I am writing to urge neighbors to vote yes on Measure BB which will allow the North Sonoma County Healthcare District to enter into a purchase agreement for Healdsburg District Hospital to NorCal HealthConnect, a secular affiliate of Providence St. Joseph Health. I believe that this sale is necessary in order to retain local inpatient and emergency department services.
In my former capacity as a healthcare attorney, registered nurse and as the Manager of Health Policy for the University of California’s statewide clinical, teaching and research enterprise, the economics of small hospital closures were typically deemed inevitable, albeit not optimal. Indeed, we’ve seen neighbors in western Sonoma County attempt unsuccessfully to save their hospital.
Since relocating to Sonoma County and working as a healthcare consultant, university instructor and local volunteer for health-related initiatives, including serving as the Vice Chair of Alliance Medical Center, I continue to be concerned about the shrinking of our healthcare infrastructure even as the need for healthcare services grows.
Neighbors have shared legitimate concerns about this sale: religious restrictions affecting potential reproductive rights and end-of-life issues, and the continued imposition of district parcel taxes. I’ve also heard neighbors opine that Sutter Santa Rosa can handle the influx from northern Sonoma County.
As a life-long pro-choice supporter of Planned Parenthood and the first UC policy manager to steer funding toward palliative care, including end-of-life training throughout the UC system, I value these issues. But as a pragmatic believer in the need to ensure that access to high quality, affordable healthcare must take precedence over other legitimate, important issues if and when a conflict emerges, I continue to fight for access.
Why am I now advocating selling our hospital in order to keep services open in Healdsburg?
Hospital capacity. COVID-19 has significantly changed hospital scenario planning in a matter of months. Prior to the onset of COVID-19, in 2018, Sutter Santa Rosa, with 84 licensed beds, saw approximately 37,000 annual visits to its emergency department. Its medical and surgical beds were often full. Sutter has embarked on a significant expansion which will add nine emergency department (ED) bays, giving the hospital 22 ED bays, and 40 additional medical and surgical rooms, but this planning was undertaken years before current health crises affected ED and inpatient utilization.
I know from my earlier advocacy on behalf of UC that hospitals all over the state have been increasing the practice of “boarding” patients on gurneys in ED hallways as moving them to rooms “upstairs” remained unavailable. Patient care inevitably suffers. Closures of hospitals in an already constricted hospital environment during a pandemic with an uncertain future is short-sighted.
Time to treatment and surge capacity in the event of other hospital closures. Climate change-induced, out-of-control wildfires will continue to affect ED utilization and, as was seen during the Tubbs fire, the fires and/or resulting poor air quality may actually cause hospitals in the region to shut down. We continue to live in earthquake country which may also result in local hospital closures.
Most health experts believe that in addition to the anticipated respiratory ramifications of poor air quality, cardiovascular events — including heart attacks and strokes — increase significantly in the weeks following wildfires. The time to treatment for strokes and heart attacks directly affects outcomes. Planning for the inevitable shut-down of existing hospitals during wildfires and earthquakes must be factored into regional planning.
And, clearly, residents in the far northern reaches of Sonoma County and southern Mendocino County will likely encounter unsustainable delays if their closest ED is in Santa Rosa, especially if this ED is already experiencing delays in treatment.
The district tax issue. If the mission of the District is to provide access to local emergency and inpatient care for northern Sonoma County residents, and the tax was acceptable prior to affiliation, and the only way to continue to provide this care is through affiliation, then I see no conflict with continuation of the tax.
The mission is the north star here. We live in a world where economies of scale dictate shared services and affiliation agreements in order to provide value.
If the voters, truly understanding the capacity and time to treatment issues, do not perceive the value in continuing with local hospital services, then they can vote no on the affiliation, which will likely result in the end of local inpatient and ED services. The tax issue reflects how local voters perceive the value of having a local hospital, no matter with whom the hospital is affiliated.
In a more perfect world, with COVID behind us, and minimal threats to our healthcare infrastructure from earthquakes and wildfires resulting poor air quality, I would likely be less inclined to ask already economically burdened neighbors to continue to support this arrangement, including the continuation of the district tax.
But that’s not the world we live in now. I believe that we will see that we need to engage in additional investment in our healthcare infrastructure, including community clinics and our public health infrastructure. But that’s a letter for another day.
Terry J. Leach