Hospital Emergency Room patterns difficult to track

Voters in the North Sonoma County Hospital District
(which stretches from Cloverdale to Windsor) are being asked to
approve a $150 per year parcel tax for Healdsburg District Hospital
in a special election on April 13. If approved, the tax will
replace a $85 parcel tax that the voters approved in November 2001,
when the hospital district was formed. According to hospital
leaders, the publicly-owned hospital will not last out the year
without the extra money. This is part three in a series exploring
the issues surrounding the hospital and the tax increase its
leaders have requested.
By Ray Holley, Staff Writer
Justin Furia, an active 12-year-old, had a “head-to-head”
collision with another child on the Foss Creek School playground on
Friday morning.
Boys running into each other at recess is a daily occurrence,
but Justin’s situation was a little different – he was actually
knocked unconscious for a few moments, the second time he has been
knocked out in a few months.
Justin was taken to the Healdsburg District Hospital Emergency
Department. He underwent an x-ray and a cat scan, and checked out
normally. Then he was released.
What would have happened if there had been no “ER” in
Healdsburg?
If Justin had had a serious wound that required specialized
stitches, if he was acting in a way that indicated that he might
have a brain injury, or if he had other complicating factors that
required cardiac or trauma specialists, he would have gone to one
of the larger hospitals in Santa Rosa, such as Memorial or Sutter,
regardless of whether or not Healdsburg was open.
“There are certain people who go to Santa Rosa (hospitals) no
matter what,” said Healdsburg Fire Chief Randy Collins, “but this
facility serves an important purpose.”
If an emergency can be considered “routine,” then Healdsburg
sees it, from 600 to 1,000 times a month.
According to the hospital’s Chief Financial Officer, Dan Hull,
the most common reasons to see adults in the Emergency Department
are breathing and heart problems – ranging from cardiac arrest to
congestive heart failure to pneumonia.
Children (defined by the hospital as age 17 and younger) are
seen most often for breathing problems, foreign objects lodged in
the wrong places, fever, stomach pains, and broken bones.
According to Hull, in December 2003 the ER saw 612 patients, 177
of whom were children.
Is Healdsburg’s fairly small Emergency Department really
necessary, with three large, well-equipped hospitals in Santa Rosa?
It depends on who you ask.
Mike DuVall, the Emergency Management Services Coordinator for
the county, said that funneling north county patients into Santa
Rosa will tie up resources and delay treatment of emergency
patients.
“You’re looking at maybe twice the time before you get that
definitive medical care,” said DuVall, who pointed out that
ambulances only bring in 15 to 20 percent of an Emergency
Department’s business. “If you drop your baby and it goes into
convulsions, you’re not going to call an ambulance,” said DuVall,
“you’re just going to jump in the car. That’s the population who
will be most affected.”
DuVall said that in cases like the dropped baby, parents will be
more likely to call an ambulance rather than deal with Santa Rosa
traffic. “What we fear is, if that facility is lost to us as an
emergency portal, that’s going to result in all those ambulances
tied up running into Santa Rosa.”
Wayne Bell agrees. Bell’s Ambulance has been in operation since
1956, and has had a close relationship with Healdsburg Hospital.
Bell sees time as the major impact of losing an Emergency
Department in Healdsburg – the time before a patient gets care, and
the time spent traveling to and from Santa Rosa.
“I don’t think people will die (without the Emergency
Department), but there is that golden hour with trauma. The quicker
they get seen, the quicker they eventually get out of the
hospital.”
Bell also notes that visiting a family member is more difficult
when the hospital is 20 miles away. He said that if Healdsburg
Hospital closes, as hospital leaders say it will if the April 13
parcel tax is not approved by voters, he will probably have to buy
another ambulance to cover the extra time his crews will spend
driving up and down the freeway. He said that an ambulance will
cost him $140,000. How will he pay for it? “I’ll have to raise my
prices,” he said.
Not everyone thinks the hospital’s Emergency Department is
necessary, especially in Windsor, which comprises the largest block
of voters in the North Sonoma County Hospital District.
“My guys tell me that 90 percent (of the medical calls that
require hospitalization) go south,” said Windsor Fire Chief Ron
Collier.
Collier said his family uses Healdsburg Hospital, along with
“the old-timers” in Windsor, but most people feel more connected to
Santa Rosa. “A lot of folks who live in Windsor are from somewhere
south of here, they don’t go to Healdsburg,” he said.
Collier said the Healdsburg Emergency Department is “very
limited on what service you get,” and that Windsor citizens prefer
more choices and services in Santa Rosa.
Collier said he will remain neutral on the parcel tax question,
but doesn’t think it will pass. “I was surprised that the first one
passed … in general conversation with people here I don’t hear
anyone supporting it.”
Collier is still smarting from a sound defeat that Windsor
voters handed to the Windsor Fire Protection District in September,
denying a request to raise the annual parcel assessment from $67.50
to $168. “I’d be a little upset if the community passed the
hospital (tax) and not the fire (assessment),” he said. “It’s like
schools. Do I support schools? Of course I do, but they took a
million dollars in public safety money from me. I’m a little
bitter.”
In Healdsburg, Collins sees a much greater impact. “The
Healdsburg Fire Department had 1,342 calls last year, an all-time
high, and 572 of those were emergency medicals. The impacts to this
department will be detrimental,” if the hospital closes, said
Collins.
Will some patients die without access to Healdsburg Hospital?
“That’s a real what-if question,” said Collins. “Given the fact
that it’s the only hospital between Ukiah and Santa Rosa, it’s
certainly a possibility.”
Dr. Walt Maack believes that if the Emergency Department closes,
people will definitely die for lack of rapid treatment, even though
ambulance personnel are well-trained and equipped. “There’s things
you can’t do in the back of an ambulance. As good as they are, they
don’t have the training of an ER doctor or an ER nurse,” he
said.
Maack has been a doctor in the Healdsburg Emergency Department
for 26 years, and hopes that the long-awaited Emergency Department
remodel will begin later this year. The department is cramped.
There are three beds with just curtains in between. The not-so-sick
patients occasionally wait in the hallway if a procedure for
another patient requires privacy or more space.
Maack said that perhaps 10 to 15 percent of the patients he sees
are what he calls “true, real, life-threatening emergencies,” but
that from the patient’s point of view, probably 50 to 60 percent
are considered emergencies.
The “non-emergencies” are primarily patients with little or no
access to health care. “We’re the court of last resort for the
uninformed, the uninsured, the un-looked after,” said Maack. “If
someone can’t afford health care, they come here, and we see them …
if this hospital closes, the poor will suffer more than the
well-to-do.”
While the Emergency Department has doctors and nurses on call 24
hours a day, the connection to the rest of the hospital affects who
gets seen. When the hospital performed major cost-saving surgery on
itself three years ago, closing the maternity ward and the
intensive care unit, the 24-hour availability of surgery affected
the Emergency Department.
Now, an operating room is typically available just Monday
through Friday during the day, so even a simple fracture or
appendectomy after hours or on weekends goes south to Santa Rosa.
Maack estimates that overall, 40 to 50 percent of ambulance trips
bypass Healdsburg and go to Santa Rosa.
The exact data about who goes to Healdsburg and who doesn’t was
unavailable from Mike DuVall’s office at press time, but he said
that his information technology staff member will be back from
vacation shortly, and the data will be available by the end of
March.
What about the rest of the hospital? Who uses it and who
doesn’t? Hull said he doesn’t keep track of patients by age, zip
code, or type of service. “We do mass-customization,” he said.
“Each patient is treated individually. We just don’t track it that
way.” Hull and his staff were able to determine that the hospital
has approximately 2,800 registrations a month. This figure includes
the Emergency Department, inpatient surgeries, outpatient
procedures such as x-rays and lab tests, and occupational medicine
visits.
Since it is a relatively small number, Hull counted by hand the
inpatient (overnight) visits by zip code. In December, out of 76
admissions, 37 were from Healdsburg, 20 were from Cloverdale, two
were from Geyserville, three were from Windsor, six were from Santa
Rosa, and the rest were from a variety of other places.
“They’re pretty much within this geographical area,” said Hull,
reinforcing the argument that the hospital serves primarily those
who want to be served in their home town.
Being a numbers man, Hull was able to be much more specific
about sources of payment. Medicare accounts for 45 percent of the
hospital’s patients; Blue Cross covers 15 percent; Blue Shield 6
percent. MediCal and other low-income patients account for 10
percent. HealthNet accounts for 4 percent.
The hospital tracked $802,043 in “uncompensated care” in 2003,
approximately 7.5 percent of the outpatient and inpatient
revenue.
Is this “charity care” a burden on the facility? Hospital
leaders say no. “There is a government mandate to see everybody,”
said Maack, “but the government doesn’t pay for it.”
Hull posed the question differently. “Is it losing money or is
it meeting a community need?” he asked. “I don’t think of it as bad
debt. I think of it as charity care. It’s part of our mission.”
Next week we will look at the hospital’s “12-Step Turn-around
Plan.” Is the plan working? What is helping and what is hindering
its progress?