Sonoma Valley Health Care Coalition

Final Recommendations Documents Available

2007-05-15T18:00:00.000-07:00

The final documents are ready and available. (pdf warning)

Executive Summary
Final Report
Statement of Purpose
Final Recommendations

Options & Survey Data Now Available

2007-04-30T23:10:00.000-07:00

Several new informational documents regarding the hospital community survey, and options presentation are available for viewing. (pdf. & ppt. warning. please don't try to download if you are using a dial up connection)

1. Options Presentation

2. Survey Powerpoint

3. Survey Raw Data

Another Monday Evening Meeting

2007-04-18T11:08:00.000-07:00

The Sonoma Valley Health Care Coalition will hold another in its series of Monday Night Coalition Meeting on Monday, April 23 at Andrews Hall in the Sonoma Community Center from 7:15 – 9 PM.

At this meeting Chuck Rund of the Charlton Group will present the findings of the recent phone survey sponsored by the SVHCC. The results from the medical staff and physicians survey and the mail-in public survey will also be shared as well as an update on the status of the major alternatives being considered and the decision making process that SVHCC is engaged in to make its recommendations to the Sonoma Valley Health Care District Board of Directors.

We encourage anyone who has attended the Monday night meetings to attend this update meeting and we also encourage anyone who has not attended but is interested in the issue, to come to the meeting.

Monday, April 23, 7:15 – 9 PM Andrews Hall at the Sonoma Community Center.

SATURDAY INFORMATION MEETINGS

2007-02-09T13:14:00.000-08:00

This coming Saturday, Feb 10, the Coalition is having two friendly meetings to give you the best thinking we've come up with and show you the options that are being evaluated.

We'll share our 8,100 hours of research and do our best to answer your questions and listen to your concerns as we move forward.

Please come to the one that suits your schedule to get the straight skinney, don't rely on gossip around the water cooler, or rumors on the grapevine. We'll give it to you straight. No secrets.

There will be refreshments, coffee and tea, of course, as well as a selection of Aug Sebastiani's wine, cheese from Gary Edwards' collection, other edibles from the valley and beyond. And, in the morning session, Shelley's Homemade Jams for your bagels and cream cheese from Homegrown Bagels.

Come for the food, stay for the presentation, or come for the information, stay for the food! Your choice!

TWO LOCATIONS -- TWO TIMES -- TO SUIT YOUR SCHEDULE -- RAIN OR SHINE
SATURDAY FEB 10

MORNING:
10-12 FAITH LUTHERAN CHURCH
19355 Arnold Drive at Petaluma Blvd
Goehring Hall

AFTERNOON:
2 - 4 FIRST CONGREGATIONAL CHURCH
252 W. Spain Street
Burlingame Hall

The Latest Documents Posted

2007-01-22T16:44:00.000-08:00

Today, we added the most recent documents for the IN TOWN OPTION and the SMALL HOSPTITAL to the blog.

The complete list of documents posted can be found on the right hand side bar. Scroll down to find the document you want to view, then click on it. It will open the Acrobat program and then open that document in Acrobat (the only way we can view PDF files in this system).

You can continue to open as many documents as you wish and print them, if you want to. Some of them take time to load, but take a few deep, relaxing breaths, and they will be on the screen before you know it.

Feel free to email me if you have questions about any of the documents, or are having trouble.

Shelley Arrowsmith
arrowfarms@vom.com

New Documents Posted

2006-12-19T12:57:00.000-08:00

Please see the new links to the documents for the Cirrus Proposal, Small Hospital Option, and Broadway Option in the sidebar. Please feel free to comment and ask questions. (documents also posted below) Thank you to VOM.com for hosting the documents for us.

Cirrus Documents
Original Proposal
John Thomas Revised Proposal
Timeline
Preliminary Site Plan
Site Plan w/Expansions
Supplement to Proposal
Square Footage Spreadsheet
Resumes of Key Personnel
Asset Management Market Study
Cirrus Response to Coalition Questions
Reconciliation of SVH & Cirrus FTEs
Program Diagram
Wayne Fairchild Resume
HFS Evaluation of Cirrus Proposal
Letter to Henry Grausz
Converted Use Estimate
Residential Land Estimate
SVH Discharges
Revised Sonoma Financial Proforma
Sonoma County Discharges
CA Heart & Surgical Hospital
Central CA Edoscopy Center
Financial Proposal
Fresno Surgical Hospital
Laguna Hills Surgery Center
Linden Crest Surgery Center
North Texas Hospital
Spring Creek Surgery Center
Surgery Center @ Craig Ranch
Thousand Oaks Surgical Hospital
Jim McSweeney Notes

Small Hospital Option
HFS Small Hospital Report
Small Hospital Description
Financial Model w/OB
Financial Model w/Out OB
OB Financial Analysis

Broadway Option
HFS Draft Evaluation
Pulic-Private Partnership
SVH $ Model- Broadway Business Plan
Ca Med Imaging Letter of Intent
SVH Construction Cost Estimate
Anshen & Allen 56 Bed Program
Amb. Svcs & J.V
Converted Use Estimate
Residential Land Estimate
Michael Roos Comments
Joint Venture Legal Structure
SVH Draft Project Timeline
Adjacencies
Construction Cost Contingency
Dr. Galanopoulos Letter to Henry Grausz
SVH OB Financial Analysis

Cirrus Health Proposal Evaluation Presented

2006-12-13T21:24:00.000-08:00

The Evaluation by HFS Consultants of the Cirrus Health proposal will be presented this Monday, 12/18 at 7Pm at the Vintage House, 264 First Streeet East, Sonoma.

This evening will be the first and only time that the HFS Evaluation of the Cirrus proposal will be presented to the public.

The evaluation, along with the Cirrus proposal and accompanying documents will be posted on the blog Friday morning.
The blog is being updated to reflect all proposals and evaluations so you will be able to view them all here, on the blog.

Hope to see you on Monday with your questions for Carl Gerlach from HFS Consultants.

Monday Coalition Meeting Replaced

2006-12-08T21:11:00.000-08:00

The regularly scheduled Coalition meeting will not occur Monday night as information regarding the next proposal to review is not, as yet, available.

Instead, a non-Coalition meeting will occur regarding the ideas about a Parcel Tax to keep the current hospital operational. Hopefully there will be as good a turnout as at Coalition meetings as this, too, is an important issue for the community to address.

The meeting will take place at Vintage House on Monday from 7 - 9PM. We urge you to attend.

Coalition Meeting Tonight

2006-11-27T17:24:00.000-08:00

Monday, November 27 at Vintage House at 7PM
We will be debuting the informational slide show that will be our "road show" tonight and will ask for your feedback.

We will also go through the schedule of activities and meetings leading up to our recommendation to the Board.

Thanks for your continued interest.
See you there.

IN-TOWN HOSPITAL PROPOSAL DEBUT

2006-11-17T10:47:00.000-08:00

IN-TOWN HOSPITAL PROPOSAL DEBUT

The Monday November 20 meeting of the Sonoma Valley Health Care Coalition will be held at Vintage House 264 1st St. East from 7 to 9 PM.

This meeting will be the debut presentation of the work of the “In-Town Hospital” sub-committee of the Options Committee. The Architects have been working hard with members of the sub-committee to evaluate how a replacement hospital would work on or near the present site. Tonight they will make their debut presentation to the Coalition.

Will they make it work, can it all fit in, have they left anything out? Come along on Monday night and find out.

While this is not an engraved and hand addressed invitation, anyone who reads this notice is encouraged to attend and bring your friends, associates, spousal equivalents, or even spouses!

This is the first time this presentation will be shared with the community. In order to speed up the future evaluation process, we have asked members of the Options Committee and the Steering Committee to be sure to attend so they will not need a separate presentation (which takes more precious time). No group decisions will be made at this time. This presentation will not be repeated. Information will be shared and questions will be answered.

Nov 13 Monday Coalition Meeting

2006-11-13T10:40:00.000-08:00

The subject of this Monday's meeting of the Sonoma Valley Health Care Coalition will be "OUR HEALTHCARE NETWORK - A HOSPITAL AND WHAT ELSE".

The committee has met a number of times and has refined the concept and has some further information to share. Your questions and input will be appreciated.

Also, there will be the usual Committee Reports and updates prior to the presentation

The meeting will be held at Vintage House, 264 1st St East from 7PM to 9PM.

Agenda - November 6, 2006 7 PM

2006-11-02T15:23:00.000-08:00

The next Monday Night Coalition meeting will be on November 6, at 7 PM at the Vintage House 264 1st St East, North of Spain Street.

We've all checked-in, we've checked-up and now it's time to talk about how we go forward. A panel discussion is planned with Steering Committee and Options Committee Leaders and you to go over the results of the Oct 23 break out group workshop. We're hoping to engage you in the conversation too.
· What Are The Most Important Things The Coalition Still Needs To Find Out?
· What Are The Most Important Things For The Coalition To Consider?
· How Do We Best Engage The Community Going Forward?
Working tonight toward the goal of taking our next steps in information sharing and engaging the community.

Y'all come! Check-In/Check-Up Workshop

2006-10-20T12:33:00.000-07:00

Sonoma Valley Health Care Coalition
MONDAY, October 23, 2006
7:00 PM – 9:00 PM Vintage House
264 First Street East
We will start on time we have a lot to accomplish!
Please come early to register and get a good seat!

1. Welcome and Committee Reports

2. “What Have We Learned” – A Check-in and Check-up Workshop
Facilitated by Jonathan Gottlieb and Cathy Webber, our community workshop consultants.

We’ve done enough education. Many of you have sat through those meetings, absorbed the information and even asked some questions. Now it’s time for YOUR FEEDBACK. We’re looking for dialog about our next hospital based on what we’ve all learned. Bring your friends even if they haven’t been involved in the past. A chance to get them up to speed and to get feedback from everyone who attends.

For a reminder of the meeting topics and speakers, see the list at the bottom of this notice, or go to the “all meeting notes” section of this Blog.

A Different Kind of Meeting Monday October 23!

2006-10-17T13:53:00.000-07:00

We need eyeballs!

No it’s not some Halloween prank. Sonoma Valley Health Care Coalition, YOUR volunteer group working to come to a solution about our next hospital needs you.

We need your eyeballs, your mind, your voice and your body for a check-in.
We’ve done the professional survey, we’re doing a mail in survey, but we want to check in with you, a little like a check-up, to see how we’re doing.

We need you to give us your thoughts and ideas about where we are, what we’ve all learned, and where we’re going on the road to our next hospital.

This will be a chance for you to express yourself and come to some concensus about where we are and where we are going.

We’ve learned a lot about what it takes to run an ER, about seismic rules and regulations, about eminent domain, about demographics, about ….. well, you name it, and if it relates to our hospital, we’ve had someone come to tell us about that subject.

Now it’s time to tell us what you’ve learned from all of this. Even if you haven’t been involved in the evening Coalition meetings on a regular basis, you have an opinion, a thought, a feeling about where we are and where we’re going.

Tell us. This is your chance. The first of a series of workshops to engage the community in dialog about our next hospital. Be a part of something big.

Vintage House, 264 First Street East
7PM – 9 PM Monday, October 23.

We’ll bring the cookies! You bring the eyeballs!

Sonoma Valley Health Care Coalition
working to find a 67% solution to our next hospital.

Monday 10/16/06 Coalition Meeting Topic

2006-10-14T18:55:00.000-07:00

The meeting topic for the usual Monday meeting of the Sonoma Valley Health Care Coalition will be Dr. Roger Richter, from the California Hospiatl Association talking about California Seismic Issues.

We are not alone in the seismic cunundrum we are in with our hospital. Dr. Richter will help us understand the seismic issues we face and why they are so important. The more we understand, the better we will be able to decide the best course of action for our next hospital.

Same time, Same place -- we promise!
Monday, October 16, 7PM to 9 PM
Vintage House, 264 First Street East,
Just North of the Plaza.

A View From Sonoma Sun

2006-10-03T12:38:00.000-07:00

In our hands

'“Whither the Hospital?” has been one of our recurring questions these last few years, and of course it was the question of concerned citizens in the Valley for many years before the Sun ever rose. Unfortunately, there is yet no answer to that question."

"We well remember when the hospital administration sat with the Sun’s editorial board last spring and said, in essence, “We can prove to you right now that the hospital will close in 8 months if Measure C doesn’t pass.”'

"Well, it didn’t pass, and it hasn’t closed. That’s thanks to continued good efforts by the administration, which we appreciate, but some credibility has been lost. That’s why we were so pleased to see the Plan B group form and step into the post-C vacuum. And why we’re so pleased the Health Care Coalition is active, though we wish Messrs. Pease and Edwards, the coalition’s designated leaders, could move its deliberations along a little faster."

"Nevertheless, the coalition’s process has been most interesting to follow, with a progression of largely disinterested speakers educating the community on sometimes complex aspects of hospital regulations, operations, financing, siting, and construction."

"Two weeks ago, the coalition heard a proposal, or more properly, a presentation, by Cirrus Health, a Texas firm that builds and runs private hospitals. If its due diligence pans out, Cirrus would build a new hospital at Eighth Street East and Napa Road, with NO taxpayer funds, and operate it in conformance with state laws requiring access by the entire community.
What’s not to like?"

"Well, as we learned at the coalition’s meeting this week, sewer and water. Those are the key problems that County Supervisor Valerie Brown and City Planner David Goodison identified for us. The county could, on its own authority, provide sewer service to the Eighth Street site, were Ms. Brown willing. And if the water problem could be solved, then the main regulatory hurdles would seem to be cleared, with no vote of the people required. That is, all the approvals could come by agency action – forget the daunting two-thirds majority of voters. No tax, and therefore no voters, would be needed! (Nor the cost of an election, nor the potential for another divisive contest.)"

"But how to solve the water problem? Wells? Really deep ones? Probably, water for the hospital is a higher priority than water for a golf course, but underground water levels reportedly have been dropping for years, in any case, and so water might need to be purchased, presumably from the Valley of the Moon Water District. And the district doesn’t serve that far east, UNLESS, of course, the land were to be within the Sonoma city limits."

"This fact ultimately puts the decision back in our hands, the hands of the voters, which is where it should be. Far better, that the citizens themselves vote to expand the Urban Growth Boundary to include the Eighth Street site, if it is to become home to our new hospital."

"A 4 percent increase in the UGB area would suffice, and the city could zone the connecting parcels as the county has them zoned now, so no immediate changes would result from the expansion of the UGB, other than to make possible a new hospital at the proposed site."

"So, fellow citizens, perhaps we’ll soon have the issue back in our hands. With rejuvenated leadership from the Hospital Board and support from the city council, this could work. Or not! We trust that the voters will make a good decision, as a community, once they have the opportunity."

"Other sites? Other proposals? Still not much from which to choose, and it may all be moot, if some measure isn’t put back before the voters, soon."

SVHCC Agenda 10-02-06

2006-10-01T14:09:00.000-07:00

Monday night’s Coalition Meeting will feature - “A Health Care System to Serve Sonoma Valley .”

Discussion will be led by Norman Gilroy who is putting together a panel of speakers with plans for breakout groups to review such matters as:

* A Network of Health and Wellness Centers
* The role of Sonoma Valley Community Health Center ,
* Integrative Medicine and the current program offered by the Hospital
* The Women’s Healthcare Initiative
* And much, much more ...

This promises to be a lively, informative session. A preliminary discussion of the subject at Thursday night’s Options’ Committee meeting elicited genuine enthusiasm for the topic and its ramifications.

You won’t want to miss this one.

Because Shelly Arrowsmith’s e-mail system is down and I do not have the complete list of Coalition attendees, would you please help pass the word along so that everyone who has interest will know what’s on tap for tomorrow night.

Thanks very much,

Steve Pease

Download Presentation Summary (pdf)

Health Care District Candidate Forum

2006-10-01T14:08:00.000-07:00

Sun to host health care district candidates’ forum
October 5th, 2006 from 7 p.m. to 9 p.m.

The five candidates running for the Sonoma Valley Health Care District board will participate in a forum on Thursday, Oct. 5, from 7 to 9 p.m. at the Sonoma Community Center.

Kathy Barnett, Lisa Hardy, Dick Kirk, Michael Norton and Arnold Riebli are campaigning for the two available seats on the board.Presented by the Sonoma Sun, the forum will be moderated by Sun publisher Bill Hammett and broadcast live on KSVY Sonoma at 91.3 FM.

Following introductory remarks from the candidates, members of the audience will be able to ask questions. All the candidates will have an opportunity to respond to all questions from the audience before making brief closing statements.

The event will be in Andrews Hall at the Sonoma Community Center, 276 E. Napa St., Sonoma.

Talking Out the Hospital Sites

2006-10-01T13:24:00.000-07:00

New hospital sites sized up (from Sonoma Valley Sun)
Officials explain permit requirements, pitfalls of potential properties

"How hard would Sonoma County fight if the Sonoma Valley Hospital tried to use eminent domain to build a new hospital at Maxwell Farms Regional Park?"

"That question was posed Monday night by Arnold Riebli, a candidate for the hospital board, to Valerie Brown, the Sonoma County Supervisor who represents Sonoma Valley. It turns out that initially, Brown was interested in building the hospital at Maxwell Park, which is located at Highway 12 and Verano Avenue."

'“I thought there was space available on Maxwell Park,” she told an audience of about 60 people who came to the Vintage House senior center for a meeting of the Sonoma Valley Health Care Coalition. It’s the ad hoc committee that’s trying to figure out how to keep a hospital in the Valley following the failure in the spring of Measure C, the ballot proposal to build a new, $148 million earthquake-safe facility replacing the existing Andrieux Street hospital, which the state may close in 2012 under current seismic safety standards."

"On Monday night, as part of an ongoing series of talks, the coalition invited Brown and other county and city officials to discuss some of the planning aspects associated with potential hospital sites.Brown said that about a year ago she invited people to sit down in her office to discuss the potential use of Maxwell Park as a hospital site."

"For years, hospital officials have eyed the park, which they consider to be ideally located to serve the hospital’s customers. Another advantage: The park is inside the city’s urban growth boundary, which means city water and sewer service is available."

'“Quite frankly, I thought it’d be nice to be somebody riding in on a white horse, doing something,” said Brown, describing her initial hopeful feeling about the park site. But it turned out that the county has taken grant money, including federal money, for the park on the condition that the land stay in recreational use."

“I honestly believe that land is sewed up,” Brown said. “I don’t even know if you can do an eminent domain on property that’s conditioned the way that is.”

"And so it went throughout the 90-minute meeting. Brown and the other officials indicated that all the proposed hospital sites were problematic."

'“I don’t envy any of you the challenge of finding the optimal site for the hospital. You’re going to have to figure out the least-worst option,” said Sonoma City Planner David Goodison. He kicked off the proceedings with an explanation of such things as the city’s urban growth boundary. It’s a line voted into place by Sonoma’s voters in 2000 that more or less matches Sonoma’s city limits."

"The only way the urban growth boundary can be expanded is by majority vote of the city’s voters. The urban growth boundary comes into play for two proposed hospital sites: a 22-acre site on the northwest corner of Eighth Street East and Napa Road and a 15 acre site on the southwest corner of Broadway and Napa Road."

"City sewer and water? It’s on the Eighth Street East site that the Dallas, Tex.-based Cirrus Health proposes building a privately funded hospital and medical office building alongside an upscale medical spa proposed by developer Henry Grause and architect Michael Ross."

"In order for the Eighth Street East site to get city sewer and water service, Sonoma residents would have to vote to expand the city’s urban growth boundary to include the 22-acre site along with about 50 acres of adjacent property. Supervisor Brown said that she met with Grause and Ross early on, when the two were simply proposing a spa on the property."

'“Quite candidly, I said to the two of them: You have huge hurdles with this property. You’ve got some huge problems attached to this particular parcel,” Brown told the audience."

“'The next time I hear about the Eighth Street East project, there’s a (proposed) hospital... alongside it.”'

"She suggested that a high-intensity use such as a hospital would be better inside city limits. Brown cited a Dec. 13, 2005 memorandum from the Sonoma LAFCO, or the Local Agency Formation Commission, that concluded that the spa would be more appropriate inside the City of Sonoma’s boundaries."

"LAFCO is a state agency created in 1963 to discourage urban sprawl. Each California county has a 7-member LAFCO comprised of local elected officials, and one member of the public who weigh in on annexations and other boundary issues."

"Steve Sharpe, executive officer of Sonoma LAFCO, told the audience of another hurdle facing any site to be annexed into the city, even if the city’s voters extend the urban growth boundary: If enough property owners inside an area that’s being annexed are opposed, the property owners can veto the annexation."

"Other potential issues that Supervisor Brown cited with the Eighth Street East site is that residents there already are upset about truck traffic, that the site floods and that she predicted wine warehouse tenants on Eighth Street East would clamor for the right to open tasting rooms, should the hospital get built."

"Or, well water and county sewer? Ross defended the Eighth Street East site during the question-and-answer period, saying the most emphasis should be placed on “which parcel has the most chance of delivering a hospital.”'

"Following the meeting, Grause said that a Eighth Street East hospital site could use well water. As for sewer service, the county has a moratorium on new hook-ups. But Ross provided The Sun with a copy of the 1998 resolution that established the Sonoma Valley Sanitation District’s urban service boundary."

"The resolution says that the county supervisors can provide sewer service from the Eighth Street East sewage plant if “a significant public... need is served.” Under that criterion, Ross thinks the supervisors could provide sewer service to a hospital on Eighth Street East, even if the property is outside the city limits."

"A proposed 15-acre hospital site on Broadway and Napa Road straddles the city’s urban growth boundary.“There has been talk about bifurcating the usage of the property,” Brown said, or possibly building the hospital inside city limits with its parking lot constructed as a separate project in the county."

"Mitch Mulas, a longtime Schellville dairy farmer, said at the meeting that there are sites with water and sewer service that could be used for a hospital, but aren’t getting attention.“I don’t think you’ve approached everybody,” said Mulas, who declined to name the sites."

What I Still Need to Know

2006-09-23T15:03:00.000-07:00

A lot of ground was covered in the Coalition Monday Meetings. But there’s a chance we didn’t cover something you need to know, or it wasn’t covered to the extent you need.

Let’s talk about WHAT YOU STILL NEED TO KNOW to make an informed decision when the time comes. Click the comment section below to begin the conversation.

You can review the handwritten meeting notes by clicking on the meeting notes section in the menu at the right.

What I learned from Coalition Mondays

2006-09-23T15:01:00.000-07:00

Almost every Monday evening for four months, the Coalition has put on educational meetings about issues relating to the Hospital. The intent was that you could gather information you need to know to make an informed decision about what our hospital should be.

This place on the blog is for you to tell us what you learned.

Did you learn something new, did you change your mind, do you feel different than you did before, or maybe it even confirmed what you already knew. Maybe there are others out there who agree with you, maybe they disagree.

You can find a link to the hand-written meeting notes to refresh your memory in the menu margin on the right.

Let’s talk!

Urban Growth Boundary Discussion

2006-09-23T12:37:00.000-07:00

UGB topic of talk

Sonoma Sun - News Briefs Sept. 21 2006

Sonoma’s urban growth boundary and the effect it has on siting a new Sonoma Valley Hospital will be discussed at 7 p.m. Monday at the meeting of the Sonoma Valley Health Care Coalition at the Vintage House senior center.

The speakers will Sonoma County Supervisor Valerie Brown who represents the Sonoma Valley and Sonoma City Planner David Goodison.

A potential new hospital site on Eighth Street East and Napa Road is completely outside the urban growth boundary while the potential site on Broadway and Napa Road is partially outside the boundary. A majority of city voters would have to agree to expand the urban growth boundary in order for city sewer and water service to reach the sites.

Topics will include whether the county would be able to extend sewer service to the sites even if Sonoma voters decided against expanding the urban growth boundary.

The health care coalition is an ad hoc group that’s been meeting regularly to work on plans for a new hospital following the failure in the spring of Measure C, a ballot proposal to sell $148 million in bonds to build a new hospital.

AGENDA Sept 24, 2006

2006-09-23T10:04:00.000-07:00

Sonoma Valley Health Care Coalition
MONDAY, September 25, 2006
7:00 PM – 9:00 PM Vintage House

Welcome and Opening Remarks – Co-Chairs (15 minutes)

• Options Committee Report
• Surveys update
• Communications – KSVY/Blog/Coalition Page
• Community Outreach Program

1. Site-related Issues: Urban Growth Boundary, Regulatory Requirements and Other Sticky Wickets (Valerie Brown, County Supervisor and David Goodison, City of Sonoma Planning Dept.)

2. Future Agendas

October 2 -- A Hospital, and What Else?: Other Healthcare System Possibilities – Norman Gilroy

October 9 -- Preliminary Voter Survey Results -- Chuck Rund, Charlton Research Company

‘Free’ Hospital Plan Gets Grilled

2006-09-14T13:05:00.000-07:00

Audience members pose tough questions at Monday forum

Sonoma Valley Sun

A proposal to build a free hospital in Sonoma didn’t get a free ride at a public forum Monday night.Audience members asked tough questions of the developers who want to build a privately funded hospital to replace the publicly owned Sonoma Valley Hospital, which faces potential closure in 2013 under state earthquake-safety laws.

And not all of them accepted the answers.At first blush, you might wonder what’s not to like about the private hospital, accompanying medical office building and luxury health spa that are proposed for the northwest corner of Eighth Street East and Napa Road.

The hospital wouldn’t cost taxpayers a dime. It would have a full-service emergency room open around the clock that would accept all patients. It would pay sales taxes and property taxes back to the community — unlike the public hospital, which pays no taxes.

Those were some highlights presented by John Thomas, president of the Dallas, Texas-based Cirrus Health, which proposes to build and operate the hospital, and architect Michael Ross, of the Boyes Hot Springs-based firm Ross Drulis Cusenbury, which would design the luxury spa.“The total public tax financing that’s being presented to you in this proposal tonight is... zero,” Ross said to an audience of about 80 people gathered at the Vintage House Senior Center for the Monday night meeting of the Sonoma Valley Health Care Coalition.

It’s an ad hoc group that’s trying to ensure that the Sonoma Valley maintains some sort of hospital following the failure in the spring of Measure C, a $148 million ballot proposal to replace the existing Andrieux Street facility. Thomas and Ross said that the privately funded hospital would make its money by drawing customers from the greater Bay Area — and the entire nation — for specialty treatments such as bariatric, or weight-loss surgery, joint replacements and “executive physicals,” 5-day stays at which wealthy patients with cardiac problems or other illnesses would dwell in one of 60 cabins at a luxury health spa that’s proposed on the property next to the hospital by Sonoma developer Henry Grause, who also took the microphone and spoke at Monday’s meeting.

The spa’s guests would learn exercise habits in the spa’s pool and other facilities and healthful cooking skills at such places as Ramekins Culinary School.Services guaranteed?Audience members didn’t pull any punches, once the presentation ended and the question-and-answer period began.

The current hospital’s administrators have said all along that some hospital operations, such as the emergency room, are money-losers.The first audience question came from coalition spokesman Bob Edwards, who wanted to know if Cirrus Health was willing to sign “legally binding” documents promising to provide the services that the public hospital now offers.

And Steve Page, general manager of Infineon Raceway and a leader in the pro-Measure C campaign, sought assurances that the private hospital would provide basic services to the community, even if such services weren’t profitable.

Page framed the private hospital proposal as a trade: Sonoma voters would have to approve an expansion of the urban growth boundary to allow public utilities, mainly water and sewer service, to reach the Eighth Street East site, which currently is outside the city limits.

That would allow the developers to open their medical spa, with the hospital and medical office building thrown in to sweeten the deal for the public. But Page said that if the hospital’s earnings took a nosedive, its investors would apply pressure to cut unprofitable services — as would happen in any business.

“Fifteen, 20, years from now... how do we assure that the memory of that deal doesn’t fade?” Page asked. In response, Thomas offered to sit down with attorneys to work out a solution.

Thomas also addressed the larger issue of private hospitals versus public hospitals.

Communities have concerns when private firms take over, he said.But Thomas said that private hospitals are successful, including in his home state of Texas where more than half of the hospitals are privately owned.

Enough customers? Robert Kowal, the Sonoma Valley Hospital’s chief executive officer, questioned Cirrus Health’s business model, saying that Cirrus planned on having 90 percent of its income come through surgery. Kowal said that, now, surgery only makes up a small percentage of the Sonoma Valley Hospital’s business.

Currently, 83 percent of the hospital’s clientele are medical patients, such as people in their 80s who need non-surgical treatment for such things as congestive heart failure, he said.“This isn’t razzle-dazzle medicine. It doesn’t pay well. I don’t see how your model can work,” Kowal said. “Our facility is just the exact opposite of what you’re talking about.”

Thomas responded by saying the proposed Cirrus Health facility would attract surgical business. At one point during his presentation, Thomas showed a satellite map of all the other hospitals, doctors and health facilities within a 30-mile radius of the Sonoma Valley — a market that he said could be tapped by the Cirrus Health facility and associated medical spa.

“This is $1.5 billion in hospital revenue, (some) of which could be brought to this community,” Thomas said.Thomas predicted that the new hospital would cost $50 million to $60 million. The capital for that would come from Cirrus Group, the real estate development sister company of Cirrus Health.

Cirrus Health is hoping to find at least 50 physicians who would each invest $200,000 in the hospital, or a total of $10 million.The physicians would own the hospital business and rent space in the building.John MacConaghy, a Sonoma attorney and elected member of the current hospital’s governing board, questioned whether the hospital would be able to attract enough business to produce the $6 million to $8 million in annual revenue that McConaghy estimated would be needed to cover the capital costs of the hospital’s construction.

Thomas said, “We believe the market’s out there to do that.” He said that Cirrus Health is working on an in-depth feasibility analysis that should be done by the end of October.Thomas said that Cirrus Health invited two dozen doctors to a dinner two weeks ago and the physicians had “high interest” in the proposed private hospital.

Throughout the evening, Thomas defended the idea of physician-owned hospitals, saying that federal studies have shown that such facilities provide superior medical care.Cirrus Health currently operates specialty surgical centers. Kowal said those only work if a full-service hospital is nearby. One woman in the audience suggested that “Sonoma will be an experiment” for Cirrus Health, because the proposed hospital here would be its first full-service facility.

Thomas responded, “We’re going to invest $50 million. It won’t be an experiment.” An audience member asked what would happen if the proposed Cirrus hospital failed. Grause said, in that case, the community could buy the hospital from Cirrus.“This community is going to buy one hell of a hospital really cheap,” Grause told the audience.If the community supports the Cirrus hospital proposal and amends the urban growth boundary to incorporate the site into city limits, Thomas predicted the new hospital could be built by March, 2011.

“In California, that’s a very quick (construction) for a hospital,” he said.Architect Michael Ross said that the Cirrus hospital proposal calls for freezing the existing zoning in place on the land that would be added to the city of Sonoma.“Therefore, it will not be sprawl-inducing or growth-inducing,” Ross said.

The Sonoma Valley Health Care Coalition won’t meet again until Monday, Sept. 25, when David Goodison, Sonoma’s city planner, and Valerie Brown, the Sonoma County Supervisor who represents the Valley, will speak about the urban growth boundary and other hospital siting issues at 7 p.m. at the Vintage House senior center.

Hospitals Struggle with Costs vs. Quality Service

2006-09-12T12:56:00.000-07:00

This Press Democrat article was reference by one of the commenters here. Please feel free to comment and discuss.

"Sonoma County doctors and hospitals are in the midst of a difficult balancing act."

"Doctors are struggling to improve the quality of health care in an environment where government and private health plans pay them less than doctors in other parts of the Bay Area.Hospitals, meanwhile, have undertaken $800 million in new construction projects at a time when the skyrocketing cost of providing unreimbursed medical care to the poor and uninsured is gnawing away at their bottom line."

"Total operating revenue for all seven hospitals in Sonoma County was up 14 percent in 2005, but operating expenses were up 18 percent, according to the county Economic Development Board."

"It's an ominous signal in a state where 70 hospitals have closed their doors in the past 10 years, said Jan Emerson, a spokeswoman for the California Hospital Association, a trade group based in Sacramento."We're very concerned about access to care," Emerson said."

"Hospitals can't continue running with a deficit situation over the long term. You can't continue to lose buckets and buckets of money and keep your doors open."

"High operating expenses are due in part to the rapidly increasing cost of providing care to the one out of four Sonoma County residents who is either uninsured or on Medi-Cal, a state low-income health plan that does not fully cover the cost of services."

"People who lack adequate health insurance delay getting health care and often end up in emergency rooms when they do get sick. Federal law requires hospitals to treat the people who show up, regardless of their ability to pay."

"Sonoma County hospitals saw the cost of providing charity care double last year, according to Moody's Economy.com, a West Chester, Pa., research firm.Sonoma County hospitals spent more than $2 million on what is known as charity care in the second quarter of 2005, up from $900,000 in the same period a year earlier."

"The figure jumped to $3.7 million in the first quarter of 2006."It's quite a significant problem in Sonoma County, and a problem for hospitals across the country," said Rakesh Shankar, an analyst with Moody's Economy.com."

"Another big expense is capital improvements.More than $800 million in construction projects are planned or under way at local hospitals. All seven in Sonoma County face a deadline of 2013 to bring their facilities up to state seismic safety standards."

"Some are replacing or retrofitting aging structures, while others are expanding their facilities to improve patient care.Sutter Medical Center, Sonoma Valley Hospital and Petaluma Valley Hospital expect to build new hospitals."

"Santa Rosa Memorial Hospital is building a new cardiac center and Kaiser Permanente is expanding both its hospital and its medical office buildings. Healdsburg and Palm Drive hospitals will be retrofitting existing structures."

"The cost of installing electronic medical records also is weighing heavily on hospitals' bottom lines. Startup costs for these systems are high, even though they may eventually save money because of better coordination of patient care."

"With such a system, doctors can access a patient's complete medical record online, together with the results of lab tests and the images made by X-rays, MRIs and and CT scans. A doctor in an emergency room who had never seen the patient would instantly be able to tell what medications the patient was taking and any drug allergies."

"Sutter Medical Center of Santa Rosa plans to implement a comprehensive electronic medical record system within two years, at a cost of $4 million to $5 million.By the end of 2007, all 20 physicians in the Sutter Medical Group will be using electronic medical records and the hospital is expected to be online in 2008, said Mitch Proaps, a Sutter spokesman."

"The system, which will be integrated with other Sutter Health providers, is expected to be the most comprehensive in the western United States, Proaps said. Santa Rosa Memorial Hospital expects to roll out its system in spring 2007 and be fully operational in 2008, at a cost of $5 million to $10 million."

"To eliminate medication errors, Kaiser plans to have a bar code system for patients. Drugs will be given a bar code when they leave the pharmacy and must be matched against a code on a patient's wristband before they are administered."

"Like hospitals, physicians are under pressure to invest in costly, but potentially life-saving, electronic medical records systems. Unlike hospitals, however, reimbursements to doctors are remaining flat. Partly because of the grim reimbursement picture, doctors are moving more slowly than hospitals to install electronic medical records systems."

"The initial cost for a physician's office is typically between $100,000 and $150,000, and most doctors' offices in Sonoma County are small.Most physicians will probably wait until there is a national standard that guarantees the system a doctor buys will be able to talk to every other relevant system, said Brad Drexler, a Healdsburg physician and a director of the Sonoma County Medical Association."

"The biggest stress cited by many physicians is wrangling payments from health plans, which peg their reimbursements to Medicare, the federal health plan for the elderly. And, Medicare pays Sonoma County physicians about 8percent less than doctors in the rest of the Bay Area, putting the county in the same basket as rural counties where the cost of living is much lower."

"In addition, doctors say the formula for annual increases does not keep pace with the skyrocketing cost of providing care."This remains the major issue for Sonoma County and the reason for the physician shortage," Drexler said.

"Unless both the formula for yearly growth and the (payment) inequities are fixed, the ability to attract and keep physicians in Sonoma County practices will continue to erode."

"The Sonoma County Medical Association, working with the California Medical Association, appealed to Medicare last year to change the ranking, without success."

"This year, the two associations will press for legislation instead. The California Medical Association is building a coalition with other states whose counties also have fallen behind, said Peter Warren, a spokesman for the California Medical Association."