By Charles Gardiner, Executive Director
This is the first installment of the Healing the Delta series. The State of California kicked off the holiday season with a Halloween grab-bag of treats for California’s water and natural resources. The draft California Water Action Plan offers up a smorgasbord of something for everyone, with more to come before the New Year. But as any doctor will tell you, a diet of empty calories, overloaded plates, and too few healthy recipes leads to serious health problems requiring medical intervention. The five-year Action Plan includes some of the right prescriptions for its ailing patient—California’s water management system and ecosystem. However, since the patient is in multiple system failure and requires emergency care, it needs a disciplined treatment plan to cure all of its ills. Over the next several weeks, we will outline the diagnosis and formulate a treatment plan to resuscitate the heart of California’s water system and bring the state’s economy and ecosystem back from the edge.
This week, we focus on three fundamental aspects of any effective diagnosis and treatment plan: vital signs, immediate triage, and the coordinated medical response team. The California Water Action Plan includes few substantive actions and commitments to address these fundamental aspects.
Vital Signs – Performance Accountability. Every medical professional and patient knows that vital signs are the starting point for diagnosis and the definition of a healthy patient. Height, weight, age, heart rate, blood pressure, temperature, breath sounds, pulse oxygen, pupil conditions, muscle response, and other metrics provide an immediate status report on the patient. Over years of practice, the medical profession has refined these metrics, along with standards of health and fitness, to quickly assess patient needs and establish health and fitness goals.
The vital signs for California’s water and natural resources are now guided by the integrated public policy goals of meeting the needs of the economy, the environment, and social equity simultaneously. In the Sacramento-San Joaquin Delta, these goals are defined as achievement of the Two Co-Equal Goals of water supply reliability and ecosystem restoration while protecting and enhancing the Delta as an evolving place. Yet the California Water Action Plan and the recently adopted Delta Plan do little to define the vital signs for a healthy California. Without vital signs, the State of California, water managers, and the public cannot diagnose the illness, identify treatments, and, most importantly, measure if the patient is getting healthier.
The 2008 Delta Vision Strategic Plan identified measurable performance metrics for each of the 22 strategies to address California’s water and ecosystem challenges. The 2013 Delta Vision Report Card recommended seven policy-level vital signs to diagnose conditions and guide progress.
Urgent Care – Immediate Triage Plan. Even before a patient arrives in the emergency room, paramedics are assessing critical patient needs and applying measures to keep the patient alive. Emergency room diagnoses assess and treat the highest priority risks to stabilize the patient, even while further tests are underway to develop the long-term treatment plan.
This California patient has been in the emergency room for at least three years, with few stabilizing actions undertaken. The California Water Action Plan acknowledges that if the coming year is dry, the patient may lose a limb or even flatline. As a five-year plan, the Action Plan must identify the immediate implementation actions, funding, and accountability that will protect existing species and infrastructure and increase flexibility in the water management system to support both the ecosystem and the economy. This part of the Action Plan must be action first, followed by monitoring and response.
Coordinated Medical Response Team – Leadership, Commitment, and Assurances. For critically ill patients, every good hospital and treatment plan organizes effective teams for emergency treatment, intensive care, recovery, outpatient support, and long-term care. The safety, health, and recovery of the patient drives every decision and action. Paramedics, doctors, nurses, surgeons, anesthesiologists, orderlies, and administrative staff all play vital, integrated roles and each is accountable for getting it right. Most importantly, institutional structures and procedures ensure assessment, treatment, recovery, and rehabilitation in spite of shift changes, promotions, transfers, and retirements.
The California Water Action Plan and the 2009 water legislation are correct to point out that better coordination and collaboration is needed across State government and among Federal, State, and local agencies and stakeholders. However, the Action Plan and the Delta Stewardship Council’s efforts to establish the Interagency Implementation Committee lack any sense of urgency that that the patient is dying, and that action, rather than planning, is needed. Furthermore, the Action Plan must address the institutional commitments and assurances that will provide long-term consistency and durability of action through and beyond the next shift change.
The Delta Vision Foundation welcomes your comments on strategies and actions that will diagnose, treat, and rehabilitate California and set the State on a path to a healthy ecosystem, prosperous economy, and equal opportunity and accountability for all.
Come back soon to see more of the diagnosis and treatment plan.
- The heart of California: Congestive heart failure in the Delta
- IV fluids: Managing flows for the ecosystem and economy
- Indigestion: Water Storage to Feed Fish, Farms, Factories, and Families
- High cholesterol and diabetes: A leaner, healthier water diet
- The insurance has run out: Funding the treatment plan
- Addictive behaviors: Necessary family interventions
- Undernourished: More greens through habitat restoration
- Outpatient treatment and family support: Public engagement and oversight
- Exercise and fitness: Performance accountability and adaptive management
- Meaningful resolutions for a healthy, happy 2014 (and beyond)