Sonoma County Health Care on Critical List
by Ken Wikle
Posted on 2008-05-28 10:17:47
Fictional depictions of 18th and 19th century insane asylums still give me the willies. Those who had “gone mad” were forcefully relegated to life under horrendous conditions, watched over by people who had no clue as to the nature of mental illnesses. The early 20th century saw treatment attempts that were sometimes effective, but too often the efforts went awry. The archetypal depiction of the latter category was “One Flew Over the Cuckoo’s Nest.” Nurse Ratched had dictatorial powers over her ward of mental patients, with unfettered freedom to exercise her cruel and sadistic whims.
At least she was a nurse. Flash forward to 21st century Sonoma County and take a look at county jail. By some estimates 30 to 40% of its inmates have serious mental disorders, and should be receiving institutional treatment. But that situation may get worse: all Sonoma County inpatient psychiatric care facilities are closed or are scheduled to close, and jail will be the only repository for people who are potentially dangerous to themselves or others. The situation is just plain nuts.
It’s not just mental health treatment that’s off the track. The county’s entire hospital situation is whacko. How did it happen?
The US per capita cost of healthcare which had long been at least double that of other industrialized countries, started going off the charts in the eighties. Soon the cities and counties that had long provided hospital treatment for the less fortunate, governments that were already squeezed of revenue sources by tax “reform,” were running hospital deficits that were beyond their means. Sonoma County was no exception, so in 1996 the then County Hospital was sold to a nonprofit corporation, Sutter Health.
The county wanted to insure that treatment of the uninsured and the less-than-wealthy would continue. By signing the Healthcare Access Agreement of 1996 Sutter promised to maintain a number of services.
The Norton Center, the county’s inpatient mental health hospital, remained a county facility, but under the agreement it was run by Sutter.
All was reasonably well in Santa Rosa for several years. As before, hospital care was divided between County (now Sutter), Memorial and Kaiser. Sutter expanded its capacity in 2001 with the purchase of Warrick Hospital. Rural Sonoma County was served primarily by the four hospitals ringing the county seat, Healdsburg, Sonoma, Petaluma and Palm Drive in Sebastopol.
But in 2002 disaster struck. The Health Plan of the Redwoods, the county’s only robust HMO other than Kaiser, went bankrupt. No other HMOs leaped to fill the gap; in fact just the opposite occurred: PacifiCare and HealthNet abandoned the Sonoma County Market. Kaiser, the last standing Sonoma County HMO, experienced a windfall. Today it holds a 70% share of the county market.
That’s all well and good, some might say. Market forces allowed Kaiser to secure a major market share, and once again our free enterprise system has proven superior to the “socialized medicine” of the other industrialized nations. Well, maybe not. Kaiser skims the cream, those that have insurance. The uninsured are shuttled off to Sutter, Memorial and the four rural hospitals. But these hospitals no longer have the revenue from insured patients that they once used to balance their losses. Sutter, tied to the Healthcare Access Agreement, was particularly hard hit. Some 40% of its patients are Medi-Cal, 60% are commercial. At Memorial, 14% are Medi-Cal, 86% are commercial. To add insult to Sutter’s injury, the ever-compassionate Bush Administration announced last week that it was cutting Medi-Cal benefits by 10%.
Kaiser patients are 100% commercial – no poor people on Medi-Cal or any uninsured need apply. If you are indigent and need medical attention, don’t bother going to the Kaiser emergency room – you’ll just be shuttled off to Sutter or Memorial. Kaiser will, however, treat bona fide emergencies requiring immediate attention.
Sutter Hospital has problems sustaining the red ink and at one point floated a plan to close. So far that has not happened and the Sutter facility continues to offer emergency and inpatient services.
Not so the all-important psychiatric facility owned by the county. The Norton Center became a significant drain on the county treasury and was closed in mid 2007. According to county mental health services director Art Ewart, the center had become financially unsustainable due to a rising number of uninsured patients, increasing costs for meeting mandatory staffing ratios and low reimbursement rates from state and federal programs. That position seems difficult to reconcile with the county strategic plan adopted last year that points out that it costs more to house mental patients in jail than it does to treat them in psychiatric hospitals.
Mental healthcare’s coups de grace was administered early this month when Memorial Hospital announced it was closing among other things Sonoma County’s last remaining inpatient psychiatric care unit. That will occur in about 30 days, at which time Sonoma County is up the creek without a paddle. County jail could well become an 18th century madhouse.
The county has preliminary plans for another facility, but that may not happen any time soon. Moreover there is hope that the local hospitals will join together to stave off the pending psychiatric healthcare disaster. Some sort of a solution could be worked out, but it will be an interim fix, yet another band-aid. A real fix has to be on the national level, but that requires leaders with the courage to do what’s right.
Ken Wikle writes the Against the Flow column for the Russian River Times, Sonoma County, CA.
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