Today’s guest post is by Faith. It is the latest in a series of posts focusing on the careers of leaders in the Church. The previous post in the series can be viewed here:


As a reminder, all of us have our own personal issues, it’s not white hats vs. dark hats; it’s all different shades of gray. We want to be tougher on systems than we are on people. However, when a “leader” tells other people how to proceed with life choices and the leader’s past reflects other choices, what are we to think and how are we to act? The facts in this history are controversial and a darker gray, when shown in the light.

Quentin LaMar Cook

Quentin, following a Q15 preference pattern, was born in Logan, Utah. He served an LDS mission to England. He graduated from Utah State in 1963, then Stanford Law in 1966. He remained in the San Francisco Bay area, working as a corporate attorney for 27 years with Carr, McClellan PC. In 1985, he created California Healthcare Systems (CHS) which managed Marin General Hospital (MGH). Cook was CEO and President of CHS. In that role, he later negotiated the 1995 CHS/Sutter merger. He then became Sutter Vice Chairman. He resigned in 1996 to administer in the LDS Church. For the church, he was called to the 2nd Q70 in 1996, then the 1st Q70 1998, and finally an Q12 apostle in 2007. In a talk, as a Seventy, Cook stated “The word saint in Greek denotes set apart, separate, [and] holy. If we are to be saints in our day, we need to separate ourselves from evil conduct and destructive pursuits that are prevalent in the world. As saints, we also need to avoid the worship of worldly gods, including pleasures, profits, credentials, titles…as we love them more than the poor and the needy. Everyone might have some of the good things of life, but it is the obsession with riches that cankers and destroys. The saint test to ask oneself is, would our associates recognize that we have separated ourselves from worldly evils?”[1] In the Cook household, there was a saying about “Saturday morning cartoons”. It referred to only pursuing worthwhile goals and not spending time on unfruitful pursuits, like watching cartoons.[2] Let us examine Quentin’s path of trying to be a saint and avoiding “Saturday cartoon decisions”.

The deal with Marin County to CHS

California state law requires counties to provide healthcare for their residents. Marin County took on $MM in debt to build and expand its’ hospital during the 1950-1985 period. [3,4,5] As healthcare evolved, MGH was advised by their legal counsel to create a new entity to stay competitive. The Carr law firm was involved, with Cook as the lead attorney. [6] The hospital administrator/CEO, Henry Buhrmann teamed with Cook to create the new lease. CHS, a new entity, was formed with Cook as the leader. In 1985, a 30-year agreement was signed between Marin County and CHS.[5] The new lease was controversial from the start. One example was that patient revenue could be used for anything and not be returned to the county and its’ outstanding debt. Anytime there was more money in the hospital bank account than needed for the 14-day business operation, MGH has the right to “sweep”. This is known as an “excess cash transfer”. In the first two decades, this was less than $3MM/year. After 2006 this was up to $30MM/year.[7] In theory the funds are transferred to other hospitals, within CHS, needing the money. However, some reports showed, some patient revenue even made it to the Cayman Islands on a one-way trip. Siphoned money is patient revenue diverted from patient care. There were accusations that CHS/MGH had diverted funds for corporate gain, while the outstanding Marin County bond debt increased to $1 Billion.[8] In layman’s terms this is known as stealing public assets. The transactions were legal, if they went to other hospital systems, however the books were closed to the public with no transparency. MGH, became a victim of its’ 1985 lease. The covert purpose of the lease was to remove decision making from public oversight and review without a vote of the district residents. In 1995, CHS/MGH merged with Sutter Health.[5]

CHS business results

The 1985 lease did not require quality assurance. The hospitals’ internal statistics reflected the change transitioning to a business model. The ratio of nursing staff (RN, LVN, Aide) for inpatient care placed MGH in the lowest quartile of hospitals. Sutter/MGH reduced in-patient RN staffing by 42% and reduced licensed (Physical Therapists, Pharmacists, Phlebotomists) available by 73.9 %. Use of unlicensed caregivers increased 1000%. A January 1995 JCAHO full survey accreditation visit resulted with MGH in the lowest 5% of hospitals. In March 1997 Sutter/MGH falsely testified before the district board that although MGH is licensed for 235 beds, the corporation had no capacity for more than 140 beds, within 36-hours following a potential disaster. Employee morale was low with physician vs Sutter/MGH management having an “attitude” problem. Professional staff who brought violations to the attention of the district and/or state regulators were harassed, reprimanded, fired, transferred, and sued.[8] Numerous complaints were filed with CA State Department of Health services describing life-threatening care deficiencies to acutely ill Marin patients. Cutbacks at Sutter/MGH raised widespread concern over the adequacy and availability of emergency medical service. By August 1997, Sutter/MGH no longer guaranteed full-time neurological staffing. This would have cost the highly profitable Sutter only $1,000 for MD coverage, every fourth weekend.[8] This is exemplified by the death of Jennifer Childs on September 27, 1997, and the inferior medical care leading to her passing.[9]

Investigations

MGH quality care issues never seemed to end. An 80-page Federal Government investigation reported in the Marin Independent Journal, describing 50 separate patient-endangering deficiencies. [11] Missing documents became common. The pre-contract 1984/1985 board agenda packages were missing entirely, no pre- 1986 taped records were found, and the 1995 tapes are missing for meetings discussing the merger. Financial records were in such disarray that the board is unable to determine if several hundred thousand dollars due to the district under the lease were collected. [9] Nevertheless, everything went according to hospital management plans until November 1996. Voters recalled two elected board members and voted in two consumer advocates for the Marin Health Care District. Suddenly, the majority of the board consisted of watchdogs. Lapdogs were now in the minority. Immediately, the management of MGH/Sutter began a campaign for mediation between the elected board and the hospital. Then a lawsuit ensued.

By way of contrast, El Camino Healthcare District, in Mountain View CA, lost $31 MM from 1994 to 1996 under a similar lease with CHS. The El Camino district successfully sued to break their lease on the grounds that a conflict of interest existed in its’ formation. This hospital lease was also created by Quentin Cook. When the county regained control, El Camino earned $17 million in the first six months of 1997 as an independent district hospital and with no cash sweeping involved. Then El Camino Hospital profits were redirected to increased staffing, purchasing new equipment, and improved healthcare within the district. The elected directors got the hospital back from CHS. It now operates profitably, openly, and honestly. [9]

Just as El Camino did, Marin County initiated a lawsuit to regain control of their hospital. The district alleged a conflict of interest, and the lease violated their public mission. The lawsuit heard in Sacramento Superior Court was that Buhrmann and Cook broke California law. Cook was a public employee when starting CHS. It is a violation of the California Government Code, Section 1090, for a public employee to make contracts that benefit himself. Later, both Buhrmann and Cook left public employment to join the private MGH Corp. [9] They made money in the transition. The lease in itself was legitimate, however with Cook violating section 1090, could result in making the original lease void. [10] However, the judges covered Cook. The Sacramento judge ruled that the four years statute of limitations had been exceeded. She made no ruling on the merits of the case. The California Supreme court concurred. By case law, the judge could have considered the case because there is traditionally no time limit when public property is involved. The court solely based their decision on the statute of limitations expiring.[9,10] In 2010, the Marin Hospital returned to under control of Marin Health care district, 5 years early with the lawsuit negotiation, after 25 years of controversy.[11]

Cook Legacy

Cook’s work in privatizing hospitals in California involved a lot of dissentions. As an attorney he represented the Marin County Hospital District, drafted the lease, and was the original CEO of CHS. As an attorney representing other public hospital districts, he negotiated deals favorable to the nonprofit healthcare corporations. Two weeks before the Marin lease was finalized, he resigned as the hospital district’s attorney. Shortly after, he went to work for California Healthcare Systems, that he created.[12] I am not implying, Cook ever took any of the funds, but he did write the contracts that set the groundwork for it to happen by future management and he was remunerated with a large salary for his efforts. Cook left management before some of the examples provided. However, he was the founder and pioneer of the system. Cook did break the law, under section 1090, by profiting in his transition from CHS to Sutter Health roles. He created the leases, at a minimum, for Marin and El Camino hospitals and possibly another 16 hospital systems, for which the records are not available. Critics claimed the deals quietly gave public revenues to private interests. The hospitals became part of CHS, which later joined Sutter Health. Cook became the second-ranking executive in the new combined corporation. [12] His 1995 CEO salary was $311,479, just from CHS alone.[9] We have no additional information about his other salaries, bonuses, and profits from his decision making. He profited while employees and patients suffered under the business arrangement. Commenting on the contract Gary Giacomini, then a county supervisor, called it “the biggest theft of public property in Marin’s history.”[9] Critics question if Cook should have faced disbarment with enriching himself, at the client expense. Additional pertinent press articles to this are included below, although many have been erased with time. [13,14,15,16,17,18,19]

Similar to Kevin Pearson’s relationship with Optum/United Health Care, Quentin Cook created a system, profited, and then left for LDS pastorship.

Legacy in 2020s

This 60-minute TV segment shows that state of Northern California health care and the effects of Sutter health. https://www.cbsnews.com/news/california-sutter-health-hospital-chain-high-prices-lawsuit-60-minutes-2020-12-13/

Reflection

Are these the actions of a Christian Saint that avoids evil conduct and worldly gods?

Did Cook separate himself from “worldly evils” and uplift the poor and the sick or is there a pattern of the obsession with riches?

Does this account represent a worthwhile life goal, or did it have the value of a Saturday morning cartoon in the end?
Was it convenient that Cook was called as a General Authority in 1996, requiring him to resign just as the public outcry and government investigations were increasing?

Did Quentin Cook leave a legacy for good or a legacy of victims with problems in Northern California?

Are there similarities to CHS/Sutter to the way the LDS church handles its’ operations?

References

  1. https://www.churchofjesuschrist.org/study/general-conference/2003/10/are-you-a-saint?lang=eng
  2. https://www.thechurchnews.com/2021/12/7/23218154/elder-cook-byu-pathway-devotional-worthwhile-goals
  3. https://caph.org/about/members/public-health-care-systems/
  4. https://medium.com/anne-t-kent-california-room-community-newsletter/marins-county-hospitals-cda62ef3dbe2
  5. https://www.marinhealthcare.org/about-us/our-history
  6. https://www.carr-mcclellan.com/our-firm/firm-history/
  7. https://www.northbaybusinessjournal.com/article/industry-news/marin-healthcare-district-sues-sutter-over-120-million-in-transfers/
  8. http://www.smartvoter.org/2000/11/07/ca/mrn/vote/severinghaus_j/paper2.html
  9. https://jweekly.com/1997/10/10/marin-crash-victim-19-lived-precepts-of-judaism/
  10. https://caselaw.findlaw.com/court/ca-court-of-appeal/1464984.html
  11. https://www.bondbuyer.com/news/marin-county-district-wins-back-hospital
  12. https://www.metroactive.com/papers/sonoma/01.11.96/frontlines-9602.html
  13. https://www.marinij.com/2010/08/26/attorney-sutter-engaged-in-120-million-rip-off-of-marin-general-hospital/
  14. https://www.marincounty.org/-/media/files/departments/gj/reports-responses/2003/healthcareoptionsfinalreport.pdf
  15. https://www.northbaybusinessjournal.com/article/industry-news/did-sutter-single-out-marin-to-take-funds/
  16. https://www.bizjournals.com/sanfrancisco/blog/2013/01/marin-general-hospital-wins.html
  17. https://www.marincounty.org/-/media/files/departments/gj/reports-responses/2001/hhs1_final_report_061202.pdf
  18. https://publicpay.ca.gov/Reports/SpecialDistricts/SpecialDistrict.aspx?entityid=1552&year=2021
  19. https://publicpay.ca.gov/Reports/SpecialDistricts/SpecialDistrict.aspx?entityid=1552&year=2010