Adam Spencer, The Triplicate

Like a lawyer talking to a jury, Duncan lays out the case against regionalization

Over the past two years, members of Sutter Coast Hospital's medical staff have taken it upon themselves to learn the ins and outs of health care law in the name of keeping local control and ownership of Crescent City's hospital.

As the fight to prevent the loss of governing control of the local hospital, also known as regionalization, moves deeper into the legal process, the self-described "country doctors" have garnered the favor of medical lawyers, the California Medical Association and most elected officials in Del Norte County.

During a Tuesday night town hall meeting on regionalization, Dr. Greg Duncan, the hospital's chief of medical staff and member of Sutter Coast's local Board of Directors, laid out his case before more than 200 concerned community members.

His presentation assumed an odd resemblance to an official legal complaint.

Duncan first showed slides of the legal definitions of "fraud," "undue influence" and "coercion," then proceeded to lay out a chronological "History of Regionalization," pointing out what he perceived as examples of fraud, undue influence and coercion on the part of some officials of the hospital and its parent organization, Sutter Health.

At the end of Duncan's presentation, he sought audience participation.

When trying to determine "fraud," for example, Duncan asked: "Does loss of local hospital ownership and governance introduce the potential for harm to our community?"

"Yes!" dozens of voices respondedl.

As an example of "undue influence," Duncan said that Michael Duncheon, general counsel for Sutter's West Bay Region, represented both the hospital and Sutter Health during a board meeting when more than 1,300 changes were made to the hospital bylaws.

On Wednesday, Duncheon said by telephone that such practice is "entirely appropriate," since Sutter Health and the hospital are part of the same system and it does not violate Sutter Health's code of conduct.

Mike Cohill, a Sutter Coast board member and the president of Sutter Health's West Bay Region (with which Sutter Coast would merge under regionalization) said he was "disappointed" by Duncan's presentation and that hypothetical statements Cohill has made in the past have been taken out of context and pointed to as "false statements."

"I'm very disappointed that this presentation was made to any audience because I understand that this whole issue of regionalization has created quite a distraction for the board, and it comes right on the heels of the (Sutter Coast) board asking Sutter Health to postpone regionalization so it can do some in-depth studies of all options open to Sutter Coast," Cohill said by phone Wednesday.

The study will take into consideration every possible future option for Sutter Coast, Cohill said, including making no changes, expanding services in order to become more economically viable, becoming a Critical Access Hospital (a smaller facility with less service but higher reimbursement to the hospital for Medicare patients), and affiliating the hospital with another health care system, among other yet to be determined options.

Duncan questioned the independence of the study Tuesday night, but Cohill said it will be funded by Sutter Coast Hospital - not Sutter Health - and the third-party consulting firm, which will carry out the study, will be chosen by a "community selection committee" made up of local residents.

"The study may in fact find that the hospital should do something that in fact the (Del Norte Health Care) District is alleging they don't have the right to do," Cohill said, referring to the court injunction the local district obtained, temporarily preventing regionalization or changing the facility to a Critical Access Hospital. "The district is saying that Sutter Coast Hospital can't make its own decision about its future... we disagree with that."

Sutter executives also disagree with a preliminary legal opinion of an attorney hired by Sutter Coast Hospital medical staff (and mutually agreed upon by Sutter Health executives).

In a letter to Duncan, attorney John Harwell said bylaws of the Sutter Health West Bay Region -- which were mostly adopted by the Sutter Coast board when it approved its numerous bylaw changes, according to Duncan -- violate state law regarding medical staff self-governance.

"In my view, the Sutter Bylaws usurp the rights and duties of the Medical Staff in these crucial activities, the protection of quality and the policies, practices and planning necessary to do so," Harwell wrote.

"We effectively and completely disagree with his analysis and his answer - he's wrong," said Duncheon by phone on Wednesday.

"There is no doubt that Dr. Duncan and his advisors have had a different view of the rights and responsibilities of Sutter Health" and Sutter Coast and the rights and responsibilities of the medical staff, Cohill said.

Many opponents of regionalization are concerned that the level of medical service that drew them to the area in the first place might decline.

John Stetson, who spoke at Tuesday's meeting, is one of them. He has been vacationing in Del Norte County to fish for salmon and steelhead for almost 30 years, and when he started to contemplate retirement he was drawn back to Del Norte by three factors: fishing, redwoods and access to medical care.

Stetson said he chose to live in Fort Dick over Brookings because he would rather be closer to medical care than avoid sales tax, as he could do in Oregon.

Still, Stetson pointed out that Duncan referencing the salaries of Sutter employees risked inciting class warfare.

Del Norte County District Attorney Jon Alexander, who was also at the meeting, agreed that high salaries weren't at the heart of local controversy, saying that "avarice and greed are not enumerated in the penal code" but the concept of fraud is.

Alexander said that "at Dr. Duncan's request," the DA's Office will be looking through documents referenced Tuesday for examples of fraud.

"And I can promise you that if we can find any evidence of any material misrepresentations that in any way have specifically caused specific injury to any of you or this community, you may be expecting criminal complaints or the convening of a criminal grand jury," Alexander said.

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