Will San Leandro Lose Its Emergency Room? 

County supes to decide whether to allow Sutter to walk away from San Leandro Hospital.

It's a strange sign of the times that even seismic retrofitting projects have their own blogs. Take SutterMedicalCenterCastroValley.org, a blog run by Sutter spokeswoman Cassandra Clark and dedicated to putting the best possible face on the hospital chain's plans for Eden Medical Center and the 120-bed San Leandro Hospital. Every week, Clark posts a new item about Eden, and why Sutter's plans are so crucial to health care in the East Bay. The blog even won two awards, Clark says.

Clark had better hope it's as good as it sounds, because Sutter has a big job ahead of it. The chain has a legal obligation to retrofit or replace Eden Medical Center by 2013, and every minute counts. But it also plans to walk away from San Leandro Hospital, by either handing it over to Alameda County or not renewing its lease to operate it. The California Nurses Association, as well as leaders from around San Leandro, are determined to pressure Sutter to find some way to save the hospital, which operates one of the county's few remaining emergency rooms. And their only leverage is holding up the permits to rebuild Eden.

On June 9, the county board of supervisors is scheduled to vote on whether to approve the Eden environmental impact report. If the hospital's supporters get their way, the EIR will go down in flames, and Sutter will have no choice but to help find a creative solution to San Leandro's problems. With millions of dollars at stake, Clark doesn't find this tactic too palatable. "This project is being held hostage for political purposes," she complained. But for nurses and residents around the city, it may be the only chance they've got to save a hospital that serves some of the East Bay's poorest people of color.

Sutter began operating San Leandro Hospital in 2004, but the hospital quickly started to lose money. Medicare reimbursements have been steadily cut year after year, and Medicare patients account for almost 70 percent of San Leandro's users. A dispute with the hospital's physicians led many of them to refer their outpatient clients to other facilities, which cut into revenue. One prominent hip-replacement physician died, and so did his lucrative practice. Last year, the hospital lost $6 million, and this year it already has lost more than $2 million. The hospital simply can't keep going down this path, Clark says.

But according to Jim Ryder, a spokesman for the California Nurses Association, Sutter hasn't exactly worked overtime to keep the hospital in the black. "Sutter doesn't talk about how they transferred profitable services over to Eden, or the fact that they're planning to build a $60 million surgery center next to the old San Leandro site," he said. "It's exactly what they did when they attempted to close St. Luke's and build a luxury hospital in Cathedral Hill. This is an indication of what Sutter does."

If both sides disagree on what caused the hospital's problems, neither do they agree on how critical San Leandro is to the East Bay's health care infrastructure. Ryder claims that San Leandro's emergency room has around 27,000 visits a year and that 40 percent of those visits are truly emergencies. Closing the hospital, he says, will have lethal consequences. "All of those emergency department patients that can't be seen at San Leandro won't be seen at Eden," he said. "That means more transport time. Patients are going to die because of the ambulance transport time. And Highland is relatively overwhelmed." But according to Clark, San Leandro's average daily attendance indicates that between forty and fifty patients occupy some 120 beds there, and the facility is seriously underutilized.

What everyone seems to agree upon is this: Although Eden and San Leandro are technically part of the same medical campus, San Leandro sees a lot more minority patients, and closing the hospital will have a profoundly disproportionate effect upon the East Bay's poor and people of color. Although Clark takes pains to point out that Sutter has not yet made a final decision about San Leandro, everyone else sees the writing on the wall and worries about the consequences. "If we don't have a health care infrastructure, we're not going to be a complete community," said San Leandro City Councilman Michael Gregory. "We'll be fractured."

But San Leandro's supporters think they have one last card to play. By law, if Sutter doesn't retrofit or rebuild Eden Medical Center by 2013, it faces losing its Medicare reimbursements. Sutter has pledged $300 million for the project, but the clock is ticking, and building a hospital from scratch is one of those things that takes a little time. Again, by law, the county Board of Supervisors must approve Sutter's environmental impact report before construction can proceed, and San Leandro's supporters have launched a massive campaign to pressure the supes to reject the EIR, effectively forcing Sutter to help come up with a way to save San Leandro as a functioning emergency room and acute care center.

"We are trying to convince the supervisors that the Eden EIR is fatally flawed, that it's illegal," Ryder said. "To make them send it back to the drawing board and restart a transparent process, with input from the community, local politicians, and the unions, on how to find a hospital operator to take it over. Since Sutter obviously doesn't want it anymore."

In fact, the county has been working closely with Sutter about the future of San Leandro. The nearby, county-run Fairmont rehabilitation hospital has its own seismic issues, and county health care director Dave Kears has been negotiating with Sutter to move its fifty-bed rehabilitation unit to San Leandro. Sutter even has offered $5 million toward that effort.

But to folks like Gregory and Ryder, these negotiations were nothing more than secret talks that bypassed the community at large and treated the closing of the emergency and acute care divisions as inevitable. "Sutter feeds information through confidential meetings, not open to the public, the unions, or even the county supervisors, to close down the hospital." Ryder said. "They offer the county $5 million as a sweetener, and the county believes they did a good thing, in that they don't lose two hospitals, they only lose the one."

For the last few weeks, Ryder and his colleagues have been swarming county supervisors' meetings, haranguing them to hold up the EIR and denouncing the closed-door negotiations. The supervisors, meanwhile, have been clearly taken aback by the furor. In one recent meeting, according to the Daily Review, things got so tense that Supervisor Scott Haggerty took a letter from the San Leandro City Council urging them to keep the hospital open, declared it "the biggest pile of crap I've seen in my life," and threw it in the garbage.

But so far, all this heat has worked at least a little. The county supervisors have repeatedly delayed voting on the EIR, and most of them did not return phone calls seeking comment for this story. The only one to do so was Alice Lai-Bitker, who doubted that San Leandro could be saved, but called back again and nervously asked that she not come across as insensitive to her constituents' health care worries.

For Clark, all these fireworks are more than a little aggravating. She claims that Sutter has been open about San Leandro's troubles for years, but the nurses and community members are only coming forward now to put the hospital chain under the gun and cost it a lot of money. "We see that as holding the project hostage to get noticed," she said. "I'm not saying that their concerns are not valid. But trying to do this now is too late. We have been very clear since the lease in 2004 to state the issues facing San Leandro, and asking the community to help. That has been to no avail." But for the nurses and their supporters, this may be the only option they have left.

This fight will come to a healthy boil on June 9, when the supervisors are scheduled to vote on the EIR once and for all. The nurses and local pols will be there, clamoring to save their hospital somehow. Sutter's representatives will look as professional and concerned as they can, even as the catcalls start. And the supervisors will curse the day this fell into their laps.


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