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.

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