Monday, March 29, 2010

Candidates Flesh Out Stances on Hospital

 SUPERVISOR-DIST 3The most pressing issue for the three candidates hoping to replace Alameda County Supervisor Alice Lai-Bitker is San Leandro Hospital. The San Leandro-centric issue may also deliver the city and the board seat to the person who best communicates a strategy going forward. Below are excerpts from Saturday's candidates forum held by the Hayward Demos Democratic Club along with analysis of each response:

As you probably know the board of supervisors voted last year to make [San Leandro Hospital] into a rehab-only facility and that is not satisfactory to the community. I would work to change that plan. Right now, I think there are two viable options that I'm actually looking into, so I don't know which one we'll end up with. One would be if Sutter would release the lease and another provider would come in and buy it. The other option is the county continues the lease, but to do a hybrid model where it would be one or one-and-a-half floors of rehab, but retain acute care beds and the ER. I'm working with the unions. I'm working with folks in the community. I went down to the hospital and talked to some of the doctors. I've already started working on this. I think we need to see which one is more viable. The main goal is this hospital has been here 50 years, it serves 27,000 in the emergency room. If it goes away where are these people going to go?

Chan has already shown an impressive grasp of the San Leandro Hospital situation, both its history and the various plans bandied about during the past year. Her background is health care and she has her fingerprints on a few of the local instances where communities nearly lost their hospitals, but were saved. Her statement, though, is similar to the current supervisor, Alice Lai-Bitker, who voted for the county to convert the hospital to a acute rehabilitation facility. When the possibility of another provider, Prime Healthcare, made its interest known, Lai-Bitker tried to rescind the county's offer in advance of possibly negotiating with the Southern California provider. She could not find a a decisive third vote on the board and Sutter publicly balked at a rival in the vicinity of a rebuilt Eden Medical Center. Two things to remember, if Chan could cajole Sutter into allowing a competitor at San Leandro Hospital, the supervisor's seat is hers, but the odds are greater Jesus IS resurrected next Sunday outside the Marshall's on Marina Boulevard. In additiohn, the "hybrid option" has been mentioned by nearly every politician in the county, but without the elusive subsidies behind it or cooperation by myriad entities, it's the equivalent of lazily kicking a can down the road.

This is a critical issue not only for San Leandro, but for our entire region. Alameda Hospital was at risk of closing eight years ago and I helped lead the process to establish a hospital district and to do what we needed to do to keep the hospital open. The delivery of healthcare doesn't just affect the community where it is but every community around it. I think we need to stop--and I've also been working on this issue--we need to stop the progress where we are now. Bring it to a screeching halt. Sutter says that hospital is operating at a loss. We don't know that. Sutter is a big enough corporation through accounting techniques, they could assign more losses to San Leandro Hospital and assign more revenues to some other hospital to make San Leandro Hospital do worse than it really is. I'm sure it's not doing really well because no hospital really is. Alameda Hospital is also having to find out how to survive. I believe we need to stop this process right now and develop a long-term straregic plan for the delivery of health care services throughout the county and that's what I would work on as supervisor.

If Chan represents the candidate who could possibly step into the San Leandro Hospital issue at the county level without playing catch-up, Johnson's statements here and earlier, may show someone more in line with the current healthcare district's vein of activism. She says she wants to call a ceasefire and push reset. In many ways, this is what Carole Rogers and the Eden Township Board is trying to do by suing Sutter and whiping away the disastrous 2007 memorandum of understanding. Accusing Sutter of cooking the books is also a constant critique by supporters of the hospital and gobbled up like dangling juicy hanger steak over a hungry pack of wolves. Also, when she says, "do what we needed to do" in reference to keeping Alameda Hospital open, what she means is the city taxed itself to fund the facility. Not to put words in her mouth, but a similar proposal is in the whisper stages in San Leandro. Although, she has been vague on what a comprehensive county-wide health care plan would be, the view fro county health officials is any plan for San Leandro Hospital and the system as a whole needs to include long-term investment, something nobody has come close to offering up.

San Leandro Hospital, I think, covers somewhere in the neighborhood of 20,000 people a year and it's interesting to understand someone would talk about closing a hospital when we're getting ready to add 30 million people who have no health insurance--4 million in California and roughtly 200,000 in the our county. I think that's the compelling argument right now. We have the ability to talk to Summit [Sutter?] and say, look, we have 30 million people coming from the rolls of the uninsured. I like to be able to address that. One of the things you'll find from me is I want to have top-to-top conversations and the broaden the conversation.

First of all, mistakingly calling Sutter Health, Summit, is not good when the county's interaction with the health care provider is one of the board of supervisor's most pressing questions. Second, misstating the number of patient visits to the emergency room by a third only makes it appear the 41-year-old financial planner may be over his head (Chan deftly used the opportunity to squeeze in the correct figure, 27,000, during her own response). Aside from the glaring mistakes, many in the audience were impressed by Lowe, with one calling him a future prospect in local politics, but his statements regarding the hospital amounted to a general indictment of closing x-hospital, in y-city, in z-state within the backdrop of post-healthcare reform America. As far as having a "top-to-top" conversation with Sutter, anybody even sure what that means?
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  1. Instituting a tax to save San Leandro Hospital is problematic. First, about 40% of the folks in the District are Kaiser subscribers. Second, the District encompasses Hayward, Castro Valley, and other areas where the folks don't usually go to SL for hospital services. To levy a new tax, it must be approved in an election by two thirds of the voters. Not likely to happen given the stated demographics. But it might be possible to carve out a separate new district with boundaries around the community served by SLH where such a vote might be possible, but still not probable.

    As for the 30,000,000 uninsured, they still get acute care by popping into the ER where federal law requires they be evaluated and if necessary treated. For that the hospitals get no reimbursement at present. With the new law, these folks will have some sort of coverage that may enable them to seek care from sources other than ERs thus reducing ER visits (although this did not happen in Massachusetts where ER use went up) or at least with the new insurance coverage the hospital will get some reimbursement for these patients.

  2. Approximately 8% to 12% of the district actually covered by Kaiser insurance. Nice Try Rico.
    Mark Phillips
    Castro Valley

  3. Dr.Rico, it seems that your statistics about district's kaiser pts and other information is taken from the same source that said 80% of SLH pts are urgent care pts. Such statments indicates that either you are living in a lala land and blindly serving your master or you think people living in this district are stupid. Dr. Rico I don't know how much money Sutter pays you for spreading lies and missinformation about the hospital and the district but its not worthed. Stop behaving like a corporate crony and act like a real doctor; please. Abdullah Wakeely

  4. http://hcfan.3cdn.net/52c8bf89762e3452a0_vcm6bxpok.pdf, If you look at this site you will see that Kaiser has 46% of the market in the Oakland-Fremont-Hayward metropolitan region.

  5. I would agree with Dr. Rico that "Instituting a tax to save San Leandro Hospital is problematic.". A primary reason is that this crisis is completely manufactured and sustained by Sutter Health. The claimed need for taxpayers to subsidize SLH services is also manufactured and sustained by Sutter.

    Dr. Rico persists in being unwilling to deal with these facts:

    - Sutter makes much, much money in the Eden District, even while reporting large losses at SLH (over $20 million in 2008 alone). The not-for-profit Sutter has also made nearly $3 BILLION in profit in the last six years. Sutter's greed and lack of concern for our communities are the only things preventing them from providing the subsidy themselves.

    - Another hospital system has offered to continue all current services without the need for subsidy. Their offer would also pay the Healthcare District tens of millions of dollars for the lease of SLH. These final facts reveal that Sutter's position "("the Hospital is not a viable business") is false. It also makes Sutter's blocking of this deal, or a more reasonable/less deadly deal with ACMC, immoral.

    The final deal that is struck to maintain the ER, ICU and other services at SLH may include some form of public subsidy. Let's not kid each other and claim that this would be justified by the facts.

  6. The scenario Dr. Rico lays out in the first paragraph of his first comment here is exactly what officials are discussing. In fact, they have had this conversation before, but it never moved forward.

    The former AC Health Services Director Dave Kears, along with Supervisors Scott Haggerty and Nate Miley excoriated the City of San Leandro in a few meetings last summer to take the situation into their own hands and tax themselves. Mayor Santos and Councilman Jim Prola opposed it then.

    Carving a separate district is quite provocative. I've never heard it proposed, nor do I know whether it is feasible.

  7. The Contra Costa County Board of Supervisors led a very hurried gathering of stakeholders in reactivating and sufficiently financing the West Contra Costa Healthcare District in 2004. Tenet pulled its funding of Doctors San Pablo Hospital with only 2 month's notice. Unlike SLH, no alternative suitor arrived, so the County achieved a great save of the ER and other services by figuring out creative ways to subsidize the Hospital. It has remained open to this day.

    Feel free to Google "Dev Mahadevan Doctors San Pablo"; the Eden Township Healthcare district's current CEO was the Chief Financial Officer at Doctors San Pablo Hospital from 2004 to 2006. Dev resigned during a crisis when the hospital appeared ready to close due to financial problems; the Hospital eventually righted itself.