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HomeMy WebLinkAboutMINUTES - 10191993 - 1.74 1.74 THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on October 19, 1993 by the following vote: AYES: Supervisors Powers, Smith, Bishop, McPeak and Torlakson NOES: None ABSENT: None ABSTAIN: None SUBJECT: Hospital Replacement Memo by REVOLT IT IS BY THE BOARD ORDERED that the receipt of the attached report dated October 12, 1993 presented by Mark Finucane, Health Services Director, regarding replacement of Merrithew Memorial Hospital is ACKNOWLEDGED. I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: October 19 , 1993 Phil Batchelor, Clerk of the Board of Supervisors and County Administrator By Deputy cc: Health Services Director County Administrator ire CONTRA COSTA COUNTY Y HEALTH SERVICES DEPARTMENT DATE: October 12, 1993 TO: Board of Supervisors -�F'-4— FROM: Mark FinucanA-"-,- Health Services Director SUBJECT: REVOLT Memo of September 23, 1993, to the Board Regarding Replacement of Merrithew Memorial Hospital This is a preliminary response to the issues raised by REVOLT (a Committee of the Republican Party of Contra Costa County) in the September 23, 1993, memo to the Board of Supervisors. A more thorough analysis of the group's comments and recommendations is currently underway by the Health Services Department. However, because a cursory review of REVOLT's report revealed a number of inaccuracies, the HSD would first like to take this early opportunity to clarify a number of errors and misrepresentations. A discussion of some of the key issues raised in the report will follow later. ♦ REVOLT inaccurately reports that the "NAACP" is among those organizations in the county which are opposed to the new hospital. While it is true that the administrative complaint regarding the Merrithew Memorial Hospital replacement project was filed by the NAACP Legal Defense Fund (which is not affiliated with the NAACP), the local chapters of the NAACP have come out neither in support of the LDF complaint nor in opposition to the hospital replacement project. ♦ REVOLT states that the Board "ignored the principal findings and recommendations of the Grand Jury" (in 1989) regarding the hospital replacement project. However, REVOLT neglects to mention that the recommendation of the Grand Jury "to have BOTH a new [but smaller] County hospital AND contractual arrangements with district hospitals", was precise]X the foundation of the "blended solution" which was adopted by the Board in 1992. REVOLT also fails to acknowledge the findings of the more recent Grand Jury report in 1992, which commended the Board of Supervisors and HSD for "a job well done", .noting that the HSD has worked diligently to increase the use of contracting with other hospitals and adding clinics in other areas of the county. ♦ REVOLT confuses the County's local Medi-Cal managed care initiative, called Health First, with the County's 20-year-old Health Maintenance Organization 2 ' (HMO), the Contra Costa Health Plan (CCHP). Health First is one of thirteen counties'programs targeted for implementation under the state's Medi-Cal Managed Care Plan. The Contra Costa Health Plan, however, has been operating since 1973 and currently manages health care for more than 22,000 county residents, which already includes Medi-Cal recipients, indigent patients, homeless persons, senior citizens, county employees, employees of small businesses, and private individuals. Although CCHP does have a large number of Central County residents and County employees among its membership, they do not constitute the majority of CCHP members, as REVOLT suggests. In fact, as of June 1993, 44% of CCHP members were Medi-Cal recipients (41% AFDC, 3% other Medi-Cal eligible); 22% were welfare recipients; 28%were County employees or other commercial members; and 6% were Medicare recipients. Moreover, the majority of CCHP enrollees (56%) were from East and West Counties. ♦ Contrary to statements in the report, the Contra Costa Health Plan maintains contracts with every District and community hospital in Contra Costa County authorizing CCHP enrollees to receive care (such as in emergencies as well as for certain specialties) at those facilities. Similarly, REVOLT's suggestion that Contra Costa's managed care proposal (Health First) would compel the entire Medicaid population to receive hospital care exclusively at Merrithew is ludicrous. There are no written or oral comments to support that contention. On the contrary, the record is replete with evidence that the managed care proposal will be relying on cooperation and contracts with community physicians and hospitals. The replacement hospital simply will not have the capacity to provide care to all Medi-Cal and indigent patients under our current system. ♦ REVOLT presents the percentages of indigent and Medi-Cal eligible patients residing in the three regions of the county as follows: 50% in West County; 35% in East County; and 15% in Central County. In fact, the percentages of medically indigent patients and Medi-Cal eligibles are between 40% and 45% in West County; 26% and 31% in East County; and 23% and 34% in Central County. More importantly, data show that from 1985 to 1993, the percentage of BACs (medically indigent) from Central County has increased 5 percentage points, while the percentage from West County has decreased 3 percentage points and from East County has decreased 2 percentage points. Similarly, with respect to Medi-Cal eligibles, from 1985 to 1992 the percentage from Central County has increased 3 percentage points,while the percentage from East County has increased only 1%and from West County has decreased 5 percentage points. ♦ REVOLT's overall position regarding the hospital replacement project is unclear and self-contradictory. At the opening of its report the group states that its "objective is to block construction of the new hospital, close the old inpatient facility in Martinez and have the county contract with the three district hospitals in the county for all inpatient services now provided at the county hospital in Martinez." On the final 3 page of the report, however, the group suggests that it would be effective "to have both a County Hospital AND contractual arrangements with District Hospitals" (which is what the Board's current plan calls for) and claims that "REVOLT's position is to maintain the County facilities as outpatient facilities." ♦ Contrary to REVOLT's statement that"the movement of patients into managed care health plans [has replaced] hospitalization in favor of less costly methods of care", managed care does not replace the need for hospitalization. While it is true that with the focus of managed care plans on more cost-efficient prevention-oriented primary care services the need for hospital care will likely be reduced, hospitalization will still be a factor in the delivery of care. ♦ Contrary to statements in the report, the total estimated cost of the hospital project is $85 million (although the County did issue $125.6 million of Certificates of Participation, which includes the cost of issuance) and the annual debt service is estimated at $10.4 million (not $11 million). Furthermore, the 1993-1994 budget approved by the Board of Supervisors included a General Fund subsidy of $14 million for the hospital (not $96 million). ♦ A decision to replace Merrithew Memorial Hospital culminated 6 years of planning plus an additional 8 years of debate and discussion (dating back to 1978). The approved plan was also based on extensive analysis by major accounting and health- policy consulting firms. ♦ Ground breaking for the new hospital is scheduled for the fall of 1994, not 1993. 13013 Although it is difficult to respond even preliminarily to a report so fraught with errors of fact and illustrative of a limited understanding of the many complex issues involved, the HSD would like to address generally a few of the specific issues raised by REVOLT. NATIONAL HEALTH CARE REFORM REVOLT implies that under the Clinton Administration's recently introduced health care reform proposal, patients will no longer seek care at Merrithew and opt instead to go to hospitals in their own community, thereby obviating the need for the replacement hospital. While it is true that universal coverage will allow greater numbers of individuals a broader choice in selecting inpatient facilities, it does not necessarily follow that the need for a County hospital will be obviated. Indeed, on Monday, September 27, 1993, Vice President Gore came to Contra Costa County in one of his first stops following the President's speech to Congress to discuss health care reform. During the forum, the Vice President was asked whether he believed that public hospitals had a future role under health care reform. The ti 4 Vice President was unequivocal in recognizing that public hospitals were essential community providers whose roles would be undiminished under health care reform. In addition, leading national health policy experts have told the HSD that, although they believe universal coverage will significantly improve health care for the poor, it is not a guarantee of universal access. Non-economic factors, including age, race, education level, language and diagnosis also contribute significantly to whether an individual can gain access to health care. These are generally and most appropriately addressed by the public health and hospital system. CONTRACTUAL AGREEMENTS REVOLT recommends that the County consider several options regarding the use of hospital beds at the district hospitals to care for the County's patient population. The Board intentionally decided to underbuild the replacement hospital and rely instead on community contracts -- including contracts with district hospitals -- to meet the needs of Contra Costa County residents through a "blended solution". The replacement hospital will be essentially the same size as the current Merrithew facility, even though the population of Contra Costa has more than doubled since this facility was built in the 1940s and 1950s. REVOLT specifically recommends consideration of the following. 1) Long Term Purchased Services Contract The County has recognized the need to rely on the private medical community in working to meet the health care needs of the County. Indeed, to ensure the potential for funding such cooperative efforts in the future, the Board, at the same time it approved the Merrithew replacement project, authorized the borrowing of an additional "Series B" bond issue of up to $20 million. This financing is available for the Health Services Department to use in conjunction with district hospitals or other private sector medical providers for capital-related projects needed to implement future joint ventures in support of the "blended solution". While Merrithew has successfully negotiated contracts with area and district hospitals for the provision of particular services (such as the OB Joint Venture with Brookside Hospital), those negotiated arrangements are insufficient to meet the total needs of the County's patient population. Differing economic goals between the County and the district hospitals render those hospitals unable --or unwilling--to provide certain services, such as non-emergency indigent care, care for jail inmates, and inpatient psychiatric care. Nonetheless, no reasonable offer from a local district hospital has ever been refused by the County. 2) Purchase of Beds in the District Hospitals As REVOLT points out in its memo, the Board of Supervisors recently ordered the 5 Health Services Department to investigate purchasing beds from district hospitals as a means of ensuring County patients access to inpatient facilities. HSD believes that this may be a workable option, and the viability of such an undertaking, as well as the willingness of district hospitals to participate in the sale of beds, is currently being explored. 3) Establishment of a Joint Powers Authority In 1988, Supervisor Powers proposed consolidating Merrithew, Brookside and Los Medanos hospitals under one regional hospital authority, but the proposal was not well-received by the district hospitals and the plan never matured. NAACP LEGAL DEFENSE FUND COMPLAINT The Health Service Department's official response to the complaint filed by the NAACP Legal Defense Fund (not affiliated with the NAACP) is currently being reviewed by the Department of Health and Human Services, Office for Civil Rights (OCR). We provided OCR with an abundance of data and an in-depth review and analysis of the County's health care system. The Department addressed the major points of concern regarding access to health care services for residents in East and West County. We are confident that the facts will speak for themselves and there will be no finding of discrimination in this matter. .. /, 3466 7880, ELI 1A This report has been prepared by REVOLT, a Committee Contra Costa County Tazpayers concerned about the high cost of D ding a new public Hospital in Contra Costa County. Questions and should be directed to R. Neal Gilbert (510) 736-1910 or Coleman (41S) •94-0128. TO: CONTRA COSTA COUNTY BOARD OF SUPERVISORS FROM: CONTRA COSTA REVOLT - A TAXPAYER GROUP CONCERNED ABOU`* HIGH TAXES AND WASTEFUL GOVERNMENTAL SPENDING RE: STOP PLANS TO BUILD NEW CONTRA COUNTY HOSPITAL - SAVE TAXPAYERS TENS OF MILLIONS OF DOLLARS EACH YEAR DATE: SEPTEMBER 23, 1993 WHAT 18 THE REVOLT COMMITTEE AND WHAT I8 THEIR OBJECTIVE? The REVOLT Committee is comprised of citizens concerned about the increasing amounts of already high taxes at the Federal, State and local levels of Government. The Committee is focusing its resources on identifying areas of governmental spending where private enterprise can provide a higher quality of service at a lower cost to the taxpayer. In this. regard the Committee has evaluated various spending programs at the local level in Contra Costa County and identified several governmental programs which the Committee feels can be better provided by private enterprise ("the Privatization Program") . Of Contra Costa County's $650 million budget approximately $129 is spent on health care programs in the County. This is above and beyond Federal and State monies paid to County providers through the Medicare and Medicaid programs. Of the $129 million of County taxpayer money spent on health services approximately $100 million is spent to subsidize the County Hospital in Martinez. On top of this already outrageously high number the County is proposing to build a new 144 bed hospital in Martinez at a cost of $125 million. The debt service on the bond issue for the new Hospital is approximately $11 million per year for the 30 year term of the bonds. REVOLT'S OBJECTIVE IS TO BLOCK CONSTRUCTION OF THE NEW HOSPITAL, CLOSE THE OLD INPATIENT FACILITY IN MARTINEZ AND HAVE THE COUNTY CONTRACT WITH THE THREE DISTRICT HOSPITALS IN THE COUNTY FOR ALL INPATIENT SERVICES NOW PROVIDED AT THE COUNTY HOSPITAL IN MARTINEZ. This paper describes how taxpayers will be saved the $125 million cost of the new hospital, $200 million of interest over the $30 year term of the bonds, and enable the County to reduce the $100 million hospital subsidy now in the County budget. A 104 savings would yield $10 million per year. . .an amount equal to the money which would be raised by extending the half cent sales tax. Likewise, saving the debt service alone on the new bonds ($10.7 million per year) would also serve to mitigate the need for the half cent sales tax extension. ■HAT IB TSE SISTORY. AND CURRENT STATUS OF THE PROJECT? . On March 2nd, 1992 the County Board of Supervisors approved the replacement of Merrithew Memorial Hospital (the County Hospital) . The new hospital will have 144 beds and will be located in the City of Martinez. The Project to replace the hospital began in 1987 when the County formed a Committee to study the need for a new County Hospital. .In 1989 they recommended building a 175 bed replacement facility at a cost of $124 million, but this plan was rejected as being to costly. By the time a scaled-down project was prepared, the cost of the scaled-down, 144 bed hospital had increased to $125 million. $125 million of Bonds (Certificates of Participation) were issued on May 1, 1992 by Contra Costa County without voter approval. Ground breaking is scheduled for the Fall. WHAT EAS CHANGED SINCE THE PROJECT WAS CONCEIVED? Clinton Health Plan The County is relying on Federal and State funding to supplement the cost of building and operating the new County Hospital. The County's plan was developed long before the Clinton health plan was unveiled. The cornerstone of the Clinton health plan is to cut $238 billion from the Medicare and Medicaid programs in order to finance extension of health benefits to the nation's uninsured. These cuts, if approved by Congress will jeopardize the ability of the County to operate the Hospital and pay off the bonds. As discussed further below, if the Hospital cannot pay off the bonds from the monies it receives from the Federal and State governments then the County taxpayers must make up the difference. Clinton's health program will also require uninsured patients to participate in managed care collectives which are already forming in the County. Once enrolled they would be required to get their care at the Hospitals which contracted with the "Collective". This means that instead of going to the County Hospital for their care they would most likely go to a Hospital in their community. Good for them. .bad for the County. If the patients don't go to the County Hospital the County gets no money for their care, thus diminishing the County's ability to pay off the bonds. Change in Financial situation and Occupanay at County District Hospitals Over the past three years the three District Hospitals in Contra Costa County have suffered large drops in occupancy due to lower lengths of stay for inpatients, a switch from inpatient care to outpatient care and the movement of patients into managed care health plans (i.e. , HMO's and .PPO's) which replace hospitalization in favor of less costly methods of care. As a result of lower utilization the financial strength of these hospitals has suffered and they have had to reduce staff and incurred millions of dollars of losses annually. If they were able 2 to receive even a small portion of the $128 million County Health Budget these hospitals could be restored to strong, financially viable full service institutions capable of providing high quality, efficient care to both County and private. patients alike. WEAT 18 THE COST AND SOURCE OF FUNDING FOR THE PROJECT? On May 1, 1992 the County issued $125,584,000 of Certificates of Participation ("COPs") to finance the construction of the new hospital. COP's are similar to bonds and for the purpose of this report will hereinafter be referred to as "the bonds". The County has created a non-profit public benefit corporation which will own the Hospital and lease it to the County. The County's lease payments for the Hospital will be paid to the public benefit corporation as rent which will, in turn, be paid to the bondholders as debt service (principal and interest) on the loan. The County has agreed to make the principal and interest payments regardless of whether or not the County Hospital has the funds to make the debt service payments from the proceeds from operations. That is, the taxpayers of the County are responsible for paying off the bonds, even though there was no vote on the ballot asking for taxpayers approval (see page 11 of bond Prospectus) . The Clinton health plan, which was unveiled on September 21st, proposes $238 billion of cuts to the Medicare and Medicaid (Medi-Cal in California) programs. Such cuts will imperil the ability of the County Hospital to make its debt service payments and thus it is likely the taxpayers will be stuck with a bill they did not approve. $300 Million of Bond Costs! The principal and interest (the "debt . service") equals approximately $11 million per year! Over the 30 year life of the bonds taxpayers will pay over $300 million just for the bonds on a hospital that is not needed! $100 Million of County Rospital Costs to Taxpapers . Eacb Year! The total proposed health care budget for Contra Costa County was $262 million in budget year 1993-1994. In a County of approximately 850, 000 residents this amounts to $308 for every man, woman and child. If one assumes that only 10t of the County's population utilizes the County health system this amounts to a staggering $3,000 for each person who uses the health system each year! Of the $262 million proposed budget, $126 million was proposed for the hospital and clinics, $43 million for the County HMO ("the Contra Costa Health Plan) and $41 million for mental health services. In the approved 1993-1994 budget for the County the Board of Supervisors approved spending for Hospital care of $96,6420000. This is after spending $100,043,009 in 1992. While health care expenditures nationwide are increasing 74 annually the County has budgeted a 48 decrease in the already outrageously high $100 3 million subsidy. ' Most of the $100 million of operating costs comes from taxpayer supported programs (i.e. Medicare and Medi-Cal) including approximately $38 million directly from the County's taxpayers. The cost to operate the County Hospital will increase by at least $10.7 million as a result of the principal and interest on the bonds. Additional costs will be incurred for depreciation of the new facility which is estimated at between $2 million and $3 million annually. With massive cuts coming for the Medicare and Medicaid programs the County cannot rely on federal and state funding to pick up these costs. WHAT. IS THE DISTRICT HOSPITAL ALTERNATIVE? There are three District Hospitals in Contra Costa County. These are public hospitals, owned and operated by hospital districts which have an elected Board of Trustees representing the communities they serve. The District Hospitals are Brookside Hospital (246 beds) which is located in San Pablo and serves both indigent and insured patients residing in western Contra Costa County. Los Medanos Hospital (227 beds, includes 121 skilled nursing beds) is located in Pittsburgh which serves the eastern part of Contra Costa County. Mt Diablo Hospital (257 beds) is located in Concord and serves the central County. Each Hospital is operating at occupancy levels well under 50%. These are significantly lower then when the County Hospital was planned. As a result of the dramatic declines in occupancy at the District Hospitals their financial viability has been adversely affected and their interest and capacity to serve County Hospital patients has increased. Board Resolutions of Each District Hospital Each District Hospital has passed a resolution opposing construction of the new County Hospital and each has agreed to work with the County to develop a plan to care for the County's patients at the District Hospital level. Mt Diablo Hospital will be presenting its plan to a public meeting on September 29th, 1993. This plan will encompass care for patients who live in the Central County and an option for a comprehensive County-wide plan in concert with the other District Hospitals. What are the potential Cost Bavings to the County if the District Hospital Provided Inpatient Care to County patients? The cost per patient day at the County Hospital is in excess of $1,500. The rate Medi-Cal pays to the District. Hospitals for Medi- Cal patients is less than $750 per day. Having District Hospitals caring for County patients could result in a 50% savings to the taxpayers. Nationwide it is estimated that almost 40% of healthcare spending 4 is spent on administration and paperwork. Since the District Hospital's already have their administrative structure in place there is a potential savings to taxpayers of another $20 million to $30 million of the $96 million County Hospital subsidy! Much of this would be from elimination of duplicated paperwork and equipment. . .not to mention the elimination of $10.7 million per year of debt service payments. Coincidently, the extension of the 1/2 cent sales tax in the County will raise approximately $10 million per year. . .an amount less then the debt service on the County Hospital bonds. ROW CAN THE COUNTY IME SURE THE DISTRICT HOSPITALS WILL OFFER CARE TO COUNTY PATIENTS OVER THE NEXT 30 YEARS AND BEYOND? There are at least three options the County and the District hospitals should explore for ensuring long-term access to District Hospital beds by the County. These organizational alternatives include: 1)LONG TERM PURCHASED SERVICES CONTRACT Under this alternative the County would enter into a contract for patient services at the District Hospitals much 'in the same way the State does for Medi-Cal services. The contracts could have long terms (i.e. 10 to 30 years) and the rates paid could be linked to the rates the State pays the District Hospitals for the same services. 2)PURCHASE OF BEDS IN THE DISTRICT HOSPITALS Two County Supervisors have proposed the direct purchase of beds, indeed entire empty floors, at District Hospitals. These beds would be operated by the County and staffed perhaps idith County Health Department employees. The County would contract for ancillary services with the District Hospitals and perhaps share some administrative support services. 3)ESTABLISHMENT OF A JOINT POWERS AUTHORITY Under this alternative the County and each of the hospital districts would participate in a new governmental agency that would control all of the health resources of the three hospital districts and the County. Each entity would have representation on the Joint Powers Authority Board of Directors. In this fashion a true County- wide health system could be formed with representation and control spread along the three electorates. Each District Hospital and the County Hospital must compete with private hospitals in and around the County. Alliances and mergers are forming all over the Bay Area. Delta Hospital in Antioch has joined the Sacramento-based Sutter Health System. Alta Bates hospital in Berkeley has joined the San Francisco-based California Healthcare System (which includes the District hospitals in Marin County and San Mateo County. The day of the independent community hospital is over. Hospitals must join collectives to operate efficiently and bargain for managed care and purchasing contracts. 5 The Joint Powers Authority provides an option whereby the District Hospitals and County achieve both an equitable power sharing arrangement and can form a competitive health system to ensure the survival of a cost competitive, high quality health system in Contra Costa County. WILL INDIGENT PATIENTS IN THE COUNTY HAVE ACCESS TO DISTRICT HOSPITALS? Approximately 50% of eligible patients (recipients of public assistance, and medically indigent patients not eligible for Medi- cal) live in the West County, 35% live in the East County and only 15% live in the Central County. While it is true that two of the District Hospital's dropped out of the Medi-Cal program in protest over low rates, all District Hospitals now participate fully in the Medi-Cal program. The administrators of the District Hospitals who made the decision to temporarily withdraw from the Medi-Cal program have been replaced. IF TEE COUNTY HOSPITAL IS CLOSED WILL THE DISTRICT HOSPITALS PROVIDE EMPLOYMENT TO EMPLOYEES OF THE DISTRICT HOSPITAL? Each of the District Hospitals has laid off significant numbers of their own employees during the past year. Nevertheless it is expected that as the census of the District Hospitals increases as a result of the privatization program, each District hospital would provide selective employment opportunities to County employees. Staff membership at District Hospitals will be offered to County Hospital physicians. REVOLT would work with the District Hospitals and the County to develop a formula to hire laid-off County employees at the District Hospitals based on increases in utilization at the District Hospitals. WHAT ARE. THE OBSTACLES TO ACCESS FOR THE CONSTITUENTS OF THE COUNTY HOSPITAL AND HOW IS THIS RELATED TO THE NAACP SUIT TO BLOCK CONSTRUCTION OF A NEW HOSPITAL. IN )LARTINEZ? The Legal Defense Fund of the NAACP has filed an Administrative Complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services pursuant to Title VI of the Civil Rights Act of 1964. The provisions of this law prohibit the use of Federal Funds to support discrimination and prohibits the use of Federal funds for any building project which excludes individuals, denies them benefits from, or subjects them to discrimination under any program on the grounds of race, color or national origin. The NAACP alleges that the location of the proposed new hospital in Martinez is so distant as to be largely inaccessible to great numbers of poor African Americans, Latinos and Asian Americans who live predominantly in the West County (served by Brookside Hospital) and the East County (served by Los Medanos Hospital) . 6 The NAACP's complaint is patterned after a Title VI complaint filed with the U.S. Department of Agriculture's Office of Civil Rights against Contra Costa County for seeking to centralize food stamp offices in Central Contra Costa County. The Department of Agriculture found that Central Costa County served a 75% white population and consequently the County dropped its food stamp centralization plan after the federal authorities informed the State Department of Social Services that its entire food stamp program was imperiled by Contra Costa County's actions. WHAT ARE THE FINANCIAL IMPLICATIONS FOR THE DISTRICT HOSPITALS IF THE NEW COUNTY HOSPITAL IS BUILT? Brookside and Los Medanos Hospitals have each issued tens of millions of dollars of bonds to modernize and upgrade their facilities in the past five years. These bonds are insured by the State of California under the Cal-Mortgage Program which is a special State program to assist hospitals that provide services to underserved populations. The State has insured over $1 billion of Hospital bonds statewide and has never foreclosed on a hospital forcing it to close its doors. Allegations by the County that .Brookside and Los Medanos would not be dependable, long term providers of Hospital care to County patients are totally false. While both Hospitals are losing money now, if they were to care for County patients and receive a share of the $96 million subsidy now paid to the County Hospital, they would become instantly profitable and financially healthy. If, on the other hand, the County builds the new Hospital and siphons most of the County's health care dollars to Martinez, then Brookside and Los Medanos may have to reduce to scope of services available to patients in their communities. Will the Managed Sealth Plan Developed by the County Improve Access for the Needy? The County has developed a prepaid, capitated health plan called "Contra Costa Health Plan". Enrollees in this plan would have to receive services only at County facilities and may be denied access to the District Hospitals in their local community. At present there are approximately 21,000 enrollees in this plan. . .most of whom are Central County residents and County employees. The County would like to expand this plan to include Medi-Cal recipients, AFDC recipients; welfare recipients and, if there is any interest, employed individuals. The Physicians Coalition of Contra Costa County and the District Hospitals would like enrollees in the plan to receive care in their local communities as opposed to being treated in a centralized . County facility. The trap the County has forced itself into is that it must service these patients in Martinez in order to service the debt on the new hospital. If the patients were treated at District 7 hospitals and by private physicians in their local communities the ) funds would go to the local provider instead of the County. IN 1989 THE CONTRA COSTA COUNTY GRAND JURY INVESTIGATED THE PLANS TO BUILD A NEW COUNTY HOSPITAL. WHAT WERE THEIR FINDINGS? The County Grand Jury submitted a report to the County Board of Supervisors with the following findings and recommendations: o A consulting firm, Lewin/ICF of San Francisco submitted a financial analysis of the Project to the Board of Supervisors. After reviewing the report "the County Administrator stated that there seemed to be no way to finance replacement of Merrithew Memorial Hospital at the present time". (page 56) o The fact that there is only one County Hospital, located in the central part of the County, means that access to non-emergency hospital care is limited for large numbers of patients because: 1) The geography of the County is such that people who reside in the eastern and western portions are far removed from any central site and those areas are the most rapidly growing. 2) The difficulties posed by the geographic spread are compounded by the inadequacies of the public transportation system, particularly during evening, night and weekend hours. 3) The majority of the patients served by the. Hospital are poor or medically indigent, live in the western or eastern part of the County and often lack means of private transportation. As a consequence, they frequently delay seeking treatment until a minor condition has escalated into an emergency. o Patient access to hospital facilities would be greatly enhanced by having hospitals in several locations throughout the County. The availability of conveniently located community hospitals will make the County's Health Plan more attractive to the general population. o There currently (in 1989) is an average of 347 vacant beds in already constructed (and since improved) District Hospitals. Contracting for vacant beds in existing hospitals would make it possible to meet increasing patient needs while reducing the size of the replacement hospital. (Note: Since then the vacant beds in the County has doubled. Total average vacant beds in the County exceed four times the number of proposed beds for the County Hospital) . o Most District Hospitals are substantially under-utilized and facing strong competition for patients. Thus, District 8 Hospitals would benefit by contracting to fill some of their I vacant beds. An effective way to provide access to health care • services is to make use of existing facilities located throughout the County. . . . to have both a County Hospital AND contractual arrangements with District Hospitals. (Note: REVOLT'S position is to maintain the County facilities as outpatient facilities) The County Board of Supervisors ignored the principal findings and recommendations of the Grand Jury at a cost to taxpayers of hundreds of millions of dollars. Given the changes that have occurred since the Grand Jury report, REVOLT feels it is time to reconvene the Grand Jury to rereview the Project in light of the new health care environment. This rereview is particularly important in light of the President's health plan proposal now before Congress and the changes that have occurred at the District Hospitals since the original Grand Jury report (i.e. , further declines in occupancy, new administrations in two of the three District Hospitals, agreement to welcome County physicians on the medical staffs of the District Hospitals, etc. ) . WHAT ORGANIZATIONS IN THE COUNTY ARE OPPOSED TO THE NEW HOSPITAL? - District Hospitals; Brookside (Richmond) , Los Medanos (Pittsburgh) and Mt Diablo (Concord) - Physician Coalition - The Contra Costa County Coalition for Managed Care - City Governments of Richmond, CA and Pittsburgh, CA - Contra Costa REVOLT Committee of the Republican Party of Contra Costa County - The Sinclere-Miller Medical Association, Oakland, CA (Local Chapter of the National Medical Association) - NAACP Note: The Contra Costa Taxpayers Association and the Alameda- Contra Costa County Medical Society are meeting this month to decide on joining the coalition. File: Hospital.mem 9