County Medical Center needs vision for survival
Oakland Tribune
Monday, October 13, 2003

ALAMEDA County, like other counties, is in a tough spot.

Vulnerable to the massive state and federal deficits, and public policy changes in California that have stripped local governments of their ability to raise revenue, it is facing very difficult choices. At last count, the county's own shortfall for this fiscal year stands near $142 million.

Alameda County Medical Center (ACMC) -- the county's system of public hospitals and clinics -- like its counterparts in other counties, is not exempt from this predicament.

Today, ACMC's problem carries a price tag of about $50 million.

The medical center is part of the nation's safety net, which is collapsing under the weight of increasing demand from uninsured patients. Those factors, coupled with dwindling government support and a steep rise in health care costs, leaves public hospitals like ours fighting to survive.

Without a clear plan in place to address this problem, the lives of thousands of patients and working families, as well as necessary public institutions, are in peril. As outgoing leaders of ACMC, we urge the county to focus on creating a positive future for the medical center, where it can improve and grow to reflect our community's needs.

As other public hospitals meet this crisis, many creative approaches are emerging.

In Kern County, the supervisors will direct more insured patients to their public hospital by giving county workers a break on their co-pays if they use the county medical center for their health care. In Monterey County, the supervisors are asking voters on Dec. 2 to consider a sales tax increase to raise funds for the strapped Natividad Medical Center. In Los Angeles, supervisors asked voters last November to support their public hospitals, and they did so, approving a parcel tax increase set to raise $168 million per year.

Which leaves the urgent question for ACMC: where will the money to operate the medical center come from? A ballot measure, restructuring the medical center's debt to the county, and creating a referral system that encourages paying patients to seek care at public facilities are just a few ideas that have surfaced.

Yet, in spite of the existence of these ideas, Alameda County still lacks a plan for its public hospital. Every day spent without direction costs more than $100,000 and threatens the long-term stability of the organization.

Which begs a second fundamental question: does the Alameda County Medical Center set its own course or does the Board of Supervisors?

As ACMC trustees, we worked diligently to identify and address the challenging fiscal picture at the medical center, to cut costs, raise revenue, and become a more efficient operation. We reached out to the county leadership, organized labor, health care advocates, area hospitals and others both to inform and seek assistance identifying alternatives to solve the budget crisis.

These efforts were hampered, however, by fundamental confusion about the status of the medical center. Though set up to function on its own as a public Hospital Authority in 1998, ACMC lacks many practical tools to do so and remains largely dependent on Alameda County. This current ambiguity has played a large part in the two governing bodies being at odds, creating a confusion that has forced the medical center to suffer.

This is a situation that requires thoughtful analysis and the leadership of Alameda County's policymakers. We hope that the county and ACMC will come together to create an atmosphere where this work can be done. A positive result is in everyone's best interests, as the ultimate goal is to ensure the continued delivery of high quality health care to all Alameda County residents.

As trustees, we were thwarted by county leadership's refusal to work constructively with the medical center on its financial crisis. We hope that the new participants will fare better, as this is a critically important issue to all of us who live and work in Alameda County.

This article was submitted by four former trustees of the Alameda County Medical Center who resigned in September in protest of Alameda County's handling of the medical center's fiscal crisis. They include former ACMC President Maria Gallo, senior vice president at Union Bank of California; Secretary-Treasurer Robert Phillips, senior associate at PolicyLink; Robert Blackburn, former Oakland USD deputy superintendent and professor emeritus, U.C. Berkeley and CSU Hayward; and Barry Siegel, president of the Bay Area Tumor Institute.