Thursday, October 31, 2013

The facts behind Sutter Health's media blitz in Crescent City

Subject: The future of hospital care in our region
Sutter Health's Media Blitz is Oncoming
October 31, 2013
Dear Fellow Residents of Del Norte and Curry Counties:
This coming week, Sutter Health will release its long awaited "independent" study on Sutter Coast Hospital.  This newsletter will provide some balance and background to Sutter's public relations campaign.

I am writing this update on the future of Sutter Coast Hospital because the hospital Board of Directors, of which my husband Dr. Greg Duncan is a member, voted to censure Greg for allegedly releasing confidential information outside the Board room.  Sutter Health and the hospital Board refuse to provide any written specific charges or evidence to support their allegations, so until we understand the implications of the censure, I will be writing newsletters.
Sutter Health is now beginning its final push to take ownership of Sutter Coast Hospital.  As Sutter's public relations blitz begins, please remember these facts:  (1) Sutter Coast Hospital is now owned and governed locally.  Regionalization is a change in ownership and governance.  If we Regionalize, local ownership and governance will be lost, and all future hospital decisions will be made by a Sutter-appointed board in San Francisco.    (2) Under Critical Access Hospital designation, 24 of our 49 inpatient beds would be closed.  If Critical Access is implemented here, people will be transferred elsewhere as a result of the restriction in hospital bed count.  People who have conditions that could be treated locally will be transferred to distant hospitals.  (3) The Healthcare District lawsuit had nothing to do with hospital ownership--it was an effort to hold Sutter Health accountable to its promises to provide expanded care and maintain a local hospital Board, in exchange for the monopoly privilege of operating the only hospital in the county. The lawsuit was settled when the cost became prohibitive for the District's small budget. What the settlement did prove is which side had more money.

But the lawsuit bought our community precious time to become educated on these issues.

The statement in today's newspaper that Sutter Coast Hospital is the rightful property of Sutter Health is meaningless.  Sutter Coast Hospital has always been locally owned and governed. Regionalization is a change in ownership--if Sutter Health already owned the hospital, they would not have needed to ask the the local Board to vote for Regionalization.

During a recorded meeting on 8/2/12, Sutter Health Sr. Vice President Mike Cohill stated to our hospital Board and Medical Staff that Sutter Coast Hospital owns Sutter Coast Hospital.  In 2006, Sutter Health Vice President Brian Hunter declared to the Alameda County Superior Court, "Sutter Health does not own any hospitals," adding, "Sutter Health's function is to provide support to the affiliated hospitals.  Absent a specific grant of authority from a hospital corporation, Sutter Health is not authorized to act on behalf of the hospitals..." [Case no. RG05221764]

As you review the results of the hospital study, please consider the following:

(1) The soon to be released "independent" study on the future of the hospital was coordinated and funded by Sutter.

(2) The independent funding for the study withdrew their support over concerns that the study results had been predetermined in favor of Sutter Health.

(3) The local "Steering Committee" was chosen not by the hospital Board, nor by an open invitation for community participation, but by an undisclosed process controlled by Sutter Health.

(4) The study consultants performed no independent financial analysis, but instead relied on financial data provided by Sutter Health.

(5) Sutter required local residents on the Steering Committee to sign a confidentiality agreement.  Greg will not sign an agreement which prevents him from sharing information on the future of the hospital with the public.

Now, let's review a point of agreement with Sutter Health:  our local hospital has been in decline.  The decline is understandable, given the fact that Sutter Health has shifted its focus to healthcare delivery in urban areas.

Does it make sense to transfer hospital ownership to San Francisco, or should we engage partners who specialize in rural healthcare and operate in our region? 
Fortunately, three other hospital corporations are interested in serving our community.   Asante Health system (which operates Rogue Regional Medical Center in Medford, Three Rivers Hospital in Grants Pass, and Ashland Community Hospital) has a proven track record of profitability and patient care excellence.  Asante would like to partner with this community.  

As you review Sutter Health's upcoming presentation and public relations efforts, please remember our community has three options:

(1) Continued local ownership and governance, with management by Sutter Health.

(2) "Regionalization"--change of ownership and governance to a San Francisco based Sutter Corporation.

(3) Affiliation with a new partner, such as Asante, which has publicly expressed an interest in a closer affiliation, specializes and excels in rural healthcare, and is in our region.

If you have questions, ideas, or would like to receive future newsletters, please email me at
Please feel free to post this email on social media, forward it to anyone you wish, or stop by our office on 1200 Marshall St. to add your name to the 3200 residents who have signed the petition opposing Regionalization.  We also need more volunteers in Crescent City and Brookings to help distribute newsletters to those without internet access!  Thank you all for your help and support.


Anne Marie Duncan, M.D.  

This email was sent to by  
Gregory J. Duncan, M.D. | 1200 Marshall St. | Crescent City | CA | 95531

Sunday, August 18, 2013

Latest Information on the Future of Sutter Coast Hospital

Latest Information on the Future of Sutter Coast Hospital
August 10, 2013 
In This Issue
First, I write to thank the Board of Supervisors for sending another excellent letter to Sutter Health, reiterating the Supervisors' ongoing opposition to Sutter Health's plans to dissolve our local hospital Board of Directors, and transfer ownership and governance of Sutter Coast Hospital to a San Francisco based Board appointed by Sutter Health.  The latest letter, addressed to Sutter Health CEO Patrick Fry and Sutter Coast CEO Linda Horn, repeated the Supervisors' concerns with Critical Access, including the facts that "the program would eliminate 50% of our hospital beds, necessitating hundreds of emergency patient transfers every year to distant hospitals, at the patients' risk and expense, and without their family or local doctor at the receiving hospital."  The Supervisors also noted that Critical Access would precipitate significant layoffs at Sutter Coast.

Sutter Health's response to the Supervisors' latest request for records was blunt.  During last week's hospital Board meeting, Sutter Health Regional President Mike Cohill stated, "we will not be releasing our meeting minutes to the Board of Supervisors or anybody else."

I understand Sutter Health is not legally obligated to release our hospital meeting minutes, but I certainly agree with several Supervisors who requested Sutter Health release the data and meeting minutes.  I fully agree with Supervisor Finigan, who advised in open session, "If you really want an open discussion, then release the data."   

Together with the Board of Supervisors and the Healthcare District, I will continue to work to preserve a full service, locally owned hospital, and prevent downsizing to a Critical Access facility.

Second, we have identified another problem with Critical Access--it will increase costs to patients, and not just costs of transports to distant hospitals.  In order to reduce the number of emergency patient transfers imposed by the Critical Access bed limit, Sutter's consultant wrote the following:  "the Hospital [Sutter Coast] can aggressively use observation bed services; however, this may not be sufficient to allow the Hospital to eliminate the transfer of patients outside the community." 

Observation patients are short term patients, who are not counted as part of the patient limit imposed by Critical Access.  Observation patients may not be commingled with patients on the inpatient nursing units in Critical Access Hospitals, and are subject to higher charges than standard patients admitted to the hospital.  Here is quote taken from the 2012 Sutter Coast Hospital Critical Access study:  "The beneficiary may not be aware that observation stays fall under [Medicare] Part B and require coinsurance and possibly other CAH charges."  According to Medicare regulations, "the beneficiary in an observation status will be liable for a coinsurance charge equal to 20% of the CAH's customary charges for the services."
(Regulation 485.620(a), 6/7/13)  

One should also know unless the hospital elects to place their observation patients in some of the 25 available hospital beds, they will need to occupy a stretcher.  Only 25 hospital type beds are allowed in Critical Access Hospitals.  Of course, on busy days like June 28, when there were 36 inpatients plus two observation patients in Sutter Coast Hospital, it will be necessary for many patients to be transferred elsewhere, due to the 25 bed limit.  Our patient numbers are typically lowest during the summer months.  What will happen during the busier winter months, when respiratory illnesses are common?

The hospital Board also held a discussion on Critical Access during our 8/1/13 meeting, which Sutter Health executive Mike Cohill concluded by stating he believed the Critical Access program would inevitably be implemented here in Crescent City, while acknowledging he had not spoken to Asante or any other potential management firms.  

If you have ideas or comments you would like to share, please send them to me at the email address below, or stop by my office on 1200 Marshall St. to learn more or add your name to the more than 3,000 local residents who have signed a petition opposing Regionalization and Critical Access designation for Sutter Coast Hospital.  To join our email newsletter, just send me an email at

Next issue: The story behind the resignation of Sutter Coast's excellent former Chief Financial Officer, and the ensuing reports of financial losses for the first time in the hospital's history.



Gregory Duncan, M.D.
Chief of Staff
Sutter Coast Hospital

Sutter Coast Hospital Never Reports Annual Loss Until They Fire the CFO

August 18, 2013 
Sutter Coast Hospital Never Reports Annual Loss Until They Fire the CFO

The next time you hear that Sutter Coast Hospital (SCH) needs to downsize to a Critical Access facility because the hospital is losing money, please remember the following story:

After 24 consecutive years of profitability, SCH first reported a yearly loss in 2011.  It was also in 2011 that former Sutter Coast CEO Eugene Suksi fired the hospital's Chief Financial Officer (CFO), following which Mr. Suksi took responsibility for the hospital finances.  SCH bylaws specifically state the CFO cannot be the same person as the CEO.

The California Corporations Code requires Sutter Coast employ its own CFO, yet SCH has been operating without a CFO for over two years.   

After the hospital Board expressed increasing concern over the absence of a CFO, Mr. Suksi confirmed the appointment of Sutter Regional CFO John Gates as CFO for Sutter Coast in two emails, sent 5/29/12 and 9/14/12, both of which list Mr. Gates as a recipient. 

I remained concerned with the absence of a CFO because hospital bylaws stipulate the CFO perform specific duties, such as reporting to the hospital Board and working with the Chair of the Finance and Planning Committee.  The CFO is the financial professional charged with providing the Board reliable data at Board meetings, but these bylaws-mandated duties were not being fulfilled. 

Ultimately, I brought my concerns to auditors from Ernst and Young earlier this year, who confirmed to the hospital Board that SCH does not have a CFO.  After that announcement, interim hospital CEO Linda Horn notified the physicians that the position of CFO at Sutter Coast remains unfilled since July 2011.

Last week, Mr. Gates stated during a recorded meeting of physicians and hospital Board members that he was unable to answer the question of whether he was CFO for SCH.  

Sutter Health will not release any of this information to the public, but if anyone reading this sits on the hospital steering committee, the membership of which is being held confidential by Sutter Health, please ask if Sutter Health will allow you to view these emails, and I will send you copies. You may also wish to ask for the meeting minutes where the Finance and Planning voiced their concern that a CFO should be hired, and raised the question of whether the absence of a CFO could be a factor in Sutter Coast's revenue cycle issues.  With Sutter's permission, I will send you that information also.

I believe the hospital Board should delay our decision on Critical Access until Sutter Coast comes into compliance with California law, adheres to our bylaws and recruits a CFO, and has the opportunity to analyze reliable financial trends.  Anything less seems contrary to our responsibility to this community. 

If you also believe the County's only hospital should not downsize to a Critical Access facility and cut 50% of our beds, please write Calif. State Sen. Jim Nielsen, Assemblyman Wes Chesbro, U.S. Congressman Jared Huffman, and Attorney General Kamala Harris. Send me an email or stop by my office if you need contact information, or would like to add your name to the petition opposing Sutter Health's plans to take ownership and downsize our locally owned hospital. Or, send me your thoughts at and I will forward your comments to our elected representatives.

Thank you again for your support and encouragement.



Gregory J. Duncan, M.D.
Chief of Staff
Sutter Coast Hospital
(Please forward this email to anyone who may be interested).

Tuesday, July 16, 2013

Please attend meeting Wed., July 17th, 3:30 p.m. at 9th and H Streets

Please attend meeting Wed., July 17th, 3:30 p.m. at 9th and H Streets
In This Issue
Opportunity for input on future of Sutter Coast Hospital
I just learned that County Supervisors Mike Sullivan and Martha McClure will be meeting with Healthcare District Board members Clarke Moore and Kevin Caldwell, and Sutter Coast CEO Linda Horn, regarding the possible transfer of ownership and downsizing of Sutter Coast Hospital.  The meeting will take place Wed., July 17th, at the Flynn Center on 9th and H Streets in Crescent City.  Dr. Caldwell is the former Sutter Coast Hospital Chief of Staff who voted against the transfer of hospital ownership, and is opposed to hospital downsizing.  
I know Dr. Caldwell would appreciate your input at this meeting.  Public input will be allowed.
Please help spread the word by forwarding this message and posting on Facebook
Please try to attend this meeting.  I am sorry for the late notice, but I was not invited to the meeting.  I just learned last night that the meeting was scheduled by the Supervisors.  I am unable to attend, but I was told Sutter Coast CEO Linda Horn was invited, and is expected to attend.  A good turnout would help our elected officials understand the importance of this issue and give you a chance for input.
Meeting date:  Wednesday, July 17th, at 3:30 p.m.

Location:  Flynn Center, 9th and H Streets, Crescent City

Room:  Suite 200 (may be moved to the first floor auditorium if turnout is high).
Please try to attend this meeting.


Greg Duncan, M.D.
Chief of Staff
Sutter Coast Hospital
Gregory J. Duncan, M.D. | | | 1200 Marshall St.
Crescent City, CA 95531

Latest News on the Future of Sutter Coast Hospital

Latest News on the Future of Sutter Coast Hospital
July 15, 3013 
I write to separate facts from rhetoric concerning Sutter Health and Sutter Coast Hospital (SCH).  Currently, SCH remains locally owned, and governed by a local Board.  In 2011, the hospital Board voted to "Regionalize" SCH, which will dissolve themselves as the governing body, and transfer hospital ownership and governance to a Sutter Board in San Francisco.  Under Regionalization, decisions which are currently made locally will be made in the Bay Area.
Why is Sutter Health fighting so hard to own Sutter Coast?
Sutter Health originally told our hospital Board that Regionalization was needed to increase efficiency in an era of decreasing payments.  However, former hospital CEO Eugene Suksi  later reported that Sutter's strategies for improved efficiency, such as outsourcing local jobs and purchasing supplies in bulk, are already in place and do not require Regionalization.  The main force behind Regionalization appears to be control.  Now, our hospital Board has the right to negotiate with companies other than Sutter Health to manage the hospital. Under Regionalization, we lose ownership of SCH, and management will be decided by a Sutter appointed Board, which meets 350 miles away and controls 11 hospitals in the Region. 
What would "Critical Access" designation mean for us?
The first major decision facing SCH is whether to downsize the hospital by 50% to qualify for increased Medicare payments under the federal Critical Access program.  Sutter Health's 2012 study on Critical Access concluded with the following statement:  "we believe the Hospital should pursue the Critical Access Hospital program."  The same study estimated that under Critical Access designation, 247 patients would have required emergency transfers from Crescent City to outside hospitals in 2011.

At Sutter Lakeside, a hospital of similar size to SCH, Regionalization and Critical Access designation were followed by massive job losses, closure of two clinics, and a 150% increase in emergency patient transfers.

Why does a charity operate in secret?
When the local hospital Board voted to dissolve themselves, they did so without looking at options, such as affiliation with Asante Health System, which operates three hospitals in southern Oregon.  Asante has publicly expressed an interest in our hospital, but to my knowledge no one on the hospital Board other than me has approached Asante.  Now, after intense public criticism of their secrecySCH is paying a consulting firm $170,000 to evaluate strategies, including Critical Access.  However, Sutter Health controls the study, after refusing outside funding from three charitable foundations.  The consulting firm is not permitted to audit the hospital financial records or make any recommendations--they are allowed only to list options for the hospital Board, which already voted to Regionalize SCH.
The most disturbing aspect of this process is the hospital Board's refusal to include the public, beginning with their 2011 vote to Regionalize SCH, cast in a closed Board room at the deliberate exclusion of interested parties.  Hospital Chief of Staff Kevin Caldwell, M.D. objected to the Board's Regionalization vote, noted that they did not understand the transfer of ownership, and asked for more time to study the issue.  Nevertheless, the Board voted to Regionalize over his objection.  The hospital Board meeting minutes, hospital financial data, and even the membership and discussions of the current "steering committee" on the hospital study, all remain secret. 

The hospital Board has not held a single public forum since their decision 20 months ago to transfer SCH ownership to Sutter Health.   Last month, the hospital CEO and Board Chair abruptly withdrew from a Town Hall event they had committed to attend.  No observers are permitted to attend Board meetings.  The Board Chair will not allow community letters of concern to be discussed in the Board room.

Last week, The Joint Commission, a national accreditation agency which certifies hospitals, validated physician concerns that the SCH Board had inappropriately excluded physicians from hospital policies, in violation of our bylaws.  SCH leadership received four Joint Commission citations for failing to address physician concerns regarding Regionalization.

SCH is a locally owned public benefit charity, with a monopoly over local hospital care and the privilege of tax exemption.  Sutter Health, and the SCH Board, are making decisions which will affect the lives of 41,000 people within the hospital's service area.

Given the level of public concern, is it not appropriate for Sutter to release the documents the public needs to understand this issue?  Why does Sutter continue to operate behind closed doors, hold secret meetings, and withhold critical information this community needs for our long term planning? 

I applaud the County Supervisors for asking Sutter to release this information.  Let's end the secrecy.  With Sutter Health's approval, I will make all the documents available on our website at, including a link to the audio recording where Sutter Health Regional President Mike Cohill discusses Sutter's program to outsource jobs, and confirms that SCH is still a locally owned corporation.   Printed information, and a petition opposing Sutter's plans, are available at my office on 1200 Marshall St.  To receive future newsletters, please send me an email at

I deeply appreciate the support from everyone who has joined our effort to stop Sutter Health, and preserve a locally owned, full service hospital.  
Gregory Duncan, M.D.
Chief of Staff
Sutter Coast Hospital
Gregory J. Duncan, M.D. | | | 1200 Marshall St.
Crescent City, CA 95531

Monday, June 17, 2013

The following letter was just sent to the Del Norte County Board of Supervisors

Latest Information on Sutter's study regarding Sutter Coast Hospital

Dr. Kevin Caldwell and I just mailed the following letter to the Del Norte County Board of Supervisors, as they consider their role in the future of Sutter Coast Hospital.  Sutter Health has hired a consultant group to help the hospital Board decide whether or not to transfer hospital ownership to Sutter Health, or cut Sutter Coast by 50% to qualify for higher Medicare reimbursement under the federal Critical Access program. 
Had Sutter Coast been a Critical Access facility, the hospital would have been closed to new admissions the majority of days during the past eight months.  Patients needing a hospital bed would have been flown by air ambulance, at their expense, to distant hospitals.

Dear Supervisors of Del Norte County:

We write with an update on the status of the Sutter Coast Hospital Strategic Options Study.  This is a study about the future of Sutter Coast Hospital (SCH), being conducted and paid for by Sutter Health, using a consultant group (The Camden Group) with ongoing business connections to Sutter Health.  As you know, the Medical Staff passed a unanimous resolution (among the physicians attending our Medical Staff meeting) that prior to participation in any study, we would like our concerns addressed with respect to  the funding, design, and rights and responsibilities of community participants.  The physicians have received no response to our concerns from Sutter Health or the Board of Directors of SCH. We have also confirmed with two community members familiar with the study that outside funding remains available, as long as the study results are not predetermined.  However, Sutter Health Regional President Mike Cohill and Sutter Health study coordinator Traci Van have rejected the outside independent funding.  Thus, although the hospital Board voted to approve a collaboratively funded and independent study, the current study is entirely Sutter funded and Sutter controlled.

You may also recall that the Medical Staff has passed two unanimous resolutions asking the hospital Board to rescind their prior vote to transfer ownership of SCH to Sutter Health's West Bay Region.  The Board of Supervisors and City Council also asked the hospital Board to rescind their Regionalization vote.  In every case, the local hospital Board refused to rescind their Regionalize vote, and in fact, the Board voted on 3/7/13 to leave the process of Regionalization in place.

Sutter Health claims SCH is losing money. In an attempt to verify Sutter's claims, I (GJD) have made repeated requests during the last year to meet with the hospital accountant, a meeting which is my right as a Director of SCH, and which was promised by former SCH CEO Eugene Suksi.  Mr. Suksi told me that the accountant was the appropriate person to show me SCH financial documents. Subsequently, Regional President Mike Cohill, Mr. Suksi, and current interim SCH CEO Linda Horn have all blocked this meeting, unless a Sutter Health employee is also present. Remember Sutter Health does not own Sutter Coast, but they are attempting to take hospital ownership. 

 In addition, Linda Horn has not responded to my requests to learn who has been invited to participate on The Camden Group's "steering committee."  The SCH Board has not even discussed the concept of a steering committee, much less discussed or approved the process by which community members would be selected to participate on the committee. However, numerous community members have told me they have received invitations to sit on a steering committee related to Sutter Health's Strategic Options Study.

In light of these facts, I would ask the Supervisors, and anyone else who Sutter has invited to participate on the steering committee, to consider the following:

1.  Mandate that your participation in a hospital study be preceded by Sutter Health releasing the meeting minutes and the financial data for the hospital.  We applaud Supervisor Finigan's call for Sutter Health to release this information, but three weeks later, Sutter has released nothing.  Be aware that study of SCH financial data will require considerable time by an independent accounting group with access to detailed records, not just summary information provided  by Sutter Health.

2.  Participate in the study only as it was originally designed and approved by the hospital Board-with collaborative funding and an independent consultant.  Community participation at the outset would ensure that the consultant candidates are selected and approved by the community, not by Sutter Health, as was the case in the current study.  (Only 3 community members selected The Camden Group to perform the study, after the first six local residents initially approached by the hospital Board refused to participate, over concern the study was not legitimate).

3.  Ask Sutter Health to stop using the word "independent" to describe the current study.  As pointed out by a community member who was asked to participate on the steering committee, the current process is clearly not independent and should not be described as such.

4.  Put the Sutter hospital study on the Agenda for a special meeting of the Board of Supervisors, to be held during the evening to allow maximum community participation.  You may not be aware that some of the individuals who spoke in favor of Sutter Health during your 5/28/13 meeting, including SCH interim CEO Linda Horn, are employed by Sutter Health, the corporation which is attempting to take ownership of locally owned Sutter Coast Hospital.

Finally, please consider the motivation behind the two sides of this conflict.  Sutter Health is attempting to take ownership of SCH.  It has become increasingly clear that Sutter Health wants to downsize Sutter Coast Hospital in order to receive higher payments for the treatment of Medicare patients.  If Sutter Health will allow me to release the audio recording of Mike Cohill, Sutter Health Sr. Vice President, you will hear information which supports this contention.  The local hospital Board and Sutter Health have not responded to the physicians' resolution to expand services to improve the hospital, nor to our "no confidence" vote in Critical Access designation at Sutter Coast.

We believe very strongly that Critical Access designation will harm the economic development and the residents and visitors in Del Norte and Curry counties, especially the elderly, poor and chronically ill.

Thank you for your consideration.


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

Kevin Caldwell, M.D.
Board Member
Del Norte Healthcare District                                                                                                                   

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

Thursday, May 30, 2013

Regionalization and Critical Access Discussed by Supervisors Today

Sutter Coast Interim CEO presents hospital update to County Supervisors
Following today's Board of Supervisors meeting, I wrote the following letter to hospital employees, volunteers, and physicians.  Please contact me with any questions or comments, as we work to preserve local ownership, and prevent downsizing, of the only acute care hospital in our region. We also need volunteers to help distribute petitions and literature, and gather email addresses of interested residents.  Your email address is stored on my home computer and is not released to anyone.  Any communication from me will come through Constant Contact, with no attachments, and is virus free.  Please contact me at or stop by my office on 1200 Marshall St. if you would like to help.

Definition of terms for newcomers: 

"Regionalization":  Sutter Health's system wide take over of once independently owned community hospitals.  The Sutter Coast Board deliberately excluded the public from their vote to Regionalize our local hospital in 2011.  

"Critical Access":  A federal program initially designed to support tiny hospitals by paying higher amounts for the treatment of Medicare patients.  Sutter Health is now considering closing half of our hospital beds to "fit" the program, which would result in hundreds of patients requiring air ambulance transfers to distant hospitals every year.

How are these programs related?  If we Regionalize, the decision to implement Critical Access, and every other decision affecting the future of our hospital, will be made by a 32 member Board, appointed by Sutter Health, which meets in San Francisco.

The physicians of Sutter Coast Hospital are overwhelmingly opposed to hospital downsizing and to the transfer of ownership to Sutter Health.  Our goal is to expand services where feasible.  We want the hospital to be open when you need it.

Open letter to hospital employees, volunteers, and physicians:

Dear Colleagues:

I appreciate the input which Linda Horn and a group of hospital employees provided to the Board of Supervisors today.  Everyone expressed the common goal of a strong local hospital.  I write with suggestions on how we may secure that goal.  

The Medical Staff has already passed several resolutions opposing Regionalization and Critical Access Hospital (CAH) designation for Sutter Coast Hospital.  In fact, five months ago, at the request of several physicians, Dr. John Tynes contacted Sutter West Bay Region President Mike Cohill seeking just those two reassurances--that we don't transfer hospital ownership to Sutter Health or move to downsize Sutter Coast to a Critical Access facility.  Mr. Cohill promised to pass our request on to Sutter Health CEO Pat Fry.  To date, we have received no reply from Mr. Cohill or Mr. Fry.

Today, Linda Horn told the Supervisors that "Critical Access is not being discussed."  In fact, Sutter Health called a special meeting of the Sutter Coast Board earlier this year to discuss Critical Access.  Sutter Lakeside executives gave a presentation on Critical Access, including a three step process by which CAH designation could be implemented here.  We are now halfway through the second step in that process.  A 2012 study on Critical Access (funded by Sutter Health) produced the following recommendation to Sutter Health (quoting directly from the report): "Based on the information presented above, we believe that the Hospital should pursue the CAH program.

The Camden Group, which Sutter is now paying to perform a strategic options study for the hospital, has been directed by Sutter to include Critical Access designation as one of the options for Sutter Coast.  The Camden Group has longstanding and ongoing business relationships with both Sutter Health and Sutter CEO Pat Fry.  Sutter Health wrote the study proposal and conducted private conference calls with their prescreened consultants. Hospital Board Chair Ken Hall then single handedly appointed three community members to select the final consultant.  Today, Ms. Horn mentioned that a group of 15-18 community members would be involved in the study going forward.  This was news to me-no such information was ever presented or discussed in the hospital Board room.

Ms. Horn also stated today that Regionalization is indefinitely postponed.  Please note the following: if Sutter would release the minutes of the 3/7/13 Board meeting, you would read that Regionalization is only being "temporarily set aside", while "the process remains in place."  Regionalization and Critical Access were put on hold by the hospital Board only after Superior Court Judge Leonard LaCasse issued an Injunction blocking both programs.  Sutter Health attorneys are currently trying to lower the Injunction.

It is my understanding that outside funding is still available for the hospital options study--why not start the process over, with outside funding and community input from the beginning, using a company without longstanding ties to Sutter Health?  We all agree we need a study-let's make it a valid one.

Our concerns with Critical Access are twofold.  First, the program would eliminate 50% of our hospital beds, necessitating hundreds of emergency patient transfers every year to distant hospitals, at the patients' risk and expense, and without their family or local doctor at the receiving hospital. Second, Critical Access would precipitate significant layoffs at Sutter Coast.

At Sutter Lakeside, which is not as busy or as remote as Sutter Coast, the implementation of Critical Access was followed by massive job losses, and closure of two outpatient clinics. According to a March 2008 press release from Sutter Lakeside, Critical Access designation would "preserve the over 600 high quality jobs SLH provides in our community," adding that "SLH will be able to invest more in our community and expand our services--not cut them."  The reality at Sutter Lakeside has been quite different.  The "over 600 high quality jobs" have been reduced to approximately 270, including a 10% across the board cut in March 2012.  SLH also closed two outpatient clinics following Critical Access designation. 

The concern with Regionalization, which dissolves our local hospital Board and transfers ownership and governance of our locally owned hospital to a Sutter appointed Board in San Francisco, is that we lose control of all decision making, including the decision to implement Critical Access, and the decision to outsource jobs out of the community as part of Sutter Health's "Shared Services" program.  Regional President Mike Cohill told us during a recorded meeting last August that under the "Shared Services" program, only employees who touch patients can be assured their jobs will stay local.  

An ongoing frustration among the community is Sutter Health's refusal to release the financial data for the hospital or meeting minutes from the Board of Directors.  We hope Sutter will honor the Healthcare District's subpoena for the financial data (which Sutter attorneys have to date ignored), and will respect Supervisor Finigan's request today that the Sutter Coast Board release their meeting minutes. An open process would do wonders to resolve this conflict.  

Please feel free to contact me with any questions or comments.  It is only through open communication that we will resolve this issue to the benefit of the residents and visitors of our two communities, and the many talented and dedicated hospital employees and auxiliary members whom I have had the privilege of working with at Sutter Coast Hospital for the past 21 years.


Greg Duncan

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

Friday, May 17, 2013

Editorial on Hazards of Regionalization

Coastal Voices: Regionalizing Sutter Coast hazardous for rural area
Written by Catherine Wiley April 10, 2013 05:36 pm
Sutter Coast Hospital provides health care services to Del Norte and Curry counties, both of which are designated by the federal government as Medically Underserved Areas by Population (MUAP) as well as Health Professional Shortage Areas (HPSA).

“So what?” one might ask. Well, those designations mean that our area residents and visitors have fewer choices in medical providers and more limited access to health facilities compared to adequately served areas. However, those same area providers and facilities benefit from financial reimbursement incentives intended to expand and enhance direct service provision. 
The MUAP designation is based on the percentage of the population below poverty levels; percentage of the population 65 and over; infant mortality rates; and the ratio of primary care physicians to the population. (That, by the way, does not reflect seasonal tourism influxes and their health care needs.)  Del Norte County was designated in 1991, and Curry County was designated in 2001. While the data used for establishing the designations are of interest and intended to be assistive, they are truly inadequate in assessing or measuring comprehensive, qualitative, holistic health care needs.

So, we are rural, remote, poor, designated as medically underserved, and many of us are old.
We also have virtually no public transportation; excessive costs for private transportation; one (and only one) north/south highway — which has failures and closures on an annual basis; one small, expensive and limited airport; dependence on life flights for emergencies (costing thousands of dollars); and, we are in a tsunami area that could be devastated/destroyed by any number of potential earthquakes.

What we deserve, and need, is not just a given number of medical providers and/or facilities. We must have the right of access to local, quality, comprehensive health care provided by culturally competent individuals. The majority of residents in our communities do not have the means, public or private, to be with ill/injured family members outside of our immediate area. The significance for each of us, particularly the cultural importance, of being with family; welcoming new life and honoring elders, cannot be overstated.  The direct benefits of support from family and friends during illness/injury have been documented physically, financially, psychologically, and emotionally. The indirect benefits are immeasurable.

Based on these facts, virtually every hospital now has “rooming-in,” directly in the patient’s room, or housing for family /patient support members, at very low cost, in near-by facilities.
The primary issue seems apparent. None of us can afford the risk of Sutter Health’s attempt to regionalize Sutter Coast Hospital, or designate it as a Critical Access hospital.  The outcomes would include the reduction of hospital bed capacity by 50 percent, and require them to maintain an average length of hospital stay to be less than four days. It would also eliminate the current requirement to have a physician on duty in the emergency room, as well as having a general surgeon and intensive care specialist on call.
 I know I am “old school,” having passed my Board exams back in the day when being in the medical profession included caring, dedication and service; and, local hospitals were involved with and cared for their communities.

Now, we have “non-profit” hospital business chains where executive salaries and net profit margins exceed many of those in major, profit-making businesses.
Perhaps the question that should be put to the Sutter Coast Hospital Board of Directors is, just who and/or what interests do you represent? Under their proposals for regionalization or Critical Access designation, will the Board or Sutter executives be paying for patient and family air transport and room and board?

According to the Time magazine Special Report, “Why Medical Bills are Killing Us”, 3/4/13, “… outpatient emergency room care averages an operating profit margin of 15% and nonemergency outpatient care averages 35%. On the other hand, inpatient care has a margin of just 2%.” If those figures aren’t clear enough profit incentive for Sutter Health’s desire to reduce access to local care, perhaps their CEO’s salary is an answer.   According to the same comprehensive and well researched Time article, “… Sutter Health (is) a dominant nonprofit Northern California chain whose CEO made $5,241,305 in 2011.

”When health service provision and access are already determined to be inadequate, it is unconscionable to consider further limitations, especially if based on profit margins and executive salaries, rather than the essential needs and rights of those of us here in Curry and Del Norte  Counties.

Please get involved with this potential threat to the health and well being of our communities. Contact your elected officials, and/or learn more on .
Catherine Wiley is a retired California registered nurse practioner who lives in  Curry County.

Tuesday, April 9, 2013

Newsletter 3/25/13

MARCH 25, 2013



Summary of the past three weeks:
3/4/13:  Hospital physicians notify Board of Directors of Sutter Coast Hospital 
that the Board's purposeful exclusion of interested parties from their decision 
to transfer hospital ownership to Sutter Health violates Medicare regulations and
Joint Commission on Hospital Accreditation standards, and that Sutter's Regional
bylaws violate California law which protects patients from corporate employees 
with no medical training having authority over patient care policies.

3/5/13:  Del Norte County Board of Supervisors draft a letter to the California 
Attorney General asking for an investigation of Sutter Health's activities in our

3/7/13:  Hospital Board acknowledges receipt of physicians concerns, but takes no
corrective action.  Instead, Sutter Health attorney Michael Duncheon states that
he will prepare a response for the Board.

3/25/13:  Sutter Health Sr. Vice President Mike Cohill announces resignation of 
Sutter Coast CEO Eugene Suksi.

You may be wondering what prompted the resignation of our CEO.  Based on the timing,
I doubt the resignation had anything to do with physician input.  Local doctors,
including those employed by Sutter Health and Sutter Coast, asked Mr. Cohill to
bring in a new CEO for our hospital last year, but Mr. Cohill took no action.  
I believe it is all of us in the community standing together that makes Sutter Health
 Our local elected leadership deserves credit for relaying your concerns
to statewide agencies. The local response has been universally positive, but in 
particular, Kathryn Murray and Kelly Schellong have been working with the City Council,
Roger Gitlin and Martha McClure with the County Supervisors, and Dwayne Reichlin
and Kevin Caldwell with the Healthcare District. Sheriff Dean Wilson and District
Attorney Jon Alexander have both written strong letters of support, and Richard 
Enea and Mike Sullivan each submitted recent letters on behalf of city and county
leadership.  The Director of the United Indian Health Services, representing seven
local Native American tribes, wrote an excellent Declaration in support of the litigation
opposing Sutter Health.  Most of all, the more than 2500 local residents who signed
our petition to oppose Sutter Health should know your voices are being heard.
  Next week, I will send a copy of the petition to state and federal representatives.

Here is the update on the litigation between the Healthcare District and Sutter 
You may recall that during the most recent hospital Board meeting, the Board
voted to "postpone" their efforts to transfer hospital ownership to Sutter Health.
But the Board did not rescind their three prior votes in favor of Regionalization,
nor did they agree to set aside litigation in the Court of Appeals, where Sutter
Health is trying to lower the Injunction that is blocking them from taking hospital
ownership or implementing Critical Access designation.

Next, some good news:  Based on letters of concern from community members, I was
contacted by the offices of State Senator Jim Nielsen, and U.S Congressman Jared
Huffman, who offered their support.  If you want to have a say in the future of 
healthcare in our region, please consider writing to Sen. Nielsen and Congressman
Huffman.  If you need help putting your thoughts on paper, send me an email at  or call me at 707-465-1126.

Finally, the best news of all:  If we keep working together, something good will
come out of this struggle.  If we can expand and improve healthcare in our region,
every resident and visitor to our beautiful North Coast will benefit.
Thank you all again for your advice, support, and prayers.

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