Governor’s newest budget slams hospital

“It’ll hit us to the tune of $250,000 per year,” said hospital CFO Jim McSweeney, “but that’s out of $440 million. So it’s not the end of the world.” But it’s not insignificant, either. Cutbacks will be inevitable. “We’re trying to aim more heavily at overhead,” he said. “We’re going to do our best not to have it affect patient care.”
For CEO Carl Gerlach, who is currently working to carve out a viable budget for the already financially teetering hospital, the $250,000 per year cut was just one more notch “in a continuing downward cycle” brought on by the State and Federal government. Over the last 10 years, inflation has outstripped Medicare reimbursement, bringing, over 10 years, a $5 million increased loss. And the gap keeps getting bigger and bigger. “It’s pushing off to the local taxpayer the burden of the promises the state has made,” Gerlach said. The higher levels of government are requiring the local hospitals to do things a certain way, and they’re not providing the support. He mentioned that State Senator Pat Wiggins (D-Santa Rosa) has introduced legislation, SB 1699, which could make renovation or rebuilding costs more efficient.
In a recent meeting, board member Mike Smith encour
aged people to stay apprised of such possibly helpful legislation and said, “We have to get down to the basic question: what is the most vital thing to the community. I believe it’s preserving the emergency room (ER), having the ICU and the lab.” Preserving the emergency room does not mean scaling back. Robbie Cohen, Director of the emergency room and chief medical executive of the hospital, explained. “There are three types of emergency rooms: comprehensive, like Memorial, which can accept trauma; standby, like Healdsburg was, where the physician is on call but not on-site; and basic, which we have.”
A basic emergency medical unit is described in Sec. 70411 of the statute as: “The provision of emergency medical care in a specifically designated are of the hospital which is staffed and equipped at all times to provide prompt care for any patient presenting urgent medical problems.” The basic emergency room must have a full time x-ray, full time lab, intensive care unit, and general surgery–and be contained in a hospital. “If you don’t have all those things,” Cohen explained, “you can’t have the type of emergency services we have here. Scaling back would be removing services the hospital already has.”
Would a stand-alone ER be possible or practical? “I don’t think our community would tolerate coming here without having full capabilities,” he said. “I’ve been here 20 years, and I cannot tell you the number of times people have come here with cardiac arrest, or who’ve stopped breathing or something awful has happened en route, and they wouldn’t have survived being transferred to another facility or even been able to be stabilized here without having the ancillary services we have here.” He said he has heard and read letters from doctors saying the scaling back could be done, “but I’ve not seen a case where there’s been a successful stand-alone emergency room. I think it would be by statute highly unlikely, and from a standpoint of delivering medical care I think it would be not good medicine.”
The escalating budget crisis indicates a system in need of change, but must it be backward, forward, or maintaining the status quo? “There are a lot of people in this town,” said Cohen, “who remember when this was a country town with country doctors, and they go to your house and deliver babies. But it’s not the good old days. If anything, you need to upscale this hospital. We want this to be a place where people want to come, not that they have to come.”
On May 28, Carl Gerlach will present the board with his budget, and discussion of the timing and nature of the next bond measure will continue.