County will require patients to pay
People seeking non-urgent care must qualify for some health plan or promise to reimburse
By Rebecca Vesely, STAFF WRITER, The Oakland Tribune
Tuesday, December 09, 2003

Starting mid-January, uninsured patients seeking non-urgent care at Highland Hospital and other county-run hospitals and clinics must qualify for Medi-Cal or another health plan or sign a document agreeing to pay part of the cost of care, the trustees of the Alameda County Medical Center voted Monday as part of a drastic budget plan.

The 2003-04 budget -- passed five months after the start of the fiscal year -- also includes cutting 176 full-time positions at the medical center to meet a revised deficit of nearly $72 million. Many of those positions are vacant, trustees said.

"We think we need to go back to patients and say, 'You need to help us,' said interim Chief Financial Officer Robert Strawn.

Strawn estimated the medical center would save $6 million this fiscal year through the patient eligibility mandate -- a policy county hospitals elsewhere have implemented. Staff reductions and not filling vacant positions would amount to another nearly $6 million savings.

On Nov. 18, the medical center's Board of Trustees announced a budget deficit of $85.6 million. That figure was reduced to $71.7 million Monday -- partly because of savings on staff vacancies and increased billing, Strawn said.

Over the past two weeks, administrators have reviewed plans to close hospital wards, lay off employees and slash speciality services.

Ultimately, the trustees agreed to some cuts, but pushed off others, preferring instead to stay about $23 million in the red.

"The problem we're facing is our responsibility to balance a budget versus our responsibility to the community to provide health care," said trustee Joe Phan.

The trustees delayed the opening of a new critical care unit at Highland Hospital from January to March, a savings of $1.2 million. And non-urgent staff will take mandatory and voluntary unpaid days off, a savings estimated at $4.3 million this fiscal year.

Nearly $1 million will be saved by consolidating vacant beds so entire units can be closed, Strawn said.

Staff attending the noontime budget

meeting were incensed at the cuts.

"You're saying none of these things will impact staff and patients -- you're wrong," said Lynne Behr, a registered nurse at Highland Hospital. "The reason we have vacant beds is that we don't have staff to care for patients."

Diane Lyles, a registered nurse at the county outpatient clinics, said charging the poor for care wouldn't just be hard on patients, but would make staff even more unsafe in their jobs. She tearfully spoke about Dr. Erlinda Ursua, a physician killed at John George in November, allegedly by a patient.

"Every day we are faced with people who will jump over the desk at us because they have to wait for services," Lyles said. "Telling people they have to pay money, that's going to make things worse when they've been getting things for free for years."

Board president Ilene Weinreb tried to reassure the staff by insisting, "We are not going to cut back on safety."

The trustees agreed to add 10 nurses to John George and continue to pay for two round-the-clock sheriff deputies added to the facility after the murder.

Distraught trustee Barbara Price, who like most of the other trustees has been on the panel since September, said the cuts were just the first step. "We're all under a horrible deadline," Price said.

Interim CEO Efton Hall Jr. is expected to present a comprehensive turn-around plan to the board in the next 30 to 45 days.

Despite the medical center staying $23 million in the red, Phan said trustees would not have to go to the Alameda County Board of Supervisors to ask for more money. He added that service closures could still happen, but "we don't want to attack services without careful consideration," he said.

The goal right now, Phan explained, is to persuade the county voters to support a half-cent sales tax for health care that will appear on the March 2 ballot, of which 75 percent of funds raised will go to the medical center.

"Before we can prove to the community that the ballot measure is worth supporting, we have to prove that we have control over the budget," Phan said.

Contact Rebecca Vesely at rvesely@angnewspapers.com