Two previous Albion Monitor series written by Harold Stearley provide background on this critical issues. "Nursing on the Edge" explains the "managed care" changes that corporations have brought to hospitals. "The Rise and Fall of Nursing Unions" continues by documenting how nurses have become "supervisors" and "coordinators" of minimally-trained workers.
On the November ballot are two state propositions: Prop 214 and 216. The editorial staff of the Albion Monitor urges you to vote YES on 214 and 216. Both propositions bring much needed reform to health care in California, in our opinion, and will prevent many of the worst abuses documented in Stearley's articles.
Further articles will be added to this series in coming weeks.]
"We are not required to run a hospital -- we are only required to provide for the indigent"
the privatization of America and the world," Rabbi Michael Robinson says emphatically when asked why he helped sponsor Measure E, the initiative requiring a public vote on the transfer of Community Hospital ownership to Sutter/CHS. "I think the people have a right to decide," he said. "This is not a county of dummies."
Robinson's principled stand is only one reason given by supporters. Said Carol Spooner, a legal aide actively working for Measure E: "For me, access to health care is the critical issue. All the other issues are secondary."
The fate of Community, which had been a public hospital until the Sutter takeover last March, has also aroused intense community feeling. More that 29,000 people signed the ballot petition -- twice the number required. And according to a poll taken last month by the Press Democrat, 35 percent of voters support the measure, with 20 percent opposing it and the rest unsure.
What will happen if Measure E passes? The initiative would nullify the lease with Sutter and require a public vote on any affiliation or change of ownership. Should it win, both Sutter and members of the Board of Supervisors have vowed to fight it in court, and at least one Supe hints that they would close the hospital rather than take it back.
Some, including 5th District supervisory candidate Mike Reilly, worry that overturning the arrangement at this point will cause chaos.
Candidate Eric Koenigshofer thinks differently. "The people deserve to have their say in the matter," he said. "We need to carry through to completion the community debate on the subject." Won't it cause chaos? "Absolutely not," he said.
If the initiative wins, the county intends to challenge its legality. Said Ernie Carpenter, "This initiative infringes on the management rights of the county. Can you budget through the voters? Our deputy county counsel's analysis was that any proposed reduction of services would require voter approval. The union won't tell you it's as draconian as it really is!" Carpenter says the lawsuit could tie up the legislation for months or even years.
Supervisor Mike Cale said, "It ain't gonna be pretty if that measure passes." Would they even close the hospital? "We are not required to run a hospital," said Cale. "We are only required to provide for the indigent."
But nurse and union activist Glenda Canfield says, "Well, you can do it now, or you can wait ten years and see what happens."
Canfield and other opponents of the Sutter lease wanted their initiative on the ballot for the March election -- before the deal was completed -- but were blocked in their efforts by the Supervisors, who took them to court in what one attorney called "an unprecedented lawsuit seeking a ban on petitioning protected by the 1st Amendment." [See "Community or Corporate Hospital?" in a previous Albion Monitor.]
She believes it will be better to do it now, even though Sutter now has control. Certainly it will be complicated, and no one can anticipate what Sutter's demands might be.
Supervisor Mike Cale is certain that Community Hospital "would go belly-up in 24 months"
what happens with Measure E, it's clear that the county's deal with Sutter will remain controversial. The hospital is leased for 20 years with renewal options up to 60 years, and the public has no control over what goes on. Meetings of the Board of Trustees are closed. The union itself does not have the access to those meetings that it once did.
Critics have renewed charges that the deal wasn't necessary, and supporters equally defend the lease. The Board of Supervisors believes that the lease with Sutter has saved the hospital from closing and put it into capable hands. Supervisor Mike Cale is certain that Community Hospital "would go belly-up in 24 months" if it did not affiliate with some larger entity.
"We tried some fairly creative things over the years," said fellow Supervisor Carpenter, mentioning a county HMO and attempts to form alliances with other public hospitals. "Petaluma was one. It chose to go with Memorial. I think we went through the gamut of trying.
"And we came out of it smelling like a rose. I don't think you'll find a board that's cut a deal like we cut with Sutter."
Critics think the deal smells, but not rose-like. "We never said Community did not need some form of affiliation -- but this is a sale," said Michael Allen, an attorney and General Manager of the Service Employees International Union (SEIU).
Allen said that the county did not really examine any other possibilities. "Every other county who decided to rebuilt or lease their public hospital did an impact study," and many of them found ways to keep their hospital public. San Mateo did a county-wide HMO, which San Francisco is now considering. Denver has a true partnership with its hospital.
(As for Petaluma's affiliation with Memorial, that decision made after Community was leased to Sutter.)
High costs and a weak bargaining position in a highly competitive market were the reasons given by the Board of Supervisors for the leasing of Community Hospital. Said Supervisor Cale, "For every dollar we spent, we'd get back 50 or 60 cents. We were digging into the reserves, and the reserves are going to go away."
But Allen sees that viewpoint as penny-wise but pound-foolish. There's "a hidden cost when you lose a public hospital. Private hospitals charge more to cover their charity costs. Premiums and co-pay increase. It takes two to three years before you see it."
Sutter and other corporations cut back on nurses, replacing them with less qualified staff
Sutter can profit
from the lease because "managed care" holds down the spiral of rising medical rates to four percent, a vast improvement over the past decade.
Said Supervisor Cale, "If you're going to provide something that looks like a public hospital, you better have some leverage in this market. Blue Cross wouldn't even talk to us. HPR was always gouging us. Supplies were always higher. Because Sutter is such a large institution, we get much lower prices."
Those discounts aren't necessarily passed on to patients. Profits are still extremely high in all areas of health care, typically around 11 percent. Sutter Health had increased net earnings by 56 percent in 1994, but even accounting for that staggering increase, Community Hospital Director Cliff Coates said it "is still a long way from matching its profit levels of five years ago."
Sutter and other corporations also cut back on nurses, replacing them with less qualified staff to perform routine chores. (Sutter is currently teaching unlicensed workers how to insert IVs, for example.) As a result, medical mishaps are on the rise. According to a study of 281 general acute care hospitals in the U.S., hospitals which reduce their staffs by eight percent or greater were more than 400 times as likely to show increases in patient morbidity and mortality.
Community is now serving less than half the number of non-paying patients
in this debate is the future of hospital care for those without insurance. Charity care refers to patients with no insurance, not people on MediCal or Medicare. Sonoma County has 90,000 uninsured residents. These are working people: People employed by small businesses, young people working at the malls, temps and part-time employees at places like the Bank of America -- even nurses who work part-time.
Ernie Carpenter said with certainty that Sutter is obliged to maintain the same level of indigent and charity care at Community as the hospital provided before; but with equal certainty, critics point out that Community is now serving only one-fourth to one-half the number of non-paying patients as it did before.
Community spent $18 million for charity care during its last five years, about $3.4 million [per year]. By contrast, Sutter has promised $38 million over 20 years, or $1.9 million annually.
Charity care will be the same, Director Coates reiterated. "With the county, five percent of the revenues generated were provided for charity care. We have committed to that level, even if it hits 6 percent."
Still, it is the county remains obligated by law to take care of the health care needs of its indigent population; if Sutter serves more indigent patients that it wants to, it can ask the county to pay the bill.
Mike Reilly and others fear that there's no going back
day approaches, voices on both sides of the Measure E debate grow louder.
Though convinced they have made the right choice in voting for the Sutter lease, neither Supervisors Cale and Carpenter seem thrilled with the outcome. Cale expressed his concern that insurance companies have too much power. Carpenter shared his feelings about welfare reform, and other developments at the federal level. But they believe, with the other supervisors, that they made the best possible choice, given the circumstances.
Cliff Coates said "Measure E will freeze the hospital in its current state and leave it out of the discussion with other market forces. People who vote on this measure need to know they are voting for county management and county liability.
"We intend to win it in the election. We will fight it in the courts." But Sutter will not participate in another election in 1998 to decide who will run the hospital. "It's just not productive to be involved in health care while being involved in political campaigning."
But that is only if the suit challenges the entire initiative. If it is only a clause in the document that is in question, then the voter approval of the lease could proceed, and the hospital could end up again in the hands of the supervisors -- which is what concerns Mike Reilly and others, who fear that there's no going back.
Albion Monitor October 16, 1996 (http://www.monitor.net/monitor)
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