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Babes in Arms

Cliff Coates
Michael Amsler

Man with a plan: Cliff Coates, CEO Sutter Medical Center

Last year voters approved the lease of Community Hospital. Now the state is probing reports of declining patient care

By Paula Harris

ANA GRAY, an amiable woman with expressive dark eyes, curls a protective arm around her newborn son, Bailey, as she briskly carries him across downtown Santa Rosa's Courthouse Square toward the state Department of Health Services office where she files her complaint.

According to Gray, patients are suffering because Sutter Medical Center in Santa Rosa--formerly known as Community Hospital--has closed its well-baby nursery, which had catered to the newborns while their mothers rested and recovered. In fact, many patients aren't aware that for the past four months, Sutter Health Center of Santa Rosa has changed to "couplet care," where mothers and babies are treated as a unit, and babies stay in the same room with mothers at all times.

Gray, 30, is incensed about her treatment at Sutter, where she delivered her son, and makes no bones about it. "I used to say Community Hospital was the best place to have a baby," comments Gray, who delivered her first two children at Community Hospital. "I wouldn't go there again."

After her delivery, Gray opted to stay the two full days allowed by the insurance company, since she had two other children, ages 10 and 2, at home and she wanted to return rested. But, she wasn't aware that policies regarding well-baby nursery care had changed.

During her Aug. 11-13 stay, Gray claims, after zero sleep for 20 hours--including 13 hours of labor and delivery--she asked a nurse to watch her newborn son, who was fussy, for two hours while Gray got some sleep. Gray says she was told the hospital no longer had a nursery and couldn't watch babies. "I couldn't believe it," recalls the young mother. "All I could do was sob into my pillow from pure exhaustion."

In her letter of complaint, Gray writes:

"New mothers used to be treated special, I appreciated being rolled from labor and delivery in a wheelchair, having my baby go in the nursery when I needed sleep or a shower. . . . I also missed the red wagons and being wheeled out to the car. These things gave Community Hospital charm and made it special.

"I feel the patient is no longer the priority, but that the appearance of the hospital is most important," she continues. "Good looks don't mean good care."

Sympathetic nurses, Gray says, encouraged her to file the complaint. She has filed one copy with the hospital and another with the state Department of Health Services.

Sutter officials later denied Gray's allegations, insisting that the nursery was still open, that it was an isolated case, that there was no change in discharge policy, and that all the small red wagons, used to transport baby gifts and belongings, had been stolen. Sutter officials also responded that allegations that nurses were watching newborns at the nursing station--a violation of state health policy--were untrue.

But Helgi Teixiera, health facilities evaluator supervisor for the state Department of Health Services, says complaints about the Well Baby Clinic not being utilized and about babies being left at the nursing station have led to a current state investigation about Sutter's perinatal services. "We're aware of [the complaints] and are doing an investigation," she tells the Independent.

"Leaving babies at the nursing station is not an acceptable practice--that's why we have nurseries. And well babies are not supposed to be in the intensive care nursery."

State regulators have told Sutter to utilize the Well Baby Nursery, she adds. "But there have been problems and complaints," she observes. "It's a viable issue. More than one person has voiced concerns."

When asked to comment, Sutter Medical Center of Santa Rosa CEO Cliff Coates says he suspects that the Health Services Department is responding to complaints from "patients, anonymous letters, employees, or the labor union." Coates insists the hospital is not involved in any wrongdoing. "We're very confident we're meeting all licensing requirements," he says, adding that the hospital is "constantly facing critics."

Babies on Board

ALTHOUGH COUPLET CARE is on the rise in the obstetrics wards of many hospitals--for mostly economic reasons, since staffing a nursery at night becomes costly--some patients and nursing staff see it as a blatant reduction in patient services and therefore a violation of the Sutter lease agreement.

Emma, a 17-year nurse who works at the facility and spoke on condition of anonymity, verified that the hospital's well-baby nursery had recently been closed and that nurses were encouraging patients to complain. "Mothers are being told they must keep the babies with them; they have no choice," she explains.

She claims the main problems are staff cuts, untrained nurses, improper evaluation of newborns, and keeping babies at the nursing station instead of the well-baby nursery because there's no one to staff the latter.

According to Emma, new mothers undergoing such surgical procedures as tubal ligations, removal of retained placentas, and cesarean sections must also care for their newborns. "I've seen a mother recovering from a C-section, under general anesthesia, snoring away with the TV blaring and the baby thrashing and screaming in the bassinet," she says. "One nurse can't simultaneously check on all babies."

However, Coates flatly denies the well-baby nursery is closed ("absolutely untrue") and dismisses Gray's complaint as a "possibly isolated case of not having a staff person [on duty]."

Says Coates: "We've been engaged in a study to look at what customers want, and what they want is couplet care--they want to be with their babies. So we've been engaged in a retraining effort in our OB department so that nurses are cross-trained in taking care of babies and mothers, as the baby should be with the mother and that's what customers are asking for.

"What that's meant is that the nursery is used much less than it used to be, but it is not closed."

He adds that the nursery is still available for babies whose mothers have undergone surgery, and denies reports that babies are being taken care of at the nurses' station.

But Stacy Giles, a registered nurse in labor and delivery who called the Independent in support of couplet care, says that of the 136 deliveries in August, none went to the well-baby nursery "because it wasn't an entity."

When the Independent asked to view the well-baby nursery, a reporter and a photographer were shown a sparsely furnished room with the lights on and viewing window blinds up, but no babies or staff members inside. The photographer was instructed by Sarah Miller, director of physician support services at Sutter, not to take pictures of the area.

Madrone Williams, director of women's and children's services at Sutter, says there is the same ratio of nurses to patients in the couplet-care model. "The nurse is 100 percent responsible for the baby's care, not the mother," she says. "It's not a cost-cutting measure."

The Name Game

IT'S BEEN ALMOST A YEAR since the hotly contested election in which 60 percent of Sonoma County voters passed a controversial ballot measure to lease publicly owned Community Hospital to Sutter Health/California Health Systems, a large health-care conglomerate with headquarters in Sacramento.

Now some critics are charging that the company has violated the lease agreement and broken a pledge not to curtail services at the publicly owned facility, arguing that planned staffing changes will have grave consequences for patient care.

Events leading up to the election can best be described as a messy tussle between the Sonoma County Board of Supervisors, which wanted to unload the debt-ridden Community Hospital, and campaigners intent on keeping it. "It's always unfortunate when well-meaning citizens get involved in something they know nothing about," Supervisor Mike Cale chided. Finally, Superior Court Judge Lloyd von der Mehden ruled against the county's motion to quash a petition drive to place the future of Community Hospital before local voters. Petitioners collected almost double the signatures needed to force an election, but though the initiative qualified in time to make the March ballot, supervisors refused to add it, forcing the measure to go on the November ballot and giving Sutter extra time to fight it.

One week before the election, Sutter ignored its vow to the IRS that the corporation would not intervene in political campaigns, and tossed more than $200,000 of its considerable resources into the campaign, using slick promotional mail, newspaper ads, and a last-minute poster campaign to defend its contract.

Once in charge, Sutter embarked on a snazzy marketing campaign, made exterior changes to the buildings, and ceremoniously dropped the name "Community Hospital" for image reasons. The May 9 "Community News," a Sutter in-house newsletter for employees, volunteers, and board members, states that "it was determined that keeping [the name] 'Community' may reduce the potential image improvement of a name change."

Ironically, the word community had figured quite prominently in the Sutter 1996 annual report, "1996--The Year in Review. A Report to the Community." It states, "At Community Hospital, we believe the key to our continued success is an open, positive relationship with the members in our community. . . . We never forget that the support of our community is what makes our success possible."

'Dangerous Medicine'

IN PAST MONTHS, and since the takeover, there have been several state Health Services Department citations criticizing Sutter for failing to continuously monitor heart patients on telemetry, not responding to patients' call buttons, understaffing the perinatal and pediatric wards, serving cold meals, and inadequately training nurses assigned to the intensive care unit.

Sutter officials say they've responded well to every state visit and add that the hospital has never been fined.

Last October, Irene Fox, an 80-year-old retired schoolteacher, died while being administered an intravenous injection while under care at the medical center. Her family has filed a wrongful death lawsuit against Sutter and against the nurse who reportedly administered the fatal, concentrated solution of potassium chloride to Fox, who lapsed into convulsions and died moments later while family members were in the room. "We will go forward with the suit and get a trial date in a year or so," says attorney Michael Casey, who is representing Fox's relatives. "We've had some discussions with the hospital about trying to resolve this, but the family thinks the hospital is not taking the claim seriously," he adds.

The past year has also seen staffing changes and restructuring of services that have proved unpopular with workers. One detailed internal memo sent by Dr. Marc Eiseman, a physician at the Family Practice Center, to Sutter CEO Cliff Coates and all FPC staff noted that patients had to wait hours for appointments; almost half the patients' charts were missing; no one answered calls to the radiology department (to help interpret X-rays); and a depleted staff was run ragged attempting to keep up.

"Things were bad before Sutter came on board, and now, with the recent cutbacks in the medical records department, they are shameful," wrote Eiseman. "From a liability standpoint, it is only a matter of time before something will slip through the cracks (an abnormal Pap smear or mammogram, elevated blood glucose, etc.) which we will fail to follow up on and which will lead to a bad outcome (an undetected cancer, diabetic ketoacidosis, etc.). . .

"This is dangerous medicine."

Another widely distributed internal memo, this time from Family Practice Center Director Sean Gaskie, M.D., notes "an alarming and unacceptable pattern of office closures and patient dislocation due to staff cuts and consolidation."

Gaskie later blasted the Independent for publishing that memo, claiming, "It is your prerogative to quote the most inflammatory and hyperbolic rhetoric to be found in the purple prose of a couple of frustrated doctors."

That Gaskie himself was one of those "frustrated" doctors--his memo also states "an office system based on a floating crap game can only repulse patients from our system"--goes unmentioned.

Team Approach

MEANWHILE, a new "team approach," effective Nov. 3, is designed to reduce costs and improve efficiency, according to management. It will affect about 31 employees, including nurses, nurse assistants, and housekeepers. Under the restructuring plan, four supervisory roles will be eliminated and the new arrangement will save the financially strapped hospital about $300,000 per year.

The plan has been greeted with skepticism by workers. Michael Allen, manager of SEIU Local 707, says the union is "pessimistic and suspicious" of what looks like "de-scaling" the workforce. Nurses and health-care workers have marched in protest of the impending changes.

"The proposed model will fragment nursing care into tasks that will be performed by unlicensed, inexperienced personnel and will undoubtedly have an effect on the quality of patient care," says Glenda Canfield, a registered nurse at the hospital.

The Sonoma County Board of Supervisors entered into the private/public partnership after the financially shaky Community Hospital reportedly lost more than $11 million in revenues over five years. Sutter/CHS agreed to run the hospital for at least the next 20 years and gave final assurance to supervisors there would be no decrease in services.

Under the terms of the lease, the Sacramento-based health-care company agreed to maintain all existing programs and services, rehire all existing staff with the same wages and benefits, and spend up to $38 million in charitable health care over the next two decades.

Sutter Medical Center CEO Cliff Coates denies any hospital services have been trimmed or eliminated. "In terms of cutbacks or layoffs, we're constantly looking for efficiency," he continues. "We've been through at least three process redesigns here, some of which included layoffs and some of which didn't."

However, allegations are surfacing from some nursing staff and patients, including Gray, and from consumer advocacy groups like HealthWatch of Sonoma County that the hospital is dramatically reducing services and thus violating its lease agreement. Now, say some observers, there are lingering doubts about whether the community made the right choice in giving up Community Hospital, a venerable 130-year-old public institution that had played a role in the lives of so many local residents.

Dorothy Hansen of HealthWatch of Sonoma County--a watchdog organization that includes many who opposed the Community Hospital lease--says her group has been collecting data to ensure that Sutter Medical Center lives up to its contracts. She believes Sutter is in violation of the lease agreement. "We expected it to be like this," she notes. "It's the same progression of staff layoffs and cutbacks in service, and that's a familiar pattern in other North Bay Sutter hospitals. . . .

"We have to realize that Sutter is an aggressive, acquisitive company with a bottom-line mentality and they bear watching."

But Coates says Sutter has "far exceeded" the terms of the lease, both in the amount of money invested in the organization and in the amount of indigent care provided. "Charity care under Sutter management has increased to over 8 percent [of admittals], where in previous years it averaged around 5 percent," he observes.

The commitment made to the county did not specify providing the same services in the same way as Community Hospital did 10 years ago or one year ago, he adds. "There's not a commitment to make no changes," he says. "I think any organization that fails to change is not going to make it in the long run, and our commitment here is to the long run. We want to grow the organization, and in order to grow the organization we will make changes and we are making changes--and the county certainly understood that."

Sonoma County Supervisor Mike Reilly says that the county has an obligation to make sure all provisions within the lease agreement are enforced, but stresses there's a difference between transformation and transgression. "It's an easy assertion to say if [Sutter] is changing something, they're violating the lease agreement," explains Reilly. "There's a difference between them modifying services and violating the lease agreement."

But he adds that if there are citizen complaints brought to him about Sutter, he'd be interested in researching them.

Coates says Sutter Medical Center is involved in a long-term conversion process and the hospital is not making a profit. "In the first nine months, we've posted a loss of $4.2 million. I think that's an indication that this is a long-term project, and a quick turnaround is not something that's going to happen," he says. "We consider the losses that we're incurring now an investment because we continue to do all the good things that this hospital does, and by continuing to do what we're doing and to be more efficient at what we're doing, I think we're going to see growth.

"It really is going to require growth in order to operate in the black here."

One of the major challenges facing Sutter Medical administrators, he adds, is that the environment in health care is changing so rapidly and the demands are so intense. "The customer is demanding the highest quality [of patient care] and demanding efficiency.

"If we aren't providing both, then we aren't serving this community," he says.

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From the Oct. 23-29, 1997 issue of the Sonoma County Independent.

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