In the first week of 1945, Dr. Lloyd Bambauer announced that the Bishop Community Hospital was in trouble. Set in a small house on the corner of Grove and Fowler streets, the hospital was struggling to meet the rural community’s needs, and its finances were suffering. Worried its closure was imminent, a committee of 11 residents tasked themselves with finding a solution. 

Over the next few months, the Bishop Community Hospital Association raised money and support, but they needed a long-term solution. Then, that September, they came up with a new idea: They would petition to create a hospital district. Such a thing did not yet exist, but special districts were gaining popularity across the state as communities voted to form local entities to manage irrigation, mosquito abatement, fire protection and recreation. Why not create a district to oversee their community’s health care needs? 

Bishop community members pushed for the passage of the Local Hospital District Law, or S.B. 586, and soon after, Northern Inyo Hospital District became one of the first two hospital districts in the state. By 1994, there were dozens of districts across the state, and they were renamed health care districts to emphasize the importance of care outside of hospitals. Today, there are 77 health care districts across California, providing care for tens of millions of people, mostly in rural areas. Inyo County, where Bishop is located, now has two: Northern Inyo and Southern Inyo Healthcare District. 

Each of the state’s 77 health care districts is governed by a five-member board of directors, and this election cycle, candidates will seek these seats all over the state. The board of directors oversees the district’s finances, the hiring of a CEO, the policies and procedures of employees at the district and, perhaps most importantly, how the district should meet the needs of the community. It is the board’s responsibility to assess the community’s health care needs and implement services to address them, which is what the Association of California Healthcare Districts said makes health care districts unique. 

“They are the most accountable form of health care that a community could have,” Association Senior Legislative Advocate Sarah Bridge said. Unlike private hospitals or clinics, each district’s finances must be made publicly available, and if a community member wants to voice their opinion about the services of their health care district, they can attend a monthly public board meeting. Those living within the district’s boundaries can also make their priorities known at the ballot box. 

But few community members attend these meetings, and many do not know these districts exist or that they may be governing health care in their region. 

Ted Gardner is the secretary of the Northern Inyo Health Care District board of directors, and he is seeking reelection this fall. He also served on the board for two terms beginning in 1990, and in his experience, it has always been difficult to get the community to engage with the board, both as meeting attendees or as board members. He said that while meetings are sometimes attended by employees or volunteers of the district, it’s rare to see people who are highly engaged. 

There’s even less interest in running for office, he said. “There does not seem to be as much interest in being a hospital board member as there might be in running for some of the other offices,” Gardner said, noting the relatively large number of school board electoral candidates. Of the three zones with open seats this election, only Zone 3 — covering the city of Bishop, where Gardner lives — is holding a contested election. Gardner is running against Laura Smith (who did not respond to interview requests), while David McCoy Barrett, in Zone 1, and David Lent, in Zone 4, are running unopposed.

Gardner, who was appointed to the board in early 2023 after no one sought the Zone III seat in the 2022 election, feels baffled by the lack of interest. “The health care district is a very important aspect of the entire county, ranging for a couple hundred miles,” he said. Gardner wonders if most district residents are even aware of the impact the hospital has on their property taxes. For those within the district boundaries, one of the largest charges on their annual property tax assessment is to pay for the bond measure funding renovations to Northern Inyo Hospital. 

Voters passed this measure in 2005, affirming what Bridge sees as one of the strengths of health care districts. “We’re willing to band together, draw these boundaries, and essentially tax ourselves to provide this service,” she said. For those within the boundaries of the Northern Inyo district, the bond is charged in addition to the small percentage that the county collects and passes on to the district. According to Inyo County Auditor-Controller Amy Shepherd, approximately 60 percent of a household’s property taxes go to schools, 30 percent go to the county, and 10 percent go to the city and special districts, including, but not limited to, the health care district. Tax payers can refer to their property tax assessment to see the charge from the bond, and can calculate that a few percentages of their total property tax will be allotted to the district automatically. 

“They’re almost like boots on the ground for hearing what their neighbors want and what the folks that they’re representing want and then get to reflect that in the strategic plan,” Bridge said. In 2022, the Northern Inyo Healthcare District commissioned a community needs assessment which identified behavioral health, access to health care services and chronic disease management as top priorities. Checking in with the community is a key part of the role, along with less glamorous duties like overseeing budgets and confirming policies. 

The power board members hold becomes more apparent when districts face challenges. In nearby Southern Mono Healthcare District, the board voted in June 2023 to close Mammoth Hospital’s labor and delivery unit, forcing many pregnant patients to seek care at Northern Inyo. While providers have reported adjusting well to the added patients, no challenge has proved as difficult for Northern Inyo in recent years than its finances. 

While health care board seats are not inherently political offices, the Health Care Districts association has seen the motivations behind these elections change in recent years. “We’ve seen the contention and the politicization of health care districts, particularly in their boards, in a way I’ve never seen,” Bridge said. Whether the discussions center on vaccine and mask mandates or the availability of reproductive health care, board members today are being tasked with making decisions that have become highly politicized.

Gardner said that while he hasn’t seen that at Northern Inyo, he still believes that the ability to listen and keep an open mind is a key attribute to serving on the board. “You need to learn to count to three,” he said, referring to the three-member majority needed for the board to pass any vote. And while board members aren’t compensated much for their service on the board — they receive just $100 per meeting — he sees participation as an important way to be involved in a critical community service. 

“Times change,” said Gardner, and being willing to adapt to the community’s evolving needs is crucial, in his opinion. He knows those changes better than most: his family first moved to Bishop in 1958, when Gardner was just 10 years old. 

After decades of working for his late-wife’s physical therapy practice, Gardner is happy to be back on the board supporting the community, and he welcomes the competition for the position. “What’s important,” he said, “is that there’s people interested in being a board candidate in the first place.”