When Alta Bates Summit announced its plan to consolidate services between its two facilities – Alta Bates Medical Center in Berkeley and Summit Medical Center in Oakland – East Bay lawmakers cried foul. The plan, which calls for “Centers of Excellence” to be instituted at both hospitals, seemed to break an agreement the hospitals made with the community at the time of their merger in 1999.
According to the consolidation plan, Alta Bates maternity services and oncology will be located at Alta Bates, while cardiovascular services and orthopedics go to Summit. Alta Bates Summit officials say that the consolidation will allow the system to provide better care in each of these areas.
Alta Bates Summit CEO Warren Kirk, recently named to his post, and Dr. James Cuthbertson, the president of the Alta Bates medical staff and member of the Alta Bates Summit board of trustees, sat down with the Daily Planet on Friday to discuss the changes they will undertake and to defend the hospital against its critics.
The second part of this interview will appear in Monday’s paper.
A lot of people are concerned that the plan calls for obstetrics to be located here at Alta Bates and removed from Summit. This would seem to contravene one of the promises that was made to the community when the two hospitals merged.
One person, Supervisor Keith Carson, says that it’s not fair to ask someone from East Oakland to come all the way to Berkeley to deliver a baby. Could you respond?
Kirk: First of all, it is true that when we first did our merger, we did say that we would make commitments to the community. One was around medical surgery services, the other was around the emergency departments and one was around obstetrics. We said we would keep those services in the community, at both hospitals. So that’s true.
The truth is that things in health care change dramatically. We’ve found ourselves, now, losing money at the rate of around $1 million per week. We’ve had to look at how we can reorganize ourselves so that we can be financially stable. If we can’t get these facilities financially healthy, they won’t be here.
So we need to figure out what we can do to become financially stable. Now, we’re not trying to be the most profitable hospital. We’re just trying to be stable enough to buy equipment, replace our facilities, give our employees raises – do the things we need to do to be a hospital. When we looked at the consolidation of services, bringing obstetrics to one place was an important part of that.
Now, there is absolutely no evidence that driving an extra 2.9 miles is a detriment to patient care. That’s just not true. Those kind of comments are being made by people who just don’t understand the delivery of health care.
Currently, Alta Bates has relationships with clinics all over Alameda and Contra Costa counties. We have community clinics from as far away as Pleasanton whose patients come here to deliver babies. We have people from much farther away than East Oakland – people who don’t have a lot of means, on the lower end of the socioeconomic scale, and they still come here to deliver babies. So it’s just not the case that it’s a burden to come to Alta Bates to deliver babies.
We want to change our view of ourselves. Alta Bates is not a Berkeley hospital, and Summit is not an Oakland hospital. These hospitals take care of patients in the East Bay. We take care of patients from the far north of Alameda county, far south, east... We have a huge cachement area. We delivered 7,000 babies at Alta Bates last year. Those weren’t just Berkeley women.
The services are still in the East Bay. We’re organizing them into “Centers of Excellence” that will increase our ability to expand our care. That’s where we’re heading.
There are people who have a different agenda. But the truth is that they’re not health care experts.
There were 3,300 babies delivered at Summit last year. How will Alta Bates cope with those patients?
Kirk: The relationship changes.
Cuthbertson: Some patients are going to move away from this facility with the consolidation of other services at Summit. That’s going to open space for the 3,000 deliveries that are moved over here. We’ll have expanded facilities for the deliveries, for the babies and for the moms.
It’s not a matter of expanding the volume of service that we have here. We’re going to be very careful not to do that. One of our responsibilities, being a neighbor here – it’s not so much what the patients in the hospital are here for, but to make sure that having patients in the hospital doesn’t impinge on the neighborhood through traffic. That’s what we’re trying to arrange, with the city and with the neighbors. Whether it’s noise, whether it’s parking, whether it’s the number of people driving up and down the street, we want to say, “This is our limit and we’re going to stay within it,” and be very careful to do that.
Another thing that people have suggested about the consolidation is that emergency services will be cut back, or concentrated at one or the other hospital.
Kirk: When you think about it, women in labor don’t come into the emergency room. They come into the lobby, and they go right up. Oncology patients who get admitted here, a large proportion of them, don’t go through emergency room, they are admitted directly by their physician.
But cardiovascular or orthopedics patients, a lot of the time, are brought in by an ambulance. Those kinds of patients will be going to Summit. So we expect, over time, that we’ll have less volume (at Alta Bates).
We’re not planning to downgrade the ER, but I think that we will see, over time, fewer visits – which, for this community, is a good thing. That’s what they’ve been asking us to do, to reduce traffic congestion. But for the patient who lives in this neighborhood and needs to go to the ER, we’ll still be here and available to take care of them.
So emergency services associated with “Centers of Excellence” at Summit will go to Summit.
Kirk: Right. Cardiovascular, orthopedic...
Cuthbertson: If an ambulance picks up someone who is having a cardiac event, they will know to go to Summit. Same with orthopedic injuries.
Certainly, though, if your loved one is having a heart attack and you put them in the car to go to the closest emergency room, (Alta Bates) might be it. That’s why we want to have the emergency room here. We’re still going to have patients in this hospital who will need a range of critical care services.
People have also been concerned about the psychological services provided at (Alta Bates’) Herrick Hospital in Berkeley. They feel that they are in peril, and from what I understand, from a letter you sent to employees, is that you feel they are imperiled as well. You say they are not supporting themselves financially. What is the problem at Herrick – why are psych. services not making money? – and what steps will be taken?
Kirk: The main problem is that the insurers, from whom we get patients, have been unwilling to pay enough to cover our costs. When the hospital stands to lose $40 million this year, we don’t have the ability to subsidize other campuses. So we have to find a way for them to be self-supporting. They don’t have to make huge profits, but they have to be self-supporting.
We believe we have an obligation to provide this service. There aren’t a lot of these services available in the county. If we don’t provide it, people will have a hard time finding a place for mental health. So we really feel that anything we can do to keep this service open, we need to do. That was the direction from the Board of Trustees and management – to find a way. But we can’t do that if we can’t get the people who send patients to us to pay us at least our costs.
Who are we talking about? Kaiser?
Kirk: The main problems we’ve had, traditionally, have been Kaiser and Medical. In the last couple of months, we’ve got a new contract with the county. Dave Kears at Alameda County Health Services was extremely helpful in helping us get a rate that will be sufficient to meet our costs, and that’s a very good thing.
Now we’re going to talk to Kaiser. We’re negotiating with them now, and they realize that if they want to continue sending patients to our facility, they need to be willing to pay us for the cost of taking care of them. They’ll decide.
It’s one of those things – every year, our costs go up. We give our employees raises, we have our union relationships that have built-in raises for many of our employees. The county and other organizations who send us patients need to recognize that and continue to give us the raises we need to stay ahead of costs.
So if you can work out a satisfactory relationship with Kaiser, there won’t be any danger to Herrick.
Kirk: Yes. But you have to realize that it’s an ongoing event. If you ask me a year from now, it could be a different story. Our costs go up, and the county and the insurers have to continue to be willing to raise our rates. As long as we can do that – stay ahead of our costs – we plan to stay in that service.