The subject, included in the Board of Supervisors' afternoon session, was a topic of passionate debate, and included a dizzying amount of information, including bed counts, fiscal impacts and hospital profit margins.
Board Chair Ed Robey said that the main reason for having the discussion was so the board could educate itself about Sutter Lakeside's proposal to seek Critical Access Hospital designation, which, among other things, would reduce its number of acute care beds from 69 to 25 and allow it a higher Medicare reimbursement rate.
Besides education, the most important thing to come out of the meeting was Sutter Lakeside Chief Executive Officer Kelly Mather's agreement to take part in a countywide health needs assessment.
Last week, Sutter Lakeside spokesman Mitch Proaps told Lake County News that the hospital administration had already done its own assessment as part of the Critical Access Hospital application process, and was not willing to do a third-party assessment.
On Tuesday Sutter Lakeside had support from Redbud Community Hospital in Clearlake and Willits' Frank R. Howard Memorial Hospital, both of which are Critical Access Hospitals owned by Adventist Health. Redbud received its designation in 2005.
Supervisor Anthony Farrington said he was suffering some “indigestion” about the hospital's plans and its failure to be clear about them with both the county and some other local entities, including fire districts.
Mather, sitting at a table before the board with her medical director, Dr. Diane Pege, beside her, explained that the designation change was the best option available for the hospital, which is facing major budgetary shortfalls.
“I'm not the bad guy here,” said Mather, adding that people need to get care at the lowest cost.
The best care, she added, is not always given in the hospital, where patients can be exposed to infections and disease.
Supervisor Rob Brown asked Mather about the perception that the hospital has spent a lot on campus improvements – including gazebos and gardens – to the detriment of critical health care services.
Mather said those upgrades to the grounds have cost between $40,000 and $60,000, a very small amount compared to the $180,000 it costs for the hospital to operate each day. Last year the hospital had $63 million in expenses, Mather said.
She said she has been accused for many years of being too focused on wellness. “I believe in healing, I believe in wellness, I believe that's the answer to our health care costs in the future.”
Supervisor Denise Rushing asked what would happen to the hospital on a day when they had more patients than the 25 beds available. Mather responded that Sutter Lakeside has contracted with Lakeport Skilled Nursing, which will initially have eight beds available for those patients who do not need acute care.
The Critical Access Hospital designation, said Mather, “is the only option where I can guarantee no layoffs for 2008.”
On the subject of patient transfers to other facilities, Mather estimated the hospital currently transfers one patient a day for higher-level care. She said the designation change could result in an additional 200 transfers annually.
The designation change, she added, would help the hospital realize hundreds of thousands of dollars in savings each month.
The supervisors asked to hear from the fire agencies, with whom Mather had met earlier in the day.
Lakeport Fire Captain Bob Ray – who told Lake County News last week that the fire agencies had received no direct contact from the hospital on the designation – said he was concerned that without information from the hospital the fire districts wouldn't know what impacts to expect.
Within the past month, the status change seemed imminent, said Ray, but fire agencies hadn't had their questions answered.
Ray said Sutter Lakeside assured the chiefs Tuesday morning they would provide the information they needed.
The board also asked for input from Jim Brown, director of the county's Health Services Department.
Brown said that, like the fire districts, his department has concerns and still has questions that need to be answered.
He added, however, that he believed that the hospital and its board of directors had done everything they could to minimize impacts to the community and maintain the best quality of care while not laying off any staff.
At that point Mather said Sutter Lakeside is willing to take part in a countywide assessment of health service needs. One was previously done in 2001.
During public comment, the sentiment ranged from support for the board and confidence in its decisions to criticisms of the cuts in service.
“I think it's a shame that the community is losing a level of medical care that you can't put a price on,” said Kim Beall of Lakeport.
Trish Combs, whose husband is a doctor at Sutter Lakeside, credited Mather with bringing top-of-the-line technology to the hospital.
Former Supervisor Gene Lovi told the supervisors that the hospital's plan is “none of your business.”
Perhaps the most tense moment of the discussion came when Becky Vreeland, a registered nurse who works in Sutter Lakeside's emergency room, stood at the podium to voice her discomfort with the plan.
She said she felt the large audience in the board chambers was stacked in support of the administration and the designation change.
“The true fact of the matter is, we wait hours for beds, we wait hours for ambulances to transport patients to other facilities,” she said.
Vreeland said the change will heavily impact the hospital, and that to her it felt like a disservice. She said she was concerned that people will now be left waiting much longer in the emergency room, where last weekend the patient load was “unreal.”
“I hope I'm wrong,” said Vreeland.
Mather responded by asking if Vreeland had attended the staff forums on the designation change. “The majority of the staff is in support of this,” said Mather, adding that the room was not “stacked.”
“I'd like to know what you think is a better solution,” Mather said to Vreeland.
Mather added that “spreading fear in the community,” which she accused Vreeland of doing, “is not an acceptable choice.”
Bill Kearney, chair of the Sutter Lakeside Board of Directors, told the supervisors he joined Sutter Lakeside's board because he cared about the quality of care, a concern shared by other community members serving as hospital board.
He said he was originally against the change. Instead, he and the board had the hospital administration review the hospital's full operations twice to find ways to avoid it.
Kearney said there would have been no value in going to the public with the issue earlier than it did last fall because the hospital was still reviewing its options.
He admitted that the hospital has made mistakes in the process, and he referred to the disconnect with the fire districts. “We wanted every stone to be unturned and we forgot one.”
Kearney also apologized to the county for not getting them more information earlier. “We were just trying to make the best decision we could for this county.”
Another Sutter Lakeside board member, Tom Lincoln, said he believes Sutter Health has invested about $50 million in the community, only a fraction of which has been paid back. Lincoln also said he believes Sutter Lakeside's staff are among the best paid in Northern California.
Lincoln also called Mather “one of the most committed people I've ever met.”
For Farrington, the issues weren't entirely resolved. “I still have concerns and I think a number of people still have concerns.”
He added that he was encouraged that Mather is willing to take part in the countywide health needs assessment.
Kearney said the hospital realizes that, in order for the Critical Access Hospital designation to truly be a benefit, it must be managed. “We can't just get this designation and walk off and say it's going to work.”
Rushing said it will take administrative investment. If there isn't, “There will be real humans at the end of this with real stories about how it didn't work,” she said.
The decision, she said, does nothing to solve the fundamental structural problems of health care. She added that she wanted to see the dialog between the hospital and the county remain open, and that she wanted the study to happen.
Supervisor Jeff Smith said he learned a lot from the afternoon's testimony. “I really believe it's going to be a positive decision.”
Rob Brown said he thought it was great that Sutter Health allowed its local board to have so much influence in the decision. The board, he said, is made up of local people who have the community's best interests at heart.
“I, too, trust their judgment,” said Brown. “I know it had to be tough for them to make a decision like this.”
“It's been a real educational experience for me,” said Robey. “That's part of what this accomplished.”
Just how the local health care assessment will be carried out, who will be involved and other particulars will return to the board for discussion at a future date, said Robey.
E-mail Elizabeth Larson at
{mos_sb_discuss:2}
How to resolve AdBlock issue? 
