Borrego Health announced reorganizational-wide team realignment and new executive team leadership. A change that, according to a press release from Dan Kramer, Borrego Community Health Foundation’s public relations counsel, are “Internal changes (to) enable highest quality patient care.”

Dr. Edgar Bulloch, interim CEO, stated, “Our goal is to move forward with a leaner, more transparent and quality driven organization focused on our core patient care needs. The changes we are announcing today are part of our ongoing commitment to our patients, communities and our valued employees to operate Borrego in a fiscally responsible manner.”

Among the leadership personnel changes are: Corrine Velasquez, replaces Mark Connelly as chief operations officer; Sergio Bautista, interim chief financial officer, replacing Diana Thompson; Victor Madera becomes chief health plan officer; and Jorge Cervantes MD, chief clinical officer.

The Sun has confirmed that Anna Navarro, head of Human Resources, is no longer at Borrego Health. As noted in a previous article, Dr. David Flick is leaving the Borrego Springs clinic to return to Colorado. His replacement is Dr. Laura Goetz, a general surgery specialist, formerly with Scripps Green Hospital. Dr. James Huot, the only other doctor at Borrego Springs, is, reportedly, away on one of his mysterious absences from the clinic.

Dr. Nithya Venugopal, DMD, MBA, Director of Dental Program Integrity, will be serving on the new Compliance Committee. Her role was to specifically implement Program Integrity Operations with the overarching goal of identifying and preventing potential Medicaid program integrity issues. According to the Borrego Health website, “Under her leadership, she will oversee her team in the review of Medicaid provider activities, audit claims, and educate providers and others on the Denti-Cal program as it pertains to FQHC’s in our state.”

Unfortunately, she failed in that role, for whatever reason. While like many others who remained silent about what they had to know was illegal, including former members of the Executive Committee of the Borrego Health Board of Trustees, it isn’t fair to place responsibility on her, but so many people, like her, had a choice to do something or go along. And unfortunately, they made the decision to go along, either for job security, friendships, or because for so long there were no repercussions.

One culprit of questionable character, Dr. Elias Koutros, is no longer being paid for medical services. The doctor holds licenses in Rhode Island, and two other states, and allegedly audited the Borrego Health dental clinics, even though a medical doctor, living on the East Coast. Go figure that one out? He was later hired at Borrego Health, and listed in the foundation’s IRS reports as one of the highest earning personnel that was not an officer. Evidently, he had friends in high places.

The press release additionally reported elimination and realignment of other top leadership positions and a significant number of administrative positions not directly related to patient care, without naming them. Also, the closure of the assisted living facility as of June 20, and transfer of operational management of the Childcare Center and Frugal Coyote to other organizations this summer. The Borrego Sun was told that there were two deaths of assisted living residents during the transition, closing the Desert View Cottages.

According to Dr. Bulloch, “We’re undergoing a major transformation, some of which may be difficult at first, and people will be displaced, but in the end these changes help us play to our strengths and make us a better organization for our employees, our patients and our community.”

And, that folks is likely an understatement, given that Borrego Health is undergoing a state Department of Justice/FBI investigation and must reduce a grandiose budget with extravagant salaries for too many officers, which were based on fraudulent dental practices and other violations of the rules and regulations that govern state and federal health insurance. Not only will the new budget be impacted, but, ultimately, the foundation will have to pay back a hefty amount of ill-gotten gains to the state and federal government

Sadly, so many are paying the price for the corrupt and illegal practices of previous officers and others to feather their own personal pockets. What is missing from the “good news,” is that employees, honest, hardworking and caring employees paid, and are continuing to pay the price for the financial abuse that led to state and federal investigations and the latest realignments of personnel.

While Borrego Health is forced to grow leaner by cleaning house of illegal dental and other practices of rewarding a few officers and doctors, some of the people complicit, and, others, are still on the payroll. Their titles are changed, but their influence and creation of a corporate culture that placed private financial aggrandizement as reward for providing government subsidized healthcare for the needy, no doubt runs deeper than changes in desk assignments.

The Sun has questioned Borrego leadership about how the organization can really clean up its act when persons of previous authority and control are still on board and on the payroll.

There are negotiations to sell Borrego Health’s Julian Clinic to the San Ysidro Health Care Clinic, which, like the foundation, is a non-profit FQHC. This is concerning, leading to the question whether other clinics might be headed for sale or transfer. When asked by the Sun, Dr. Bulloch, deflected politely the question, explaining that keeping the Julian clinic open was the primary motivation for the sale, but that Borrego Health was leasing land that it hoped to reopen as a Julian clinic in the future. While the optimism is welcome, the question is does Julian need two clinics, especially given the financial and structural downsizing Borrego Health is undergoing? And are other clinics potentially on the auction block?

Which leads to the subject of the future of the Borrego Springs clinic.

There’s a lot of hurt resulting from the actions of Borrego Health’s past officers and leadership, and it’s not limited to the clinics.

In Borrego Springs, it extends to the Frugal Coyote and Children’s Center. The Frugal is an institution, which has been managed with love and care for the community for years prior to being taken over by Borrego Health. Now it too, is paying a price. Hopefully, it will find new sponsors. Jim and Anne Wermers, with Dan Wright, are working with community members on a plan to save the Frugal Coyote and Children’s Center, but the financial dilemma is far from resolved. Where the downsizing will end, and extend of damage done to innocent people, finding themselves unemployed because of the unethical schemes undertaken by Bruce Hebets and collaborators, will not be known in the near future.

People, despite the nice words in the press release like, “internal changes enable quality of practice and service,” Borrego Health is in trouble. And, assuming the folks in charge are doing their best, and even qualified for such a major overhaul, needed to get it back into a realistic fiscal alignment, it will still require cuts and big changes.

So, if Borregans want a clinic, and if the community wants a clinic that is better than in the past, then it’s going to be up to Borrego to save it.

Borregans have always stepped up to take care of their own. Well now’s the time, the necessity and the opportunity. Time is of the essence, while strategic pieces of opportunity float around the community unconnected, not speaking and not working together. There are enough resources here to, not just upgrade the clinic, but to plan an entire continuum of care from prevention to hospice.

Borrego is blessed to have a clinic. Yes, it’s pretty unfunctional right now, and has been for quite a while, but there are people willing to work on that.

The Borrego Cares group of Dr. Carrolee Barlow, and other highly esteemed and respected medical and professional leaders have offered their time and expertise: They come with nationally recognized credentials, administrative, recruiting, fundraising, and medical specialties and are offering to identify and help recruit the appropriate specialists for the clinic, as well as work on a business plan to assure financial stability. They are looking to meet with Dr. Bulloch and his team as soon as possible.

There’s another important piece, the Borrego Valley Endowment Fund (BVEF), that has been entrusted with millions of dollars in donations to provide for a clinic, which are not being used for that purpose. And since the BVEF has closed down the idea of a second clinic, they should play a significant part in the reorganization of the clinic. BVEF is underwriting the cost of travel and access to health care by paying patients money to hire drivers. Additionally, BVEF members are a rich source of noted experts in starting, administrating and funding foundations. Members arm’s reach into the San Diego Foundation, hospital administration, and psychology.

There’s precedent for a partnership that utilizes Borrego Health’s FQHC status, yet operates independently with a separate board of trustees. Dan Anderson, outgoing chairman of the Borrego Health Board, has this advantage. He knows it can be done; he does it through his Riverside Community Health Foundation.

Count the resources that Borrego Springs has and could pull together for a strategic healthcare continuum. There’s the clinic building, and solid, if underserved, patient base. There’s a pharmacy and dental office. These are three important services that few rural communities have. Add to this the fact that Borrego has an emergency air flight service – Mercy Air – located right next door to the clinic. Actually, there are two flight services vying to serve. The BVEF has a generous agreement with Mercy Air, which is expected to underwrite and reduce the cost of these flights for Borrego residents.

Borrego has its own fire protection district, with trained paramedics and a commitment to the community. There are financial problems, but it’s an asset, and it’s about time someone came up with some answers to the pay scale problem, rather than worrying about it.

County Supervisor Jim Desmond has asked the County to find ways to make more use of the paramedics, as a result of their service during COVID testing and vaccinations. It’s possible that the paramedics can fill gaps in service in Borrego Springs and other rural communities, which might even help address the salary inequities the Borrego Fire District faces. Borrego’s interested health partners need to be part of that discussion.

A continuum of care includes prevention, there’s federal and state funding available to a FQHC clinic for this important element of health care. There are unaddressed, consistent obesity, nutritional, dental and health maintenance needs. Beginning with Borrego’s children and youth, the school district has blessed Borrego with Martha Deichler, who will go anywhere, anytime, help any program or organization, working to protect and improve the health of Borrego’s children and families.

Bob Kelly, chairman of the BVEF, has started a well-being and mental health foundation program to prevent the devastating health effects of isolation and loneliness so many seniors endure. There’s a place on the continuum for better use of the Senior Center and more thought given to helping Borrego’s notoriously older population, both permanent and seasonal.

Supervisor Desmond has a grant for a model intergenerational program for seniors and youth. Maybe, that would offer Borrego Springs some inspiration.

There are other private health care activities from Yoga, to exercise swimming, which need to be open and assured. Borrego has professionals in alternative and natural medicines.

One crisis on the uptick, due to the pandemic, is mental health, and Borrego Springs is not prepared to deal with this crippling aspect of health care management.

However, Borrego has the pieces. Borrego has the people and experts, plenty of social clubs, volunteers and resources waiting in the wings. It just needs someone to take the leadership and pull it all together. We can have the model of rural quality health care. All it will take is the will and initiative. And, the time is now. Necessity, they say, is the mother of invention, it’s also the father of change. What we do know is that Borrego Health is in trouble, no matter the optimistic press releases and efforts of the people seriously trying to save the clinics. If ever Borrego Springs was needed to pull together to do what Borrego Springs always does, which is take care of its own, the time is now.

Borrego Health is broken and expecting that organization to meet the health care needs of the community is a fantasy long passed.