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MARIN COUNTY'S NEWS MONTHLY - FREE PRESS
(415)868-1600 - (415)868-0502(fax) - P.O. Box 31, Bolinas, CA, 94924

September, 2004

Marin General May Lose Medicare Coverage
By Karen Nakamura

 

   Once again Sutter Health is taking flack for sloppy operational practices. As reported in local papers, the Centers for Medicare and Medicaid Services (CMS) under the California Department of Health and Human Services, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have cited Sutter Health and Marin General Hospital with "extremely serious" violations of the Health and Safety Codes.
   The final compliance deadline of August 6th came and went and not a word has been heard. However, a battalion of lawyers was seen huddling at Marin General during late August. CMS however had already began taking steps to terminate Medicare/Medicaid participation at Marin General. Unless compliance is complete, cessation of Medicare/Medicaid coverage will become effective Oct. 16.
   The consequences are staggering for the entire county. The poor, working or not, and the elderly are especially vulnerable.
   Policy complaints are not new. Sutter has been under investigation for the past decade for a numerous irregularities, including a poor record regarding patient care quality, adequate nurse/patient ratios and charity mental health care avoidance even though it's a non-profit organization. Sutter Health has faced nurses' strikes in its hospitals across California. San Francisco has had complaints as has Yolo County, Roseville and Sacramento. Almost every complaint has centered on bottom line issues and the cutting of services. The evaluations only add fuel to the situation.
   As SF WEEKLY's Lisa Davis commented in its January 21, 1998 issue, "Sutter Health, which owns one of California's largest hospital empires is a nonprofit, tax-exempt charity, critics wonder why Sutter dispenses so little charity and vacuums so much profit from the hospitals it acquires."
   When Sutter Corp. picked up Marin General in the late '80s, the Coastal Post's reporters Joan Reutinger and Patsy Ford undertook an extensive expose of Sutter's less than professional tactics to wrestle control of Marin General from the Marin Healthcare District Board. Sutter leases the hospital from the publicly elected Board and disagreements between the two entities have flared up over the years. There were several issues that particularly irked the hospital board. One of these was the confiscation of approximately $2 million in safety-net funds that were transferred to Sutter Health's corporate coffers. The lease itself has been intensely controversial with continued efforts to retain/regain local control of the hospital an ongoing election issue.  
   The current problems at Marin General were revealed in February 2004, when CMS notified Sutter/MGH that it "was not in compliance with the requirements for participation as a Medicare provider of hospital services." This was an serious development for Marin patients due to Sutter's near monopoly in the region. Problems appeared in the areas of nursing staff, infection control, pharmaceutical services, patient rights, and medical records among others. 
  In March, CMS notified Sutter/MGH that it had removed its status as a hospital accredited by the Joint Commission on the Accreditation of Hospitals (JCAHO). In May, CMS revisited the hospital to see if MGH was compliant and instead found even more violations. CMS began steps to terminate Sutter/MGH provider agreement unless the hospital came into full compliance by August 6th. CMS notified Sutter/MGH that "mere plans of future correction or evidence of progress toward correction will not be sufficient" to stop this process. It then notified Marin of the October 16 cut off date for Medicaid/Medical coverage. 
   CMS does evaluations of about 500 hospitals in the Western region including 400 in California. It inspects about 7% (35 hospitals) annually with 7 hospitals typically failing. Thus, only about 1.5% of hospitals perform as poorly as Sutter/MGH. Since Sutter/Solano also reached this stage, quality of care in at least two Sutter hospitals are among the worst in the Western region.
   What did the Complaint Validation Surveys find? We talked to Linda Remy who works with Marin Safe Healthcare, a local organization giving voice to public concerns. She has the original reports and gave us a synopsis. First, the CMS/JCAHO evaluations were 80 and 110 pages long. The extensive non-compliance list revealed, among other concerns, antibiotic resistant staphylococcus was found in the surgery and intensive care units. The rate of staph infections went from 5% in 1997 to 55% in 2003. Anesthesiology complications in post-op were not always noted on medical records.
   There were feeding deficiencies among malnourished patients. As Linda Remy stated in our interview, "One patient was required to have 2000 calories per day but received only 840. Other patients required 6 oz. of food but received only 4 oz because the hospital didn't purchase 6 oz. containers. Cal/OSHA fire safety violations were found. Medications requiring refrigeration were left out. Even the dispensing of the wrong medicine occurred when the inspectors were present. All three organic/natural food distributors were found to be in violation and had not had health services checks. Can you imagine?"
   Marin Safe Healthcare can be reached at [email protected] A web site is in the works and the group is active in the November election of members to the Marin Healthcare District Board. Others involved include Diana Parnell, Marty Roth, Robbie Kingston and June Swan, all respected community activists. 

 

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