FEATURED STORY
“Working to save children is as close to God’s work as I’ll ever get,” says Diana Dooley of the California Children’s Hospital Association
Now, sixteen years later, Diana Dooley has advice—and warnings—that could affect all of us.

I first met Diana Dooley when I moved from Los Angeles to Visalia in 1991. At that time she and Rita B. Hill were partners in Dooley-Hill, a successful Public Relations firm headquartered in the old bakery building on the Oval in Visalia. I contacted her to set up a meeting to discuss the business I was about to dive into headfirst— Advertising and Public Relations—and she graciously offered me good and sensible advice.

Now, sixteen years later, Diana Dooley has advice—and warnings—that could affect all of us.

Publisher R.J. Latronico:

You’re originally from the Central Valley, right?

Diana Dooley:

Yes, I was born in Hanford. My husband Dan and I went to high school together. I attended Fresno State because that’s where he was. He was a year ahead of you, but you caught up with him, right? Yes, in college. By the time Dan finished law school, I had taken a job with the Personnel Board, for the State of California. When Jerry Brown was elected Governor in 1974 I took what I thought was a temporary assignment on his staff in Labor Relations and pay setting. That was pre-collective bargaining. Since there was no collective bargaining process, all of the pay and benefits, including retirement benefits were set by legislation each year so I necessarily got involved in the legislative process. I moved from a labor relations analyst to being a lobbyist for the Governor. So what started as a short-term assignment turned into a seven and a half year gig. I started working for Brown in October of 1975. I stayed until we closed the offices in January of 1983.

So how did you wind up here?

Our first daughter was born in 1979. When she was little we decided that we didn’t want to raise her in Sacramento. After Dan finished law school, he also worked in the Brown Administration as the Chief Deputy Director of the Department of Food and Agriculture. So both of us had very high profile jobs in a young administration. But we didn’t really want that political lifestyle.

What was your plan?

We wanted to raise a family. So Dan’s brother, Calvin, (who later served in Congress), together with Dan and their parents formed a farming business together. His father had always been a farmer. The boys and their parents farmed together as Dooley Farms Incorporated throughout the eighties. When I finished working with the Brown Administration, I worked for a brief time for the City of Visalia.

Public relations was the perfect fit for you?

Exactly. I started in advertising in 1985. One of my clients was the developer who built the Radisson Hotel. As you may recall that project created quite a bit of controversy. I believed in the project and supported Greg Collins and the City Council prior to that in the belief that you have to have concentric growth around your downtown core. I also seem to remember that you worked on some political campaigns. Yes, I also represented several political candidates – always for non-partisan offices and many Republicans! I used to joke, if I didn’t have Republican friends, I wouldn’t have any friends in Tulare County. I really came to appreciate local government. You’ll remember that I already had worked in State government for Jerry Brown when I was twenty-four. I pinched my self all the time to be sure it was real. I was very young and inexperienced then, but very respectful of the process and the people who dedicated their lives to public policy. I feel very fortunate to have had all those experiences. And that experience really directed the rest of my life.

It wasn’t long after that, I understand, that you decided to go to law school?

Dan had wanted me to go to law school in 1973 when he started so we could go together. But I’m pretty frugal and I couldn’t bear the debt. I had a good job and by the time he finished, I was working for the Governor. So who has time to go to law school?

Right.

       And so my life kept finding me. And I was doing wonderful things. But at that point when I began to think about what I might do, I was looking for a different forum. And the law was kind of appealing. So, I decided to give it a try and I started law school in the fall of ‘92.

    How old were your girls at that time?

     Twelve and Seven.

    About the time when you were taking them to dance lessons and soccer?

     Yes, yes!

    And in the midst of all that you go to law school?

     Right. I was the President of the Swim Parents Club. And running my business with Rita Hill and going to law school.

    Wow!

     Rita and I agreed that at the end of the law school, we would dissolve the partnership, and she would go forward. That only worked for about halfway through law school. Something had to give and it was that.

    I can imagine that it became overwhelming.

    Yes. So we dissolved the partnership before I finished law school. I then began practicing law in 1995. I joke frequently about being forty before I went to law school and that I hoped I would never forget how I used to think before I was a lawyer. I think I am very pragmatic and brought that to the law.

     Were you working independently?

     At first I thought I would join Dan’s practice and I did that briefly after I finished law school. But then the Tulare County Superior Court had one research attorney who had been there for many years—twelve or thirteen. And she resigned to take a position at the Fifth District Court of Appeal. The court didn’t have a research attorney and I knew several judges and one of them asked if I would help fill in on a short-term basis while they did a recruitment for the position. I did that and I liked it. And I applied and they went through the recruitment and selected me to be research attorney. I did that for about three years. But I really did want to be in private practice.

    Is that when you became partners with Gary Paden?

     Yes. We’d been at Fresno State together. I really enjoyed that time as his partner. I did some of the overflow for him and then brought clients of my own. I was developing a practice when—again—life just jumped out and kind of found me.

    Another good opportunity?

     Yes, Valley Children’s Hospital. My husband and I had supported them for many years. He also served on their Board of Directors. In 2000, a new CEO was hired. He had been the head of the Motion Picture and Television Fund in Hollywood, which has a whole healthcare system of their own. He was the President and CEO of that system and then he came to Valley Children’s. And one of the first things he identified was the need to have in-house council. He also had a change in staff, which meant that he didn’t have anyone doing their government relations.

    So . . .

     So he approached me and suggested that we set up legal services and do the government relations and communications in one position. Since I had all these pieces—he asked me to make something work.

    That certainly sounded like the perfect job for you.

     It was a difficult decision to give up working with Gary since he had made such an investment in me. I so much appreciated working with him. But in the end he was very supportive. When I joined Children’s Hospital, I thought that was the pinnacle – I thought that this is as close to God’s work, as I’ll ever get.

    What a great feeling to have about your work!

     It combines everything I’ve done in my life—with a client that I completely care about and was committed to. So this new position allowed me to practice law and work with the legislature with people I had known for twenty years.

    I bet you spent a lot of your time telling them about the hospital.

     Yes, and what a fabulous jewel we have in that hospital. Then, five, six years later, the association goes through a change. They do a national search for a leader and they invite me to be a candidate. I thought, well I don’t know—maybe I still don’t know what I’m going to be when I grow up. I’m now fifty-six! So, in July of 2006, I accepted the appointment as President and Chief Executive Officer of the California Children’s Hospital Association, of which Valley Children’s Hospital, or Children’s Hospital Central California, is one of the eight members of the association. There are eight regional Children’s Hospitals in California. They voluntarily associate with each other and support the association through assessments.

    Can you explain to our readers a little about Children’s Hospital and the association itself?

     It’s a trade association and our mission is to advocate on behalf of the Children’s Hospitals to assure that the Hospitals have the resources they need to meet the needs of the various communities.

    Where are the other hospitals located?

     We work primarily in Sacramento and Washington D.C., with coalitions of others interested in child health. Children’s Hospitals are very different. Many of the rules, requirements, and conditions that are imposed on general community hospitals aren’t appropriate for the operation of a Children’s Hospital. So our objective is to ensure their viability. There are only eight hospitals for thirty million people. There are also five Children’s Hospitals that are not independent, but are associated with the University of California Teaching Hospitals. So each of the five University of California Teaching Hospitals has within it, a strong children’s program, and they are associate members of our association.

    Tell me how the California Children’s Hospital Bond Act plays a part in your work.

     In 2004 the voters approved Proposition 61. It provided funding via state grants, through borrowing. The state funded capital investment in the eight independent Children’s Hospitals, plus the five UC hospitals. So we are really thirteen in number. The independent hospitals are non-profit.

Was the association was strongly behind Prop 6?

     Yes. Were you involved with that at all? I was, on behalf of Children’s Hospital Central California. I was General Council. And as such, I was also involved with drafting the proposition and working with the statewide coalition of leaders. That was also in the Valley. I led the campaign in the Central Valley to get its passage. There were five health care propositions on the ballot in 2004. The Children’s Hospital Bond passed in every Valley county.

    What do you attribute that success to? Was it the lobbying effort?

     I think it is the great recognition that people throughout the valley have for their Children’s Hospital. Valley Children’s Hospital was founded in 1952. They built that hospital with great community support. Most hospitals have one guild. But Children’s Hospital Central California has fourteen guilds. That’s hard to believe. Las Madrinas in Tulare County is one of the founding guilds that is older than Children’s Hospital itself. There are two guilds in Kings County—one in Hanford, and one in Corcoran. There are four or five in Fresno, one in Madera County and one in Merced. They’ve all been champions for the needs of children in their communities. These guilds were founded by and are led today by women and mothers with the foresight to make the investment in children’s health.
Sounds to me like very dedicated individuals. Valley Children’s Hospital helps the children who are most seriously ill and injured. --Those that need pediatric sub-specialists. These doctors are in very short supply.

    I understand.

     Having a pediatric hematologist or pediatric neurologist located in a rural area is really extraordinary. It was particularly impressive to find these specialists in the valley in 1952.

   Are you still practicing law?

     No, I’m not practicing law now. In this position my work is informed by my legal experience. Our issues are not primarily legal in nature. They’re primarily regulatory and advocacy. We are now considering another Bond Act for 2008. So I will be working with the Bond Council again to make sure that we succeed as we did in ‘04. My current position it is very much a leadership advocacy, general administration position.

    Do you miss going to court and the general practice of law?

     I don’t miss going to court. I don’t miss the different clients. I liked my work at Children’s Hospital more than the private practice of law because it is very focused. I do miss the real problem solving. You know, most people, if they had their druthers, would never want to have anything to do with politics.
You are right about that.
It’s frustrating to everyone, including those elected, to make public policy decisions. There are more needs than there are resources available. My job is to position the needs of the children served by the Children’s Hospitals in a way that they can make good policy decisions that help us do our work. And I’m here, day in and day out, with the educators and the law enforcement and the road builders…

    It sounds like a whole different field for you; yet, it pulls in all of your past experiences.

     Yes, it’s a different kind of work. It’s important. I’m humbled to have been asked to do it.

    Obviously, they knew what they were doing when they asked you to head up the operation.

     Thank you! There’s a great opportunity to affect public policy. The day in and day out work is done at the local level. And so I’m glad I have that. There are a lot of people that I know from thirty years ago. It’s sort of satisfying to still have relationships with those people. When I worked for Governor Brown my motto was that credibility is a non-renewable resource. It served me well because there are still people in Sacramento that I’ve known for thirty-five years. I didn’t burn any bridges.

    You were a young person in a young administration. You had to prove yourself.

     They trusted my word. And my word was my bond. And that’s important. But I don’t want them getting tired of hearing from me. They need to know what impact their decisions have in their own communities. I’m working to strengthen the bonds of the local Children’s Hospitals with their elective officials. I give them the tools to be able to do that.

    What, in your new position as CEO, do you find most frustrating?

     Balancing the interests of several hospitals. While they’re very much the same, they all have different needs and occasionally they bump into each other with competitive issues. Looking for those common threads sometimes is a challenge as is minimizing the differences and rough spots.

    I’ll bet that’s where your political experience comes into play.

     Yes, well, it requires a certain amount of diplomacy to help them see where their common interest is and guide them in that way. My Board of Directors consists of eight very successful CEO’s. They are each running a very big hospital in their own community, and they’re under a lot of pressure. They don’t have time to mess much with politics.

    You mentioned the, the possibility of a new bond measure.

     Well this is the year of healthcare reform. As you listen to the Governor articulate it. We have great respect for him bringing the power of his office to focus the attention on these issues. There are very many moving parts, however, and our healthcare system is seriously challenged. We are working very hard to find a way to make reforms that get the payment system closer to the delivery of service. It’s very complicated.

    Your hospitals will accept anyone who walks in the door, regardless of their ability to pay, correct?

     Yes. The Children’s Hospitals all have the mission to provide essential care without regard to ability to pay. Seventy percent are Medi-Cal patients in a few of our hospitals. The one just outside of Fresno had seventy two percent Medi-Cal last year. So, when the Governor talks about a hidden tax and shifting the under-paid government clients to private pay, you can’t shift seventy percent on thirty percent. So there is a series of supplemental funding that the state and federal government have to make. Well these supplemental funds over the years have been added on, sort of like categorical aid in education. It doesn’t necessarily tie into the service that’s needed. And so we’ve got this a house of cards that could collapse at any moment.

    And then you would have the medical community complaining about the payments, right?

     Right. So the hospital has to step in and provide support to the sub-specialists who are needed to take care of the children with the greatest needs. Those costs aren’t accounted for in the current payment system. It’s all a thread on a sweater. When you pull part of the thread it all begins to unravel. So, as ambitious as the Governor’s plan is, it is doubtful that he could make it work, because it’s a massive re-distribution. I think that the dislocation of those dollars is going to make it very hard to get the kind of comprehensive reform the Governor wants. But we want something that is more cost-based, that lets everybody know that if you provide a service, you get paid for it and that child isn’t going to be left without the care that they need.

    Is help available on the federal level for the healthcare industry?

     No federal help. Fortunately the healthcare leaders for the state have a fuller appreciation of the special needs at Children’s Hospitals than they do at the federal level. There’s a lot of pressure on the share that the federal government pays for medical. They’ve got very big budget deficits and very few places of discretionary spending. So, the health budget at the federal level that matches the states investment for medical is being reduced. And we’re fighting very hard in Washington just to keep what we already have. I was in Washington just two weeks ago on this matter. It was my fourth trip this year. I gave them absolute real-time examples of what will happen if they proceed with the plans that they currently have.

    And….

     The federal agency that governs spending has been trying to make dramatic cuts in a way, for California alone, would be a reduction of over $500 million dollars every year for the next five years. Congress has opposed that, but the administration is proceeding under regulatory authority that it alleges it has.

    Sounds like a battle.

     We’ve had years of tax cuts and war spending. There are very few places for them to turn. And we’re there telling them, don’t take it out on the children.

    Do you think that will change if a Democrat gets elected?

     I think all of the candidates on both sides in the next Presidential election understand the huge challenge we face with healthcare reform and spending. I am certainly going to be looking to support a candidate who cares about real healthcare reform. The spending question is difficult to divorce from reform. And the Democrats are going to have a big budget hole to dig out of if they are successful. You know, when Clinton was elected in 1992, no one expected him to be a budget hawk. When he made the hard choices to balance the budget during his administration, it was at the expense of some issues that Democrats were surprised to lose on. So, I think the next President is going to have some very hard choices to make in how we pay for healthcare. And I hope that we will be able to be smarter about it. I don’t think we’re going to have more money to spend on it than we already have.

    So you’re optimistic that healthcare reform will happen?

     I am not. It’s very difficult to get the political will to make the kind of sweeping change that needs to be made. And I give our governor a lot of credit for really talking about shared responsibility. Everybody has to give up something to make the whole better. And no one wants to give anything up. Everybody wants all that they have, and more.

    But there’s simply not enough to go around.

     You’re right! To do that kind of fundamental reform is going to take some risk and some courage to step out and say, I don’t know if this will work better, but I know what isn’t working. That’s the kind of work that I’m doing with the Children’s Hospitals. Is there a way that we can restructure the system so that there are some cost savings that we can all benefit from.

     It’s very difficult. People talk about cost containment but want to control costs. We don’t have enough nurses. The new drugs are expensive to develop. The equipment is very expensive. You know, we’re saving the lives of children who even five years ago wouldn’t have made it to the hospital to enjoy the benefits of the research. That’s very expensive. And you can’t trim that back without limiting the care in some way. Nobody wants to do that. I certainly don’t. So we’ll keep incrementally trying to get as much care as we can afford to the children who need it the most. It’s a tough battle.

    Is there one obstacle, a mindset, or a barrier that you have not been able to break through?

     I wish there would be a way to have more people take more responsibility for their own health. Our system is very oriented toward the care of the critically ill or injured. It’s a widely known statistic—that eighty five percent of the healthcare dollars are spent in the last six months of life. And that’s for good reason because you’re trying to save lives when they’re most threatened. I don’t know how to back away from that. If one of my daughters needed care, I would do whatever I had to do to get them that care. Child obesity is a huge problem that needs special attention. We need to improve our diet. We need to eat better—more fruits and vegetables. If primary care physicians would see more children in their offices and provide the follow-up care that’s needed for asthmatics, fewer of them would have to be in Children’s Hospital in a critical condition.

    I am aware that asthma is a big problem in the Central Valley.

     The valley’s air is critically important to children’s health. It’s also important in recruiting professionals.

So, if you had a magic wand?

     I would clean up the air! Our whole healthcare delivery system is oriented toward critical care, and the expense of critical care. I wish there was a magic wand that could turn that upside down so we can invest more in health, rather than in illness. I’m not smart enough to know how to do that because I don’t know how to say we’re not going to provide this kind of care when it’s needed. Whose cancer aren’t we going to cure? Whose heart are we not going to repair? What premature baby are we not going to put on a ventilator? That is the conundrum.