Two years after voters gave Alameda County the authority to impose a half-cent sales tax to augment medical and health care spending, the county is just beginning the process of monitoring how a major percentage of Measure A money has been spent.
Six months into the monitoring process, the kinks are still being worked out.
“We’re way past the deadline for our review,” Measure A Oversight Committee Chair Dr. Larry Platt said following a committee meeting in San Leandro last weekend. “This should have been done two years ago.”
With the Oversight Committee just beginning review of the 2004-05 expenditures, Platt said “we hope to finish our reviews by August so that we can get a report out to the supervisors.”
He said that committee review of 2005-06 Measure A expenditures for the fiscal year ending in July would begin immediately afterwards.
Measure A won the support of 71.1 percent of Alameda County voters in March of 2004. Seventy-five percent of the sales tax money was earmarked for the beleaguered Alameda County Medical Center, the county’s public hospital and clinic system that has fallen on rough financial times in recent years.
The remaining 25 percent was to be parceled out by County Supervisors to community-based health care providers and hospitals providing services to low-income citizens.
Since then, Measure A sales tax revenues have been running above budgeted expectations, according to reports from the Chief Financial Officer of the Alameda County Medical Center.
With collections starting in September of 2004, the county received $95.8 million in Measure A monies in fiscal year 2004-05, with $71.6 million going to the medical center and $24 million going to the remaining health care agencies.
As of the first eight months of fiscal year 2005-06, the county received another $74.2 million in Measure A funds, with $55.6 million going to the medical center and $18.7 million to the health care agencies.
According to Alameda County Health Services Agency Director David Kears, who is supervising the health care agency portion of Measure A funding, organizations began receiving funds at the beginning of the 2004-05 fiscal year.
Among the agencies receiving that money were the Alameda Health Consortium on behalf of eight health care clinics throughout the county and the Bay Area Consortium for Quality Health Care. In December of 2004, the Berkeley Unified School District received $450,000 in Measure A funding for three nurses to be placed in Berkeley public schools.
According to Susan Schroeder, chair of the health committee of the Alameda County Council of the League of Women Voters, “The wording in Measure A said that the county would appoint an oversight committee. When a year and a half had passed [in October of last year] and that committee had not been appointed, Nancy Bickel [chair of the LWV Alameda County Council] wrote to Alameda County Supervisor President Keith Carson expressing our concerns about the lack of an oversight committee.”
Schroeder said that the creation of the oversight committee came “fairly soon after that.”
A Piedmont LWV online newsletter says that Health Care Services Agency Director Kears wrote Bickel in late October, explaining the delays in appointing the committee and saying that the nomination process for the oversight committee would begin Nov. 1, 2005.
Supervisors eventually appointed an eighteen-member oversight committee, five representing each supervisorial district, two apiece representing the League of Women Voters, the Service Employees International Union, and the City Managers Association, and one member apiece representing the Alameda County Taxpayers’ Association, the Alameda County Mental Health Advisory Board, the East Bay Hospital Council staff, the Alameda Contra Costa Medical Association, the City of Berkeley, and the Alameda Health Consortium.
Some committee members believe that the oversight committee should provide funding recommendations to supervisors as well as review expenditures by agencies under the measure. But Health Services Agency Director Kears said in a telephone interview that both the language of Measure A and the ordinance which followed its passage restrict the committee to oversight only.
“The committee’s function is to determine if the agencies have spent the money consistent with the broad guidelines set forth in Measure A, as well as actually spent it on the items that were in their proposal,” Kears said. “Their purpose is to make sure the money is well-audited and that organizations don’t keep the money and spend it for something else.”
Kears added that because “the committee’s role did not start until after the first year of funding,” the oversight process was being carried out on a timely basis. He blamed any delays on setting up the committee on the organizations who nominated representatives.
“Some of them took three to four months to give us the names after we made the initial contact,” Kears said.
Once the committee began meeting last December, confusion immediately surfaced over the issue of how committee members would handle potential conflicts of interest, considering that some members represented organizations that had already received Measure A funding.
After listening to a presentation at an early committee meeting from Jason Lauren of the Alameda County Counsel’s office outlining how members would have to recuse themselves when issues concerning their own organization’s funding came up, Alameda Health Consortium Executive Director Ralph Silber resigned from the oversight committee, saying that the conflict was too difficult to avoid.
But when Lauren gave a second conflict of interest presentation at this weekend’s oversight meeting, Silber, who was there to present his organization’s funding report, pointedly said that Lauren’s current interpretation of the potential conflict was different from his earlier one.
“I resigned based upon what you told us before,” Silber said, adding that he would not have resigned based upon Lauren’s new interpretation.
Lauren suggested that Silber contact supervisors to see if his resignation could be rescinded.
Schroeder of the League of Women Voters said that her organization had discussed the issue of conflict of interest among oversight committee members, but had not taken a position on the issue. “As a general policy, the league believes that all members of such committees should simply represent the public at large, and not specific organizations,” she said.
Kears said in an telephone interview that some of the committee confusion is taking place “because this is the first year of operation. I am assuming that as the process gets more routine, it will get easier.”
The next meeting of the oversight committee is scheduled for May 26. In addition to presentations from agencies receiving portions of the 25 percent funding, the committee will hear a presentation on how the Alameda County Medical Center is spending its 75 percent portion of the Measure A funding.
Following the meeting, however, members were unclear as to how much oversight their committee would have over the ACMC portion of the funding..