Sunday, December 2, 2012

Judge puts Sutter Coast decision on hold

Opinion letter from Dr. Duncan

Opinion letter from Dr. Duncan

Wednesday, November 28, 2012

Update on Sutter Health's "Regionalization" Plan

Update on Sutter Health's "Regionalization" Plan

In this issue
Critical Access Study

Dear Friends, Patients, and Fellow Residents:

I write with information on Sutter Health's study of Critical Access designation for Sutter Coast Hospital. Critical Access is a federal program which pays qualifying hospitals a subsidy for Medicare patients. In order to qualify, we would need to close 50% of our beds.  Also, Sutter Coast would no longer be required to have a physician on duty in the ER, or a general surgeon or critical care specialist available "on call," as is currently required.

Critical Access would impact our community in two ways.  First, there would be an uncertain financial impact on the hospital.  Second, there would be a negative impact on patient care, due to fewer beds and services being available for sick or injured patients. When Sutter Lakeside Hospital converted to Critical Access in 2008, the bed capacity was cut from 69 to 25 in order to qualify for the program.  Despite Sutter's assurances to the contrary, this was followed by reduction of the hospital workforce by 50%, closure of two clinics, and a large increase in patient transfers to outside hospitals. In 2012, three years after they became a Critical Access hospital, Sutter Lakeside laid off 10% of the workforce, due to continued financial troubles. (source:  Santa Rosa Press Democrat, 3/30/2012).

Earlier this year, Sutter Health financed a study on the impact of Critical Access designation to our community.  The initial study addressed only the financial impact of Critical Access on the hospital, not the negative impact on patient care. You may be curious as to the findings of Sutter's study.  The answer: Sutter Health will not release the results.  The study was completed last August, but Sutter executives will not release the data, stating "it is in a draft form."
Therefore, I decided to conduct my own analysis on Critical Access for the past month. Remember that the cap on patient beds under Critical Access designation is 25, but the "working cap" is 22, because three beds must be set aside for pediatric and maternity patients (in order to reduce the frequency of sick or injured children, or pregnant women, being shipped to outside facilities when the hospital is full).    

Here are my results:  for the month of October, there were 11 days when the Sutter Coast Hospital census exceeded 25, and 17 days when it exceeded 22.  In other words, there were at least 11 days, and probably 17 days, when patients in the Emergency Room who needed a hospital bed would have been shipped to another hospital. Due to our remote location, these transfers would occur by air ambulance, at the patient's expense, without their family, and without their doctor at the receiving hospital. And this is not flu season, when the number of hospital admissions rises sharply.

My analysis assumes that the three beds currently set aside for high security inmates would no longer be reserved for prisoners. If Sutter keeps the beds set aside for prisoners, our working cap would even less (19 beds), and it would be possible that following a riot, a hospital bed would be available for an inmate but not for an injured correctional officer.  If the inmate beds are closed, we would no longer have a secure location for correctional officers to guard high risk prisoners.  (Sutter executives have not disclosed how they would handle prisoners under Critical Access designation).It is clear to the physicians of Sutter Coast that Critical Access is not appropriate for our community, which is why we have passed unanimous resolutions against Critical Access designation, and against Regionalization (which would transfer hospital ownership to Sutter Health).   We passed a separate unanimous resolution stating our goal should be to expand, not contract, patient care services at our hospital.

In summary, financial stability comes not from downsizing and cutting services, it comes from management which includes input from employees, physicians, community representatives, and the residents of this region--the exact opposite of our current Board, which operates a closed Board room and deliberately excludes this community from important decisions affecting our health.  (A recent example:  this week, the hospital Board Chair refused my request to allow a fellow physician to attend Board meetings, in the capacity of an observer).

Want to help?  Please forward this email to interested friends.  Stop by my office and sign the petition to stop Sutter.  Send me an email if you would like to join our team of volunteers.  And please email questions to the address below.  As I told a reporter from the Bay Area this week, I appreciate positive comments, but I like to answer hard questions too.


Greg Duncan
Chief of Staff
Sutter Coast Hospital



Background: On November 3, 2011, the Sutter Coast Hospital Board of Directors voted to turn over control of Sutter Coast Hospital to Sutter Health and its Sutter West Bay Hospitals Board of Directors, a process called “Regionalization.”
Sutter Claim:  “The local community, healthcare workers, and Del Norte Healthcare District were included in the decision to Regionalize.” (source: Eugene Suksi, CEO of Sutter Coast Hospital)
            FACT: The Sutter Coast Hospital Board, appointed by Sutter Health, and against the objection of Chief of Staff Kevin Caldwell, decided to exclude all of the interested parties in the discussion, information, and decision-making sessions prior to the vote to Regionalize. (source: Kevin Caldwell, M.D.)  Sutter Coast’s Board did not seek the advice of Medical Staff, Sutter Coast employees, Healthcare District Board members, or the community at large.
Sutter Claim: Sutter Coast Hospital is not guaranteed any seats on the Regional Board, which will take over control of our hospital, because Sutter’s rules forbid any such guarantee. Mr. Suksi stated to the Del Norte County Board of Supervisors on 2/28/2012, “I want to remind you that no affiliate is given any particular guarantee.”
            FACT:  In Sonoma County, prior to their decision to Regionalize Sutter Medical Center of Santa Rosa, six Regional Board seats were guaranteed. The Sonoma County Board of Supervisors’ report states “The West Bay Regional Board will include 6 members who are residents of Sonoma County.” (source: County of Sonoma Agenda Item Summary Report, 9/29/2009)

Sutter Claim: When questioned about local representation on the Regional Board, Mr. Suksi stated, “it starts from the Community Advisory Board, and then you kind of poll and nominate.” (source: E. Suksi, presentation 2/28/2012)

            FACT: Mr. Suksi failed to mention that Regional Bylaws state “Directors shall be appointed by the General Member” (the General Member is Sutter Health). (source: Regional Bylaws, Section 5-1, H.) “Any appointed member may be removed from the Board by the General Member without cause.” (section 5-1, I.) So, Regional Board Representation is entirely at the pleasure of Sutter Health.
Sutter Claim: “Sutter has always put more resources into (Sutter) Coast than they’ve drawn out.” (source: E. Suksi, Del Norte Triplicate, 2/29/2012)

            FACT:  For 26 years, Sutter Coast Hospital has been profitable, despite an annual management fee of $750,000 paid to Sutter Health. 2010 profits at Sutter Coast were $5.2 million. An additional $5.8 million was reported as “inter-company transfers” to Sutter Health.  Sutter Coast has never been subsidized by Sutter Health. (source: California Office of Statewide Health Planning and Development)

Sutter Claim: “Decisions regarding the affiliates’ medical staff including medical staff privileging will remain at the affiliate level.” (source: E. Suksi, presentation 2/28/2012)

            FACT:  Sutter Health has violated Sutter Coast Hospital physician bylaws by introducing patient care policies without physician review or consent (source: Kevin Caldwell, M.D.)  Under Regionalization, the Regional Board would have authority to “make decisions regarding all clinical policies and procedures.” (source: Bylaws of Sutter West Bay Hospitals, section 8-5, B2) 
            Sutter Administration has also misrepresented the credentials of a physician for appointment at Sutter Coast. This physician’s credentials did not meet Sutter Coast Medical Staff requirements, and the appointment was blocked by local physicians. Regionalization gives Sutter Health broad control over our Medical Staff appointments. Regional Bylaws state that the Regional Board can “review, evaluate, and make decisions relative to all applications for appointment or reappointment” (of medical staff).  (source: Bylaws section 8-6, B5)

Sutter Claim: “Prior to our November 2011 vote, the Sutter Coast Board contacted the Administrative and Advisory Board Leadership at Sutter Lakeside Hospital, a similarly sized Sutter affiliate located in Lakeport, California, to discuss their experiences with Regionalization. The Lakeside leaders stated that outcomes had been favorable without the loss of local input.” (source: E. Suksi, presentation 2/28/2012)

            FACT:  Since Regionalization of Sutter Lakeside, 50 percent of the employees, or 300 people, have been laid off.  As recently as 3/30/2012, Sutter Lakeside announced a ten percent across the board staff cut. Their CEO said every individual at the hospital will feel the impact—from those losing their jobs to those who have to pick up extra responsibility due to the staff cuts. (source: Lake County News, 3/30/2012)  This is despite the fact that Sutter Lakeside had the highest Medicare revenue of any Critical Access Hospital in the nation for fiscal year 2009-10. (source: Billian’s Health Data, 11/9/2010)
            Some history on this crisis: In 2008, Sutter converted Lakeside Hospital from a 69 bed general hospital into a 25 bed Critical Access Hospital, claiming in a news release that this “will preserve the over 600 high quality jobs SLH provides in our community.” According to Lakeside staff, it was the first hospital in the nation to deliberately shrink to fit Critical Access status. “It (Critical Access) was originally designed for hospitals that had an average daily census of 12 or less.” (source: E. Suksi, presentation 2/28/2012)
            When the change to Critical Access Hospital was announced, Lakeport Fire Captain Bob Ray complained, “I’m unhappy that they’re being less than open about this.” Ray, a paramedic, stated that the reduction from 69 to 25 acute care beds could result in a “huge” impact for Lake County, because it was already not uncommon to have too few beds, and “my biggest thing is, we’ve been kept in the dark.” (source: Lake County News, 2/24/2008)
            Four months after Critical Access designation, the hospital CEO left to start a new job at parent network Sutter Health.  (Source:  Lake County Record-Bee, 7/24/2008) 
            In addition to the bed restriction, Critical Access Hospitals limits average patient stays to no more than 4 days. (Source: U.S. Health Resources and Services Administration)  Mr. Suksi, discussing the option of Critical Access status for Sutter Coast, stated “it isn’t determined that it makes sense for Sutter Coast. But we’ll look at it.” (source: E. Suksi, presentation 2/28/2012)

Sutter Claim: “And yes there is an initiative for us to take a look at our rates and make our rates more affordable for consumers because consumers are going to have to pay more of the freight.”
(source: E. Suksi, presentation 2/28/2012)

            FACT: Sutter Coast’s charges have always been much higher than those at surrounding facilities.  Sutter Coast charges over $3300 for a knee MRI scan, which is 3 times the cost of the same test in Medford, Oregon.

Sutter Claim: “It is certain that the Region exists to support the affiliates.” (source: E. Suksi, presentation 2/28/2012)
            FACT: On June 30, 2010, the Marin Healthcare District took back control of Marin General Hospital from Sutter Health, after cancelling Sutter’s management contract. Marin Healthcare District then sued Sutter Health, claiming that Sutter improperly transferred $180 million from Marin General to Sutter Health, between 1995 and 2010. (source: Marin Independent Journal, 1/17/2012) An analysis by the Marin Independent Journal determined that Sutter Health withdrew $74.6 million from Marin General, while contributing only $5.3 million, from 1995 to 2007. (source: Marin Independent Journal, 7/18/2008)
            Marin General Hospital now plans to build a new hospital. In June 2010, Sutter Health’s Regional President Martin Brotman, M.D. said “In 2005, provided our lease was extended to 50 years, Sutter offered to build a new $400 million hospital for Marin—at no cost to taxpayers or the Healthcare District.” (source: Marin Magazine, June 2010)  However, Healthcare District CEO Lee Domanico stated Sutter never offered to spend any of its own money to rebuild the hospital. Instead, Domanico said Sutter offered to “support Marin General Hospital spending (Marin’s) own $300 million to rebuild its hospital, and at completion the hospital would be owned by Sutter.” (source: Marin Independent Journal, 5/14/2010)

Sutter Claim: “If an affiliate is not plugged into a Region, support services cannot be efficiently obtained, and cost effectively, and some may not be able to be obtained at all.” (Source: E. Suksi, presentation 2/28/2012)

            FACT:  The supply chain for Regionalization has already been in place for 18 months, without Regionalization. (source: E. Suksi) Local jobs have already been lost due to Regionalized billing.

Sutter Claim: “Health care is local.  Success depends on honesty, integrity, and transparency.” (source:  Martin Brotman, Sutter Health Regional President.)

            FACT: Sutter Health violated the Bylaws of Sutter Coast Hospital by extending the term of Board Chairman Andy Ringgold past his 9 year limit. His term was extended in order to implement Regionalization without a change in leadership. (source: Bylaws of Sutter Coast Hospital, Section 5-1, H)

Final Question: Do we trust these people with our community hospital?

Sutter Health Holds Future of Healthcare over Small Town Hospital

Sutter Health Holds Future of Healthcare over Small Town Hospital
Crescent City, CA is the northernmost port on California’s rugged Pacific coast.  Ninety minutes by mountain roads to the next largest city, and with limited air service, it is also a community highly dependent on the only hospital in the region.
History of Sutter Health in Del Norte
Twenty six years ago, the Del Norte County Healthcare District transferred management authority of its hospital to Sutter Health Corporation.  An agreement was reached which granted Sutter Health monopoly privileges over hospital care, in exchange for specific obligations, such as construction of a new hospital, increased scope of medical services, and local ownership and governance. 
Land for the new Sutter Coast Hospital was donated by Sonny Hussey, and his sister, Sharon Van Bebber.  Years earlier, Sonny had been transferred to a distant hospital for intensive care after a trucking accident. He dreamed of a new, local hospital to serve the community. With Sonny and Sharon’s donation, Sutter built a 59-bed hospital, which opened in 1992.  Sutter Health agreed the hospital would be governed by representatives of the community, and would provide “improved and expanded” care.
Sutter Changes the Rules
The relationship between Sutter Health and the Del Norte community prospered, and the hospital was profitable for 26 consecutive years.  In 2011, everything changed.
Contrary to the wishes of the community and the donors of the land upon which the hospital rests, Sutter Health is now attempting to revoke its promises of local ownership and governance, and expanded care.  Of particular concern is Sutter’s consideration of closing 50% of the hospital beds in order to qualify for guaranteed reimbursement under a federal program known as “Critical Access.”
Bylaws Revisions
In 2011, Sutter Health quietly implemented its strategy to take over the hospital.  Beginning with over 1300 changes to the hospital bylaws, and followed by confidential presentations to the hospital Board of Directors, Sutter’s plan nearly succeeded—without the employees, doctors, or the community even being aware.  Sutter Health called the process “Regionalization” rather than stating what it really was—a transfer of hospital ownership, governance, and all decision making authority into the hands of Sutter Health. 
The new bylaws declared that the hospital was now under the control of Sutter Health.  The community mission statement--which stated that the hospital existed to serve the needs of the sick, injured and disabled—was deleted.  Instead, the local Board was directed to be “loyal to the Corporation and Sutter Health.” The stipulation that the majority of the Board of Directors reside in Del Norte County was also deleted.  The new bylaws were briefly discussed, then approved by the Board the same evening they were introduced by Sutter legal.  In one meeting, 26 years of local hospital governance was erased.
The Rush to Regionalize
Sutter’s “offer” to take ownership of the hospital was first presented to the hospital Board in September, 2011.  The Board deliberately excluded physicians, employees, elected officials (including the Healthcare District Board), and the community from the educational sessions and the decision to Regionalize.
In October 2011, Dr. Martin Brotman, President of the Sutter West Bay Region (into which ownership of Sutter Coast would be transferred) presented his case for Regionalization.  In response to concerns of loss of physician autonomy, Dr. Brotman reassured the Board that under Regionalization, “physician and credentialing decisions are always made at the local level.” That statement, repeated by other Sutter executives, is false.
In November, only two months after the initial offer to Regionalize, the Board made its decision.  Without any independent input, they voted to Regionalize by a 9-1 margin—the one dissenting vote cast by Chief of Staff Dr. Kevin Caldwell.   Dr. Caldwell asked the Board to postpone its decision in order to seek independent information and community input, but his request was denied.
Sutter’s takeover plan almost worked.  If not for Dr. Caldwell’s opposition, Regionalization would have taken place.  Instead, Dr. Caldwell sought help from his fellow doctors, patients, and the community he has served for the past 28 years.
Now, Crescent City is fighting to learn the secrets of Sutter’s closed Board room, and retain ownership of the hospital which represents a lifeline to this isolated region of California.
Takeover Without Representation
The local Board did request guaranteed representation on the Regional Board, but was told by Sutter executives that guaranteed representation was contrary to corporate bylaws, never offered to an affiliate hospital, and not an option for Crescent City.  This was another of many statements by Sutter executives which turned out to be inaccurate.  The Sonoma County Board of Supervisors had requested guaranteed representation in advance of Regionalization, and was granted six permanent seats on the Regional Board.
Claims of Financial Losses
Besides the offer from Sutter Health to Regionalize, 2011 also brought, for the first time in its history, claims of financial losses from Sutter Coast Hospital.  Based on information available at the state website where non-profit hospitals report earnings, Sutter Coast has been transferring cash into the Sutter Health “treasury” for many years, including $5.8 million in 2010.  But Sutter Coast CEO Eugene Suksi reported the hospital lost money in 2011.  In a newspaper interview, he attributed the losses to decreasing patient revenue, citing Regionalization as the needed fix, but failed to mention one huge source of money loss—corporate mismanagement. 
In 2011, Sutter Health decided to outsource billing services for Sutter Coast Hospital, a function which previously had been performed locally.  Sutter claimed it could cut costs by laying off local billing staff and transferring the service to its Regional billing firm.  The results suggest otherwise.  Sutter’s regional billing company failed to submit claims for services totaling $7 million.  So, after 26 years of profitability, the Sutter Coast CEO reported a loss, while failing to mention the intercompany cash transfers or the billing errors.
In spite of corporate mismanagement, Sutter executives prospered. From 2006 to 2010, the latest year for which salary information is publicly available, the annual salary of Sutter Health CEO Patrick Fry doubled from $2.3 to $4.7 million.  Dr. Martin Brotman’s 2010 salary was $4.2 million.  Sutter Coast employees, on the other hand, received no salary increase during the past three years.

Critical Access
In another attempt to increase profits, Sutter Health is now considering downsizing the hospital in order to qualify for a federal program called “Critical Access,” which guarantees higher reimbursement for the treatment of Medicare patients.  The Critical Access program is a “cost based” reimbursement model, providing federal subsidies to small, rural hospitals.  The program was initially funded to increase access to care by maintaining remote hospitals with 12 or fewer beds.  Hospital bed capacity is capped at 25, and the average length of patient stay may not exceed 96 hours.  When the hospital reaches the 25 bed cap, or when a patient with a diagnosis requiring more than four days in the hospital arrives in the Emergency Department, they must be shipped to another hospital.

Sutter Health had already downsized a hospital in order to qualify for Critical Access.  At Sutter Lakeside in Lakeport, CA, Sutter Health cut bed capacity from 69 to 25 in order to qualify for the program.  Now, approximately four patients a day, who previously would have been cared for locally, are transferred elsewhere.  In essence, a federal program originally designed to increase access to care is now being used by Sutter Health to reduce access to care in order to qualify for federal monies.   The advantage to the hospital is clear—all costs, including salaries, are factored into the final bill submitted to Medicare, which is paid in full.  In 2010, Sutter Lakeside received more federal dollars than any of the nation’s 1300 Critical Access hospitals—consistent with the fact that Sutter Lakeside is often “full”.   

Air Ambulance Transfers
Due to Sutter Coast’s remote location, virtually all the patient transfers occur by fixed wing aircraft.  The transfer cost, borne by the patient, varies between $5,000 and $30,000--assuming an aircraft is even available.  Due to the large fluctuation in demand for air transfers that Critical Access would bring, the multiple aircraft needed may not be available.  Of course, the patient’s local doctor will be not be present at the accepting hospital, and in a low income community where reliable transportation is often unavailable, friends and relatives may be unable to visit their loved one.
The other cost associated with emergency patient transfers is even more important, but less tangible—the delay in treatment.  An accepting hospital, and an accepting physician, must be secured.  The patient is first transported by ground ambulance to the airport, followed by transfer to an air ambulance, then another ground transport from the destination airport to the accepting hospital.  The process takes hours.  If a patient with a life threatening condition presents to the hospital, which is “full” due to the restrictions of Critical Access, the treatment delay during transfer could easily result in greater morbidity or even mortality.
California Medical Association
The physicians on Sutter Coast’s Medical Staff were excluded from Sutter’s presentations on Regionalization, and were never given the opportunity to understand the effect on patient care.  Dr. Mark Davis, a local urologist and trustee of the California Medical Association (CMA), asked for help.  CMA, representing 35,000 California doctors, defends the rights of physicians to care for their patients, independent of corporate interference.  California law also upholds the right of physicians to remain autonomous from corporate influence with respect to patient care and hospital governance.
CMA determined the claims from Sutter executives regarding Regionalization were not only inaccurate, but also that the Regional bylaws may be illegal.  CMA Chief Litigator Long Do reported that Sutter’s Regionalization plan transferred “unusually vast powers” to the Regional Board.  Contrary to prior statements from Sutter executives, Mr. Do concluded that Regionalization “would represent a major shift in authority from local governance to the Region.” Following the CMA presentation, the physicians unanimously resolved that the Board rescind its prior vote to Regionalize.
Second Vote on Regionalization
Gregory Duncan, M.D., the new Chief of Staff for 2012, presented the Medical Staff’s resolution to the hospital Board on June 7, explaining that if the prior Regionalization vote were rescinded, the physicians and the community would finally have the opportunity for involvement in a process from which they had been excluded.  Despite physician concerns, the Board refused to rescind their prior vote to Regionalize.  Instead, they agreed that merger documents would not be signed until the Regional President made a presentation to the Medical Staff.
California Law on the Practice of Medicine by Corporations
California law prohibits corporations from hiring specialist physicians.  The rationale is to prevent hospital corporations from influencing patient care decisions made by their employed physicians, such as where tests or procedures are performed.  Patients are often unaware of the vast cost differences between facilities.  For example, a knee MRI at Sutter Coast Hospital for a privately insured patient is $3,367, while the same MRI in Medford, Oregon is $1409.  The “Corporate Bar” on the practice of medicine was implemented in order to eliminate conflict of interest, such as corporate-employed physicians directing their patients to company owned facilities, regardless of cost or quality.  
Possible Violations of the Corporate Bar
Sutter Health hires specialist physicians in Crescent City through a physician foundation, the Sutter Pacific Medical Foundation.  But the relationship between Sutter Health, the Sutter West Bay Region, the Sutter Pacific Medical Foundation, and Sutter Coast Hospital is unusual.  One person—Mike Cohill--is an executive in all four organizations.  Mr. Cohill is a Senior Vice President of Sutter Health, President of the Sutter West Bay Region, CEO of the Sutter Pacific Medical Foundation, and a Sutter Health appointed member of the Sutter Coast Hospital Board of Directors. 
Questions of Conflict of Interest
The ten member hospital Board includes Eugene Suksi (Sutter Coast CEO), Mike Cohill (Sutter Health Executive VP, SPMF CEO, and Sutter West Bay Region President), Sutter Health appointee Dr. Thomas Polidore, and Board Chair Andy Ringgold.
In 2011, Mr. Ringgold’s term as Board Chair had been extended beyond the nine year limit stipulated in the hospital bylaws.  The term extension, in violation of the bylaws, was granted “in order to implement Regionalization without a change in leadership.” (per Eugene Suksi, hospital CEO)
Another potential conflict developed four days prior to the Regionalization vote, when it was announced that hospital Board member Dr. Thomas Polidore had signed on with the Sutter Pacific Medical Foundation (SPMF).  Dr. Polidore had previously been appointed to the hospital Board by Sutter Health, and was now an employee of SPMF, part of the Sutter Health network.  Four days after Sutter announced his affiliation with SPMF, in the presence of his CEO (Mr. Cohill), Dr. Polidore voted for Regionalization, opposing his colleague Dr. Caldwell, the Chief of Staff elected by local physicians.
The final signatures to transfer ownership of the hospital into the Sutter network now belong to a nine member Board, eight of whom were appointed by Sutter Health, four of whom have potential conflicts of interest, and none of whom recused themselves from the vote to Regionalize. 
In order to comply with IRS Safe Harbor guidelines, no more than 20% of the voting power of a non-profit Board may be vested in any contracted service provider.  Because Sutter Health provides management services for Sutter Coast Hospital, and SPMF provides physicians and recruiting services for Sutter Coast Hospital, four of the nine Board members may be conflicted, triggering questions of compliance with the IRS Safe Harbor rule.
Meeting with the Regional President
On 8/2/12, Sutter Health Regional President Mike Cohill presented his arguments in favor of Regionalization to the hospital Medical Staff.  Without providing any specifics, he claimed Regionalization was a financial necessity.  Despite the $7 million billing error by the Regional billing service, Cohill believed that Regionalization would eventually cut costs.  But he also acknowledged the claimed efficiencies could be implemented at any time, without the change of ownership which Regionalization represents.  So, the rationale for Regionalization remained dubious.  What is clear is that if Regionalization occurs, all future decisions involving the hospital, including Critical Access, will no longer be made locally, but by a 32 member Board in San Francisco, 350 miles to the south.
Cohill did acknowledge that Sutter Coast Hospital is locally owned.  His Regional Vice President had stated the opposite--that Sutter Health owns the local hospital and could Regionalize it at any time.  Sutter Coast CEO Eugene Suksi also claimed Sutter Health owned the hospital, and that Critical Access could be implemented without any change in routine operations—all of which is inaccurate.
Cohill was questioned about the possibility of Critical Access, which had already resulted in massive job losses and increased emergency patient transports at Sutter Lakeside. He was blunt—Lakeside’s two choices were Critical Access or the possible outcome of “going broke and closing the hospital,” which “might be one we choose here in Crescent City.”
Future Directions
Regionalization of Sutter Coast Hospital is now being challenged on multiple fronts.  A grassroots effort is underway to keep ownership local, including two community rallies in front of the hospital, a petition opposing Sutter Health signed by over 2000 local residents, and a Town Hall meeting arranged by local doctors, where 300 citizens finally had the opportunity to express their opposition to Regionalization.  The doctors have been joined by the County Board of Supervisors, City Council, Mayor, Sheriff, District Attorney, Board of Realtors, Healthcare District Board, Chamber of Commerce, Del Norte Senior Center, and the United Indian Health Service, representing seven Native American tribes.
The County Board of Supervisors and City Council jointly wrote a letter to the hospital Board, asking them to rescind their prior vote to transfer hospital ownership.  When the hospital Board met to respond to the letter, Chief of Staff Dr. Greg Duncan was dismissed from the meeting, under the direction of Sutter Health’s attorney, charging his opposition to Regionalization represented a conflict of interest. 
On July 12, the Healthcare District was granted a Court Order, restraining Sutter Health from taking any action to merge Sutter Coast Hospital with Sutter Health, from implementing Critical Access, and from downsizing any hospital departments in preparation for Regionalization.  The order extends until 10/17/12, at which time a Hearing for an Injunction against Sutter Health is scheduled in Superior Court.
Sutter Health continues to withhold Board room information from the community, insisting that the meetings are closed and the minutes are confidential.  Cohill has twice promised to provide a legal opinion on these Board room policies, but four months later, none has been provided.   

Gregory J. Duncan, M.D.
Chief of Staff
Sutter Coast Hospital
Crescent City, CA

Read about the latest dispute at this link: