want to try oh my wheel was turned get wrecked on myself so this is uh actually a bit harder than just uh driving it normally trying to uh Basically drifting your lane In a real drive drift car. Oh too much See go a little bit too wide. So this is actually uh A challenge in itself You want to try some precision? Drifting try doing this In a drift car and hit all your checkpoints while going sideways. Oh, that's uh This is a bit of a a twist on my uh little challenge here We go It's a little bit better a little clutch kick Loss of power there, but we're still uh Someone staying in it a little bit on the wall, but we're good. We're just kind of staying in our lane We're hitting all our checkpoints.  Now i'm getting the i'm getting the feels of it That's not going to get the feel of it that will save me. Oh my gosh so a bit of uh a fun little Drift Exercise, how did we make that? Oh my god Yeah, I'm not worried about winning. I don't I just want to know how we made that this is a little bit of a Drift exercise workout trying to do some uh Legal street drifting if it's uh legal by any means This is actually pretty fun doing a little sideways sliding in a In a race where we gotta stay within our It within our lines. Oh boy Other than that, that was way offline and now we're gonna have to do this Fill the opposite way That guy missed the checkpoint Oh, I as I say that I completely just passed that checkpoint so Try this with a drift car as well this is uh Something else and it it's it's a fun challenge by itself, but Throw a drift car in the mix and trying to stay within your uh Then your points while going sideways I drifted a little too wide. We're able to get that point though. I have to drift the outside now Not like that. We don't so I'm definitely gonna have to uh practice this myself and uh Get better at doing this sideways Staying in my lane. Walla drifting So a fun little take on a created race Give it a guys give it a shot. Let me know what you guys think about it and uh Make sure you guys follow me on instagram and also for media sites all which are found in the description box below And as always I like thank you guys for coming back. I hope you guys enjoyed this video I hope you try this challenge. It's definitely a lot of fun So until next time I'm evil rabbit


Welcome everyone. I first want to acknowledge all of you for taking the time out of a Sunday afternoon to be here in solidarity around protecting Watsonville Community Hospital's a critical resource in our area. Just to introduce myself my name is Jennifer Holm. I have worked at Watsonville Community Hospital in the intensive care nursery as a registered nurse since I graduated from Cabrio College in 2005. My youngest child was born at the hospital surrounded by family the family that is directly related to me but also the remarkable colleagues who truly have become family by choice. I am now also a Cabrio College nursing instructor and the welcome that our hospital gives to our students. The opportunities that they have to learn and develop their practice is an invaluable opportunity for the community to be served by those from within the community itself. To me the heart of what is special about our hospital really is each and every one of you.  Today we'll hear from nurses who will give a brief rundown of the history of the hospital, describe a community health assessment, areas of concern. We will also also on the panel are of course Watsonville City Mayor Francisco Estrada, we have Dr. Joe Gallagher, we have Dori Rose Inda, CEO of Salud Parlajente and Deandre James, CEO of the Pahoa Valley Community Health Trust. We will also have a question and answer comment period and we've anticipated that there may be a large number of questions and comments. So we took a page from a town hall that Secretary of State Alex Padilla and County Clerk Gail Pellerin had about voting rights last year and we're asking those of you who have a question or comment to fill it out. Our moderators, Elisa Arrona, Executive Director of the Health Improvement Partnership of Santa Cruz County as well as Maria Elena de la Garza, Executive Director of the Community Action Board will be compiling and organizing the questions and comments, grouping similar types so that we can address as many issues as possible in the time that we have available. So if you haven't picked up a card, we have some nurses who will be filling them out. We will be you know gathering them probably after the nurses speak and then while the rest of the panel is introducing themselves and then we'll head into the discussion. If there are a large number of cards that we can't get to, we will be following up. So please put your contact information so we can provide that to you. We'll then close and there'll be refreshments in the community room. Felipe, did you want to welcome the community as well? My first time up here, sorry. I took one of the welcome folks up here as well. My name is Felipe Hernandez, Watson City Council member and I appreciate everyone you know being here and this is what's great about our community that you know the City Hall is filled up on a Sunday afternoon. This is what community is about. So thank you for being here. You know our community has a history of coming together when there's a time of need from earthquakes to labor strikes to floods. The community always comes together to help those in need. You know the community should always be concerned when the nurses are out in the community in City Hall instead of the hospital. Nurses, you know their primary job is to take care of the community and so when we're sick, we go to the hospital and they bring us back to health. Right now, we as a community have a responsibility to help the nurses at this time in need when they're in need. I think that as a community we need to make sure that the nurses are well taken care of. You know, the nurses and the workers at the hospital are the heartbeat of that hospital. They're the ones that make it run. So let's come together. Let's ask the pertinent questions about the new ownership and about our local healthcare system. We all have a connection to this hospital. We all have a family member or a friend that works there. I myself was also born there. All my brothers were born there. My sister was not born there. My sister was born in Santa Cruz because my mother didn't want to cross the picket line at that time. So let's give the nurses and let's give, you know, our community a big round of applause and welcome them. Thank you, Felipe. So as somebody who serves on the Pahoa Valley Unified School District Board of Trustees, I know that many of our elected officials are here in their capacity as a community member rather than in their publicly elected roles, but I want to take a moment to acknowledge a few people and I know that somewhere either here in the other room, Dominic Dursa is here representing Robert Rivas, a California State Assemblymember for District 30. Dr. Ferris Sabah, Superintendent of the Santa Cruz County Office of Education. From the Cabrillo College Board of Trustees, we have Dan Rothwell and Adam Spickler. From the Pahoa Valley Unified School District Board of Trustees, Danny Dodge Jr. and Kimberly Deserpa. From Watsonville City Council, of course, our mayor, Francisco Estrada and Felipe Hernandez. Aurelio Gonzalez, Rebecca Garcia and Trina Kaufman-Gomez. If there are any elected officials that I did not see, please stand and briefly introduce yourself with your name in your office. Is there anyone I missed? Okay, good. Well, with that, we are ready to begin. Good afternoon. My name is Rosanne Ferris and I've been a registered nurse in this community for the past 23 years. I work at Watsonville Hospital in the Critical Care Department and I'm just thrilled to see all of you guys here today coming together as a community. So I'm going to present the history portion just to give some information about the history of Watsonville Community Hospital. So over 100 years ago in 1895, Dr. P. K. Waters came to the Pahoa Valley to build Watsonville Hospital, a five-room sanitarium next to his home on East Beach Street. His vision was to improve health care for our community and to promote modern medicine. Having served its purpose and needing replacement, a group of local doctors initiated the drive to build the new hospital. In 1938, they invested to build the new hospital, which was on Montevista Avenue, and sold stock in the community to fund this venture. Right after World War II, the maternity wing was added by selling additional stock. In 1956, the Ford Foundation paid to expand, remodel, and add a laboratory to the hospital. As a non-profit hospital, income was returned to maintain and operate the facility. The board of directors at the time, 23 physicians, one banker, one lawyer, two service league members who were all well established members of the community. The pride in the hospital was an important factor in its success. In 1965, our population had grown, requiring the new facility that was built on Green Valley Road. $3.2 million was needed to build this hospital. $400,000 was borrowed. The community raised $600,000, and the remainder came from federal and state grants. The community raised more than was borrowed. The community valued having a cutting-edge facility raising a total of $638,235, which was the largest amount raised in the history of the Pajaro Valley. The people living in Watsonville Community Hospital service area looked to the hospital to care for their needs. Likewise, everyone in that area gave special attention to the needs of the hospital. The people of the Pajaro Valley have always supported the hospital. This can be seen by the repeated contributions to the hospital year after year. In 1989, the Loma Prieta earthquake devastated our community. Small community hospitals were already experiencing financial challenges. Even with the FEMA assistance, the earthquake had a devastating effect on the hospital that significantly contributed to the need to sell the hospital. Prior to the initial sale in 1998, the community lost inpatient drug and alcohol rehab unit and the inpatient medical-surgical rehab unit. The Pajaro Valley Coalition to Save Community Healthcare was a group of community advocates that formed for the purpose of safeguarding acute care, particularly charity care and keeping the ER open. The hospital board at the time worked with the Attorney General and succeeded in keeping charity care. Dr. Stanley Hayduk was one of the board members and he was instrumental in securing the emergency room state open. However, the most important item that they secured for the future was the Rite of First Refusal. Eventually, 20 local people from all walks of life were appointed to the new Pajaro Valley Community Health Trust. What they shared in common was that they valued and worked towards ensuring adequate access to health care for residents of the Pajaro Valley. When a non-profit hospital is sold to for-profit corporation, it requires the Attorney General to ensure that the health care needs of the community are met by the owner. One of these needs is to protect health care for the poor. At the time, the Attorney General required the existing contracts for indigent care to be maintained. And these protections are lost once the hospital is for-profit facility. In 1998, Community Health Systems, a nationwide for-profit hospital chain, purchased the hospital and made many promises to improve and grow health care services for our community. Later that same year, CHS laid employees off across the board. This was the first of several rounds of layoffs. CHS owned the hospital from 1998 to 2015. During that time, the community witnessed the closure of the oncology unit, home health agency, including mother and baby home visiting program, sweet success, a diabetes support program for pregnant women, the outsourcing of billing and coding departments resulting in significant loss of jobs to this community. In 2015, CHS spun off the hospital to its subsidiary Quorum. Under Quorum, the cardiac catheterization lab has been closed for two years and the hospital stopped using 30% of its available beds, effectively turning away patients forcing them to seek care in other communities. The Pajaro Valley Community Health Trust was formed with the excess proceeds of the initial sale for the purpose of safeguarding health care needs of our community. As a protection, the PV trust has the right to match a potential buyer's offer and purchase the hospital thereby returning it to the community. As a community hospital. In talking with the community, I got a sense that people love this hospital. At some point after it was sold, there was a disconnect of the community to the hospital. Those ties were no longer. You can see this by the donor plaques that represented decades of support from the community that have been removed from the walls of the current hospital. We need to regain that pride and we do this by taking the responsibility for this being our community hospital again. Thank you. Hello and thank you all again for being here today. My name is Amy Groters. I'm a registered nurse at Watsonville Community Hospital in the emergency department. I have been a staff member there a little over a year. I came as a traveler immediately noticed that there was something special about this community hospital and about the community of Watsonville. So I decided to stay and make it my permanent job. What I will be going over today is the health assessment of Watsonville in our community. Some quick demographics. The population of Watsonville is greater than 53,000 people. 84% are Hispanic, 11% white and 2.9% Asian. The poverty level within Watsonville is a key determinant when assessing community and individual health. More than 30% of total households in Santa Cruz County do not make enough to meet basic needs. In Watsonville, 15.6% of the population, that's one out of every 6.4 persons, lives below the poverty level. That is a higher than average percentage when compared to the rest of California. That means being poor in Watsonville means you're really poor. As we take poverty levels into account, we begin to recognize the impact it has on our social environment. For example, CalFresh, a food assistance program, has had a steady increase of participants from 2008 to 2015 within our county. The purpose of this program is to provide food for those who would otherwise be without. This shows us that there is a steady need of people in our community who need assistance in obtaining food. And in spite of being in a rich agricultural center, Watsonville is considered a food desert according to the USDA standards. Meaning that for many in this community obtaining food is limited due to low income, poverty, and lack of access to affordable healthy foods. Access to health care is another determinant in health assessment of a community. Santa Cruz has a lower percentage of people carrying health insurance when compared to the rest of California. Though we can see on this graph that the primary care provider ratio to population is high, higher than the state, it does not account for retiring physicians, physicians who do not take Medi-Cal or physicians who are unable to take new patients. That's why it's vital for organizations such as Saludparta La Jente to be in our community. One highlight is Watsonville Hospital has improved its number of breastfeeding mothers. There has been a declining rate of C sections. There has been improvements in low birth weights of babies. There has been decreases in adverse outcomes of infants. And our nurses have noticed a decrease in number of neonatal stabilizations. What this means is that mothers and babies are healthier. This is a direct result of partnerships between our community organizations and the nurses and doctors at Watsonville Community Hospital. As we have seen from this health assessment so far, there's a large population living in Watsonville with high levels of income inequality, high levels of poverty, and in terms of health are of population affected by higher than average rates of diseases, specifically heart disease, cancer, obesity, drug and alcohol disease and diabetes. This staggering slide shows us that there's also an increase in suicide rates in Santa Cruz County higher than that of the state and national levels. With very few mental health services accessible in Santa Cruz County and even less in Watsonville, the community is greatly affected. This slide here is a graph of premature death rates within Santa Cruz County. Premature death is a death that occurs prior to the average life expectancy. As you can see, Santa Cruz has had a steady increase in the number of premature deaths. For Watsonville, these premature deaths are related to cancers, heart disease, obesity, diabetes and drug and alcohol disease, many of which, though not all, are preventable with appropriate health care services in place. The premature deaths related to suicide are often reflective of homelessness, poverty, and a lack of access to mental health services. The data from this health assessment shows that many living in this community are faced with high cost of living while living in this community and affected by disease at high rates. As a nurse in this community, I see daily the effects that these factors have on the people of this community. I can attest that Watsonville, as well as Santa Cruz County, is in vital need of maintaining our local hospital, improving services, increasing services, and not cutting or limiting services for the betterment of the people in this community. The point is this, having a community hospital, which is dedicated and understands the community health it serves, is not just critical in treating people who are sick, but in keeping people healthier on the whole. Thank you. Welcome, everyone. My name is Kiche Rubalcava, and I've been a registered nurse at Watsonville Community Hospital for the past 16 years. I've been a nurse at Watsonville Community Hospital. What I'm going to touch on today is some of the concerns that the nurses have. On June 6, 2019, our community and the 620 employees of Watsonville Community Hospital learned for the first time that a brand new for-profit entity with no traceable track record of owning hospitals and unknown funding sources was apparently seeking to buy our hospitals. In the Pajaronian, Halson also stated it had been working on the purchase for more than a year without any prior notice before that late date to the Pajaro Valley Health Trust, who has the legal right of refusal in the case of any sale of Watsonville Community Hospital. And there was no prior announcement or public discussions with our community and no discussion with hospital employees. As frontline registered nurses with an all too clear knowledge of what for-profit corporations have done to so many of the medical services, specialties, and our ability to give safe quality of care here at Watsonville and other communities across California and the U.S., we were immediately concerned. One of our most immediate concerns had to do with the real possibility of vital unit closures because of what we know of these for-profit business practices. The closure of these vital units is usually based on their profit margins without regard to our patients and community needs. Closures of vital departments and units such as ERs, labor and delivery and critical care have risen dramatically across the country. In California and especially in rural and semi-rural communities, emergency departments are particularly vulnerable because they are not seen, often seen as not profitable enough. In 2016, because CHS was in debt from borrowing too much to purchase too many hospitals too quickly, it chose to offload 38 hospitals across the country to a spin-off, Quorum Health Corporation. Watsonville was one of those 38 hospitals and like CHS, Quorum also used the rural model as its business strategy, implementing the same policies that prioritize profits over patients. We can see the strategy in the closure of our cardiac catheterization lab after Quorum took over in 2016 and its decision to reduce the use of beds in key areas such as telemetry, medical, surgical and critical care units. The registered nurses know we cannot afford this kind of decision when it comes to our emergency department and other vital units. From 2012 to 2015, CHS reduced or eliminated emergency rooms, trauma centers, obstetric services, labor and delivery units, pediatric units, psychiatric units and medical detox units throughout the country. Due to the CHS rural model, many of these services were the only ones available for miles, placing particular hardship on non-urban residents. In one of the most comprehensive studies on this subject to date, the California Office of Statewide Health Planning and Development studied 48 hospitals that closed their emergency room departments between 1999 and 2010. As you might imagine, closing emergency rooms has real-life consequences. It means longer response times that are dangerous in emergency situations. Time is of the essence in the cases of a heart attack, stroke and severe infection. The California study showed that heart attack, stroke and severe infection patients faced a 15% greater risk of dying in the hospital if there had been a closure of an ER nearby when compared with similar patients at unaffected hospitals. Obstetric departments have also seen overwhelmingly high rates of closure between 2004 and 2014. The percentage of all rural counties in the U.S. that lacked hospital obstetric services increased from 45% to 54% due to the hospital OB unit closures. A key result of OB unit closures is that patients may show up at the delivery with little or no prenatal care due to the distance of the next nearest hospital adding to the risk of delivery, poorer outcomes and increased risk of death. But the real bottom line of OB unit closures is that mothers and newborns pay the price for lack of access to medical care in their own communities. A for profit decision that as nurses we cannot condone. CHS has a record for the slash and burn model of buying, extracting the most profit possible and then closing hospitals. A hospital bankruptcy and closure is one of the most serious concerns for Watsonville nurses after learning an unknown completely new for profit was attempting to purchase our community hospital. Hospital closures are on the rise in rural and semi rural areas like Watsonville in both California and across the U.S. In fact, just as we see in trends of cutting critical units such as the ER, labor and delivery and critical care, for profit corporations have a dismal record of buying, making all they can and then shuttering entire hospitals. We can see this trend clearly in the slash and burn business model CHS has employed. After extracting all the wealth possible, CHS and quorum typically sell the hospitals or shut them down. When CHS closed two hospitals in East Tennessee last December, a region deeply affected by poverty and a public health crisis related to the opioid epidemic, it caused an already strained healthcare infrastructure to get worse. Last March, in the letter to the editor of the local newspaper, a resident of Knoxville, Tennessee writes that his wife had to wait for 15 hours on a gurney in the hallway of a local hospital before she could be seen by an emergency room doctor. And when he asked why it had taken so long, he was told that this was the new normal there, it was the new normal there due to the healthcare shortage. In January, one gunshot victim in downtown Knoxville who ultimately died is believed to have had a chance of surviving if it weren't for his longer wait time to get emergency medical help. Emergency departments also serve as a safety net for people with acute mental health or addiction treatment needs by stabilizing them and arranging for their transport when needed. When whole hospitals close, local capacity to address these needs disappears. The lack of a major health center or acute care hospital can create a domino effect. Doctors don't move in. Hospitals are short staffed and underfunded and potential residents and businesses are discouraged from relocating by the absence of nearby healthcare. All of this affects the local economy. For the Watsonville registered nurses, the real risk of this happening due to yet another for profit venture is just too high. Thank you. Good afternoon, everyone. My name is Francisco Strada, and I have the honor of representing the good and hardworking people of the city where I was born and raised. For the sake of transparency, I would like to let everyone know that I'm currently an employee of the Pajaro Valley community health trust as a program's officer. But I am here today speaking to you as the mayor of Watsonville and as the first servant of the people. First off, I'd like to thank each of you for being here today on this Sunday afternoon, as well as our moderators, our panelists, and specifically the remarkable team of nurses who have worked diligently to bring the community together to have this important, inclusive, and frankly overdue discussion about the future of our local healthcare system. We would also like to thank the health trust. It's board and executive director for all that they have done in such a short amount of time on behalf of the Pajaro Valley community. As the mayor for the city of Watsonville, and speaking on behalf of the city council, I want to assure everyone present here today that our highest priority is, and will always be, to safeguard the health of the community and to protect the well-being of the people we serve. And this includes advocating for the hospital staff and their families that have gone above and beyond for their community and who depend on the hospital for their livelihood. Since we became aware of the intent by the health care group to purchase Watsonville community hospital, the city council and the city manager's office has been closely monitoring every development. We have offered the health trust our full support. We have held multiple conversations with the potential buyers to share with them the concerns of our community. And I like to, and each member of council has done its best to meet with residents about this complex issue. Particularly, I like to thank my colleague Trina Coffing-Gomez for her leadership as a member of council as the city's representative on the health trust board and as a former employee of the hospital in helping the city perform its due diligence. Finally, I am here today as someone who will live with type 1 diabetes for the rest of my life. As someone working to manage a lifelong disease, I do not take my health or the health of my fellow residents for granted. I can tell you firsthand how important it is to have a local health care system that champions prevention and upstream medicine especially for our most disadvantaged populations. For a long time now, our hospital, for a long time now our hospital hasn't been the pride of the community that it once was. Ever since it became a private entity, I personally don't think it's been the facility that we know it can be. We have a unique opportunity today to collectively discuss and begin building the inclusive health care system that we all deserve. Remember, at the heart of the names Watsonville Community Hospital and Pajaro Valley Community Health Trust is community. Thank you. Ladies and gentlemen, thank you for coming and I'd like to thank California Nurses Association and the local nurses for putting on this community meeting. My name is Joe Gallagher. I'm a family physician and been here a long time in Watsonville. I'm not here as a representative of the medical staff or of the hospital. I'm here as someone who worked in the old hospital and has worked in the new hospital as well. Certainly the hospital in Green Valley Road and prior had a matter of quite a bit of civic pride about it and community connection but I'd also like to add that good medicine was practiced there. People worked hard on a daily basis to make sure the right thing was done for patients and quality improvement was taking seriously. It was a central part of how we managed that hospital. Another characteristic that to me is the kind of lingering characteristic of that hospital is that it was fundamentally honest. You could trust that if someone told you something, it was the truth. The culture of the leadership was also transparent and the overwhelming climate for employees was one of democracy. Employees grew as a result of working in that hospital. Unfortunately, all that was lost in the fourth quarter of 1998. The culture of community health systems was remarkably opaque. Even board members did not have access to what was going to happen at the board meeting prior to being present at the meeting that night. You've heard about the cuts in services instead of presenting to the health trust the need for a cut in services. Services were cut and then forgiveness was asked for. With regard to the oncology unit, there was a change in the way chemotherapy was reimbursed. And then CEO Kaler Schenberger went to the employees of the oncology unit and as part of his description of the reasoning he said it's not that we're going to lose money on oncology. We're just not going to make the amount of money we'd like to be making. One of the most startling things that happened early on was that the new organization fired people on Christmas Eve in 1998. When I challenged the CEO about it he said well I didn't really think that was the right decision. So I knew we were in trouble when they would do something that inhuman and then not take responsibility for it. When I first heard about Halson I looked at their website and saw some internet research about the principal members of Halson Corporation and what I found in the Orange County Register the Orange County Weekly and the Desert Dispatch were really quite startling. Hospitals there had great difficulty when affiliated with the members of Halson. In my opinion the things that I read on the internet from those newspapers that we had lived through for the past 20 years excuse me. So I believe it is exactly for this reason that the health trust has the right of first refusal. The purchase of a hospital fits squarely within its mission to improve the health care of all members of the Pajaro Valley. The philanthropy that it has pursued for the last 20 years has been a very valuable thing. That has assumed that there is a functional hospital in the community and that assumption is no longer guaranteed. It is my sincere hope that the health trust comes to understand that a community non-profit hospital is the best way to reliably assure access to hospital care for the members of the Pajaro Valley. Should Watsonville Hospital falter or close, it throws the whole county health system into crisis. There is not sufficient capacity either in the Sutter hospital or in the Dominican hospital to absorb for example the 30,000 ER visits that occur in Watsonville in a year. I would also like to take this opportunity to say that I would be very much appreciate being the leader of a team that puts Watsonville Community Hospital as a non-profit. One that serves the community's needs. One that regains your trust. That doesn't exploit anyone in the process and does so in a way that's financially stable. I believe my passion for this and that of all of us in the room is an important piece of a solution here. But I also believe that it's not enough. We wonder if there is technical expertise to do this and I can assure you that there really is very good technical expertise to bring this together. Thank you very much. Good afternoon. My name is Dory Rose Inda and I am the Chief Executive Officer of Salud para la Gente and I have lived and raised my family in Watsonville over the past 25 years. Salud para la Gente is a federally qualified health center which means that we are federally mandated, missioned, regulated and funded to ensure access to primary care regardless of ability to pay and insurance. We provide those services through medical, dental, vision, behavioral health and counseling, supportive services and various specialty services. Our medical services include family practice, pediatrics and OBGYN and specialty services that include pediatric psychiatry, nephrology and chiropractic services on site and through telehealth services, endocrinology, dermatology, neurology and adult psychiatry. We serve 27,000 of our community members close to half if not half of our community all of whom count on Watsonville Community Hospital as their hospital. Salud partners very closely with Watsonville Community Hospital to ensure high quality comprehensive health care for local residents from birth until death. Since 2015 Salud partnered with Watsonville Community Hospital by providing a 24-hour a day, seven days a week hospitalist group to deliver almost all of the infants born in the hospital each year. This partnership allows women comprehensive perinatal services and ensures enhanced services in the areas of nutrition, psychosocial and health education and walking hospital tours for expecting moms, daily on-site hospital-based scheduling for newborn and lactation follow-ups and postpartum check-ups at Salud's clinics including the two who are co-located on the hospital campus. The Salud's partnership with the hospital ensures that all pregnant women delivering at Watsonville Community Hospital receive the same excellent standard of comprehensive care allowing each entity to contribute to quality while realizing efficiencies and promoting cost-effectiveness. We partner with the hospital for gynecological surgical procedures allowing patients to stay in their hometown for treatment of acute health conditions. To address substance use disorders and addiction we partner with the hospital to ensure counseling is available on-site for individual assessments of substance use allowing for treatment plan for the moment of crisis in which patients are most likely to accept this life-saving service. Across most areas of care Salud and the Watsonville Community Hospital partner allows for timely and seamless transfer of patients and records between health care providers and facilities. This reduces complications allows for good coordination of care and improves patient satisfaction, provider satisfaction and patient outcomes most importantly. Salud's demographics reflect the same of the hospital and our community. 90% of our patients are Latino almost 80% primarily speak Spanish and almost 80% live below the federal poverty level. Not surprisingly 70% of our patients rely on MediCal and 10% are uninsured. A little over 40% of our patients are farm workers and many others work in ag-related and service employment. While these workers rise at dawn and work until dusk to ensure healthy food is on our plates that keeps our region our state and our country healthy their reality is quite different. Immigration status race, language literacy barriers very low wages and one of the most expensive housing markets lead families to rely on substandard housing unfair or unsafe working conditions and sometimes dangerous family relationships. These in turn result in poor physical and mental health. Salud's patients experience and this community experiences high rates of hypertension diabetes obesity and musculoskeletal injury. While agriculture is essential to our region it is also rated one of the most hazardous work. Farm workers face high risk of injury and illness yet often go without insurance and hesitate to access care because of the same fears mentioned above. Recent federal policies and actions including those threatened today exacerbate this fear and jeopardize a willingness to access healthcare. Farm workers earn a median annual wage of 20,000 a year 10,000 below what California family poverty threshold is. Nearly 30% of families with children under age 5 in this area live below 100% of the federal poverty level. While these are very significant challenges and our community faces significant health disparities we have an amazingly strong community. It is a very hard-working community with tremendous partnerships among government and community-based organizations and healthcare that ensure this community feels safe and is able to access as much as the services that it can. The community that Salud serves does face many health disparities and it does not fit into a formula that results in a profit margin for a hospital. In fact without Watsonville Community Hospital caring for this community the sustainability of all of our healthcare partners in the region become at risk. As mentioned earlier, Dominican Hospital provides significant care for the MediCal and underinsured population if it were to be responsible for the care of our community as well it would be unlikely to be able to sustain its services. Together Watsonville Community Hospital Salud para la gente, Sutter Kaiser the County of Santa Cruz and Monterey Dominican Stanford, Natividad and our other FQHC partners make sure all the needs of our communities can be addressed. Watsonville Community Hospital is a crucial partner that ensures this fragile infrastructure and without it the sustainability of all the others is jeopardized. This important community deserves the same health and well-being it makes possible for the rest of the region the state and the nation. Watsonville Community Hospital matters this community deserves an opportunity to make sure its hospital always has the community's needs and interests at heart and not outside investors focused on maximizing profits. A locally controlled hospital is not simple nor a sure thing but with cross community cross sector and cross health care institutional commitment and investment it is the only promise for local sustainable health care that can provide the services that our community needs and that lead to a healthy and thriving community. Our community is too often suffers under the burden of fear and lack of opportunity to advocate for its own best interests. All of us, each of us as concerned community members face an important opportunity to restore service and quality through a hospital that puts the needs of our community first today and the future. Thank you. Good afternoon. DeAndre James, CEO of Power Valley Community Health Trust I'd like to thank you all for inviting us and being here. The Mayor City Council like officials, our nurses thank you all for being here, our community for being here this is a I understand a very large topic for the community in the last years. I want to say that the Health Trust mission is to improve health and the quality of life for all people at Greater Power Valley. We envision the community in which each every resident has the opportunity necessary to restore full potential. We accomplish our mission and vision by ensuring access to high quality culturally responsive health care services and supporting the community in building strong aligned health systems. We uphold this mission through our core values of respect involvement integrity and equity. In regards to this topic and all our focus is to ensure that we have long standing, high quality health care with partners in the community for the foreseeable future and to us is regardless of who owns the hospital the importance is that we have these services that are necessary for the community and that's been our focus the entire time of being notified from June 6 and our board and everybody in SOS have been contacted by a lot and it's been humbling that this community reaches out in this fashion and this is the heart of the community and as the Health Trust we take that very very seriously and this is not a light of heart and we want to make sure that we have the services necessary in the community for the foreseeable future. Alisa Alisa I just want to believe it has a quick logistics announcement. A few house items first I'd like to acknowledge council member Lowell Hearst they just arrived also on both sides of the wall you'll notice that there's the light switches that keep going off and on if you lean back on those they'll flick the light switches on so be careful with the light switches there's a disco in here also the restrooms just to let you know are right outside the doors across the hall make a quick right and a quick left and they're right there on the double doors you'll see them right outside across the hall thank you Great good afternoon everyone and thank you for coming on a Sunday to talk about this important community decision that we are all making I want to thank the Watsonville community hospital nursing staff for their informative presentation and also the community leaders who have come today to share information and to answer questions I am pleased to be co-moderating today's discussion with this panel I am joined by Maria Elena who I'd like to introduce herself please Maria Elena Good afternoon I'm Maria Elena and I am purposely on this side of the podium as my responsibility is to help bring to life the comments that people in this audience have I would like you to know that I have five comments thus far and we will still be collecting comments as we go through this part of the of the day I am Maria Elena de la Garza I'm born and raised in Watsonville and I was born in the old Watsonville community hospital and today I was to be a fly on the wall to listen to what the community had to say and to learn about this important conversation and I was asked by Alisa to help and to support the conversation so I'm here with respect with humility as a representative of the community that I am a part of Thank you Maria Elena for joining me My name is Alisa Arona I am the Executive Director of the Health Improvement Partnership we are a local nonprofit organization and we represent the health care organizations here in the community as explained at the beginning of the town hall by Jennifer we have collected comment and question cards in English and in Spanish and the comments will be read aloud by Maria Elena and I will be asking the questions to panel members we only have about an hour left and probably a little bit less because we are going to need some time for closing comments so keeping that in mind we are going to do our best to share all questions and comments but it does mean that the questions will be grouped by themes you may not hear your exact question but we hope to by theme be asking similar lines of questions of the audience excuse me of the panel members we also plan on responding to all questions at a later time so if you have submitted a question please also include your email address if you would like a response I want to remind everyone that we will not have an open mic there are so many in the room and we really are trying to manage the time that we have so we really appreciate everyone's respect of that process so that all questions and comments can be brought forward or responded to at a later time sure I've covered my bases so we will start with comments from the audience we really appreciate the hour that you've spent with us listening to this information gathering your thoughts and now we'd really like to share your voice so I'm going to ask Maria Elena to come please add to the podium and share some of those very very concerned about the possible sale we need Watsonville Community Hospital and its vital services we need to reopen and revitalize our beloved local hospital access for the poor will be diminished because a for-profit must pay shareholders and taxes I am concerned quality of care will be compromised we need to protect this most valuable resource in our community it should be owned and managed by people who are advocates for the health needs of the Watsonville Community I would prefer to see a true community hospital with a CalPERS pension for their employees I am concerned for profit corporations buying Watsonville Community Hospital my concern is some inflation adjusted costs 638,235 community raise funds in 65 equals 5,189 823 in 2019 sale price in 98 was 56 million in 2019 is 88 million the current price equals one third of the 1998 value when you sell a business at such a deep discount it is not a healthy business with an aging parent on a fixed income I am concerned with the reduction of care due to cuts and the possibility of a closure and distance to Santa Cruz which risks life in an emergency situation the concern is the new model of operations of a hospital is to fire travelers to hire travelers to staff not local people travelers from Everstate with no connection to the community here for three months and gone I would like to just take a moment to acknowledge those comments from the audience and to ask if any of the panel members have any response to any of those particular comments I also have a more formal question if you would like to proceed Dr. Gallagher in terms of the sale price being one third of the 1998 sale price there is much of the background financing of quorum health systems that is involved in coming to that sale price okay so I am going to start with the first question from the audience I am from Spanish and I will translate after I would like to know if the nurses of the CNA are going to continue to work without cuts and hours and at the same salary and benefits under the new ownership I will answer the best I can being that I do want everybody to understand that I signed non disclosures and other legal documents that will limit it some of the conversation that I can have today but any questions that I could shed a little light to in the agreement they have bought the entire asset purchase agreement which includes current contracts and current so mostly all the current contracts and so that includes whatever is happening with the nurses as far as I know or whatever is happening there today thank you Deandre please Rosanne so just to share I would hope so we don't know for certain I can say that we have contracts and we don't know what will happen when we get to the table and negotiate those contracts so I would say yes I would hope so for the well-being of the nurses and for the community thank you in my conversations with the potential buyers alongside Councilwoman Kaufman Gomez these are some of the questions that were asked and put in front of the potential buyers and the overall impression that we got as we were told is that they would do their best to not make cuts and so what that means you know again you know it's important to to try to if these things were said to us to perhaps find a way to keep them accountable keep them honest but at the end of the day this is a private transaction and the best that we can probably do is just continue to advocate for our families and employees at the hospital so as a follow-up question from the audience what assurances do we have that the hospital won't be shut down or sold? once again I guess that comes to me so in those contracts there's also what the 1998 original agreement and covenants those are also what they have bought in that group and the reason why we have the right of first refusal today so I imagine there will be continued conversations around those original 1998 agreements I don't think those assurances can be provided under any circumstances regardless of who the owner is I think it was mentioned earlier that the sustainability of small rural hospitals is challenging under any circumstances and I think from some of what was mentioned earlier more challenging for the for-profit corporations but I think there isn't a way for any one of us to earnestly and with evidence give an insurance like that on a similar topic there's a question what is the mission statement of Halston Health Care why did they feel Watsonville Community Hospital was a good purchase and Dan, before you answer I just want to share that we do have a statement from Dan Brothman who's here with us this afternoon so I'd like to ask Marielena to please share that my name is Dan Brothman I am CEO of Halston Health Care we are excited about the opportunity of Watsonville Community to acquire this hospital we have extensive experience in this area and believe we will provide a safe, comfortable and inclusive environment for all the employees we will be accountable to the community we are not like CHS or Quorum we will be accountable to the Watsonville Community we are willing to put members of I'm sorry we are willing to put members of trust and FQHC on hospital boards we will not close services like OB or ER we will not lay off employees we have great financial backing and over 90 years of experience we are committed to mental health and expanding services can you read the question make sure I'm gathering what was the original question what is the mission statement of Halston Health Care why did they feel Watsonville Hospital was a good purchase I don't know the mission station of Halston Health Care I think Dan Brothman and his team can answer that what I can answer is that Quorum Health Care has been trying to sell Watsonville Hospital for quite some time that has not necessarily been publicly known and it's been shared amongst if you in the health care realm that that has been Quorum's mission to sell Watsonville Community Hospital so everybody had the opportunity out in the health care universe to purchase the hospital and their choice is not to or to is beholden to that organization Watsonville Community I mean Watsonville itself is a great community so I wouldn't imagine why anybody wouldn't want to be here but I can't answer directly for Halston Health Care in regards to why they felt that it was a right purchase I can only share what I've been told which is that there were other hospitals that Halston was negotiating with Quorum in another state that fell through and Watsonville Community Hospital that was then offered as an option so that isn't necessarily a prime reason but it is background on this topic we're going to share a couple of related comments I work at SLRH in Gilroy OCH and SLRH have been bought quotation or stolen in parentheses by Santa Cruz by Santa Cruz County or Santa Clara County Santa Clara County SC County after being lost by Verify who went bankrupt with three years of buying us don't let your hospital go through what we continue to go through see us as a cautionary tale of what can happen when corporate entities try to run or operate community hospitals we want an administration an owner who care about patients and staff more than profits for shareholders of those the new company purchasing the hospital will cut back services for the people of the community we cannot allow this to happen it is unsafe and we cannot let them play with people's lives okay so on an alternate topic but related a question from the audience how realistic is community ownership at this time how would it proceed in terms of let me sort of compose myself for a second before the earthquake in 89 the hospital had about a 65% market share in Watsonville after the earthquake and continuing it has stayed at about 50% or under there are a number of things that need to be done to write that one of those is to re-attract the community to this hospital there are other areas that need to be fixed billing and collections has been a problem under quorum so that even though bills are generated collections are very poor because of that obstetrics has experienced a decrease in the number of births by about 20% I guess is my sense so I think there are things that are fixable there are also things that we could do here that have not been done and all those could be analyzed to see whether they would add to the bottom line or how they're best done so I think there are fixes to make Watsonville hospital sustainable it's a sort of more complicated answer but I think that's the best overview of it just in general for a community hospital to go or a community locally controlled and governed hospital to move forward would require significant partnership and investment from the other healthcare partners in the region that's one essential part it would require some very significant work on identifying the appropriate structure and governance what authority under which it would move and that would have to happen pretty quickly we have examples in the region from Salinas Valley Nativedad has also done research at least while it didn't transition its structure it did a lot of work around how to move towards that and there's other hospitals outside of the immediate area that can provide examples and technical assistance around how to do that but I think those are the really key general steps that would have to happen very quickly okay, thank you I'd like to share another comment that has been provided by the Halston representatives that are here in the room today so I'd like to invite Madeline to share that please I look forward to working with this community I grew up in McAllen, Texas on the Mexican border I understand an agricultural community I understand the importance of curing for the underprivileged Halston is not publicly traded and will never be we have the ability to make decisions with the community we will not cut services we will grow the services we want to employ locals, prefer not to staff travelers or registry we will maintain current staff and not cut pay so, first of all, I want to really thank the audience for participating through all of these comments and questions they are grouping but as you can see, we're doing this in real time but I want to make space for some of the other comments and questions that are coming related to health services in the community and those needs but I also want to remind everyone that the clock is ticking and we now have 25 minutes left for this portion I hope it doesn't seem like we're rushing through some really important topics but there are quite a few different kinds of questions and comments that are coming here so, on the topic of health services there are some questions related to the ability to add mental health services for pregnant women as well as substance abuse services there's also a question in addition to indigent care what commitment to specialize care to minority communities like the transgender community and what commitment to progressive reproductive rights will be asked of future ownership regardless of private or non-profit especially in light of the Trump administration's efforts on religious liberty and those potentially life-threatening impacts on these and other marginalized populations I want to answer it as a general question and I think Dory can probably shed more light because this is her direct work but in regards to services I think hearing these things is the most valuable point of that hearing that somebody has been marginalized or hearing that there's not services for certain dead sexes is really what this meeting one of the hearts of this meeting is so we can get that from the health trust perspective to make sure regardless of ownership that we incorporate those thoughts and those things into our in our mission of making sure that we have long-standable health care in the community so I definitely cannot answer on behalf of the hospital but I can say that mental health and substance use services and transgender care are essential services for the most vulnerable in our community as I mentioned earlier partners closely with the hospital to ensure that substance use and mental health services are available and we also provide a significant amount a growing amount of transgender care in terms of the hospital these are these are exactly the kinds of services that require a community commitment and are not necessarily tied to an ability to get reimbursement and make a profit as a community health center of course is committed to and invests significant resources towards those services and works closely with the hospital to make sure we can leverage the most effective use of funding and efficiencies to reach as many people as possible a hospital that continues to increase access to those services because they are really I would say just beginning services they have a lot of room to grow and increase to actually meet the need would take a very strong commitment to to providing the services regardless of the ability to bring in profit margin around them and in fact probably areas of investment rather than revenue I'm going to jump in and share some comments from our community public health is very important in this community especially because of our economic disadvantage status we need to make sure everyone has access and quality service equal access for all there is a tremendous need for psychiatric care in a hospital setting both inpatient and outpatient. NAMI requests Watsonville hospital address this whether using existing facility or building a new facility on the large Watsonville campus. With home base health requirements for MediCal I am concerned of departments like diabetes is closed and they cannot partner with our local hospital the domino effect will be lost funds to clinics my greatest concern is compromising everyone's right not privilege everyone's right to quality safe health care offered by an accredited hospital community hospital to various communities in California other health care systems have made identical commitments when purchasing hospitals or merging hospital systems for example no cuts or no layoffs eventually when the layoffs and cuts come there is a long list of usage justifications it's abundantly clear that Watsonville is in dire need of all of its services the no layoffs and no cuts need to be in writing and with enforcement provisions to protect this precious community Do the panel members want to respond to any of those particular comments? I'm happy that these concerns are being raised right now and I'm happy that the potential buyers whoever that might be are listening today I'll say that after my conversations with the potential buyers they said everything I think we wanted to hear but what does that really mean I have no idea what that really means because the last thing that any of us want is not to have a hospital a precious resource in the community so more than anything I want to thank the potential buyers for making it public some of these things that were said to us in private my biggest concern is keeping them accountable they're saying they're not going to do these things today but what happens if something does happen tomorrow what resources do we have as a community to make sure that the livelihoods of our employees are kept safe I'm just really appreciative of these comments thank you I will add that the only true legal resource in that it was what was created in 1998 it is now 2019 so our lawyers that have been going through that not only has Watsonville changed since that healthcare has changed since 1998 as far as accountability what's in those documents and how we go through those documents is the only true accountability we have at this point I'm not saying there is anything else open to that but at this point those original agreements that group has agreed to take on that and so how our legal team is walking through that to make sure those things and so hearing these things as I mentioned is very valuable in those conversations of things that we are that we can hold that group accountable to or anybody that owns the hospital let me just make sure that's the case I just want to go back to the question about substance use and mental health transgender care those areas I know I mentioned that Salud works in them but they rely on partnerships across the county with the counties and with other community based organizations and health entities and I just want to touch a little bit on transgender care because there has been a reduction in access recently Salud's transgender care includes what's called gender affirming care across all ages both under 18 and adults we do not provide gender affirming hormones for under 18 we do refer those to UCSF and to Stanford and we're currently working on a program that connects specialists with on the ground practitioners to help train our providers and therapists to increase our ability to serve that those health care needs but in terms of gender affirming surgery it hasn't been available in our county yet we do refer out for that so I just wanted to answer that and earlier I talked about a lot of the partnership around substance use and mental health thank you for that clarification Dori so there are a number of questions related to the trust's role and the right of first refusal and particularly how much financial support would be needed for the trust to exercise the right of first refusal and acquire Watsonville community hospital and also related to that question is the history of the hospital and its original sale and some clarification around why it was originally sold and if the community model is viable no thank you for the question I'm only going to state facts and once again I said they're or due to legal and other things there is limited answers to my questions but I will say this and this is public information is a 17 million dollar asset organization the sale of the hospital is 45 million 45 days and the difference between 17 million and 45 million is that now what does it take to own a hospital I think there's other people in different ways and different parts of the country they can tell us exactly what it takes to run a hospital but I just want people to understand that that's where the trust is that it's a 17 million dollar organization it's a 45 million dollar ask of the sale I want to make sure I'm clear on the other part of the question was the history of the original sale so the history 1998 and I think being Dr. Gallagher had a nice conversation about this the hospital was in a good position the the earthquake happened and then the hospital and the community was put into a very serious financial situation FEMA was not helping a lot of things were not in the right order they were had to make a decision had to make a decision to say what is the best thing for the community at this particular point so a group of community members and others on selling the hospital and that was the best option for at that time I will say this in defense of anywhere that the community has had a hospital for 20 years and a lot of communities as we hear from others and around the country have closed during that same time so we might not have the thought is that we have not probably had the best partnership with CHS or quorum during that time but there is a level that a hospital was open during that time but it is at 1998 it was a very financial decision to keep a hospital happening in the community but what happened also during that time which is great that the community came together and said let's protect the community at the same time and created the health trust thanks for the opportunity I wanted to add to my previous answer two parts about this one about what does it cost to own the hospital the asset purchase agreement is a public document it's available in the reference section of the library and part of that is that my best understanding in recollection is that at 45 days it requires a nonrefundable 10% deposit to start moving forward the other thing about the viability of the hospital in 1998 the details were a little fuzzy to me so I called the fellow who was the CFO at the time, his name is John Nicole and he said the finances for the hospital had been leaned for a number of years but it still had reserves it was able to pay its bills it had not defaulted on the municipal bonds that were assured that required financial reserves what happened after the earthquake was that FEMA granted money for the building but not for any property on which to put the building so in order to purchase that the board made a decision not to go into additional debt but the sale the sale and so I'm very happy to get the opportunity to clear up the misconception that the hospital in 1998 had financially failed you talked to Gallagher and as a follow up question there could not the trust partner with Santa Cruz County Health Services and possibly Kaiser Permanente or other health systems partners in the community as Dory kind of alluded to earlier that is a possibility that that could happen that would take a lot of different things to happen in the community at one point or another to happen to happen within a quick time frame everybody would have to roll up their sleeves and make that happen and those individuals have to come prepare to do a lot so there is a possibility or that could be a possibility happening but I want to know the real the realisticness of that happening is a lot and a lot of people get in the room in partnering and doing that very quickly I do think that DeAndre's answer is referencing a general partnership with healthcare partners not necessarily specific to the two that were mentioned and I think the question about how does a locally controlled or governed hospital go forward and whether or not it's viable as I mentioned earlier there are examples of how it's been done successfully as close to us as Salinas Valley Memorial and if healthcare partners not just those that were mentioned but those others that are in our community all the way from the north Stanford, Sutter, Kaiser, Dominican both of the counties Nativedad, Chomp, they're the partners that provide care for this community and that is the key really to whether or not as you heard the discrepancy between the assets that DeAndre shared of the trust and the actual purchase price that would be only the beginning of what's necessary to be able to open and run a hospital so there would have to be a significant commitment on behalf of the healthcare partners some or all in order to to act as quickly as DeAndre just mentioned and move forward but there are examples of that happening and it's certainly at least in my opinion and the research that I've done does promise the ability to make sure community interests are always at the heart of the direction of a hospital. I have another question in Spanish I would like to know when any changes at the hospital of the new owners would happen and will they give us time to know about those changes well the we have to enact or sign the roefer July 21st is the time oh the right of first refusal sorry we have to sign or not sign the right of first refusal July 21st after that point then the official sale of the hospital would have to take place between whoever that is or being us or being that there's time between it there's so the actual sale would have to take place after the actual sale takes place then there is the strategic planning and the operations and things like that so I would imagine that you're a little bit of time between knowing when things are going to happen or not happen and in that I think right now we're in the process of sale itself let's figure out the sale itself and the accountability as the mayor mentioned of that sale and then there is the operations and those things of the hospital to follow I can just add one thing and DeAndre and I have sort of mentioned it a little bit but the 45 day window is not enough time 45 days is not a lot of time to be able to think about this to talk about this to process this and maybe there were an opportunity to extend that window for future situations like this I think it'd be to the benefit of the community for sure so respecting all of your time we are going to close the comment and question period now I'd like to just thank Maria Elena de la Garza for joining me here and moderating the panel today and I'm just going to end and this is a way to pass the baton back to Jen what does the trust and the community need from the members of the audience today toward next steps music so while the sale of the hospital does raise concerns I do want to emphasize the power we have as a community in raising our collective voice one of the ways that we can demonstrate that is through a petition and the Watsonville registered nurses have been passing that around they have it available at the back table we're asking for your signatures the petition includes a call to action for the health trust to purchase the hospital through the right of first refusal as well as a community benefit agreement for any and all future owners of the hospital please take a moment to add your name and show the support that the community has for the health trust in taking a lead role in acute care in this area again I want to thank everyone for being here and taking an active interest in our community's health care we will have refreshments in the community room but I also want to invite everyone to gather refreshments and then step outside for a group picture of all of the coalition that includes all of you in a historic moment with that the formal portion of our town hall is concluded thank you


Dear students, in this topic, we shall discuss the hormones of neurohypophysis, i.e. the hormones of posterior lobe of pituitary. The posterior lobe of pituitary is also called neurohypophysis or pars nervosa. It stores and releases two hormones, the anti-diuretic hormone, ADH, and oxytocin. Both these hormones are peptides containing 9 amino acid residues. The ADH and oxytocin are synthesized and packaged in the cell bodies of two groups of neuro-security cells of interior portion of hypothalamus. Neurosacritic cells are the supra-optic nuclei and para-ventricular nuclei. After their synthesis, these hormones are transported within the axones of hypo-thelmo-hypo-physyl tract, i.e. from the hypothalamus, the nerve tract, which is coming into neuro-hypophysis, is released along with the tract or transported. After transport, they are released by the nerve terminals in the posterior pituitary where they are released into the capillary bed that contains the blood. The anti-diuretic hormone promotes water reabsorption in the kidneys. As a result, it decreases urine volume. By these processes, it helps to regulate the osmolarity of blood. It also acts as a vasoconstrictor, increasing the arterial blood pressure. For this reason, it is named as vasopressor. Now we shall discuss the functions of oxytocin. Oxytocin mammals' most important function of oxytocin is the uterine contraction during childbirth. Apart from this, after childbirth, the ejection of milk from the mammary gland during the nursing process, which comes out of the milk, is also controlled by oxytocin. This is its second most important function. Apart from this, it also has some auxiliary functions, i.e. it functions in the regulation of mood and sexual arousal, both in males and females. Words in which the process of parturation or milk production is not present, oxytocin is also present. There are 8 functions in reproduction in the motility of oviduct.


quote for the meeting thank you mayor wisdom is the reward you get for a lifetime of listening when you've when you'd have preferred to talk with the clerk please call the roll for the meeting let's try it again if this is my fault because we're late this is gonna be a big trouble pretty much pretty much yeah one more time no it's not gonna do it okay call roll Bellinger here Carlson here Dessler here Donahue here Herman Hammond excuse height of men Lissard here Lewandowski here Penteco here Manichuk excuse the ill here Ben Akron excuse Vanderweal here Percy here born was excused also I'm born I missed him sorry 11 present five absent thank you tonight we have some guests in the gallery the Boy Scouts from troop 890 for the holy name in St. Clement parishes I'd like to ask them to come forward and please lead us in the Pledge of Allegiance I pledge allegiance to the flag of the United States of America and to the Republic for which it stands one nation under God indivisible with liberty and justice for all to thank you very much yeah next we'll move on to the minutes from our last meeting all in Carlson thank you mayor I move to approve the minutes second it's been moved in second to prove the minutes of our last meeting is there any discussion seeing none will the clerk all in favor to signify by saying aye aye opposed motion passes there's no public forum tonight and I do have a couple of announcements there's gonna be a neighborhood meeting scheduled for the Southlake neighborhood that's Broadway Avenue South Union and approximately South 12th Lake Michigan that'll be held this Saturday November 9th at 10 a.m. and the address is 713 Dillingham Avenue that's a residence I also like to note that the senior activity center is hosting an open house and art scale a night on Thursday 11 14 from 4 o'clock till 7 p.m. and that's sponsored by Terrace estates the fall leaf collection continues through November 22nd residents are allowed to rake leaves into the gutters please consult the schedule on the city website at shaboyganwi.com for the day they'll be working on your neighborhood and you'll find on your desk tonight that we've got some information on the United Way last year our city 16% of our employees generously donated to United Way this year the countywide campaign is to raise 2.5 million dollars to address the needs in our community during our Common Council meeting on Monday the 18th United Way executive director John Dole provide a brief overview of the tremendous community need the very important programs that United Way supports I'd like you to please consider being a leader in this area and as we have our campaign within City Hall going on and please turn United Way pledge form to the clerk either prior to or at the beginning of that Common Council meeting we appreciate your leadership support and generosity next we'll move on to the consent agenda Alderman Carlson thank you mayor I move to accept and file all our O's accept and adopt all our C's and pass all substitute ordinance second we have a motion on the consent agenda is there any discussion on that motion and with a clerk call the roll Bellinger I Carlson I Dessler I Donahue I Herman Lissard I Lewandowski I Penteco I feel I Vanderweel I Percy I Levin eyes motion passes under communications and petitions item 3.1 will be referred to public works under reports of officers item 4.1 through 4.6 will be referred to various committees under resolutions 5.1 will lie over 5.2 will be referred and items 5.3 through 5.5 will also buy over under reports of committees item 6.1 is an RC by finance recommending and authorizing a transfer of appropriations in the 2013 budget and establish revenue and appropriations for grant received from the what Wisconsin Department of Justice heroin initiative 2013 Alderman Carlson I move to accept and adopt and pass the resolution second thank you for that motion and support a motion to adopt and pass the resolution is before us is there any further discussion none will the clerk please call the roll Carlson I Dessler I Donahue I Herman Lissard I Lewandowski I Penteco I feel I Vanderweal I Percy I Bellinger I Levin eyes motion passes next we'll go on to item 6.2 which is an RC by law and licensing recommending the nine of beverage operator license 0134 based on his failure to accurately reveal all the convictions on his application is record of violations related to the license to activity and his failure to cooperate with the committee Alderman Vanderweal thank you I'm with the RC be accepted and adopted second it's moved and seconded under discussion is Joshua Neumeyer here this evening okay he did not appear before committee the last two times that we called him in so I'm going to move that we refer this back to committee okay we have a motion on the floor to refer back to committees there's second and moved and seconded any discussion seen none all those in favor of moving back to committee signify by saying aye opposed next we'll go on to ordinances items 7.1 and 7.2 be referred to the city planning Commission 8.1 is a resolution by Alder persons Hammond Bellinger Dassler to authorize a transfer of appropriations in the 2013 budget estimate revenue and appropriations for a donation from triple a for the police department to purchase in a Toxalock device Alderman Carlson I moved at the resolution you put upon its passage second it moved and seconded to pass that resolution under discussion see none will the clerk please call the roll Dassler I Johnny Hugh Herman Lissard I Lee Wendusky I Penteco I deal I Vanderweal I Percy I Bellinger I Carlson I Levin eyes next is item 8.2 which is a resolution by Alder persons Hammond Bellinger Heidemann and Dassler authorizing the chief administrative officer to enter into a contract for obtaining audit services Alderman Carlson I moved that the resolution be put upon its passage second been moved and seconded to put resolution 8.2 on its passage any discussion on that resolution see none will the clerk please call the roll Johnny Hugh I Herman Mark Lissard I Lee Wendusky I Penteco I deal I Vanderweal I Percy I Bellinger I Carlson I Dassler I Levin eyes next we'll move on to other matters I'll turn it over to city attorney Stephen clean 9.1 is an arrow by the city clerk submitting various license applications for the period ending June 30 2014 and June 30 2015 9.2 is an arrow by the city clerk submitting communication from Rockards for schools spaceport Sheboygan requesting three of the city's free days at the Blue Harbor Convention Convention Center for May 1 through 3 2014 event and also requesting support from the police and fire departments and public works that will be referred to finance public works and public protection and safety 9.3 is a resolution calling for an update and review of the compensation package for city of Sheboygan fire chief referred to salary and grievances 9.4 is a communication from Darnell Johnston requesting a waiver from the sex offender residency restrictions in order to live at 1411 North 4th Street that will be referred to public protection and safety 9.5 is an ordinance amending sections 122-403 122-404 and 122-405 of the municipal code relating to sewers and sewage disposal that will be referred to the public works committee next item on our agenda is a closed session Alderman Carlson I move to convening closed session under the exemption provided in section nineteen point eight five one e wisconsin stats for the purpose of deliberating the possible purchase of public property where competitive and bargaining reasons require a closed session second moved in second into going into closed session with a clerk please call the roll Herman hi Lissard Lee Wendusky hi Penteco hi feel hi Vanderweal hi Bursi hi Bellinger hi Carlson hi Gassler hi Johnny Hugh hi Levin eyes okay we'll take a three minute recess and reconvene closed session