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Thursday, October 31, 2013
The facts behind Sutter Health's media blitz in Crescent City
Sunday, August 18, 2013
Latest Information on the Future of Sutter Coast Hospital
Latest Information on the Future of Sutter Coast Hospital
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learn more at www.crescentcityhospital.
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SUPERVISORS REQUEST INFORMATION, SUTTER HEALTH SAYS NO
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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 drgjduncan@yahoo.com
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.
Sincerely,
Greg
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
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Sutter Coast Hospital Never Reports Annual Loss Until They Fire the CFO
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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 drgjduncan@yahoo.com and I will forward your comments to our elected representatives.
Thank you again for your support and encouragement.
Sincerely,
Greg
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
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Crescent City, CA 95531
Latest News on the Future of Sutter Coast Hospital
Latest News on the Future of Sutter Coast Hospital
Gregory J. Duncan, M.D. |
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drgjduncan@yahoo.com |
1200 Marshall St.
Crescent City, CA 95531
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Crescent City, CA 95531
Monday, June 17, 2013
The following letter was just sent to the Del Norte County Board of Supervisors
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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
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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 drgjduncan@yahoo.com or stop by my office on 1200 Marshall St. if you would like to help.
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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.
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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.
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Open letter to hospital employees, volunteers, and physicians:
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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.
Sincerely,
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
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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 http://crescentcityhospital.blogspot.com/ .
Catherine Wiley is a retired California registered nurse
practioner who lives in Curry County.
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Tuesday, April 9, 2013
Newsletter 3/25/13
MARCH 25, 2013
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LATEST NEWS ON SUTTER HEALTH'S REGIONALIZATION AND CRITICAL ACCESS EFFORTS
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SUTTER HEALTH ANNOUNCES RESIGNATION OF HOSPITAL CEO EUGENE SUKSI
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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.
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LATEST NEWS ON SUTTER HEALTH'S REGIONALIZATION AND CRITICAL ACCESS EFFORTS
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SUTTER HEALTH ANNOUNCES RESIGNATION OF HOSPITAL CEO EUGENE SUKSI
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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
region.
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.
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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
nervous.
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.
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
Health:
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.
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 drgjduncan@yahoo.com 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.
Greg
Gregory J. Duncan, M.D.
Chief of Staff
Sutter Coast Hospital
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