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.

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LAKEPORT – As Sutter Lakeside Hospital gets closer to completing a process to reduce its number of beds, leaders of several county fire agencies are voicing their concerns about the move's ultimate impact on local health care and the need to transfer more patients to out-of-county facilities.

Last fall, Sutter Lakeside Hospital announced its plans to seek Critical Access Hospital designation. The move would reduce the hospital's bed count from 69 to 25, while gaining a higher reimbursement rate from Medicare.

Sutter Lakeside spokesman Mitch Proaps said, currently, only one out of every five patients who visit the hospital covers the cost of care, a number he said will be raised to four out of five with the new designation.

The California Hospital Association reports that community hospitals around the state are feeling the financial pinch due to several factors – the billions required in seismic retrofits, $5.4 billion in underfunding from government programs and the nation's largest uninsured population, an estimated 6.8 million, a number which is growing.

The result, the association says, is that nearly 50 percent of all state hospitals are operating in the red.

It's that kind of financial pressure that Sutter Lakeside's officials said led the hospital's board of directors to choose what they believe is the best option – the Critical Access Hospital designation, which was granted to Redbud Hospital a few years ago.

Proaps said the decision was not motivated by profit, but rather by the fact that Sutter Lakeside has not been able to cover its own expenses. “Our shortfall for Medi-Cal, Medicare and the uninsured is too great.”

The Critical Access designation, he said, will allow the hospital to retain staff, cut the least amount of services and actually allow Sutter Lakeside to grow by generating revenue through higher reimbursements.

However, concerns about seeing the county's bed count further reduced and what the designation change will ultimately mean have landed the item on the Board of Supervisors' Tuesday agenda, where the board will discuss its position on the proposal.

The designation change also is raising concerns with the leaders of local fire districts, who say Sutter Lakeside has not been open with them about its situation or its plans, plans which they say could have huge impacts on the fire districts and the community.

The basis of fire agencies' concerns

To better understand the concerns expressed by the fire districts, it's important to go back to 2004.

From 2000 to 2004, Redwood Empire Life Support (RELS), a private, Santa Rosa-based ambulance company, contracted with the county to provide interfacility transport – taking patients from one hospital or medical facility to another, both inside and outside of the county.

In March 2004, RELS abruptly dropped its local services with no warning and no official notice to the county.

The move left the county without the interfacility transport services.

In response to the need, and with the knowledge that they could provide reliable, consistent response, the county's fire agencies took over the responsibility of providing ambulance services, adding staff – including former RELS employees – to do so.

Kelseyville Fire Protection District Chief Howard Strickler said that Kelseyville, Lakeport and Lake County Fire Protection Districts became responsible for interfacility transport. All fire districts also provide 911 patient transport.

Strickler said he has two ambulances that make the transport trips, one staffed by a full-time crew and the second with a part-time, volunteer crew.

Last year, Kelseyville Fire made 464 out-of-county transports, averaging 45 per month, said Strickler. Most of those trips were to St. Helena Hospital, with the second-most common destination Santa Rosa Memorial Hospital or a cardiac testing facility in Santa Rosa.

Lakeport Fire Chief Ken Wells said he has one ambulance devoted to interfacility transports that is staffed by a part-time crew. He has two 911 ambulances on call at all times, and explained that out-of-county transports don't interfere with local emergency response.

Captain Bob Ray of Lakeport Fire, who oversees the department's medical transports, said that for calendar year 2007 the agency made 339 out-of-country transfers from both Sutter and Redbud, and 378 within the county from either one hospital to another or between other care facilities. That's an average of just under two a day, said Ray.

Lakeport Fire mostly transports patients to St. Helena Hospital, followed by Santa Rosa Memorial, Sutter Santa Rosa and Kaiser Santa Rosa, Ray said. One transport from Sutter Lakeside to St. Helena can take up to five hours, counting the round trip and paperwork.

Other trips – to Sacramento, UC Davis Medical Center, San Francisco or Stanford Medical Center – can take many more hours than that, Ray added.

Proaps said Sutter Lakeside currently transfers about 350 patients per year to other hospitals mainly for higher levels or specialty care that isn’t available in Lake County. Any increase in transfers after Critical Access Hospital designation, said Proaps, would be to Lakeport Skilled Nursing, Ukiah Valley Medical Center or to St. Helena Hospital for the same or lower level of care provided at Sutter Lakeside.

United Healthcare Workers (UHW) West, which represents between 150 and 170 of Sutter Lakeside's staff, offered its own analysis on patients treated out of county.

UHW stated that in 2006 838 Lake County residents were treated at either Sutter Medical Center in Santa Rosa or Santa Rosa Memorial Hospital, although it was not clear if those patients were direct transfers from Sutter Lakeside.

If the designation goes through, and beds are reduced, UHW estimates another 300 patients will need to seek care out of county.

Statistics for Lake County Fire Protection District and South Lake Fire Protection District were not immediately available.

Tomorrow: Fire officials explain their concerns, which include Sutter Lakeside's failure to contact them directly to discuss the ramifications of the status change.

E-mail Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it..

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The office of attorney Tibor Major confirmed this week that he would file a suit in Lake County Superior Court on behalf of Desiree Chantal Perez, 19.

Perez was driving through Clearlake on Nov. 17 when she was hit at the intersection of Highway 53 and Lakeshore Drive by Clearlake Police Det. Richard Towle's patrol car, as Lake County News reported last fall.

Towle was on his way to an emergency call involving a man threatening an off-duty Clearlake Police officer.

Although Towle had his lights and siren on, at the time Clearlake Police reported that “natural vision obscurements” prevented Perez and other drivers at the intersection from seeing Towle until he was actually in the intersection.

Clearlake Police's investigation into the crash ruled that Towle was at fault because he failed to ensure that all cross traffic at the intersection had come to a stop, which violated the need to drive with “due regard” to the safety of other people on the road.

Both Towle and Perez were treated for minor injuries after the crash.

Perez filed a claim against the city on Feb. 6, which sought $5,262.70 in medical expenses, $50,000 for pain and suffering, and lost earnings with “unknown” stated under the amount.

At its Feb. 14 meeting the Clearlake City Council, at the suggestion of city staff, voted 5-0 to reject Perez's claim against the city.

City Clerk Melissa Swanson told the council that the city's third party claims administrator is currently investigating the claim.

If the claims administrator were to determine the city was at fault, the city could offer a settlement, up to $50,000 of which would come from city funds, said Swanson. Any amount over that would come from a liability program offered by the Public Agency Risk Sharing Authority of California.

Swanson said that, following the city's rejection, Perez has six months to file a lawsuit.

Major's office said the monetary amount that would be sought in the lawsuit had not yet been decided.

E-mail Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it..

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The agreement, tentatively reached Jan. 8, was approved overwhelmingly by IHSS providers, who were represented by the California United Homecare Workers Union.

Although it's been years in the negotiations process, the contract wasn't greeted with universal enthusiasm amongst the Board of Supervisors, acting in the capacity as the Lake County IHSS Public Authority.

Supervisor Anthony Farrington wanted more specifics included in the memorandum of understanding regarding an enhanced IHSS provider registry, which would offer a wage above the $8.33 an hour – plus 60 cents per hour in health benefits – that will now be offered to all of the roughly 1,400 IHSS providers in the county.

Social Services Director Carol Huchingson, whose department oversees the IHSS program, said it would take time to work out the enhanced registry and its details. “I would hesitate to have the language be more specific at this time and absolutely commit to an enhanced wage.”

Farrington said that, for him, the driving issue was making the IHSS program a quality one.

He also noted his concern about the lack of drug testing, an issue that has come to divide the union and the public authority.

Supervisor Rob said union President Tyrone Freeman had told the board last year that he supported drug and background testing, “and we saw what happened to that.”

Supervisor Jeff Smith said it was time to move forward and get past the sticking points of the past. He said he has confidence an enhanced IHSS provider registry will work in Lake County because the union has put a similar program in place in Los Angeles County.

“It's for the benefit of the folks who are out there working,” he said. “I want to see it happen.”

Brown remained skeptical.

Getting up from his seat on the dais, Brown put up a display of several blown up, poster-size mug shots from the Lake County Sheriff's Web site showing several IHSS providers who had been arrested and convicted for various crimes.

They included Andre Stevens, convicted last year of a murder in Clearlake. Stevens, who had a previous robbery conviction and had done time in state prison, worked as his girlfriend's IHSS worker, as Lake County news has reported.

“These are the IHSS workers that I don't think we should be representing,” said Brown. “We shouldn't be giving them a raise.”

Brown said his first priority was for the clients. There are about 1,600 IHSS customers in the county, many of them elderly and disabled, according to the IHSS Public Authority.

“We've had a long history of fighting against giving these people a raise without drug testing and background checks,” Brown said, gesturing to the mug shots.

He added that he considered it a slap in the face to the good IHSS providers to lump them in with the criminal element.

Board Chair Ed Robey agreed, but said ultimately the state Legislature had created the system and its inequities.

Brown said it would do little good to appeal to Sacramento, where “all we have is some whiney activist.”

Many people are subject to drug tests and background checks for jobs, Brown said.

Supervisor Denise Rushing took a different approach.

“I'll just say this, no one wants to give criminals a raise,” said Rushing.

Gesturing to Brown's mug shot collection, she added, “These are the Willie Horton pictures here,” referring to a man released on a prison furlough program who later committed robbery and rape, and whose story was used against former Massachusetts Governor Michael Dukakis in the 1988 presidential election.

Rushing said she felt the contract was a path to improving the program.

“I want to see the workers get a raise and I think it will have an immediate affect on their lives in Lake County,” she said.

Brown responded that he didn't have as much faith in the IHSS program as he used to. He suggested that it was “so corrupt and sabotaged” that it may need to be scrapped and replaced.

Any of the convicts he presented pictures of, said Brown, could get out of prison and return to work as an IHSS provider. “That is so fundamentally wrong that that can be allowed to happen.”

Smith said not approving the agreement would hold back many good people who deserved a raise. The agreement, he suggested, gets the county to a point where it can start working on improving the program and putting pressure on legislators.

“It might not be exactly the way we wanted but at least it's a start,” he suggested.

The board ultimately approved the contract 4-1, with Brown voting no.

Robey said afterward that there's “a lot of pent-up frustration involved” for the board relating to the IHSS negotiations.

E-mail Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it..

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Lake Family Resource Center Executive Director Gloria Flaherty said the event, held at Mt. Konocti Growers, attracted more than 650 people – 250 more than did last year's event – some coming from as far away as the Washington and Arizona.

Flaherty said Wine and Chocolate was one of the largest single day events, attendance-wise, in Lake County. Lake Family Resource Center estimated the event itself raised between $20,000 and 25,000 this year. The Priest Family Charitable Fund is donating an additional $10,000 to the center's domestic violence center project.

The great weather allowed attendees to sip their wine outside while viewing antique cars and boats on display, said Flaherty. Coordinated by Allen and Donna Thomas, the car and boat show included beautiful Chris Craft Boats, and beautifully restored pickups and roadsters. Jeff Smith’s 1923 pickup filled with Dusinberre wine barrels marked the entrance to the event.

Three workshops proved to be very popular and were filled to capacity, Flaherty reported. Presenters included Chef Zino Mezoui (Zino’s Ristorante & Inn), Sommelier Stephanie Green (Focused on Wine) and Julie Hoskins (Chic Le Chef).

There were many sponsors for the event providing everything from linens to printing, boxed lunches to banners, cash to porta-potties.

Marilyn Holdenried gathered 18 items for a silent auction that raised over $3,000.

“We are so grateful for the support of our Lake County community,” said Flaherty. “Over 35 businesses and industries worked with us to make this event a success and we look forward to 2009. This event showcases Lake County, provides a wonderful mid-winter opportunity to support a good cause, and experience 27 wineries in one location!”

Lake Family Resource Center is preparing to launch a capital campaign to build a 25-bed domestic violence and family resource center for Lake County families, Flaherty reported.

“We expect to have to raise almost $3 million by the time its all said and done,” said Flaherty. “It will be accomplished through public and private grants, local donations and sheer determination.”

The new shelter, she said, will be accessible to all members of the community; it will include a child development center, classrooms, large meeting rooms, family services, and a safe and secure shelter for women and their families fleeing domestic violence.

The need for an adequate domestic violence shelter is high; Flaherty reported that, over the past few years, there have been seven deaths in the county resulting from domestic violence.

In the past year Lake Family Resource Center's Freedom House has provided more than 4,000 bed nights to an average of over 11 women and children every night, the center reported. The current facility is rented, small, and isolated from local services.

The nonprofit agency hopes to keep the construction project as local as possible and encourages representatives from the building trades to get involved.

Sutter Lakeside Hospital provided the land through a 50-year, $1-year lease, and Kelseyville Lumber has pledged to provide the lumber at their cost plus a small 5-percent handling fee, Flaherty reported.

On Tuesday's Board of Supervisors agenda, Lake Family Resource Center is requesting a waiver of all possible fees in the domestic shelter building project.

The center wants to make the third annual event, scheduled for February 2009, even more successful, so planning already is under way, said Lake Family Resource Center’s Board Secretary and Wine and Chocolate Committee Member Kathy Fowler.

“We have a two-year tradition of beautiful weather and we expect that to continue,” said Fowler. “The venue has pledged more space for 2009 and the committee has received some wonderful ideas. We hope to increase our attendance even more!”

If you would like to help with the domestic violence shelter building effort, please call Lake Family Resource Center at 707-262-1611.

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At 5 p.m. there will be a staff and council workshop, with a staff presentation to the council and Lakeport Planning Commission on reorganization as part of the Community and Economic Development and Redevelopment Business Plan.

The council's regular meeting will begin at 6 p.m.

On the agenda is a presentation from Lake County Community Radio/KPFZ on its new full-power station.

Sitting jointly as the council and the Lakeport Redevelopment Agency, members will approve disbursing tax increment pass-through payments to affected local taxing agencies.

A staff report by Redevelopment Manager Richard Knoll explains that the city is receiving $487,652.38 in tax increment revenue in the 2007-08 fiscal year, and state law requires it to pass on a portion of those funds to taxing agencies in the Redevelopment Project Area.

Of those funds, 20 percent – or just under $98,000 – will go to the city's housing set-aside fund, commonly used for affordable housing projects.

Another 20 percent will go to affected agencies, including the city, City of Lakeport Municipal Sewer District, Lakeport Fire District, Hartley Cemetery, Lakeport Unified School District, Mendocino College and the county, among others.

Under council business, City Manager Jerry Gillham will take to the council a discussion item on planning Phase II of Westside Park.

The council also will discuss holding a joint public meeting with the county and the City of Clearlake to discuss traffic mitigation fees.

Following the open session, the council hold a closed session to discuss labor negotiations with the Lakeport Employees Association.

The council meets at Lakeport City Hall, 225 Park St.

E-mail Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it..

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