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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

August, 2005

 

Patient Care Advocates Receive Good News
By Carol Sterritt

Local advocates for patient care received two pieces of great good news in the last weeks of July 2005. Dr. John Severinghaus, of the Marin Health Care District Board, was prominent in both news items.
During the week of July 18th, Dr. John Severinghaus was allowed to hire Peter Szekrenyi, DPH (Doctor of Public Health) to serve as the interim District Board Executive Director.
Szekrenyi will be able to use his full professional resources and his high level knowledge of how hospitals should work to assist the Marin Health Care District as it examines the operations of Marin General Hospital. (The hospital is currently operated by Sutter Health.)
Szekrenyi is a very staunch advocate for District hospitals, a philosophy that will be put Sutter Health to the test as the Health Care District continues to fight Sutter on several fronts: patient care, accountability of revenue, earthquake retrofit obligations and other related items, such as personnel short-staffing.
And on Monday, July 25th, the Marin Health Care District announced that they would be filing a counter suit against Sutter Health. Although the contract that Sutter Health signed with the District Board way back in 1995 clearly spelled out that Sutter Health would be liable for all responsibilities in meeting federal and state building requirements, Sutter is now backing away from doing this. Instead Sutter is so appalled by the possibility of needing to spend tens of millions of dollars on earthquake retrofits that is hoping to utilize the local courts to step away from its obligations. The State of California earthquake retrofit requirements put Sutter Health between a rock and a hard place: the retrofit must take place before 2013, and Sutter's lease on the Marin General Hospital facility is set to expire sometime in 2015. Backing away from this expense is the latest tactic in a ten-year strategy to get the most in profit for the least in effort.
To see what I am saying, let's examine a typical afternoon at Marin General Hospital. Nurses and medical techs rush in and rush out. The hospital personnel smile pleasantly at patients as they follow their routines.
The many patients and their families respond to the cheerfulness of staff. It indicates that all is well on the hospital floor. But tremendous problems cloud over the bucolic facade. Over the last ten months, two dead bodies of hospital workers have been found on hospital grounds, each a victim of a drug overdose.
In late May 2005, Jane Arnold-Creighton suffered a fatal stroke hours after receiving her hospital roommate's medication by mistake. Also in recent months, two other patients died through neglect-one a cardiac patient who was not monitored correctly, and another a patient whose death was the result of the hospital failing to adequately protect her from a tendency to fall.
An interview with one of Arnold-Creighton's surviving daughters can create further cause for concern. Jean Arnold was in the room with her mother when the nurse came in and administered the medication. This was between 7:30 and 8:30 p.m. The nurse did not address the patient by name. (An important principle emphasized in nursing school is to always address a patient by name.) Nor did she look at the woman's hospital ID bracelet.
By 8 am the next morning, the hospital staff determined that Arnold-Creighton had suffered a stroke. The hospital and several hospital doctors insist that the medication, "Kayexolate" was not to blame. But Jean Arnold wonders about it. "After all, this drug is used for the purpose of draining potassium from the kidneys of patients with diabetes. And you read in the media about athletes who have pushed themselves past their limits, and in doing so, they knock potassium out of their system. Then they suffer a serious stroke."
Her mother, as a heart patient, needed all available potassium.
Arnold wonders about other things also. At the time of her stroke, Arnold-Creighton was in the middle of her third stay in the hospital. Her first admission had been for a pacemaker. Her second admission had been for a cardiac event. But on this, her third admission, there was no record of her second visit to the hospital. To her daughter, it seemed as though there was a huge and alarming delay in transmitting information from that visit into the central computerized database. And she wondered how proper care can be administered if doctors and nurses do not have access to the history of entire hospital stays when so much occurs -changes in meds, vital statistic reports, diagnosis reports, etc. Why is this computerized data reporting so inept?
Arnold is not the only one wondering about such things. Throughout 2004 and 2005, the agency in charge of MediCare reimbursements to Marin General has threatened to terminate such reimbursements, due to patient care issues. This agency, The Centers for Medicare and Medicaid Services (CMS,) had given Marin General Hospital one deadline after another to make good on serious problems with hospital operations involving patient care.
Ironically, just about the same time that Creighton-Arnold succumbed to her stroke, on June 6th, the MediCare reimbursement threat was lifted. Calls that this reporter made to CMS have not yet been returned, so it is unclear why these threats were lifted.
But patient care deficiencies are making waves on other fronts. As I write this, these deficiencies are played up in Jill Kramer's July 22nd 2005 Pacific Sun article. Local Belvedere resident Linda Remy has taken it upon herself to track the number and willingly releases her figures to those who ask. (Remy is a paid health analyst at UCSF.) As reported by the Pacific Sun, before 1995, when Sutter first acquired the hospital, Marin General's record was clean. Since that time, there have been 425 violations, complaints and deficiencies of care. "It's one of the fifteen worst high volume hospitals in the state," explains Remy.
One might ask why this is. Deficiencies in care almost always indicate a serious shortage of trained hospital personnel. Often the personnel shortage goes hand in hand with the lack of management holding to a cohesive view of how the personnel should operate moment-to-moment while working their shifts. Staffing entire floors of a hospital with visiting nurses might save Sutter Health on rising costs for health insurance, pension plans and cost-of-living wage raises. But doing so also carries a huge risk to the patients.
Now in some areas of the world, and in poorer areas of the United States, lack of money results in such trends. But in Marin County, certainly lack of money cannot be cited as a reason for the shoddy treatment. Another local hospital critic, Bill Rothman, explains, "Sutter's critics think the hospital could afford to hire better staff if it really wanted to." In fact, "the last tax return for Marin General Hospital showed that from 2002 and 2003, profits increased from $7 million to $18 million," says Rothman.
The Lewin Group, a consulting firm hired for $300,000 to examine the hospital's various problem scenarios, had a hard time determining whether there even was a shortage of hospital personnel. At their recent June 2005 Public Forum, the consultants griped that the information that Sutter furnished them on personnel was incomplete. The consultants could not, for instance, decide whether certain numbers of nurses were full time or part time, "visiting" nurses or hospital regulars. Without that information, their expensive study will contain gaping holes.
Muir Beach resident Don Cohen would probably doubt that Marin General is suffering from lack of cash. After a recent fall, he went to MGH's emergency room, where he suffered through the usual ER room treatment. You know the drill-a lonely sterile bed separated from the other ER beds by hanging curtains, the skimpy hospital gown, then a trip or two to radiology. He was there maybe 3 and a half hours. His bill for this: a whooping $23,500. He does admit that the cost of his tests ran about $1000 to $1500 at the most. But how can he account for the rest of the excessive charges? Very simply, he can't. And the hospital does not feel it needs to assuage his financial pain by explaining the bill. Apparently Sutter health feels that MGH's field is patient care, not accounting.
However the letter sent to Cohen to detail his bill mentioned only the following: due to the expenses of a future hospital earthquake retrofit, local residents must realize that they will be sharing in the financial burden.
For the state-imposed earthquake retrofits shadow Sutter Health. By mid-2004, Sutter Health was talking about being willing to undertake this burden only if its lease was extended out another thirty years. Then and only then, Sutter indicated, was it willing to meet the retrofit requirements. With the lease extended out, Sutter said that they would be willing to spend $300 million dollars and build a whole new hospital.
But who now living in the year 2005 can even pretend to know what a hospital in 2045 should look like? And certainly the Marin Hospital District board, now dominated by Sutter critics, is not happy with the idea of giving Sutter this kind of carte blanche. Indeed one of the key statements that the Lewin Group made during their June forum was that the Health Care District did not have any authority over the corporate-run hospital. Without that authority the Health Care District cannot punish Sutter for poor patient control, nor can it demand that Sutter opens up its financial records or sheds light on its business dealings.
The Health Care District certainly does not want to extend this type of situation out into the hazy infinity of a lease ending in 2045. Perhaps its best shot will be in taking its case to court, and having a judge ruling that Sutter must indeed comply with its 1995 lease provisions to follow state mandates regarding earthquake retrofits. Or else, it is to be hoped that the same judge will rule that Sutter must cancel the 1995 lease if Sutter will not comply with it.

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