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Future of Sonoma County health care on tap Monday
Published: Sunday, July 19, 2009 at 5:13 p.m.
Last Modified: Sunday, July 19, 2009 at 5:13 p.m.
Is Sutter Health’s proposed 70-bed, $175 million hospital in Santa Rosa too small, or just the right size?
Will it meet the terms of Sutter’s contract with Sonoma County to provide medical services to the poor and uninsured?
And will it end up sending overflow patients to surrounding hospitals?
The answers to these questions will be heard today, from 9 a.m. to noon, in a workshop expected to draw key players in the medical community to the Sonoma County Board of Supervisors’ chambers.
The board will hear the findings of an analysis conducted by the county Department of Health Services of Sutter’s proposed replacement of the aging Sutter Medical Center.
“We’ve got $175 million burning a hole in our pocket," said Sutter spokeswoman Lisa Amador, noting that consultants already have been hired to work on the environmental report on the new hospital proposed next to the Wells Fargo Center for the Arts at Highway 101.
Sutter’s average daily census of patients has dropped 18 percent a year since 2002 which means building a hospital any bigger than 70 beds would be “irresponsible,” she said.
But critics, including Santa Rosa Memorial Hospital officials and representatives of smaller community hospitals, say more analysis is needed apart from the health department’s review. That review concludes that Sutter’s proposed hospital would be operating at full capacity as soon as it opened its doors in mid-2013.
Where would patients go during peak bed demand periods? asked Evan Rayner, CEO of Healdsburg District Hospital.
“There’s been no due diligence on the financial or economic impact this could have on all health care providers in the region," Rayner said.
The proposal has been under review by the Sonoma County Department of Health Services since it was presented to county officials last November.
Health officials released a preliminary draft of their findings last week. After reviewing those findings, the board will consider a resolution that would direct county officials to begin the environmental review process, one that would include a consideration of alternatives to Sutter’s proposal.
Sutter’s proposed hospital would replace the facility on Chanate Road, which is under a state deadline for seismic upgrading or replacement.
Amador said Sutter has requested a two-year extension from the state that would push the state seismic deadline back to years to 2015. But she said one of the conditions for the extension is that construction begin next year.
“We have to have a shovel in the ground by the end of 2010,” she said, adding that failure to do so could result in closure of the Chanate Road campus until construction of the new facility is finished.
The existing hospital on Chanate Road is licensed for 135 general acute care beds, which includes 91 medical/surgical beds, 16 intensive care beds, 18 perinatal beds and 10 neonatal intensive care, or NICU, beds. The hospital has 15 emergency department bays.
The new hospital would have 70 acute care beds, which includes 20 medical/surgery beds, 8 intensive care beds, 30 perinatal beds, 12 NICU beds and 12 emergency department bays.
Sutter’s proposal also includes a potential expansion of 29 beds, including 10 medical/surgical beds, 4 ICU, 12 perinatal and 4 emergency bays. Sutter also has plans for a second, 28-bed hospital adjacent but separate from the main hospital.
The smaller hospital, called the Physicians Medical Center, would be a joint-venture between the Sutter Health and local doctors including the Sutter Medical Foundation. This hospital would focus on cardiac and other invasive surgeries that would be included in the 70-bed hospital.
That has raised concerns among local medical providers who question the exclusion of invasive cardiac surgeries from the new hospital.
Sutter officials say that under the Health Care Access Agreement with the county there is no requirement that they provide invasive cardiac surgeries. What’s more, Sutter has stated that any patient requiring invasive cardiology procedures, regardless of his ability to pay, would be treated at the Physicians Medical Center.
The diagnostic cardiac catheterization lab, or cath lab, at the proposed main hospital would be used for interventional vascular procedures that are non-cardiac.
That assurance does little to assuage critics, who point out such joint ventures between hospitals and doctors could be outlawed by health care reform currently being championed by President Barack Obama.
“Some of the assumptions are premature with respect to health care reform,” said Rayner. “We want to scrutinize this a little further. We need to delay or defer a decision until all of us digest it more thoroughly.”
The county’s bed demand projections, conducted by Deloitte Financial Advisory Services, projected if neither the expansion nor physicians hospital were built, the 70-bed hospital would be short 33 medical/surgical beds and 4 ICU beds by 2014. By 2021, the hospital would be short 41 medical/surgical beds and 6 ICU beds.
Amador, who insisted the new hospital is “sized” to meet current and future demand, rejected the county’s conclusion because Deloitte did not take into account likely advances in medical technology. These advances have historically allowed more medical procedures to be done on an out-patient basis, reducing the need for inpatient beds.
Sutter’s projections also project bed shortages if the expansion and joint-venture hospital are not built. But Sutter anticipates that fewer, not more, beds will be needed in the county.
Amador said Sutter expects Kaiser Permanente to continue its dominance in the local commercial insurance market, further decreasing Sutter Medical Center’s market share. Also, she said a county initiative that could place Medi-Cal patients into a regional managed care model in the fall of 2009 would result in a dramatic reduction in hospitalizations and emergency room visit.
Sutter does have its supporters.
The Redwood Community Health Coalition, a network of clinics and community health centers in Sonoma, Napa, Marin and Yolo counties, said it has given “conditional support” to Sutter’s proposal.
Nancy Oswald, executive director of the coalition, said a smaller hospital would work only if more is done in the county to expand primary care services that keep people healthier and prevent people from seeking health care in the emergency room.
Expansion of primary care services through federally assisted health centers is a key component of President Obama’s national health care reform.
“Building a smaller hospital only makes sense if you build more primary care and prevention,” Oswald said. “Just building a smaller hospital is not going to make that happen.”
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