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.