LAKE COUNTY – How will Sutter Lakeside Hospital's plan to reduce its number of beds from 69 to 25 affect local residents? The hospital says it will have little or no local impact, but local fire officials say they don't have enough information to allay their concerns.
Those concerns have set the stage for a meeting on Tuesday between Sutter Lakeside Chief Executive Officer Kelly Mather and the county's fire chiefs.
Critical Access Hospital designation is necessary for the hospital to keep important programs intact, said Tammi Silva, director of Sutter Lakeside Community Relations and Wellness Center.
The decision to seek the designation wasn't made lightly, said Silva. The hospital's senior executive team struggled with the plan but, ultimately, decided it was better than more serious alternatives that could have involved loss of services.
The county's hospitals and fire departments share an important working relationship when it comes to patient transport. Since 2004, three local fire agencies – Kelseyville, Lakeport and Lake County Fire Protection Districts – have been primarily responsible for interfacility transfer, which means taking patients from one medical care facility to another, either inside or outside of the county.
However, the fire chiefs said Sutter Lakeside has so far failed to approach them with information about what the status change could mean to them.
In the four months since Sutter Lakeside announced its plans to seek the Critical Access Hospital designation, fire officials said hospital has not provided them with direct information about the issues or possible impacts relating to patient transport. Likewise, there has been no approach from hospital executives about the impacts on the fire district.
“I'm unhappy that they're being less than open about this,” said Lakeport Fire Captain Bob Ray.
He added, “They know where to find us.”
Hospital executives dispute the claim that they haven't been open and haven't approached the districts. They also asked why the chiefs haven't brought their concerns forward sooner.
Sutter Lakeside Hospital spokesman Mitch Proaps said the hospital made its plans known to fire officials through the Lake County Interfacility Transport Committee.
“There's been a lot of work done here,” said Proaps, adding that the transfer of patients is integral to the current plans.
Silva said the hospital made a presentation to the Interfacility Transport Committee on Sept. 28, 2007, and that the committee didn't respond negatively to the information.
But Ray and Kelseyville Fire Chief Howard Strickler both deny that any presentations were made at the committee.
The committee also doesn't have representatives from all fire agencies, pointed out Northshore Fire Chief Jim Robbins, whose department isn't represented on the committee because they're not part of interfacility transport. Robbins he felt that he has been kept largely in the dark about Sutter Lakeside's plans.
Ray said the interfacility transport committee is a very minor player. Sutter Lakeside should more appropriately have contacted the Emergency Medical Care Committee, which is an advisory board to the Board of Supervisors. Ray, who chairs the committee, said no approach was made to that group, either.
The Board of Supervisors will host a discussion on Sutter Lakeside's access change at this Tuesday's board meeting. The same day, Mather will meet with the chiefs to discuss the situation.
On Thursday, Ray said Lakeport Fire received a message from Mather's office that she wanted to meet with Wells and other chiefs at her office at 10:30 a.m. Monday – the day before Sutter Lakeside's designation is to go before the board – to talk about the issue.
Wells and Robbins indicated the meeting time didn't work for them because of previous commitments. So, also on Thursday, Mather's staff contacted Robbins to request time on the Lake County Fire Chiefs meeting agenda Tuesday morning.
Gauging the effects
Ray is among the most knowledgeable people in Lake County when it comes to understanding the issues with medical transport.
He joined Lakeport Fire full-time in 1974 and has been a paramedic since 1992, also working part-time with private ambulance companies operating in the county from 1973 on.
Ray called Sutter Lakeside's full-page ads in local publications and its media campaign “propaganda,” and a “whitewash” of the truth – that the designation will, in fact, stretch local resources even thinner.
Case in point: Lake County has one of the highest senior populations, per capita, in the state, according to census statistics. Having fewer beds will only exacerbate the critical issues of health care already faced by local seniors, said Ray.
And in the cold and flu season, more seniors are likely to become hospitalized, said Ray.
Proaps, however, disputed that notion. “We're not really in a seasonal industry.”
Ray said he also is concerned that the county's residents may never know just what this will mean to them – that they'll simply accept the hospital's explanations without question.
Sutter's public outreach campaign included a mailer that arrived in homes this weekend, assuring area residents that the Critical Access Hospital designation would allow the hospital to continue accommodating 98 percent of the patients it currently admits.
The hospital reported that 90 percent of the health care it provides is done on an outpatient basis – a number which grows to 98 percent if one counts the patients treated in the emergency room.
While Sutter Lakeside has issued these numbers, it has not released documentation to support them, either to the public or, more specifically, to local officials.
Some of the most important numbers, which the hospital has not released, have to do with its hospital's daily census, or the number of beds occupied. Proaps said the hospital's average daily census is 24.7 beds, which hospital officials say will allow it to fit into the Critical Access Designation limit of 25 beds.
But, as Ray points out, an average of 24.7 beds means that, while on some days the census is well below that number, on other days it could be well above.
When Lake County News asked Proaps about the exact bed count for this past week, he wouldn't offer specifics.
“Where my concern is that they have not come to us and said this is what we're doing, we really have no choice, and this is how it's going to impact you,” said Ray. “Instead, all we've heard is, 'It's not going to impact you.'”
The reduction from 69 to 25 acute care beds could result in a “huge” impact for Lake County, said Ray. The county currently has 94 beds – between Sutter's 69 and Redbud's 25 – and it's not uncommon to have too few beds now, he added.
What, he asked, will be the result when 94 beds narrows to 50?
He said when Redbud Hospital sought the Critical Access designation a few years ago, they had a less serious reduction, from 32 to 25. But Ray said it still had a noticeable local impact on health care, and the need to seek it elsewhere.
“My biggest thing is, we've been kept in the dark,” said Ray.
Proaps said it's important to understand that the hospital doesn't currently use all 69 beds it's licensed for, and that Sutter Lakeside would have to staff up to operate all 69 beds.
Some of the patients the hospital currently serves could be better served in a facility such as Lakeport Skilled Nursing, with which Sutter Lakeside is contracting to take patients that need observation rather than acute care, said Proaps. That is one way of reducing bed census with no negative effect, he added.
Ray said he is concerned that, with the county's population growing while its bed count shrinks, it will be extremely difficult to increase the number of beds in a few years. He also asked if the designation really would bring the hospital more money in the form of higher reimbursements, one of the main reasons the hospital has outlined in seeking the designation.
Jim Araby of United Healthcare Workers, which represents between 150 and 170 hospital staffers, said the union would like to see the process slowed down, with an independent analysis done to gauge what the ultimate effects will be on Lake County.
Proaps said that's not going to happen.
The hospital, said Proaps, had their own experts conduct a “very in-depth needs analysis” for the county, which the state already has approved.
Ray said that the hospital should be more forthcoming, considering it's a provider of essential services to the community.
As such, he said the hospital should share the documentation for that analysis along with its census statistics, which it has so far been unwilling to do.
“Why would they not want to share it with us if there is nothing there for us to be concerned about?” Ray asked.
The hospital may, in fact, need the designation change, said Ray, and he conceded that it could be the case that the impact will not be serious. But he said he can't draw that conclusion from what little information he's received.
The chiefs are unable, at this point, to have a clear picture of what to expect.
“I presume that this is going to cause more interfacility transfer, patients that normally would have been taken care of here,” said Strickler.
“I don't know what the impact will be,” said Wells.
Wells said he wants to make sure it doesn't negatively impact his department while also ensuring the community is protected.
If the change will, indeed, require more out-of-county transports, Wells said he needs to be proactive and ready to increase staffing.
“Show us the study and reassure us that we aren't going to be affected with out-of-county transports,” he said.
“We're staying afloat but if there's a big influx of additional transports to other facilities we need the heads up on it,” said Wells.
If more transports are needed, necessitating more staffing and expense, it's unclear at this point just who will pay for it.
The Tuesday meeting with the chiefs “seems like the only time she's going to let me know what's happening,” Wells said of Mather.
Silva, who said she plans to attend the meeting with Mather, said hospital officials realize there have been gaps in communication and have learned valuable lessons in the process of seeking the designation change.
E-mail Elizabeth Larson at
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