HomeMy WebLinkAboutMINUTES - 06061986 - 1.138 1. 138
THE BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y, CALIFORNIA
Adopted this Order on _June 6, 1989 , by the following vote:
AYES: Supervisors Powers, Fanden, Schroder, McPeak, Torlakson
NOES: None.
ABSENT: None
ABSTAIN: None
------------------------------------------------------------------
------------------------------------------------------------------
SUBJECT: Report Entitled "County Hospital Replacement"
The Board on May 26, 1989 received from the 1988-1989 Contra
Costa County Grand Jury the report entitled "County Hospital
Replacement. "
IT IS BY THE BOARD ORDERED that received of the report is
ACKNOWLEDGED and same is REFERRED to the Internal Operations
Committee and County Administrator.
I hereby certify that this Is a true and correct copy of
an action taken and entered on the minutes of the
Board of Supervi rs on the date shown.
ATTESTED: G • /!� P
cc: Internal Operations Committee PHIL TCHELOR,Clerk of the Board
County Administrator of Supervisors and County Administrator
Grand Jury
Presiding Judge, Superior Court Byl� %! Deputy
A REPORT BY
THE 1988-89 CONTRA COSTA COUNTY G �f/ind L��L 9130
P. 0. BOX 1110
94 RECEIVED
Martinez, CA 94553
( 415) 646-2345
MAY 2 61989
PHIL BATCHELOR
CLERK BOARD OF SUPERVISORS
C
OST A CO. D
B
COUNTY HOSPITAL REPLACEMENT
The grand jury recommends that an integrated
system of care encompassing a smaller-than-
originally-proposed County Hospital, contracts
with district hospitals facilitated by an in-
dependent third party and enhanced clinics/
health centers be developed.
APPROVED BY THE GRAND JURY:
DATE
I PHILIP S TZ , SR.
GRAND vJURY FOREMAN
ACCEPTED FOR FILING:
DATE: �O
c-WAYNE W STO ER
JUDGE OF THE SUPERIOR COURT
ward ��Eri� ers (provided).
COUNTY HOSPITAL REPLACEMENT
SUMMARY
Merrithew Memorial Hospital (County Hospital) is in need of
extensive and costly repairs. Since the facility is outmoded as
well as deteriorating, the County Board of Supervisors has
determined that the Hospital should be replaced. While there is
general concurrence with the decision to rebuild, the
identification of funding sources to cover construction and debt
service, as well as operating costs, is proving difficult.
The grand jury explored options which might make it possible to
build a smaller, less costly County Hospital while continuing to
provide the best possible health care services for those patients
who are the County' s responsibility. The grand jury recommends
that an . integrated system of care encompassing. a smaller-than-
originally-proposed County Hospital, contracts with district
hospitals facilitated by an independent third party and enhanced
clinics/health centers be developed. This promises the most cost
effective, accessible and equitable health care services for
Contra Costa County.
INTRODUCTION
The County Hospital and its staff have rendered invaluable
services to the people of Contra .Costa County for most of this
century. This grand jury investigation specifically excluded any
consideration of .the quality of services and directed its efforts
toward exploring the options for building an affordable County
.Hospital while continuing to provide the best possible health
care for the County's patients.
FINDINGS
1. After 40 years, Merrithew Memorial Hospital is in such a
state of disrepair that loss of accreditation and/or closure
are possible consequences of failure to take corrective
action.
The present 13-acre County Hospital site was purchased on
June 16, 1880 for $825. Contra Costa County began caring
for indigent patients in 1881-82 after the construction of
three small buildings at a cost of $3,225. More substantial
construction was undertaken in the five-year span 1910-1915.
The original buildings occupied the upper section of the
campus and met the needs of the County through World War I
and the depression of the 1930s.
Throughout this long period, the lower section of the
Hospital acreage was occupied principally by the superin-
-1-
tendent' s home, the original juvenile detention facility and
an orchard of olive and walnut trees, a few of which still
stand.
The inadequacy of the Hospital became apparent during World
War II . Major additions began in 1949 and ended in 1960.
The name of the Hospital was changed in August 1986 from
County Hospital to Merrithew Memorial Hospital in honor of
the medical director who served from 1911 to 1948, Dr. Edwin
W. Merrithew.
2. After much consideration and a two-year study, the Board of
Supervisors has determined that a replacement hospital
should be built on the present, County-owned site.
In January 1986, the Board of Supervisors found that it was
more appropriate to rebuild than to repair, established the
basic parameters of the replacement hospital and directed
that a staff study be prepared to analyze alternatives and
.financing (Exhibit 1) .
In December 1988, a report prepared by Arthur Young & Co.
was presented to the Board to analyze the replacement and
financing parameters (Exhibit 2) . This report recommended a
replacement hospital of 227 beds with a total cost of $152
million. Financing was to come principally from State
Proposition 99 (Tobacco Tax Initiative) and from Senate
Bill 1732 subsidies. On that date the Board authorized
approval of continued planning and seeking qualified
architects to pursue detailed design (Exhibit 3) .
During the Board of Supervisors meeting of February 1, 1989,
the County Administrator stated that since the use of Prop.
99 money had become doubtful, the .size of the replacement
hospital was to be reconsidered.
On April 4, 1989, the Board of Supervisors was presented an
analysis of hospital replacement parameters prepared by the
consulting firm of Lewin/ICF, 5028 Geary Boulevard, San
Francisco, California. This analysis predicted hospital bed
requirements based on County demographics and presented
several scenarios under varying assumptions for hospital
replacement and operating costs. Members of the Board
requested additional information.
During the April 25, 1989 meeting of the Board of Super-
visors, the completed Lewin/ICF report was received by the
Board. It contained an analysis of the financial conse-
quences of nine different scenarios. The cases and
financial impacts are summarized in Exhibit 4. Although no
action was taken other than receiving the report, the County
Administrator stated that there seemed to be no way to
finance replacement of Merrithew Hospital at the present
time.
-2-
3 . 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:
♦ 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 (Exhibit 5) ;
♦ The difficulties posed by the geographic spread are
compounded by the inadequacies of our public
transportation system, particularly during evening,
night and weekend hours (Exhibit 6) ;
o Transporting patients to the County Hospital by
ambulance or ambuvan offers some relief from the access
problem but it is very costly and currently limited to
patients with very specialized needs.
4. A majority of the patients served by Merrithew Memorial
Hospital are poor or medically indigent (Exhibit 7) . They
are significantly affected by the access problem since many
live in the eastern and western portions of the County and
often lack reliable means of private transportation. As a
consequence, they frequently delay seeking treatment until a
minor condition has escalated into an emergency.
5. Patient access to hospital facilities would be greatly
enhanced by having hospitals in several locations through-
out the County. Since the County obviously cannot afford to
build multiple hospitals, this geographic dispersal could be
accomplished by a combination which includes a new,
smaller-than-proposed County Hospital in Martinez and
contracts with district (and private) hospitals throughout
the County. In addition to improving access for poor
persons residing in the eastern and western areas of the
County, the availability of conveniently located community
hospitals will make the County' s Health Plan more attractive
to the general population.
6 . There are three district hospitals in Contra Costa County:
Brookside located in San Pablo, Mt. Diablo Hospital in
Concord and Los Medanos Hospital in Pittsburg. These
hospitals were partially funded by government monies under
the Hill-Burton Act and are obligated to provide a specified
dollar amount annually of free health care services to
medically indigent patients.
1Since the grand jury is concerned only with public dollars,
it did not interview representatives of private hospitals, but it
believes that they should be invited to participate.
-3-
Hill-Burton obligations are generally fulfilled in the first
six months of the year; after that, they are only obligated
to serve the poor on an emergency basis.
7 . A hospital network encompassing a County Hospital and other
hospitals ( linked by contractual relations) would achieve a
more equitable system of care, since County patients could
be served at any hospital in the network at any time
throughout the year.
8. There currently is an average of 347 vacant beds in already-
constructed district hospitals (Exhibit 8) . Contracting for
vacant beds in existing hospitals would make it possible to
meet increased patient needs while reducing the size of the
replacement hospital. Thus, if it is ultimately determined
that 225 beds are optimum, the need could be met by a new
hospital with, say, 175 beds and contracts for the other 50
beds (or some other combination) .
9 . As presently planned, the estimated cost of debt service
(principal and interest) for a replacement County Hospital
will be approximately $13 ,640, 000 in the year 1996. Of that
$13 ,640,000, SB 1732 is estimated to provide $6,233, 000
(Lewin/ICF) . Even if additional funds should become avail-
able, the County' s annual cost would be substantial. Since
construction of a smaller hospital would mean reduced debt
service obligations for the County, the savings could be
used to help defray the cost of the contracted services.
10. Specialized needs such as psychiatric and inmate services
could be met at Merrithew Memorial Hospital. District
hospitals would not be called upon to provide these
services.
11. Low occupancy threatens the economic survival of hospitals
in general, and most district hospitals are substantially
under-utilized and facing strong competition for patients.
Therefore, district hospitals would benefit by contracting
to fill some of their vacant beds (Exhibit 8) .
12. Failure to achieve a contractual relationship between the
County and district hospitals, despite years of effort,
indicates that there are significant obstacles, including:
♦ Differing economic goals for the County and district
hospitals. The County is desirous of providing/
securing services as economically as possible and the
district hospitals are interested in securing
reimbursement to cover their costs and provide addi-
tional revenue. (In this connection, it is important
to note that district hospitals cannot serve indigent
patients below the cost of care except in emergencies
or in fulfillment of Hill-Burton obligations, per
Section 32125 of the California Health and Safety
Code) .
-4-
4 District hospital concerns about insurance, including
both liability coverage and malpractice suits.
4 Reluctance on the part of some private physicians to
serve "County patients. " This concern could be largely
obviated if County-employed, board-certified physicians
were to become affiliated with district hospitals to
admit patients to County-contracted beds.
All three district hospitals have expressed interest in
contracting with the County provided that these obstacles
are addressed.
13 . A variety of outpatient services are provided at County
clinics/health centers located in communities throughout the
County, including Pittsburg, Brentwood, Richmond, Concord,
and Martinez (the latter co-located with Merrithew Memorial
Hospital) . The adequacy of facilities and. hours of service
vary considerably from clinic to clinic, and Health Services
Department administrators are considering a number of needed
improvements including, for example, a more adequate facil-
ity in Brentwood and the possibility of modifying the
Richmond Health Center. However, there are presently no
specific plans or dollar allocations for upgrading or
replacing any of the clinics except the Martinez Health
Center which is slated for rebuilding as part of the hos-
pital replacement proposal.
14. Urgent care services are available every weekday evening at
the Martinez Health Center, located on the site of Merrithew
Memorial Hospital. Evening urgent care services are,
however, generally . not available at the outlying clinics.
Therefore, patients who live outside Central County and are
dependent upon public transportation have limited access to
urgent care services.
15. The two-year study by the consulting firm of Arthur Young
and Co. included a specific recommendation that .enhancement
of the County' s outpatient clinics be included as part of
the overall planning for needed health care services.
CONCLUSIONS
The 1988-89 Contra Costa County grand jury concludes that:
1. Because of the outmoded facilities and the poor physical
condition of Merrithew Memorial Hospital, replacement rather
than repair is warranted.
2. Given the geography of Contra Costa County and the limited
availability of public transportation, an effective way to
provide access to health care services is to make use of
existing facilities located throughout the County - to have
-5-
BOTH a new County Hospital AND contractual arrangements with
district hospitals.
3 . Contracting for some hospital services from existing
hospitals would allow the size of the proposed replacement
hospital to be scaled down. The resultant savings in
construction costs, debt service and operating costs could
then be used to defray the cost of the contracted services.
4 . District hospitals may be more receptive to the possibility
of negotiating long-term contracts with the County than they
have been in the past because they are experiencing low
occupancy and high competition for patients.
The possibility of achieving success in negotiations between
the County and the district hospitals would be greatly
enhanced if:
♦ the offered remuneration were adequate to cover their
costs;
♦ all district and private hospitals in Contra Costa
County were approached;
♦ the County provided its own doctors and contracted only
for bed space and ancillary services;
♦ the County offered assistance in providing liability
and malpractice insurance coverage.
5. An independent negotiator, working with the Board of Super-
.visors and the Boards of Directors of the hospitals, would
be extremely helpful in finding ways to accommodate the
different needs and perceptions of the County and of the
hospitals... so that contractual agreements which are advan-
tageous to all of the parties can be developed.
6. It is essential that ALL county clinics/health centers be
included in planning for the replacement hospital, since the
resultant plan will guide the delivery of Contra Costa
County health care for many years. Special consideration
should be given to:
♦ the potential impact of projected population growth on
the service needs of the various communities
(Exhibit 5) ;
♦ upgrading the facilities and equipment;
♦ expanding the hours and offering evening urgent care
services at all clinics/health centers.
-6-
RECOMMENDATIONS
The 1988-89 Contra Costa County grand jury recommends that the
Board of Supervisors:
1. Continue the deliberations which are currently being under-
taken to determine the optimum size of the replacement for
Merrithew Memorial Hospital.
2. Simultaneously engage an independent third party to facili-
tate a new round of negotiations with district and private
hospitals to contract for use of their vacant beds and
ancillary services. It is essential to:
a. negotiate long-term contracts;
b. make reasonable financial offers;
c. approach ALL of the County' s district and private
hospitals;
d. address the insurance issues;
e. explore a variety of contractual options including use
of County-employed, board-certified doctors as attend-
ing physicians for County patients at other hospitals.
3 . Include plans for needed enhancements of all County clinics/
health centers as an integral part of the replacement
hospital planning. Special consideration should be given
to:
a. upgrading facilities and equipment;
b. expanding clinic hours;
c. making urgent care services available at all clinics/
health centers.
COMMENTS
The grand jury commends the actions to date (April 30, 1989) of
the , County Supervisors and administrators in considering the
replacement of Merrithew Memorial Hospital.
Although we have experienced the frustrations of watching govern-
ment in action ( seeming at times to move one step forward, two
steps back) , we have been pleased to see how a project can change
as it progresses through the many steps in coming to fruition.
The grand jury feels that the analyses underway will lead to
sound decisions regarding the size of a replacement hospital and
how or if it can be financed.
The system is working.
-7-
EXHIBIT 1
SUMMARY OF BOARD OF SUPERVISORS ' MEETING
January 14, 1986 : The Health Services Director made a presenta-
tion to the Board of Supervisors indicating that:
A. Renovation of the existing deteriorated
County Hospital was not practical.
B. Leasing space and services from other
hospitals in the County to meet County
health needs was not practical.
C. The existing County Hospital should be
replaced by a 120-bed hospital plus a
geriatric institute.
On January 14, 1986, the Board of Supervisors approved the
recommendation of the County Administrator that the concept of
replacing Merrithew Memorial Hospital be approved, its feasi-
bility be verified and preparatory work in identifying funding
sources, optimal size, etc. , be started. The firm of Arthur
Young & Co. , 2175 North California Boulevard, Walnut Creek,
California, was engaged by Contra Costa County in December, 1986,
to provide this analysis at a final cost of approximately
$190,000 .
1-1
EXHIBIT 2
SUMMARY OF ARTHUR YOUNG REPORT: "STRATEGIC, ARCHITECTURAL
AND FINANCIAL PLANNING - REPLACEMENT COUNTY HOSPITAL. "
A. Arthur Young was engaged to provide strategic, architectural
and financial planning assistance in order to determine the
feasibility of building a replacement for Merrithew Memorial
Hospital ( County Hospital) . It was not contracted to
consider the location of a replacement hospital, to consider
the merits of contracting with existing hospitals or to
assess the needs for clinic services.
B. Planned hospital size had increased from the 120 beds recom-
mended in 1986 to 227 in 1988 . Costs were estimated to be
almost $700,000 per bed, or $670 per square foot.
C The proposed number of beds was up 25 percent from the
present 181 beds; proposed space was up 83 percent from the
present hospital. Overall spacerequirements were provided
by hospital staff and management.
D. The report contained recommendations which needed to be
addressed for the conclusions to be valid. Some of the
recommendations require both the enhancement of clinics
throughout the county and the improvement of transportation
to county medical facilities.
E. Total cost of hospital replacement was estimated to be $152
million, including financing and new equipment, provided
that all financing be obtained at the outset of the project
and that there be no interruption of construction after it
had begun.
F. It was proposed that the Hospital expand its role in areas
which are deemed to be profitable: obstetrics, geriatrics_,
programs to attract Medi-Care and other payor classes.
2-1
EXHIBIT 3
SUMMARY OF BOARD OF SUPERVISORS' ACTIONS
DECEMBER 13 , 1988
The County Administrator recommended that:
A. The Directors c' General Services and Health Services be
authorized to proceed with selection of consultants for
schematic design_ and project constructicn management.
B. The County Auditor-Controller be directed to reserve Tobacco
Tax (Prop 99) revenues for this and all subsequent years to
replace or repair the existing hospital facility.
C. The Health Services Director be authorized to utilize state
revenues available through SB 1732 to replace or repair the
existing facilities and to aggressively pursue commitment
from the state for these funds at the earliest possible
date.
D. The impact of hospital replacement financing on t1n.e County
be evaluated.
The County Administrator' s recommendations were approved by the
Board of Supervisors with amendments that:
A. A request for proposal (RFP for design of facilities be
submitted for Board review.
B. The necessity for an environmental impact report (EIR) be
determined.
3-1
EXHIBIT 4
FINANCIAL SCENARIOS
r
; # Or ; COST/BED; CA? COST; C0U_I TY ; PF0J=CT
BEDS ; P ER DAY /BED/DAY; SU_SZDY : CAPITAL
; 1995 11996 ! 1996 11995 COST
C1S- A - BUSI'1=SS AS USU3?, : 211 : 31596 : 3227 1 513, 823 ; S83, 788
CAS3 B - GOOD _L=PKET
. 234 ; S1522 : S221 15_4,9'•_8 ; S96, 701
CASE C - BAD 1,=P{_T : 221 : S1643 ; S231 1 $15, 579 : S83, 406
;
CASE D P_GGPESSIVE BUSINESS ; 190 ; 31686 15244 1311, 808 1584, 345
AS USUAL ;
CASE D - OP.T±I.ISTIC FINANCE : 190 ; $1536 : S227 ; S10, 015 1 $88, 788
CASE D - PESSIMISTIC FINANCE 1190 ; 51657 ; 5227 1517,936 1588, 788
RETAIN PRESENT FACILITY ; 181 151487 ; S 58 1S 9,737 ; 312, 000
BUSINESS AS USUAL
RETAIN PRESENT FACILITY 1181 151594 1S 65, ; $ 8,843 ; 312, 000
AGGRESSIVE MAYAGE2CENT 1
WORST CASE 1178 1 $1808 ; 5264 1 $19, 451 ; 588, 788
* COMPILED FROM LEWIN/ICF REPORT OF APRIL 25 , 1989 .
4-1
EXHIBIT 5
CONTRA COSTA COUNTY POPULATION
10l" loso 1988 ! 3a;o % % 20t-!��: -FROjECTICIM.
POF OF TGT CF TOT F7_11=
ADVE00H, 42,09 S4,20e 6 . 7. 19 91 100 10 .215
4,234 S, 4407 (D .67 0.85 5 -.2
4025
CENCORD 1 2-51 1 CS,'S.11 71 14.46 ,-;(.)0 12 . 5-'L
E= CERRITO 22, 431 23, 132 3 . 46 :3 .07 27,&)(D', :11
1 .61; 1 200
2,
L'!.FA�.YETTE 20,S79 22, ES2 3 . 18 2 . 2_,(-{ 2 .4'-
!"!A= 1 ivi'E 1, 22,582 2S, S42 3 . 44. 3.9E, 42,400 4 . 77
McRi�C-A . 0,014 le,ess 2 .28 2. 10 17 s 200 1 . 5 Z41
t�-,
F:1 E 1 5 1 .5, 2-1,af 12 . I a 2.02 2_"-;(."o 2 . 511
F;1TTSS.tjq-.,(i 33,034 43, 012 15 .03 S.71 Sa,700 1 . 1-7
FLE."ic-AiNT HILL
S. 25, 124 :30,672 3 .82, 4.07 IS,30C. 4 -013
F 0 N ED 74,676 131 ,511 1 1 .36 10..82 C-2,. I oo 1 i 41-;
SAN FFA E.L fD 19,750, 21A57 3. 00 2.85 21,800 2 . 7'z--
SIM RAMON
_ ,,41,�4 o .00 .(114 _; , n00 6
NUT ',-:F-,EEK E3,643 62, 538 8 . 16 8.30 -:3 00
till 110:010513RATE.-D 194,034 140, 110 2'y .52 1 E s6z 7,-�,800 .8 5S
TOTALL ES7,252 7S3,456 ses,soo
SOURCES- 1980-1988 POPULATION, 1988 CAFR
5-1
EXHIBIT 6
�G�
' ^�] .1 Cr,L, PLEASE HAVE EXACT PAR_ w
DRIVERS 00 NOT MAKE Ci1ANG2 `Y9-• �„� qt - �
FARES
. .,
To=C Transit:surrercer Valid transfer t° Senior/ , r-A•"^a _,,,+' t`" `"'.
Cart7f»d- µ '�`^
cc^:' e your;r•p.(It you reed to ride two Regular Manccottped 'y�'R '�y s+? z1°17'� �„t
ACTra.:_lt uses, an add:lional transfer 1`.+�_ -v •,�y�.r n" .. ,_ g�
may-Se cctairec.`er cne-had that system's s1ca -
rE_•_.ar-ccsTare•i.e.,35c:cr acults,25e for '
yc_:r:. icc for seniersrcerdtied handl-
ca::.. :idersl. From AC Transit: sur- ,�„w..c-rlit
.
rencar.afid transfer olus one half of Line
3G-='_s fare:i.e.,50c(only 250 for sen-
icr_:ar•Pied handicapped riders).To BAP is enrcute to SART trains, pay
recu:sr bus tare. From BART:surrender 31ARTIN'c:
vwic':a-s;er(obtained inside station)plus
one.:_f cf Lr,e 30-7 bus fare to continue
tr%' - HILLTOP
To °ART E.-cress Bus: surrender valid RIC1i,
trars: =•om BART Express Bus:sur-
renc;r Vaiid transfer plus one-half of Line M
3C-z ccs rare. •1;(c ,t_,''
To Ccunby Connection and WestCAT:
- .. _ ,-r:er vaiid transfer plus 25e. From
Cxnry Connection and WestCAT:sur-
rer:ar•.olid transfer p us one-half Line 30-
Z__s`are.
M FRIDAY
EFFE-371Ft•JTIVE:
May 4.1987
ser-
PASSENGER STOPS PASSENGER STOPS OPS vice sGnarrechtingLweste n Contrank commuteruCcsta
TO MARTINEZ TO RICHMOND with the County Seat is a ccereratrre
RICHMOND MARTINEZ effort operated by WestCAT (Western
EART,Fichmond AMTRAK Station Contra Ccsa Transit Authority). Other
Mac3cnald Ave.at 21 at St Marina Vista at Alhambra Avenue interested agancies supporting this Ser-
22r-'SL at Macdonald Ave. Benellesa SL at Meflus SL vice include:AC Transit BART,Cental
23rc SL at Rheem Ave. Eerreilesa SL at Soto SL Contra Ccsta 'County Connection' and
SAN PABLO Alhambra Ave.at"S”SL theocar.of Supervisors of Contra Costa
23rd SL at Market Ave. Alhambra Ave.at"F"St
23rd SL at Brookside Drive Alhambra Ave,at Muir Lodge TRANSIT INFORMATION
San Pablo Ave.at College Lane Alhambra Ave.at Walnut Avec
U.S.Veterans Hospital(Main Entrance) In western Contra Costa,call:
_.,. .. RICHMOND HERCULES AC Transit rws,rm,:+most 232-5665 .
Hifitoo Shopping Center-Stop#3 WestCAT Transfer Terminal BARUBART Express .....236-BART
PINCLE PINOLE WestCAT Dial-A-Ride .....724-RIDE
Pinole Valley at Henry Tennent Ave.at Pear SL WestCAT administrative
Tennent Ave.at Peach St . .......724-7593
.. . - --. ?ennentAve.atPeachSt °CCB'-'-•••' '
Tennent Ave.at San Pablo Ave. -Pinole Valley at Henry In Martinez call:
. .:s:...:.,:-..
HERCULES RICHMOND BART/Express ....... ..933-BART
WestCAT Transfer Terminal County Connection ....:..938-7e54
Hilltop Shopping Center-Stcp#2 -
MARTINEZ SAN PABLO
.. U.S.Veterans Hospital(Main Entrance) San Pablo Ave.at Stone SLOST ARTICLES
L
Alhambra Ave.at Walnut Ave. 23rd St at Brookside Dr. A friendly reminder... before leaving
the bus,please be sure you have all your
Alhambra Ave.at s..855 23rd St.at Bush Ave. y0
. AI`emote Ave.at"G"SL 23rd SL at Rheem Ave. bebngir.Ss.Articles inadvertently left on
AI`,amtra Ave.at Bar'lots St the bus.when found by the driver, are
Alhambra Ave.at Allen SL RICHMOND turned over to WestCAT.,- where Vey
Alhambra Ave.at Mellus SL Macdonald at 21 at St. may be retrieved upon proper identitfca-
ESC0bar SL at Castro SL BART/Richmond .. tion by the owner.Call 724-7993.
Court SL at Escobar St. - •Boob mt wn«knv,ee,avoia ,
AMIFAK Station
No Service overated Saturday.Sunday or Holidays Inc"4ding New Years.Christmas,
Monday through fr9da Thar,ksgiving,Labor Day,July 4th.MemorialDay.Washington's Binhday.Veteran'sDay.
artd Marin Luther King tins Birthday.
FROM MARTINEZ TO BART/RICHMOND STATION FROM BARTIRICHMOND STATION TO MARTINEZ - --
Laa.a flare Leave Amee Antre Amr1w Aulle Arrive lean Lana .W.e Laan Lane A1dw Arrive Antft
Amtrak County Vetanro West Wt HMwp SanPsblo 21st St BART/ BART/ 21st SL SanVabioHlptap Wm Cat Vataram County Amtrak '-
- Sbdon Hospital Hospital Temind Map &a A Alae• Rich. RkX. a Wo- a El Moa Trn4w Hospital Hospital station _
Portal domaid mond am donakl Penal
:. 5:30 8.C4 8.11 827 837 643 8_'o SS2 A 71.0 702 709 7.15 7.5 7.41 7.47 732 -
i':^^ 1C04 Icil 1027 1037 1043 105° 1052 9C0 902 9.09 915 925 9A1 9.47 992
0 1204 1211 1227 1237 1243 t243 1252 1too 1102 11 C9 11!5 1125 1141 1147 1152
300 1G 111 127 3.37 143 150 332 !.200 LC2 2-C9 2.13 223 2.41 2.47 2.52
Sls 119 5.29 142 5.52 5.53 8.03 607 4.00 402 4,09 4.13 4.25 442 4,49 434
Light Face Figures A.M.
Dark Face Figures P.M.
Coach has wheelchair access.
6-1
EXHIBIT 7
DISTRIBUTION OF MERRITHEW MEMORIAL HOSPITAL PATIENTS
MedlCal
fTT
(Proportions are.
approx. , based on
verbal informa-
tion from hosp.
Map—BAC personnel)
Medicare
Private
CDf
County Hospitals have historically been charged with responsibility for serving
poor and indigent persons who do not receive medical care from any other source.
This is still a valid description of the County's mission. However, a portion
of the original "poor and indigent" population now receives federal assistance
through the Medicaid program
Medicaid (or Medical, as it is known in California) serves recipients of AFDC,
recipients of SSI (a welfare program for needy aged, blind and disabled per-
sons) , pregnant women and refugees. It was originally designed so that poor
people could use ANY doctor, clinic or hospital in the community. Unfortunate-
ly, however, the federal reimbursement for this program is so low that many
doctors, clinics and hospitals are refusing to serve Medical patients, and they
are once again becoming largely dependent upon County-operated facilities. At
present, Medical recipients are the largest single group served by Merrithew
Memorial Hospital.
Medicare patients comprise the second largest groups served by Merrithew Mem-
orial Hospital. Since the federal reimbursement for Medicare is far greater
than for Medical, most hospitals are in competition for these patients, and
County Hospital's share of this market appears to be declining.
Medically Indigent Adults (MIA's) , the third largest group served by MMH, are
impoverished adults between the ages of 21 and 64; they meet stringent income,
property and residence requirements but do not fit into any of the groups
covered by Medical. MIA's (also known locally as BACs) may receive medical
care ONLY at County-operated facilities. This program, originally operated by
the State, was turned over to the counties in 1982-83; the decline in State
funding since that time has caused great hardships for the counties. MIA-BAC's,
generally referred to as "County patients," comprise about 10-15 percent of the
population served by the Hospital.
Uninsured persons who have incomes over $750/month for an . individual, or
$1,350/month for a couple, do NOT qualify as MIA's. They may, however, be
served by County Hospital on a private pay basis (with long-term contracts to
help them meet their obligation) . Private pay patients comprise fewer than 5
percent of County Hospital's population.
The Hospital also serves County employees who have enrolled in the County's
health plan and a few "others."
7-1
EXHIBIT 8
DISTRICT HOSPITAL BEDS AND OCCUPANCY
LOS XT
TED A`lOS D I ABLO BROOKS T_ ?
L7C=5SED BEDS 81 393 246
GCC?:?AYCY FEPCENTAGE
_937 E1-, 7 6o. 6 42. 9
_988 5 . 6 54. 1 42. 5
1-989 TO DATE 52. 3 52. 9 47.6
Cr" TT=I SD BEDS
'987 50 2*8 106
1988 42 213 105
1989 TO DATE 42 208 117
E:•f f BEDS
1987 31 155 140
=938 39 180 141-
1989 TO DATE 39 185 120-
YEAR
29YEAR AVEP.AGES
BEDS OCCUPIED 373 (51. 8%)
BEDS EV—PTY 347 (48. 2%)
BEDS AVALIABLE TO C031TRP_CT
2510 OF EMPTY BEDS 87
50% OF EMPTY BEDS 174
75% OF EMPTY BEDS --- 260
1007, OF EMPTY BEDS 347
8-1