Fixing Cal's Collapsing Hospital Corridor
Ventura County Local News - December 23, 2010
Bracing for a Seismic Shift in Health Care
Anyone who has asked the question recently, “What’s the state of health care in America?” is almost sure to have been fed the answer, “You know, you just raised a very complex issue.” [Translation, “Sorry son, but you’re about to be hogwashed.”]
To go along with this, a “friend” once told the following story:
“It’ll probably start one fine morning as you prepare for your first in-patient hospital visit … the trepidation, of course, when all you’ll think about are the bad jokes – hospital gowns and what-have-you. But the worst will come when you’re told you’ll be sharing your misery with a complete stranger. As they wheel you into the elevator, you’ll think, “Oh my God, if they have to bring the paddles in I hope they slap them on the right patient.” And yet it will only be after they’ve begun your treatment that you’ll realize how sick you are … that you’re actually in the hospital and you really are too miserable to care anyway.”
Well that must have been his experience. The kicker, though, is that this young man had great insurance, or so he thought – Blue Cross/Blue Shield from his workplace. Apparently he’d told the intake nurse that there could be no equivocation – he must have a private room. “Oh, no,” he was told. “Your insurance won’t pay. You’ll be in a semi-private.”
What he needed was a “Cadillac” insurance plan, and of course he didn’t have it. Lesson learned. Today he has one.
That was in the go-go‘80s, and yet today the trend is away from these ultra-premium plans which have contributed so significantly to the skyrocketing cost of health care in America. Even in 1993 it was recognized that our precious market-driven health care system would one day collapse under the crushing weight of runaway costs.
Now fast forward to the final quarter of the slow-go ‘00s, when it became clear “the day” was just around the corner, and while we stalled over the debate, the number of Americans without healthcare coverage doubled – going from 15 million to 30 million, and with most of them being children.
So as we enter the second year of the second decade of the 21st century, are we all up to speed? Maybe, and maybe not. Delivery systems march forward … improving as they must, with new hospitals, better-educated research professionals, advanced equipment and compassionate caregivers working together to provide what is often called the “Finest health care system in the world.” Most people know the standard comeback … “If true, why is our infant mortality rate the highest of any industrialized nation?”
Maybe it has something to do the way we provide health care in this country. Actually, a short primer on the subject was given by Gary Wilde, CEO of Community Memorial Hospital in his yearly Stakeholders Address delivered back in May, 2010.
He began by reminding us all that CMH is a not-for-profit corporation … that it doesn’t have shareholders but it does have stakeholders. You can see them here, not quite filling a very small auditorium. Who are these people? Well, they’re the people with “skin in the game,” of course.
Mr. Wilde also emphasizes the point that being a not-for-profit corporation, CMH is owned by the community itself, so if you’ve ever wondered what your community looks like, here it is sitting right here in this room … without an inch of black or brown “skin” to be seen, by the way.
The address then moves on through some obligatory PR material before arriving at the real meat … the financial condition of the corporation. Particularly telling are two slides showing the hospital’s revenue sources and total income from all sources, which lists those sources which Mr. Wilde describes as indispensable to the operation of this hospital and any hospital, saying explicitly, “We simply couldn’t exist without these grants – no hospital could.”
This is, Mr. & Mrs. John Q. Public, where the government – assuming you don’t mind the grittiness of the expression – “takes over” your health care system, meaning that as long as the poor lonely taxpayer keeps pony-ing up for the bills, your health care plan is safe – or so you might think. Why, did you know that the minute the anesthetist “puts you under” in this little-known world of government-run health care (the one that pays the bills), government surgeons, who they pay in Rubles, rush in, immediately overthrowing your choice in doctors, not even being aware of whether it’s your gallbladder or your appendix that you wanted removed? 
The Unfunded Mandate.As we all know by now, Community Memorial is rebuilding itself into a new, ultramodern medical arts complex. It’s nice, it’s new … but the real question is, is our health care system as vulnerable to collapse as are 417 hospital structures along a north-south corridor of California real estate that stretches from the San Diego/San Francisco coastline up to and through parts of the great Central Valley? We hate to deal with predictions (especially where the future is concerned)  but we see the potential for real problems ahead.
Let’s not be misunderstood. The new CMH will be a grand addition to this community and beyond … a chance to lead and save lives. But this is its job – its function – after all. Will it create good jobs, expand the tax base, infuse capital into the local economy? … it may, but these are ancillary issues. The questions are, really, whom is it serving, how, and how well?
The answer … “it’s complicated,” as you might expect. All one has to do is mention the date January 17, 1994 (if you live in the L.A. area) and it’s usually one of those “where were you when …” moments, like, “Where were you when JFK was shot?” … only this one goes, “Where were you when the Northridge earthquake hit?” Hopefully, you weren’t in a hospital.
Not to put too fine a point on it, but could January 17, 1994 – all these 16 years later – be a “date that will live in infamy?” The partial collapse of the Veterans Hospital near the Golden State Freeway causing the death of 47 residents in the Sylmar earthquake of ’71 (photo at left), then damaged again in ’94, helped raise a furor over the earthquake hardiness of structures associated with our first response system, primarily hospitals. (If some of this seems like old news and you’re ready to move on, feel free – but we wouldn’t recommend it.)
The California Legislature got involved and passed Senate Bill 1953, which most people (and especially hospital administrators) call an “unfunded mandate.” And as though calling something an unfunded mandate would be the equivalent of making the problem of hardening hospitals against similar occurrences in the future simply go away, someone (lobbyists probably) convinced the legislature to pass an extension bill – SB1801.
SB1801 did several things. It took the first target date of 2008 set by the original bill SB1953 (we’re back in 1994, don’t forget) and moved it out to 2013, giving hospitals 5 more years to comply with only the most urgent structural changes necessary to meet the new requirements – part of this “unfunded mandate” once again. But of course “part of” is the key. The original bill requires full compliance by the year 2030. So hospitals will have had 36 years to comply fully.
Ah, but wait a minute – not so fast. There’s a catch … the legislature said, okay, in order to get the extension (to 2013) approved, you (hospital administrators) must show us that you will be forced into such financial hardship in meeting the first deadline, that it will cause you to cut your number of hospital beds by 50%. Well we don’t want you to try and guess what happened next, so we’re going to show you.
Take a look at page 3 of an official government document, 17 pages long in fine print, older, but it’s just one of those things you have to ferret out. The answer lies in the right-hand column where it says, "Diminished Capacity." You can also link to the full document right here. It contains a list of 417 (it seems like more) California hospitals who immediately raised their hand and said, “That’s us! We can’t do what you’re mandating in only 14 years! And of course our 2 Ventura hospitals, CMH and VCMC, are not only both among them, both were approved along with the other 415 that appear.
So what does all this mean? It means that in as few as 2 years and as many as 4 – half of our hospital beds here in Ventura will disappear. So just because we’re able to stop the hospitals from collapsing, this doesn’t necessarily mean that the health care system will remain standing. It may be worth remembering also that hospital administrators made this deal only to become eligible for the 5-year extension, giving them a total of 19 years to comply with the first phase involving only the most urgent need. It was a 5-year bargaining chip in which they agreed to cut beds, patient care and (assumedly) staff also by 50% -- all because over the same 14 years where the NYSE stood at 14,000, its record high – well, apparently the time just didn't seem right.
And so after having gone through the greatest boom times in our history during the past 16 years, and now with a fiscal performance deadline only 2 (maybe 4) years away, we’re in recessionary times that according to some economists may become “the new normal.” If business executives can’t meet an obligation like this in boom times, how well will they do now that the banks have just had the fear of God thrown at them? Nero fiddled and look what happened. This would be a scandal only if it weren’t such a disaster. Who among these administrators went to business school, if they don't mind our asking?
Inquiring Minds Want to KnowWe want very much to ask the city manager how the city is planning for the expense of civic construction involved at a time when employee pay and pensions have been cut just to maintain day-to-day operations. How long, we would ask, after the new hospital opens will roads be torn up with traffic being detoured through our residential neighborhoods? And if the hospitals make their deadline, we will still, as a community, be the beneficiary of just one complete hospital because both will have cut capacity by half.
Ask yourself, as we shall of the city manager, if we’d be ready for the next disaster – earthquake, tsunami, or fire – without even thinking about the flu pandemic scare we endure almost yearly. One of these days a pandemic won’t be a scare, and who will we hold accountable when the finger pointing starts following the realization that there are only 250 hospital beds available in a city of 106,000 people?
What we want to know is, “What are the contingency plans,” if any, surrounding the impactful nature of a sea change such as this? We also want to know if collusion was involved in creating the problem. We’re only asking the question, you understand, but how could 417 or more hospitals jump on the same bandwagon, claiming the same deficiencies (and hardship) as well – all being fed the same “suggested course of action,” if you will, by lobbyists and lawmakers who have certainly never before been caught in bed together?
Bucking the Trend in Health CareNow there is just one more facet to this jewel that has been nonchalantly tossed out – probably in the hope that it won’t get connected to the main issue – which again involves the methodology that most, if not all, of the 417 used to “cut” their capacity. We can tell you with certainty how Community Memorial did it – they decided to do away with semi-private rooms and make every room private. Now … wanna see the same plan in action elsewhere? We’re providing a link for you that is worth checking out. Buckle up and click “play” on the first video.
The Sutter Group has hospitals all through the northern part of the state, and miraculously, the Sutter Medical Center, Castro Valley is just slightly ahead of our own CMH in its construction of a plan that is similar in size, scope and price, believe it or not -- $320 million. CMH has a “fly around” on its website, but the one you’ll see from up North will knock your eyes out. This isn't our eternal competitor, Santa Barbara. This is World Class of World Class – the Bay Area, and while they probably spend like this before lunch on any given day, we Venurans continue to whisper to ourselves in darkened rooms, dreaming over the prospect of one day becoming home to five-star hotels and world-class gardens. The difference is that others are not bucking the uncertain economic trends of the future. They secured their future while it was still possible to do so.
If you’ve already watched the video, hopefully you paid close attention to the interior fly-through. If you paused the action as the camera swept through a private room, then you really “get it” relative to what this discussion is all about. If not, run through it again while trying to picture yourself in this setting. and hopefully you managed to trade your “Cadillac” in for a “Rollsie”.
So are we “flying” to conclusions? Maybe. But there’s no conjecture about 100% private room construction going on here in our neighborhood. Sorry to keep piling on with the bad news, but we checked with Medicare. Cadillac plan? Uh-uh. Medicare can barely spell the words “private room.”  We spoke briefly by phone with a hospital spokesperson to try to clarify the issue and were told that Medicare “has no problem” paying for private rooms.
The truth obviously lies somewhere between the goal posts, but CMH officials couldn't meet directly with us in time to meet the deadline for this article. Any errors or omissions that have either crept into or have been left out, however, will either be retracted or corrected as soon as we receive the updated information.
There’s a real story here. We’re working on it and we’ll keep you posted.
 Really? Did you have to come here to see if this is true?
 Quote attributed to Yogi Berra.