Thursday, November 20, 2003
Yes on Measure Q: For good reasons, and for selfish reasons, Natividad Medical Center deserves our money.
Dr. David Dansky doesn't work at Natividad Medical Center. He doesn't stand to lose his job, or his patients, should voters reject Measure Q, the proposed half-cent sales tax initiative that would generate about $25 million a year to support the county-operated hospital.
Yet Dansky, a 10-year ER physician at the Community Hospital of the Monterey Peninsula (CHOMP), urges voters to support the proposed sales tax and vote yes on Q even if they don't live in Salinas or receive medical care at Natividad.
Imagine, Dansky says, if Measure Q does not pass. Natividad's emergency room sees upwards of 30,000 patients each year, and its clinics see an additional 130,000. If Measure Q fails, doctors and hospital staff have said that some of --if not all of--Natividad's doors will shut.
"Upwards of 160,000 people will have to go somewhere else," Dansky says.
He points out that local physician's offices, hospitals and emergency departments are already operating at close to capacity, and cannot possibly handle the 450 people per day that rely on Natividad and its clinics. Hospital emergency rooms, however, must by law evaluate and treat anyone who comes in the door. These 160,000 patients will by necessity largely be distributed between Salinas Valley Memorial and CHOMP.
"Both these displaced patients and our own will suffer increasingly," Dansky says. "Our already overburdened health care system will be dangerously overwhelmed."
He's right. Approving Measure Q will cost taxpayers about five cents a day. Rejecting it will cost Monterey County a whole lot more. The Weekly supports a yes vote on Measure Q.
Taxpayer groups, the Libertarian Party and the Farm Bureau, among others oppose Measure Q. Supporters include doctors, teachers, firefighters and emergency workers.
Opponents boil the issue down to dollars and cents. They say the proposed tax rewards bad policy and mismanagement at the hospital. And some, including a group called the "Coalition of Taxpayers Against a Sales Tax Increase," (the authors of the voter's handbook argument against Measure Q) argue: "Why should we subsidize a hospital that people in other parts of the county do not use?"
One answer is: "Because it's the right thing to do."
Natividad's a safety-net hospital, committed to serving all Monterey County residents regardless of their ability to pay. This means the county's poorest people use the hospital. About 13 percent of Natividad patients don't have any insurance. However, the bigger problem arises from the fact that 70 percent of patients rely on state or federal health programs, like Medi-Cal and Medicare.
These are the people picking lettuce in the fields, or washing dishes in the restaurants, or making beds in the hotels. In other words, the people who are driving Monterey County's multi-million dollar tourism and agricultural industries.
So: "Because we have a sense of social responsibility," would be another answer to the Measure Q opponents' question.
"Simple math" is also a good answer.
Natividad's administration and Measure Q supporters alike have acknowledged that money problems do exist. But they are working hard to fix them.
For the last three months, says Natividad's new CFO, Tim Nguyen, the hospital has been running in the black without any money advanced from County coffers. In September, Natividad showed a positive balance of $277,000--that's compared to a $2.1 million loss at this time last year.
Jobs have been cut, clinics closed and bills have been collected. But, Nguyen says, this savings isn't enough to keep the hospital afloat.
"Natividad has reduced expenditures, so people say, why do we need Measure Q? Because management can only fix some of the problems. We can try to control expenditures, but some things are totally beyond our control."
He's talking about state and federal subsidies, both of which have been cut. This means that providers will be paid less, and fewer private-practice doctors will likely provide care for Medi-Cal and Medicare patients.
Other Natividad expenditures include skyrocketing drug costs, along with labor, retirement, service and technology costs--all of which the Hospital has little or no control over.
"This is a county hospital," Nguyen says. "It's a safety-net hospital. We depend on subsidies to keep us afloat. Plus we've got the mix of patients--we have to treat everyone who comes to our door.
"This is straight math. It costs you X amount of dollars to run the hospital. You get reimbursed less than what it costs you to run the hospital."
There's another, purely selfish reason to support Measure Q. If it doesn't pass, CHOMP and Salinas Valley Memorial patients will feel the county-hospital patents' pain. If Natividad's ER shuts down, most of those patients will go to Salinas Valley Memorial or CHOMP's emergency room because, by law, the ERs have to provide care.
"We see between 47,000 and 49,000 a year at CHOMP's emergency department," Dansky says. "So this would impact us heavily. When you get sick with a kidney stone or a migraine, or you are in a car accident, how long are you wiling to wait with your child screaming or with your finger bleeding? How long are you willing to wait not because we don't want to see you but because there are no beds?"
Measure Q opponents say the hospital can outsource jobs, or sell the public hospital to a private company. Neither are good ideas.
Natividad has already tried outsourcing various departments. This was before Nguyen came on board. "Most didn't work out," he says. "We need to manage and control the whole process, not just piecemeal here, piecemeal there."
What are the chances that a commercial hospital would come in and buy out Natividad?
Nguyen's background is in for-profit hospital administration. He says Natividad could be a profitable medical center. But only if it cut services, reduced Medi-Cal and Medicare, denied medical assistance to all undocumented immigrants, and cut the program that pays for adults without any insurance.
"But that's not the county's mission," he says.
Natividad will never be a moneymaker for Monterey County. But that's not an excuse to shut it down.