Here are highlights from the Aug. 2 meeting of the medical staff, the local Sutter Coast Hospital Board of Directors and Mike Cohill, Sutter's president of the West Bay Region, headquartered in San Francisco.

Critical access designation: Cohill said that in Lakeport, Calif., critical access was the only option other than going broke and closing the hospital. He also said those may be the only options for Crescent City. We also learned, for the first time, that Sutter has hired an outside consultant to study the feasibility of converting to the critical access designation at Sutter Coast Hospital.

Hospital ownership: Despite prior claims by Sutter Regional Vice-President Dr. Toni Brayer and Sutter Coast CEO Eugene Suksi that Sutter Coast Hospital is owned by Sutter Health, Cohill said the opposite.

"Sutter Coast Hospital is a separate hospital," he said. Sutter Coast Hospital owns it."

Regional representation:When asked about a guarantee of local representation on the Regional Board, Mike made it clear that was not an option, but did say our county would probably get a seat on the 32 member Regional Board, filled by a Sutter appointee.

Cash transfers from Sutter Coast to Sutter Health:A very murky topic, not clarified at the meeting, was the intercompany cash transfers from Sutter Coast to Sutter Health ($5.8 million in 2010).

When Dr. Anne Marie Duncan asked Cohill if he knew about this process, he responded "yes" and turned away. Cohill said later that the money goes into the Sutter treasury and is not set aside for return to the affiliate.In other words, once the profits leave Sutter Coast, which is locally owned, they become the property of the Sutter treasury.

Hospital bylaws changes:A recently discovered issue is the sweeping hospital bylaws changes which the local Board quietly approved in February 2011.Two deletions - language requiring the local Board to have a majority of Del Norte County residents, and the community mission statement - had been in place since signature of the 1986 Health Care District lease agreement with Sutter.

Our hospital mission statement, which states we are to "care for the sick, injured, and disabled ..." is now gone.Instead, the new bylaws direct the local Board to be loyal to the corporation and Sutter Health, "always furthering the interests of the Corporation..."

Other bylaws changes infringe on the medical staff's self-governance, and state that in the event of a dispute, Sutter Health bylaws prevail over our hospital bylaws.None of these bylaws changes were ever announced to the medical staff, and I suspect were never divulged to the Health Care District, either. Cohill told us he knew the medical staff was unaware of these bylaws changes when they were enacted.

Future steps:Local Board Chairman Andy Ringgold made the following verbal commitment to the medical staff: Because our concerns were not resolved at thismeeting, the Board of Directors would take no further action on critical access or regionalization, even if the court restraining order is not extended, until at least one additional meeting between the medical staff and the Board of Directors takes place.

Medical staff news:I notified the Board of Directors that the medical staff has formed a committee to seek resolution of our grievances with the Board of Directors.In the event the dispute cannot be resolved, the medical staff has the right to seek relief in Superior Court.At our last medical staff meeting, the physicians passed the following two unanimous resolutions:

First, the hospital should be seeking to expand our scope of services, such as chemotherapy and possibly renal dialysis, not reduce our scope of services offered to the community.

Second, we passed a "no confidence" vote on implementation of critical access designation at Sutter Coast.

I would not be surprised, based on the considerable community opposition to critical access, if the Board issues a statement that it has decided against critical access implementation at Sutter Coast Hospital. If such a statement is released, remember that prior to our town hall, when many of you expressed grave concerns about critical access, our CEO had been telling employees it was a 50 percent likelihood.

As you review this letter, recall that Sutter Health and our local Board deliberately excluded you from the regionalization (loss of ownership) process, and continues to operate in a veil of secrecy.

Finally, please remember this: if regionalization takes place, we no longer own Sutter Coast Hospital.Then, the decision to implement critical access, and every other decision regarding our hospital, will no longer be ours to make.

Greg Duncan is a Crescent City physician and chief of staff at Sutter Coast Hospital.