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Public vs. Corporate Health Care Debated

Many denounce lease plans for Community Hospital

By Bruce Robinson

It may be clearer now, but it isn't any more popular. In almost three hours of testimony on Friday afternoon, only two local speakers endorsed the concept of leasing Community Hospital. Instead, most of the participants at the first of two public hearings before the Board of Supervisors--who overwhelmingly support the transfer--denounced the county's decision to seek a lease agreement with a large health-care corporation, and pleaded with the board members to resume the search for other ways to sustain the venerable hospital.

"You are eliminating competition in health care," warned Debbie Bautista, who urged the supervisors to "be sure you have really and truly exhausted all other efforts" before moving ahead with their plans to "dump this hospital." Two other speakers, including 5th District supervisorial candidate Mike Reilly, suggested creating "a public hospital district, with taxing and bargaining authority" as a possible alternative.

Several references were made to Community Hospital trustee Nancy Dobbs' recently published call for the creation of a public partnership with Community, Sonoma Valley, and Petaluma Valley hospitals, plus a network of local physicians. But Supervisor Mike Cale said that approach had been tried earlier, and fell flat. "We had meetings with both [other] hospitals two years ago, and I thought we had a chance to make something positive happen," Cale said, "but eventually both withdrew."

That was then, this is now, countered nurse Patricia Hobson. "Maybe once you failed, but try and try again." Pointing to the initiative effort that has been started to force the question of a transfer of hospital ownership to a public referendum, supervisorial candidate and public health educator Maddy Hirschfield added that "a lack of creative solutions was the reason this petition drive was started."

Her comments came shortly after Sonoma County Superior Court Judge Lloyd von der Mehden ruled Thursday against the county's motion to quash the petition drive. Von der Mehden noted the county must wait until the petitions are submitted to the elections office to challenge their validity. The county maintains the decision to lease the hospital is an administrative action that should not be subject to review by the voters.

Many speakers also expressed strong reservations about a possible takeover of the county-run facility by Columbia/HCA, the largest health-care conglomerate in the country. Columbia and Sutter Health Systems of Sacramento--a smaller, non-profit corporation--are the two suitors the county is considering. An analysis of their bids by an outside consultant hired by the county concluded the two bids are neck and neck, but there are concerns that neither company is ready to shoulder the full cost of providing "charity care" for the poor and uninsured in Sonoma County. Last year, that cost reached $3 million.

This is not fair to local taxpayers, argued John Turngren. "Community Hospital subsidizes local hospitals by caring for the uninsured. It's picking up the tab. It's helping them make a profit," he said. Turngren also predicted that it may make little difference which corporation the supervisors choose, because "within five years, Columbia will own Sutter."

That concern was shared by Sherry Smith, who reported on her research on Columbia, which also owns Healdsburg General and Palm Drive hospitals. "If Columbia/HCA leases Community Hospital, I fear that they will shut down either one or both of the hospitals they own in Sonoma County," she said. "This could adversely affect the medical care of residents in west and north Sonoma County. I am concerned that they could monopolize health care in our county."

Smith also warned that under a Columbia takeover "they will not be required to hold open meetings or fully disclose their activities to the public as is currently required," so that fiscal accountability will be much more difficult to track.

Paul Kaplan, another union officer, summarized the distrust of the massive Columbia corporation. "Instead of running big ads telling how great they are, why not print the whole text of their proposal?" he suggested.

"With the specter of Columbia, I suppose Sutter looks palatable," sighed Stu Buman of Friends House.

Sutter Health Systems was defended by several speakers from other counties who reported positively on their experiences with the regional corporation. Steve Martin, a former supervisor from Amador County, said both his board and that county's citizenry have been pleased with the results of their merger with Sutter in 1990. "It will work," he suggested. "Give it a shot."

But Ester Blau, a nurse from Marin General, said the takeover of that facility by California Healthcare Systems, which is about to merge with Sutter, has "typified the impersonal face of the corporate hospital." Since the change from public ownership, she said, Marin General has suffered "high turnover, frequent complaints about inexperienced personnel, and many postoperative complications."

The two voices in support of the supervisors' chosen course came from a pair of respected members of the Community Hospital's administration: Dr. Louis Menachof, former chief of staff, and Dr. Marshall Kuboda, head of the residency program. Community as it stands is " a model of care that is in decay," Kuboda said, while the move toward affiliation is "full of potential for our program."

But the fiscal details are still murky in some important areas. "You have nowhere a list of what these proposals are going to cost the county," protested Greg Wonderwheel, vice president of the union and a leader of the petition drive, who called the bidding process "financial voodoo."

Supervisors agreed that there are several areas where the bids are unclear, and have directed their consultant to provide further analysis and explanation before the second scheduled hearing Nov. 17.

Meanwhile, the plan to complete a lease agreement by next February remains in place. "I wouldn't anticipate a lot of changes based on the current set of what is being proposed," said Supervisor Cale.

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