Adventists Make Their Move

The Mendocino Coast Healthcare District edges closer to affiliation with Adventist Healthcare. Negotiations are ongoing, but the Coast hospital released a “Fact Sheet” Wednesday, September 25, detailing many of the terms of a potential 30-year lease agreement (with potential five year opt outs) in which local taxpayers and voters would retain control of the healthcare district and its property while Adventist Health would take charge of running all aspects of the Coast hospital, its clinic, home health, and its ambulance service.

Under this structure the current Board of Directors of the Mendocino Coast Healthcare District will remain intact; however a new “community” board will be formed with members appointed by Adventist Health. Most likely it will consist of eleven members, including three members from Adventist Health, one member from the existing board, the hospital's chief of staff, and six representatives from the local community, who will be selected by Adventist.

According to the Fact Sheet, affiliation will provide more resources “to recruit and retain staff as well as bolster departments that currently have unmet needs such as new equipment and upgrading existing facilities.” Adventist is likely to pour as much as $8-10 million dollars into capital maintenance projects as part of an affiliation agreement.

Readers will recall that when a request for proposal was sent out by the Coast Hospital District last spring, Adventist Health's response was deemed the only acceptable one by an ad hoc committee made up of two hospital board members and the interim chief executive officer (CEO). The hospital's chief of staff, Fort Bragg's city manager, and at least one other individual have been added to this committee since that time, though the full board of directors of the hospital has seemingly never voted on the additions.

As has been documented before, Adventist is not a newcomer to affiliating or acquiring financially distressed hospitals. In recent years it has gone through similar procedures with facilities in Marysville, Lodi, Tulare and Tehachapi. The Fact Sheet material claims that these hospitals have seen “significant improvements in patient and employee satisfaction. These areas have seen growth of services and financial prosperity as a result of affiliation with a larger system.”

Much of the Fact Sheet is presented in a question and answer format, such as “How will the decision be made?”

The responding answer: “The District Board is negotiating with Adventist to develop mutually agreed upon terms. If this is successful, then those terms will be presented as ballot measure language by November 26, 2019, for voting on March 3, 2020, by the registered voters in the Health Care District. A vote of greater than 50% will allow the affiliation to occur.”

Thanks to an error-filled editorial run by the coastal newspaper in late June, misconceptions have abounded about the parcel tax money collected by the hospital district as a result of the passage of Measure C in 2018. According to that June 27th editorial, “If the hospital affiliates, that $1.4 million a year from local property owners will very likely go straight into the revenue stream of whatever company takes over the facility…”

The Fact Sheet responds to that error. “The District currently raises approximately $1.6M per year through Measure C. This money will not be affected by the affiliation. The money will remain under the control of the District and will be spent locally following the stipulations stated in the ballot language of Measure C. The Measure C oversight board will also remain in effect.”

Readers and local radio listeners may be interested to know that on June 28, the day after the coastal newspaper editorial went public, KOZT radio DJ Kate Hayes compounded the falsehood by reading that portion of the erroneous editorial, more or less verbatim, on air, apparently having made no effort to verify its validity.

The Fact Sheet states that the present collective bargaining agreement will be accepted by Adventist. In answer to the direct query, “Will some staff be laid off?,” the response was, “It is expected that the clinical areas will maintain the current staffing with some even experiencing an increase. However, it is likely some positions will be centralized. Affected employees will be given an opportunity to move into other available positions and receive re-training.” That's polite language for some employees may have to take jobs in other Adventist facilities away from the coast, and, yes, some people will lose their jobs. How many remains to be seen.

Questions about clinics and what will happen if a doctor chooses to leave rather than work for Adventist were answered this way in the Fact Sheet: “All clinics will be maintained throughout the affiliation. If a provider (physician, nurse practitioner or physician assistant) chooses not to remain in their current position, then an interim provider will be brought in to ensure uninterrupted patient care until a permanent replacement can be hired.”

Which leads to the politically tinged questions about abortion and the rights of lesbian, gay, bisexual, or transgender individuals. The Fact Sheet states, “While Adventist Health does not allow elective abortions to be performed in its facilities, it does allow counseling around such options to be given to a woman by her provider, who would then make an appropriate referral out of the system for such services if the woman chooses an abortion. This is similar to what happens now. Currently, about one elective abortion is performed here [at the Coast hospital] every five years. There are no restrictions placed on performing a therapeutic abortion in an Adventist facility. So, in the case of a woman undergoing chemotherapy or similar situations where there would be a medical indication for terminating a pregnancy, this is fully allowed.

“While the Seventh Day Adventist Church has a stand opposing same sex marriage, it is important to know that Adventist Health is associated with but not run by the Church. State and federal law prohibits an employer and a health care provider from discriminating against patients or employees based on sexual preferences.”

The medical definition of therapeutic abortion is, “An abortion induced when pregnancy constitutes a threat to the physical or mental health of the mother.” Of course, interpretations of that statement can be broadened or adhered to in the strictest of interpretations.

The response to the specific subject of women's reproductive health was handled in this manner within the Fact Sheet, “Adventist Health does not place any restrictions on family planning discussions between a patient and her provider. This includes discussing such options as birth control, IUDs and elective abortions. There is no restriction on birth control (including IUDs) which can be placed in the clinics.”

Leaving that aside, perhaps more importantly, look to future agendas of the coast hospital's planning committee for discussion about the formation of a women's health center that would avoid competing with existing hospital services, but plug holes where services are not fully materializing.

The work of that planning committee may take on a more and more important role in light of the obfuscations on abortion rights and the omission of any direct Q&A in the Fact Sheet on the subject of obstetrics (OB)/labor and delivery. Of course, another hard reality remains the ever dwindling number of deliveries at Mendocino Coast District Hospital. After the first two months of this fiscal year that number had barely eked into double digits. Maintaining physicians and nurses for this service has become a financial drain on the hospital that nears two million dollars per year.

The economic elephant in the operating room remains the required seismic upgrade of the hospital by 2030. The Fact Sheet responds with, “Bringing our existing [nearly 50-year old] building to code will cost at least $24M. In which case, we are still left with an old building that lacks modern health care innovations. Building a new hospital will cost around four times that; however, it will be much more attractive, both physically and functionally. The role of Adventist in helping meet this requirement is a key part of the ongoing negotiation.” 

That last sentence is the financial understatement of this and the upcoming decade.

Public forums to address questions surrounding the potential affiliation are scheduled for Elk on October 7, 6 pm, at the Greenwood Community Center; Albion on October 8, 6 pm, at the Pacific Union College Field Station; Fort Bragg on October 14, 1 pm, at the Senior Center; Comptche during the evening of October 14, 6 pm, at Chapel of the Redwoods; Mendocino on October 16, 6 pm, at the Hill House; Fort Bragg on October 21, 6 pm, at Town Hall; Fort Bragg again on October 24, 6 pm, at Cotton Auditorium. A forum in Westport is planned, but exact date and time is yet to be determined.

(More on hospital affiliation at malcolmmacdonaldoutlawford.com.)