Coastal Voices: A closer look at Critical Access at Sutter Coast


I write with information on Sutter Health's study of Critical Access designation for Sutter Coast Hospital. Critical Access is a federal program which pays qualifying hospitals a subsidy for Medicare patients. In order to qualify, we would need to close 50 percent of our beds. Also, Sutter Coast would no longer be required to have a physician on duty in the ER, or a general surgeon or critical care specialist available "on call," as is currently required.

Critical Access would impact our community in two ways. First, there would be an uncertain financial impact on the hospital. Second, there would be a negative impact on patient care, due to fewer beds and services being available for sick or injured patients.

When Sutter Lakeside Hospital converted to Critical Access in 2008, the bed capacity was cut from 69 to 25 in order to qualify for the program. Despite Sutter's assurances to the contrary, this was followed by reduction of the hospital workforce by 50 percent, closure of two clinics, and a large increase in patient transfers to outside hospitals. In 2012, three years after they became a Critical Access hospital, Sutter Lakeside laid off 10 percent of the workforce, due to continued financial troubles. (source: Santa Rosa Press Democrat, March 30, 2012).

Earlier this year, Sutter Health financed a study on the impact of Critical Access designation to our community. The initial study addressed only the financial impact of Critical Access on the hospital, not the negative impact on patient care. You may be curious as to the findings of Sutter's study. The answer: Sutter Health will not release the results. The study was completed last August, but Sutter executives will not release the data, stating "it is in a draft form."

Therefore, I decided to conduct my own analysis on Critical Access for the past month. Remember that the cap on patient beds under Critical Access designation is 25, but the "working cap" is 22, because three beds must be set aside for pediatric and maternity patients (in order to reduce the frequency of sick or injured children, or pregnant women, being shipped to outside facilities when the hospital is full).

Here are my results:for the month of October, there were 11 days when the Sutter Coast Hospital census exceeded 25, and 17 days when it exceeded 22.In other words, there were at least 11 days, and probably 17 days, when patients in the Emergency Room who needed a hospital bed would have been shipped to another hospital. Due to our remote location, these transfers would occur by air ambulance, at the patient's expense, without their family, and without their doctor at the receiving hospital. And this is not flu season, when the number of hospital admissions rises sharply.

My analysis assumes that the three beds currently set aside for high security inmates would no longer be reserved for prisoners. If Sutter keeps the beds set aside for prisoners, our working cap would even less (19 beds), and it would be possible that following a riot, a hospital bed would be available for an inmate but not for an injured correctional officer. If the inmate beds are closed, we would no longer have a secure location for correctional officers to guard high risk prisoners.(Sutter executives have not disclosed how they would handle prisoners under Critical Access designation).

It is clear to the physicians of Sutter Coast that Critical Access is not appropriate for our community, which is why we have passed unanimous resolutions against Critical Access designation, and against regionalization (which would transfer hospital ownership to Sutter Health). We passed a separate unanimous resolution stating our goal should be to expand, not contract, patient care services at our hospital.

In summary, financial stability comes not from downsizing and cutting services, it comes from management which includes input from employees, physicians, community representatives, and the residents of this region -- the exact opposite of our current Board, which operates a closed Board room and deliberately excludes this community from important decisions affecting our health. (A recent example:the hospital Board chairman refused my request to allow a fellow physician to attend Board meetings, in the capacity of an observer).

Greg Duncan is chief of staff at Sutter Coast Hospital.

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