Friday, February 26, 2016

Sutter Coast 's Critical Access Application Withdrawn!

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A Major Victory But Not an End to the Sutter Conflict

The Past:  On December 5, 2013, the Sutter Coast Hospital Board voted, over my objection, to downsize Sutter Coast to a Critical Access facility.

The Present:  This week, hospital CEO Mitch Hanna confirmed he had sent a request to the State of California, asking to withdraw Sutter Coast's Critical Access application.  Mr. Hanna also confirmed Sutter Coast registered multimillion dollar profits again in 2015, after Sutter's "independent study" and former CEO Linda Horn had foretold of heavy losses through 2018.  As so many in our community have told me, Sutter can cook its books any way they wish, because hospital Board meetings and financial records are kept secret.  At the same time, Sutter Coast is granted a "hardship" tax exemption, claiming they are a charity.

Thanks to your efforts, Sutter's decisions to move hospital ownership out of Del Norte County and to downsize to Critical Access, have been stopped for now. Sutter told us we could not stop them, that we had no voice, that our community just didn't understand.  You proved Sutter wrong.

The immediate threat of Critical Access designation has passed. However, Mr. Hanna made no promises that he would not implement Critical Access in the future.  Here is why I opposed Critical Access:

--huge increases in out of pocket costs to local Medicare patients

--closure of 50% of the acute care hospital beds

--restriction on how long patients may stay in the hospital

--mandatory patient transfers to outside hospitals

--nationwide, Critical Access hospitals have been shown to have higher death rates for patients with pneumonia, heart failure, heart attack, and following elective surgery.

The future:  My next focus will be on Sutter's high charges for care, which result from their statewide monopoly and high income needs of their multimillion dollar executives and attorneys. 

Sutter's high charges drive up your insurance premiums and harm our public employees, teachers, individuals, and small and large businesses.  Statewide, Sutter's charges have been found to be up to 60% over market averages, while its executive pay has skyrocketed. This injustice must end.  

Please send me your thoughts to, and tune in to a recent radio interview on KCIW, available by podcast, tablet, or smartphone at:


Gregory J. Duncan, M.D.
Diplomate, American Board of Orthopedic Surgery

Sunday, February 21, 2016

How Your Healthcare Dollars Are Paying Sutter's Executive Salaries

Introduction by Greg Duncan, M.D.

This newsletter tells the success story of how our community fought Sutter Health's efforts to downsize and take ownership of Sutter Coast Hospital.  Local attorney Bill Gray investigates Sutter's misconduct, exposes the harm Sutter has brought to our community and our state, and offers advice on how to bring justice to Sutter.  To learn more, please stop by my office on 1200 Marshall St., pick up fact sheets on how Sutter is increasing your healthcare costs, and join the more than 4,000 residents who have signed the petition opposing Sutter's plans.  To subscribe to this newsletter, please send me an email at   Read past newsletters at

Most of all, thank you for your support, ideas, and prayers.

Greg Duncan, M.D.
Diplomate, American Board of Orthopedic Surgery
1200 Marshall St., Crescent City, CA  95531
Myth Busting Sutter Health:
Community Benefit or Executive Greed?
by Bill K. Gray, Esq.

(originally published in the Anderson Valley Advertiser:
Sutter Health is a tax exempt public charity.  The tax code requires Sutter to operate solely for community benefit. Indeed, for decades Sutter Health served to manage community owned hospitals which were governed by community Boards of Directors. In 2010, Sutter Health's role changed when it implemented a statewide merger effort to transfer ownership of the community hospitals into large multi-hospital corporations.  Now, Sutter Health controls two massive "Divisions" containing nearly 40 hospitals and surgery centers.  The result?  Sutter Health's monopoly allows it to charge up to 60% more than market rates for healthcare.  Sutter executive salaries more than doubled during its merger.
Who pays Sutter's executives?  You do.  Whether in the form of higher health insurance premiums, lower wages (as more employer dollars are used for employee health insurance), or direct payment of Sutter's inflated charges for care, everyone in California is impacted by Sutter Health's monopoly.
Today, only one Sutter hospital in California remains locally owned--Sutter Coast Hospital ("SCH") in Crescent City.  This article tells the story of how our town fought off Sutter's attempts to transfer hospital ownership outside of our community.  We debunked Sutter's false claims, one by one, until Sutter agreed to leave us out of its two "Divisions."  We know Sutter Health will be back, but for now, SCH is locally owned and governed. 
Sutter employed four tactics in its takeover attempt:
(1)  Threats to close the hospital if the local hospital Board did not comply with Sutter's corporate plans.  For years, Sutter executives claimed SCH needed to transfer ownership to Sutter's regional corporation, and to downsize to a Critical Access facility (which would allow SCH to triple its charges to Medicare), in order to survive.  Sutter's threat to close the region's only hospital nearly worked.  In 2011, the Sutter Coast Hospital Board (which contains three highly compensated Sutter employees) voted to transfer hospital ownership to Sutter's multi-hospital corporation.  But protests from every elected body and thousands of residents, and talk of eminent domain against Sutter by the Del Norte Healthcare District, forced Sutter to put the merger on hold.
(2)  False claims of financial losses.  Former Sutter Coast CEO Linda Horn stated 2008 was the last year Sutter Coast was profitable.  Sutter's paid consultants (the Camden Group) predicted heavy losses from 2014 to 2018 unless the hospital converted to Critical Access. Now we know the truth: Sutter's claims were all myths.
IRS filings confirm Sutter Coast made over $7 million in profits combined in years 2009 and 2010. That's on top of many millions in profits from 1985 through 2008.  Sutter's predictions of losses from 2014 to 2018 are also proving false.  According to current hospital CEO Mitch Hanna, Sutter Coast generated a "healthy profit" in 2014.  How healthy?  $10.8 million in 2014, with similar profits predicted for 2015, when Mr. Hanna's annual salary was $840,000.  So, without downsizing to Critical Access, Sutter Coast's profits and Mr. Hanna's salary both appear quite "healthy."
But what of the health of our community?  In 2014, Sutter Coast transferred 872 patients out of our county for medical care.  Sutter Coast outsourced local hospital jobs to Sutter's regional service center, cut hospital staff, and has become a revolving door for physicians leaving the county.
(3) Secret meetings. Sutter claim:  "We act openly and truthfully in everything we do."  Here are some facts:  Sutter only released "select information" from its self-funded "independent" hospital study. Sutter muted the telephone lines during its internet-only public presentation of the study, so audience members could not hear questions from other participants.  Sutter holds closed Board rooms, dismissed a dissenting Director from the Board room, and censured our local hospital Chief of Staff for allegedly releasing Board meeting minutes, while providing no evidence to support the allegation. 
(4) Broken promises. Sutter, a public benefit company, has hosted no public meetings during their four your conflict with the community.  During a Town Hall meeting on February 17, 2015, Sutter Coast CEO Mitch Hanna, unable to answer many questions from the audience, stated he would return within 30 days to discuss hospital finances. One year later, Mr. Hanna has failed to appear.  Sutter Health executives also ignored official record requests from our city and county leaders. 
Sutter's tax exemption means our county, state and federal governments cannot collect hundreds of millions in yearly tax revenues which "for profit" companies must pay. Does Sutter deserves its tax exempt privilege and above market charges for health care?  You be the judge . . . . .
Sutter's violations of California law are too numerous to detail here.  If you would like to help address Sutter's misconduct and its impact on California healthcare costs, please join Dr. Duncan's team of volunteers by writing him at, and join our city and county leaders, who have already asked Attorney General Kamala Harris to investigate Sutter Health, by writing to:
The Honorable Kamala Harris
Attorney General of California
1300 "I" St.
Sacramento, CA  95814-2919

Tuesday, January 19, 2016

The Root of the Hospital Problem: A Sutter Coast Hospital Board Mired in Secrecy

In This Issue 
January 16, 2016
The Root of the Hospital Problem:  A Sutter Coast Hospital Board Mired in Secrecy
By Greg Duncan, M.D., with original email by Larry Eninger, M.D.
This article contains an internal hospital email written by my colleague Dr. Larry Eninger, providing a "behind the scenes" look at the conflict between our community and the Sutter Health appointees on our local hospital Board.  Dr. Eninger served on the Sutter Coast Hospital Conflict Resolution Committee, formed when hospital physicians opposed the Board's secret vote to transfer hospital ownership out of our community.   Local readers already know Dr. Eninger as a caring doctor with a wonderful staff in Crescent City and Brookings.  Less well known is his resume--retired Navy captain and flight surgeon, former Sutter Coast Chief of Staff and Director, and former staff physician at the Scripps clinic in La Jolla, California.  Dr. Eninger's  experience in multiple practice settings was a great asset to the committee.  For three years, he met with physicians and hospital Board members, studied the hospital bylaws changes written by a Sutter Health attorney in 2011, and offered his advice to resolve the Sutter conflict.
This week, Dr. Eninger resigned from the Conflict Resolution Committee.  His resignation email , sent to all members of the Sutter Coast Conflict Resolution Committee, follows:

(note: "Kevin" refers to Dr. Kevin Caldwell, who was advised by a hospital Board member that Dr. Caldwell could not release any committee information to anyone)
"Kevin, you don't need anybody's permission to share our communications. 
Anyone who thinks their words/actions should be kept secret should probably reconsider those words/actions.  I will certainly be perfectly candid if anyone cares enough to ask me what has transpired in our committee."
"I have been tight-lipped, but I fully understand your frustration.  All the secrecy is counterproductive.  Do some think they need to make decisions for the community without the community's knowledge because they are so much smarter than the lowly people who just wouldn't be able to understand their wisdom?  Or maybe they are ashamed of their actions and know that anyone with knowledge will recognize that those actions are indefensible?"
"I've tried for years to be understanding, but it's time to call a spade a spade.  It's convenient and comfortable to criticize Sutter Health, the big nebulous corporation in Sacramento, rather than our friends and neighbors.  But Sutter Health is not primarily responsible for the decline of Sutter Coast Hospital over the past few years.  Sure, they could have been more open and spoon-fed us with the negative aspects of their plans, but why should they?  They are a corporation whose Board is responsible for the success of that corporation.  Their primary concern is not Sutter Coast Hospital or our community.  That responsibility belongs to our local Sutter Coast Hospital Board."
"In defense of our Board, it is a tough job.  Nonetheless, it is our Board's responsibility to protect the interests of Sutter Coast Hospital, and by virtue of the hospital's charter, the local community.  Whether by ego, ignorance, ineptness, laziness, cowardice or combination thereof, our local Board has failed miserably in that responsibility."
"Some board members still believe that Sutter Coast Hospital is owned by Sutter Health.  They either don't understand their responsibility as Trustees of Sutter Coast Hospital or they choose to ignore it.  They weakened their powers, and thus their ability to meet their responsibilities, by accepting the Bylaws changes of 2011; they tried to give them away completely by voting for regionalization; and they voted for Critical Access, a designation that burdens our community.  Then when confronted with opposition they chose to spend hundreds of thousands of dollars on a carefully-orchestrated, dependent "study" carefully constructed & interpreted in the then-CEO's office to support their position before hunkering down behind a wall of secrecy.  They chose to ignore the physicians and community with whom they clearly (should) have common goals and instead listen to the lawyers of Sutter Health, a corporation whose goals are, although generally aligned with, not the same as those of Sutter Coast Hospital."
"Our Sutter Coast Hospital Board is at odds with our community - fighting us on behalf of Sutter Health.  Until the majority of our Board is once-again composed of community-focused individuals who are capable of independent thought, our efforts on the Conflict Resolution Committee are a waste of time.   I am truly sorry about the events of the past 4-5 years for all of us.  However, 4 years is enough of rehashing the facts and having them repeatedly ignored.  I had hoped to contribute to resolution of our conflict, but I hereby admit my failure to meaningfully do so and submit my resignation from this committee."
Larry Eninger, M.D.
How Can You Help?
If you support the goal of affordable, accessible healthcare, please join the more than 4,000 local residents who have signed the petition at my office on 1200 Marshall St., opposing Sutter Health's corporate plans; write a letter to the Del Norte Triplicate (P.O. Box 277, Crescent City, CA  95531) and join the statewide effort to compel Sutter Health to open its hidden books and records by asking Attorney General Kamala Harris to investigate Sutter Health's conduct and whether Sutter deserves a tax exemption:
The Honorable Kamala Harris
Attorney General of California
1300 "I" St.
Sacramento, CA  95814-2919

Gregory J. Duncan, M.D.
Diplomate, American Board of Orthopedic Surgery
Please post this letter on Facebook and forward to interested friends!
Gregory J. Duncan, M.D. | | | 1200 Marshall St.
Crescent City, CA 95531

Monday, January 4, 2016


by Roxie Hazard, Certified Radiologic Technologist
Here is a brief history on California's Healthcare Districts, and why our local Healthcare District is so important to our community:
In order to address healthcare shortages in rural areas, the California legislature approved the formation of local Hospital Districts, now called "Healthcare Districts." By law, Healthcare Districts have specified statutory rights, including the right of eminent domain, in order to provide appropriate healthcare for communities.  The Del Norte Healthcare District is governed by five elected county residents who, among other contributions, built the Del Norte Community Health Center, the largest clinic in Del Norte County, providing primary care, dentistry, and mental health services.
Four years ago, as part of Sutter Health's statewide hospital merger effort, the Sutter Coast Hospital Board voted (over the objection of Chief of Staff Dr. Kevin Caldwell) to dissolve itself and transfer ownership of Sutter Coast to a San Francisco based, multi-hospital corporation, entirely controlled by Sutter Health. Sutter excluded the hospital physicians, the Del Norte Healthcare District, and our community from its decision to transfer ownership of Sutter Coast Hospital out of Del Norte County.  In spite of widespread public concern, the Sutter Coast Board Chair refused to reconsider the Board's decision, stating, "the train has left the station."
Two years ago, the Sutter Coast Board voted (over the objection of Chief of Staff Dr. Greg Duncan) to implement "Critical Access" status, which, according to hospital CEO Mitch Hanna, would allow Sutter Coast to collect an additional $5 million a year from Medicare. However, Critical Access also required Sutter Coast to close half of its beds, and would greatly increase out of pocket costs to local Medicare patients. Whenever Sutter Coast was "full" under the 25 bed cap imposed by Critical Access, patients would be shipped to outside hospitals, at their expense.
In response to Sutter Coast's decisions, the Del Norte Healthcare District led an effort to stop Sutter Health's plans to take hospital ownership and to downsize Sutter Coast to a Critical Access facility.  Now, Sutter Coast states it has ended its effort to transfer hospital ownership out of Del Norte County, and has tabled its plans to downsize to Critical Access.
The problem is, the Sutter Coast Board has not made any binding promises--they have not withdrawn their Critical Access application and have not rescinded their vote to transfer hospital ownership out of our county, despite being asked to do so by the hospital physicians. The Sutter Coast Board has also refused to release their meeting records and financial data, and they continue to hold meetings closed to the public.
Q.  How can we bring better healthcare to our community?
A.  By supporting our locally elected Del Norte Healthcare District Board. 
Over 4,000 area residents have signed the petition at Dr. Duncan's office, opposing Sutter's corporate plans for Del Norte County.  Please stop by his office on 1200 Marshall St. and add your name to this list.  Our community, together with our Healthcare District, can improve local healthcare.
Our Healthcare District generally meets at 6:30 p.m. on the 4th Tuesday of each month, but with the holidays, the next meeting is scheduled for next Tuesday,
January 5th,  2016, at 6:30 p. m.  Meetings are open to the public, and are held at the Wellness Center, 550 Washington Blvd, Crescent City, CA 95531.  The phone number is:  (707) 464-9494, Monday through Friday, 8 am to 12 noon.
Please join me on Jan. 5, and the fourth Tuesday of each month, and bring your ideas and questions.  Together, we can make better healthcare in our region a reality. 

Roxie Hazard, CRT
Crescent City, CA

Monday, October 26, 2015

Headline Article Debunks Sutter's Prior "Gloom and Doom" Forecast

October 18, 2015 
In This Issue
Headline Article Debunks Sutter's Prior "Gloom and Doom" Forecast

For those who missed the 10/1/15 headline article in The Del Norte Triplicate, and were unable to attend yesterday's Town Hall meeting, here is "the rest of the story" on Sutter's financial claims  . . . . 

Background:  In late 2013, Sutter executives told us that downsizing Sutter Coast Hospital to Critical Access status was necessary to stem Sutter Coast's financial losses. Former hospital CEO Linda Horn publicly announced the hospital had not had a positive operating margin since 2008. (Ms. Horn's statement is contradicted by Sutter's own data, which shows operating income of $7 million for years 2009 plus 2010.)

The Camden Group (a consulting firm paid by Sutter) and Linda Horn both projected heavy losses at Sutter Coast through 2018. Those dire predictions were used to justify removing half of the hospital's beds from service, which hospital officials conceded would necessitate an increase in mandatory patient transfers (due to the 25 acute care bed cap imposed by Critical Access).  But in the face of the projected losses, Critical Access would allow Sutter Coast to triple its payments from Medicare. (source: Linda Horn, NewsPlus," 1/17/14.)  Thus, the downsizing was portrayed as a necessary trade off in the face of predictions of steep losses ahead.
Fast forward to 2014:  The Del Norte Triplicate's headline article 10/1/15 reported Sutter Coast Hospital's profits were $10.8 million in 2014, and according to Sutter Coast CEO Mitch Hanna, expected to be roughly $11.9 million in 2015 (without Critical Access). (source:

Sutter's gloomy 2013 forecasts turned into huge profits the next year. These profits are not surprising--Sutter Health is nationally renowned for its high prices and profiteering--see the following New York Times article, which discusses Sutter Health:

Critical Access news for 2015:  The Sutter Coast Board of Directors, noting an influx of patients seeking treatment, voted to hold off converting Sutter Coast to Critical Access, but hospital officials "declined to share the census numbers for 2015 that prompted reconsideration of the Critical Access application." (source:

Hospital CEO Mitch Hanna later confirmed Sutter Coast's Critical Access application has not been withdrawn, so the hospital Board keeps open the option of Critical Access at Sutter Coast, behind the veil of secrecy of Sutter Coast's closed Board room.  

Why Is This Important to You?  Because if Sutter Coast downsizes to Critical Access, there will be 50% fewer available beds, more mandatory emergency patient transfers, plus, higher out of pocket costs and higher secondary insurance premiums for Medicare patients. (sources: Office of Inspector General Report Oct., 2014, and Kaiser Health News, 10/7/14)

How you can help address Sutter's high prices, conflicting statements, and closed Board rooms:

1. Write The Del Norte Triplicate, letters to the editor, 312 H. St., Crescent City, CA 95531, or by email at   Be sure to include your phone number, which is not published.

2. Contact me at if you would like more information, or if you have any information on hospital charges or patient transfers.

3. Join the 4,000 others who have signed the petition at my office, opposing Sutter's plans to move ownership of Sutter Coast Hospital out of our county.

4. Please read the editorial below, published 10/15/15 in The Del Norte Triplicate, also available at this link:

Thank you all for your continued support,
Gregory J. Duncan, M.D.
Diplomate, American Board of Orthopedic Surgery
Sutter's Profiteers Cause for Dismissal
By Curtis Bower

October 15, 2015

(reprinted with permission from The Del Norte Triplicate and Curtis Boewer) 

In follow up to the excellent headline article regarding Sutter Coast Hospital's multimillion dollar profits, published Oct. 1 in the Del Norte Triplicate, please consider the following: 

Hospital finances: 

When it benefited Sutter Coast to show losses (as the hospital board attempted to convince our community that hospital downsizing was needed for financial reasons), Sutter Coast showed losses. When it benefitted Sutter Coast to show profits (as the healthcare district considers purchasing Sutter Coast through an eminent domain action), Sutter Coast shows profits. It seems Sutter can make its books show whatever Sutter wishes.

Do the hospital employee salary reductions Mr. Hanna oversaw apply to him? IRS filings show his 2013 compensation was $645,399, plus other income described as "deferred in prior form 990." Was Mr. Hanna's salary reduced in 2014? Hopefully, he will fulfill his promise made earlier this year to return to a town hall meeting and discuss hospital finances.

Hospital utilization:

Mr. Hanna repeats the claims of the last two CEOs - the number of patients using Sutter Coast is declining. Let's think about reasons why fewer people would be going to Sutter Hospital. Could it be the hospital's reputation, its high charges for care or the fact that in the past two years a Sutter surgeon general, a Sutter orthopedic surgeon and a Sutter family practice doctor have left our area to work elsewhere? Dr. Duncan and Dr. Davis offer surgery at Mad River Hospital, where charges to patients are much lower. It seems Sutter administrators are responsible for the fact fewer patients are choosing to receive care locally.

Hospital profits:

Our community should know that the profits taken in by Sutter Coast are transferred every two weeks to Sutter Health in Sacramento, where Sutter executives decide where to spend the money. This may explain why Sutter Health CEO Pat Fry saw his own salary increase from $2.4 million in 2007 to $6.4 million in 2012. I prefer those profits stay locally - for more staff and better wages for the hard working employees at Sutter Coast.

Finally, I ask two questions: 

Is Sutter Health trustworthy?

Which is a higher priority for Sutter Health executives - our health care or their salaries?

As a former hospital administrator, I support the Del Norte Healthcare District's effort to expand and improve local health care.

Curtis Boewer

Curtis Boewer of Crescent City, is a consultant, former administrator of Good Samaritan Foundation, vice president of Good Samaritan Hospital, both in San Jose, and a former administrator of Marion Medical Center in Santa Maria.

Gregory J. Duncan, M.D. | | | 1200 Marshall St.
Crescent City, CA 95531

Saturday, April 25, 2015

Sutter Health Does Not Play Nicely in Sandbox

Sutter Health Does Not Play Nicely in Sandbox

by Roger Gitlin, Del Norte County Supervisor
Originally published in The Del Norte Triplicate, available online at (search "Sutter Health" for this article and related information).

"Who's going to protect the people of Del Norte County?"

Those words of Kevin Caldwell, M.D., reverberate loudly. It was Dr. Caldwell who first dared to stand up to the multi-billion dollar goliath Sutter Health by opposing Sutter's decision to move hospital ownership out of Del Norte County to the Bay Area and lower the 49-bed Acute Care hospital to a 25 bed Critical Access facility.

Dr. Caldwell was the first local physician to see Sutter's malfeasance. As hospital chief of staff, he identified Sutter's repeated implementation of patient care policies without physician input. Sutter Health was telling doctors how to practice medicine, in violation of California law. With great effort, Dr. Caldwell was able to unwind Sutter's illegal policies. Later, after Sutter Health executives advised the local hospital Board to dissolve itself and transfer hospital ownership to the Bay Area, Dr. Caldwell asked the hospital board chair for a guarantee Sutter would not close the obstetrics service. Dr. Caldwell could not get that guarantee. He stood alone in defense of our community.

Dr. Caldwell joins medical colleagues Mark Davis, M.D., Manfred Ritter, M.D., and Gregory Duncan, M.D., all of whom have experienced the pain of a revengeful, insatiable bully, Sutter Health Corporation. Sutter Health, parent of Sutter Coast Hospital, does not play nicely in the Del Norte sandbox. 

Do you recall hospital CEO Mitch Hanna's announcement this year that Sutter had suspended its application for Critical Access designation? Not true. According to a letter sent to me by Dana Forney, regional manager of the California Department of Public Health, as of April 3, no changes to Sutter Coast's Critical Access application have been reported to CDPH. Was Mr. Hanna's big announcement just more public relations designed to quiet the growing concern with Sutter's decisions? 

The recently-exited Manfred Ritter, M.D., FACS, a superb surgeon who was recruited to Sutter in 2010, saw the writing on the wall and has taken his skills to Seaside, Ore. His recruitment was initiated and endorsed by Sutter Pacific Medical Foundation. After Dr. Ritter opposed Sutter Health corporate policy, his contract came up for renewal - with Sutter slashing his income guarantee by 50 percent. Sutter sent a clear message to a medical professional who had zero complaints levied against him and a rating of "superior" from over 98 percent of his patients.

Likewise, Dr. Davis suddenly finds his 22-year urology practice in Del Norte County in peril. Sutter Health has recently hired another urologist, whose income will be subsidized with Sutter's tax-exempt war chest, to compete with Dr. Davis. One might say, "What's the matter with a little friendly competition? That's good for the economy." To the contrary - the now-famous Camden Report, commissioned by Sutter, identified numerous health care needs, including cardiology, nephrology, oncology and mental health. Likewise, Sutter's Community Health Needs Assessment identified many unmet health care needs in our county. But neither study identified a need for a second urologist. Other than driving Dr. Davis out of town on a rail, what could be the reason Sutter Health has hired another urologist?

Dr. Greg Duncan's experience follows the pattern. After he opposed Sutter's plans to downgrade the hospital, Dr. Duncan found himself the subject of multiple investigations by Sutter Health and Sutter Coast Hospital. Dr. Duncan was forced to spend thousands of dollars and countless hours to defend himself from Sutter's baseless allegations. In the end, it was Sutter who was cited for misbehavior by the Joint Commission (which evaluates hospitals nationwide) and the California Department of Public Health (which regulates hospitals in California).

When Sutter's Exclusive Provider Organization was rolled out this past winter, none of the local independent doctors were invited into the network. CEO Hanna said they are part of the Sutter network, yet to date, Sutter has failed to send local doctors the appropriate paperwork to join, and those doctors are not part of the Sutter network. Drs. Caldwell, Davis, Ritter and Duncan each share a public opposition to Sutter Health's quest to lower hospital status and move all decision-making out of Del Norte County.

I would think a nonprofit "charity" would be obligated to maintain the very highest level of medical services. Sutter does not play nicely in the sandbox. It should come as no surprise that local doctors who have worked in our community for decades now find themselves with a fistful of sand granules tossed in their eyes.
Roger Gitlin is District 1 Del Norte County Supervisor.

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How You Can Help
If you support expanded, affordable healthcare in our region, please join the thousands of citizens who have signed the petition opposing Sutter's plans, available at my office on 1200 Marshall St., Crescent City, CA  95531 or reply to this email with your thoughts.  Thank you all for your help and support!

Gregory J. Duncan, M.D.
Diplomate, American Board of Orthopedic Surgery

Thursday, February 19, 2015



by Kevin Caldwell, M.D. and Donna Sund, D.O.

Many readers are aware of the new local EPO Health Plan being offered by Sutter Health, Anthem, and CalPERS.  You may or may not be aware that Redwood Medical Offices and several other local offices are not currently listed on the provider panel.  Here's why:

The new EPO plan is an "Exclusive Provider Organization."  This means that in order for you to be treated, you have to go to an approved provider and an approved hospital.  None of the local independent (non-Sutter affiliated) providers we contacted were offered an opportunity to join the provider panel before the initial plan roll-out on January 8.  We learned of the plan in the middle of January, when patients approached our office with letters from Sutter Health/Anthem Blue Cross/CalPERS, offering them a new health plan in our area.  We knew nothing of the plan until patients brought us these subscriber letters, and our patients obviously had many questions and concerns.

In the past, when a new health plan was made available, especially to large local employers, the plan administrator would contact us before the roll-out to offer us an opportunity to be on the provider panel.  However, this time the list of participating doctors included only Sutter-affiliated providers (two of whom have already left the area). The only hospital on the approved list is Sutter Coast Hospital. For 30 years, Redwood Medical has always been offered participation in local health plans, and we have been providers for CalPERS/ Anthem since its onset.  In fact, we provide a significant amount of the local primary care to these many employees and their families, and have done so for decades.

When we realized our office was not on the EPO provider list, we immediately contacted Anthem to learn why not. This was the reply from Anthem Senior Managing Consultant Mark Johnson:  "Sutter is taking the lead on adding additional Del Norte County physicians into their EPO plan network providers."  Mr. Johnson added that he would forward our concern and request to be listed on the provider panel to Sutter, but we never heard back from Sutter or Anthem until later that month.

On January 27, Sutter Coast Hospital CEO Mitch Hanna told the hospital Medical Staff that he understood providers who are on Anthem's PPO list of providers were eligible to be on the EPO provider list.  He invited Medical Staff members to call him if they were interested in joining the plan. So we contacted Mr. Hanna's office the following day, indicating our interest in joining the provider list and asking for more details.  But our inquiry to Mr. Hanna about the plan's terms and restrictions has gone unanswered.  Now, halfway through the patient sign-up period, we are still not on the panel, and have not received any further information from Sutter or Anthem about the plan.

Some of our unanswered concerns about the EPO include:

(1) According to the letter sent to plan subscribers, the plan offers "no charge for inpatient or outpatient" hospitalization (as long as you go to Sutter Coast Hospital).  But according to the actual EPO Disclosure Form, there is a $250 co-pay charge for endoscopy, cataract surgery, and spinal injection, and $50 co-pay for an emergency room visit.   

 (2) According to letters from Sutter Health/CalPERS/Anthem sent out on Jan. 8 and Jan. 19, "members do not need to select a primary care physician."  Those same letters also state that the "EPO Plan is specifically designed to not require a primary care physician." But according to an email sent to a local doctor by Nora Nunn Powers, Anthem Regional Director of Provider Contracting, "the structure of the product requires that any request for referrals outside of the established/approved EPO panel need to be directed back to the primary care physician for referrals to other specialists."

 (3)  If patients present emergently to Sutter Coast Hospital and require transfer, either due to specialized needs, such as a heart attack, or because our local hospital is "full"and unable to admit more patients, can these patients be transferred, as has been traditionally done, to the closest available facility (most often Rogue Valley Medical Center), or will they be transferred to a Sutter facility at a much further distance in order to stay within the Sutter network of providers?  In addition, many patients are referred from our office to specialists in southern Oregon or Humboldt County.  Will the new EPO make it impossible for patients to see these usual specialists?

As of today, Redwood Medical Offices is still not on the EPO provider list.  We have made several attempts to learn the details of the EPO plan, but we continue to wait for answers from both Sutter and Anthem.  We hope these answers will be forthcoming, and that we will be able to continue to provide our many long-time patients with the excellent health care they deserve.


Kevin Caldwell, M.D.                                                        Donna Sund, D.O.
                                      Redwood Medical Offices
                                           1240 Marshall St.
                                      Crescent City, CA  95531