The long-awaited trial for the case of the Marin Healthcare District vs. Sutter/MGH is scheduled to begin September 20 in Sacramento Superior Court. The District's case has two major components. First, the District is trying to establish that the tenant Sutter/MGH has breached the woefully inadequate lease in ways that materially harm the District-financially as well as with respect to quality of care at our publicly-owned Marin General Hospital. Second, they are arguing that the lease is void because it was made in violation of California's anti-corruption laws. The District has said it will appeal the second part of the case to the Supreme Court following resolution of the lease breach issues.
The Coastal Post has covered these issues extensively ever since the lease was first proposed in 1984, and with increasing scrutiny since 1995. Unlike the coverage provided by other media outlets, Coastal Post readers have been kept well informed as to the substance of the issue. In this article, I am not going to rehash history. Instead, I am turning my attention to information recently uncovered which further documents the declines in quality care at our publicly owned hospital and which shows why the fight to restore MGH to public control has been so important. The California Department of Health Services (DHS) is responsible for licensing and certifying hospitals. When complaints are made regarding quality of care, DHS is empowered to investigate and make a determination as to their validity. The DHS Licensing and Certification division has had a significant staff shortage for many years, due to government funding cutbacks. For several years, they have been about 60 investigators short, so they have not been able to follow through on complaints as much as in the past.
The Department also conducts in-state investigations for Medicare, since Medicare pays the State to conduct those investigations. For the last few years, the Federal Government has focused on violations in long-term care facilities. Since Medicare is paying for most of the DHS investigative expenses, DHS has not been able to give much attention to complaints regarding care at acute care hospitals. Nonetheless, here is what DHS records indicate.
In 1985, the last year the District operated Marin General Hospital, two complaints were filed with the State Department of Health Services. In the 5-year period from 1986 to 1990, 25 complaints were filed, an average of 5 per year. In 1991 and 1992, no complaints were filed. Since 1993, when Sutter/MGH started its staffing redesign, euphemistically called "patient focused care," 47 complaints were filed through the end of 1998, for an average of about 8 complaints per year.
This may not seem like a big deal. Marin General Hospital treats 10,000 to 11,000 patients each year. In 1985, this would be about 2 complaints per 10,000 patients. During 1986 to 1990, this would translate into about 5 complaints per 10,000 patients. Since 1993, about 8 complaints per 10,000 patients. The rate of official complaints to DHS has increased at least four-fold since our hospital was leased.
This may not seem like a lot to you. But let me put this in perspective. In the last few years DHS has received perhaps 100 complaints a year for about 25 hospitals in our region (Marin, San Francisco, and San Mateo counties). These hospitals treat about 200,000 patients, or about 5 complaints per 10,000 patients. MGH treats about 5% of the region's patients, but generates more than 10% of the region's total complaints. Does this seem out of proportion to you? It sure does to me.
When the State follows up on a complaint, it can issue a Statement of Deficiency identifying the violations of Title 22, the law that regulates hospital care, and requiring the hospital to cure those deficiencies in order to maintain its license. Since 1985, DHS has cited Sutter/MGH for deficiencies in 125 areas of Title 22.
Recent deficiencies have included failing to staff the Newborn Nursery and instead putting well new-born infants in the Perinatal Intensive Care Unit, exposing them to extremely sick infants. Turning off oxygen for a frail elderly patient who had been oxygen-dependent for ten years. Many serious drug administration errors occurred. Cancer patients were not fully informed of treatment options or asked to sign informed consent before undergoing breast surgery. Frail patients fell out of beds when they were left unattended with bed rails in lowered positions. Patients were improperly restrained in "poseys." Medical staff were performing a neurosurgical procedure in the intensive care unit for which no procedures or policies were in place. Sutter/MGH was cited several times for failing to adequately staff the hospital.
In addition, in 1995, Sutter/MGH received the lowest initial score of any hospital accredited in the United States and hid this fact from public knowledge. In 1997, the College of American Pathologists released a 33 page deficiency summary when it came to accredit the lab at Marin General Hospital. DHS released 89-pages of deficiencies identified when it conducted its 1998 accreditation of Marin Home Care, another District asset transferred to the private corporation at the time of the lease.
Most patients at MGH experience positive outcomes from their hospital stays. However, conditions like these are outrageous. We should be thankful that our publicly elected District Board is doing everything it can to return Marin General Hospital to local control.
After the years of struggle, Marin is on the verge of one of the most important legal decisions in our county's history. On September 20, and for several weeks thereafter while the trial is in progress, wish the District-and us, its residents-Godspeed.