In response to the July 18 Coastal Voices piece by my colleague, Dr. Greg Duncan (“Secrecy imperils locally owned, full-service hospital”), I feel compelled to offer a slightly different viewpoint from a physician who has also been in this community for a long time.
Although I have agreed with my fellow physicians on some of these issues rejecting regionalization, it is solely because I believe that it is a step that will lead rather quickly to critical access application for this hospital. Based on what I know about the many ramifications of critical access, I would prefer that Sutter Health not take that step, at least not until it was absolutely necessary.
The main objection of the medical staff has been the process of the decision by the Board of Directors at Sutter Coast, in that we physicians as a group were excluded, and we do not understand, even at this late date, the need to take these steps. We want to understand the reasoning behind this process and we are also convinced that the public deserves similar understanding.
If, however, critical access were not being discussed in the same breath, I might be in favor of regionalization because the potential benefits might outweigh the numerous objections that have been raised.
I do not favor the hospital Board’s decision to “go regional” without bargaining to get a permanent seat on the regional board. But even setting that aside, if Sutter Health through the West Bay Region could assure a supply of physicians to this community by virtue of the resources of the West Bay Region physician foundation, then “going regional” might be the best solution to the main chronic medical problem in this community — lack of physicians.
In the first years I was here, in Crescent City alone, there were seven private primary care offices whose physicians had privileges at the hospital, and at their peak these offices numbered about 15 physicians between them. Now there are two such private offices in this town, with four physicians between them. I am now in my 21st year as a working physician in this community and during that time I can think of only one or two cases where physicians, after announcing their intent to leave, have actually replaced themselves, or been replaced in a timely way. All the others have retired, died, or moved away and turned their patient files over to the care of a partner or some other local office. Numerous physicians have been brought to this community to try and fill the gaps, and in most cases they left after only brief stays.
And make no mistake about it; Sutter Health has been the driving force for recruitment and retention of those numerous physicians for decades. Many of the very best physicians who have remained in our community were brought here and assisted in their practices by the financial support of Sutter Health.
I have been in disagreement with my colleague on a major point. He continues to insist on “local ownership” as being a key point in this effort to reverse the process of regionalization.
I was not present when Sutter Health first came to the community to manage Seaside Hospital, so I don’t fully comprehend the arrangements at that time, but I am familiar with the more recent versions of the working bylaws of the hospital Board of Directors. They all state in some fashion that Sutter Health will always be the sole “General Member” of the company that is Sutter Coast, that Sutter Health must approve the membership of Sutter Coast’s Board of Directors, and that said Board is principally charged with the duty of protecting Sutter Health’s interests in the hospital.
On top of that, Sutter Health financed the construction of the current hospital, and has also financed the two major revisions of the hospital. No public money was used, no local bonds were raised. The profits of the hospital, after paying for charity care and for local donations and local projects, have always gone into the Sutter treasury and nowhere else, and the money to build and rebuild this facility came through the Sutter treasury, and nowhere else.
I guess it is a matter of semantics, but it seems to me that if you pay for something, you ought to own it, and if you are solely in control of it and are the sole entity that can claim any revenue from it, you also own it.
At best I think it is reasonable to state that we have a unique and potent interest in the future of one of Sutter Health’s subsidiaries, largely by virtue of the fact that it is the only hospital we have and because it replaced a true community-run hospital.
Changing medical care in a community such as this changes its very nature as a place to live, but it is also undeniably true that under the new federal law the way medical care is bought and paid for in hospitals is also changing.
I know for a fact that Sutter Health has been considering critical access for this facility for much of the last decade. I am no longer certain that any other company would not be considering the same thing in 2013.
My greatest fear from all this is that it will be even harder, after such a bitter and public dispute, to entice physicians to enter this community, and that those of us who can will start to look for a less complicated place to practice medicine. We have already heard that one of the key physicians in this community has decided to leave, in part because of ill will and harsh words passed between members of the medical staff over this dispute.
I would like to remind my more vocal colleagues and the community at large that many of our physicians are at an age in their careers where they need to make a final decision about where they want to be when they retire.
I would hate to see this community pay the price of losing even more doctors as a consequence of this struggle. It would be one of those unforeseen consequences that could be disastrous, and truly not worth any perception of victory.
Warren Rehwaldt is a local physician.