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May, 2007



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Marin General Hospital's Days Are In The Future
By Norman Carrigg M.D.

It took some effort in the middle of the last century for activists to pass a general obligation bond, which made construction, possible of Marin General Hospital on donated land. Managed by five elected directors, the Marin Healthcare District filled a void.
At last Marin had a full service hospital owned by the residents of the district (all of Marin except Novato).

All went quite well and with little controversy until 1985 when the five elected directors voted to privatize their hospital. It was easy. The directors signed a 30-year lease with leases that actually wrote the lease and also benefited from it. CEO Henry J. Buhrmann and hospital attorney Quentin Cook, after funding a shell corporation with millions of dollars of public assets, assumed the sam3e positions in the new MGH corporation.

Late in 1985 Marin residents awakened to the fact that they no longer controlled their community hospital. Like all public facilities MGH had operated with transparency but note so after privatization when closed-door operation began and continues to this day.

A stand-alone operation, operating profitably, now was history. MGH in 1986 "affiliated" with California Healthcare System, San Francisco. Millions of dollars of patient revenue were siphoned to San Francisco annually. Enough revenue was left behind to fund MGH adequately. In 1996 MGH and C"HS "affiliated" with Sutter Health, the hospital chain headquartered in Sacramento.

The Sutter Era
MGH CEO Buhrmann, shortly after Sutter assumed control in 1996, asked the elected board to approve MGH entry into Sutter's "obligated group." What are the obligations? MGH became a guarantor of Sutter's multi-billion dollar aggregate debt and permitted "excess cash" to be funneled to Sutter. The definition of excess cash? Any amount in excess of that needed fore fourteen days operation.

It took the votes of three directors to make this possible; Valerie Bergmann, Suzanne Cox head and Dr. Larry Bedard. Coxhead, a Sutter sycophant, retired November 2006 after twelve years of undistinguished service and Bedard was recalled November1996. In 2006 Bedard ran for the board and was elected again. Sutter clearly was in control of the elected board beginning shortly after acquisition of the lease in 1996.

The Sutter era, 1996 to the present, is one of absolutely undistinguished hospital care and what I consider hospital dismantling., MGH has been cited since 1996 hundreds of times for lapses of care by the Dept. of Health Services and once was on probation until certain deficiencies were corrected and threatened at that time with termination of Medicare reimbursement.

Lucrative (for the hospital) services have gone elsewhere. For example, in a joint venture with endoscopists a center was established in South Eliseo for endoscopy. Although Sutter eventually disconnected from this venture, the effects linger.

For example, lucrative colonoscopies are done on South Eliseo but if the patient is Medi-Cal, done at MGH.

Ambulatory surgery for various reasons often is done in surgery centers thus depriving the hospital of this revenue. Sutter competes with MGH in a Terra Linda care center in a building which once housed the Velvet Turtle. Surgeons complain that major surgery is more difficult at MGH than it should be: Lack of adequate nurse assistance and availability of what is need for the procedures. This encourages using Sutter's Novato Community Hospital where everything works.

MGH gouges Kaiser requiring full price for any service to a Kaiser patient. Kaiser once referred radiation therapy to MGH but now goes outside of Marin because of cost. Sutter has threatened to build a facility in Marin City that no matter what it is will compete with the Greenbrae hospital.

April 19, 2007
Since privatization in 1985 there has been turmoil at MGH with efforts to return the hospital to community control "this included lawsuits. An opportunity came to rid MGH of Sutter before 2015. Sutter, if it stayed to the year 2015, would have to make seismic upgrades of the older central and east wings of the hospital. So Sutter sued the Marin Healthcare District demanding the district which has virtually no money to do the upgrade.

The district countersued. The district board chairman, Dr. John Severringhaus, opted to negotiate with Sutter at this point. So he and Sharon Jackson, a director, negotiated secretly (secretly at Sutter's demand) and Sutter got exactly what Sutter wanted. Sutter will return the hospital to community control in 2009 or the first half of 2010. Sutter chooses the departure time. Sutter will not be required to do seismic upgrades.

So, sometime in 2009 or 2010 the community will get its hospital back or a shell of a hospital back. The challenge will be enormous. Paying and insured patients may be sparse. It may be appropriate instead of seismic upgrades to replace the older central and east wings with a new wing. The newer west wing has no seismic problems. The east and west wings were built with revenue bond financing. In 2009 or 2010 there probably will not be adequate revenue for construction. Voters may be asked to approve a general obligation bond. What with 40% of Marin residents Kaiser patients that would take some doing.

Dr. Severinghaus ended his service last November. Sharon Jackson is the new chairman of the board. She and dr. Archimedes Ramirez are two holdovers on the board. Dr. Ramirez is the only doctor of the three who still is in practice and thus a crucial member. The other two doctors, James Clever and Larry Bedard, as well as Jennifer Rienks were elected last November. They will be around for the transition years 2009 and 2010. Their responsibilities will be enormous. I have followed the board since 1974 and feel the most difficult time ever lies ahead for Bedard, Clever and Rienks.

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