ACT NOW TO GET HOSPITALS OFF LIFE SUPPORT WE CERTAINLY KNOW THE PROBLEMS; ALL THAT'S LACKING IS THE INITIATIVE.

Byline: Keith Richman  LOCAL VIEW

WHILE reports detailing Medicare's dismal financial condition and the financial troubles at San Fernando Valley hospitals provide statistical evidence of our nation's accelerating health care crisis, tangible proof can be found in our own community.

In recent weeks, Tenet Health Systems announced it was selling 19 California hospitals, including two in the San Fernando Valley - the Encino and Tarzana medical centers. The reason given for the sales was the hospitals were not profitable, losing a combined $40 million during 2003. If the two hospitals eventually close, they will add to the 40 percent reduction of the Valley's hospital capacity during the past 15 years.

While there is always room for improvement, the financial crisis confronting California hospitals is not rooted in poor management. Indeed, more than half of California's hospitals lose money and the average profit margin for all hospitals is negative.

Such widespread financial trouble indicates systemic problems, not individual ones. Although strong efforts will be made to find new owners for these critically needed Valley facilities, the prospects for finding financially viable operators are slim. Remember, just a year ago Granada Hills Hospital closed, leaving a critical gap in the Valley's health care network.

With each hospital closing, our community loses access to quality medical care. Emergency rooms become more crowded, requiring ambulances to be diverted to more distant facilities. The closing of hospitals, emergency rooms and treatment wards also reduces access to quality care and our ability to respond to disasters and public health emergencies, when every available bed might be needed.

The systemic problems eroding our hospitals' balance sheets have been repeatedly identified, analyzed and reported. The problems of caring for the uninsured, low state and federal reimbursement rates, seismic retrofitting and nursing costs come up every time someone wants to grab headlines, but there is rarely ever any follow-through.

For example, strengthening hospital buildings to survive earthquakes sounds like a great idea, but the cost of actually doing it is daunting - an estimated $24 billion statewide. Besides the broader issue of establishing priorities for how that substantial amount of money is best spent to meet health care needs, it is having a very direct impact on hospital closures.

Tenet Healthcare highlighted $1.6 billion in seismic retrofitting costs as one of the reasons it's selling its California properties. With the 2013 requirement to upgrade most hospital facilities on the near-term horizon, those costs have to be added to future financial projections. It is ironic that instead of having a hospital at risk for not being available after an earthquake, the plan to reduce the risk may close the hospital without experiencing the earthquake.

Another seemingly good public policy prescription has also backfired and threatens the health care system it was intended to save. Several years ago, the Legislature addressed concerns about patient care by requiring specific nurse-to-patient staffing ratios for all hospitals to follow.

Unfortunately, the regulations implementing those ratios require the ratios to be in place ``at all times.'' The poorly drafted regulation requires substitute nurses to be standing by to allow regular nurses lunch breaks, restroom breaks or any other absence, however short, from their duty station. Previously in California, and currently throughout the rest of the nation, on-duty nurses fill in for each other during short breaks without requiring additional staffing.

While it is costly to pay fill-in nurses for short breaks, a bigger problem is there are simply not enough nurses. Many times nurses are simply not available at any price. If a hospital cannot provide the proper staffing ratios and backup coverage, they have two choices: break the law or reduce the number of patients.

As a sign of the widespread impact of this misguided regulation, a survey by the association representing California hospitals shows that more than 90 percent of California hospitals fail to meet the ratios ``at all times,'' and all hospitals are feeling the financial impact of the unreasonable regulation. These preventable costs add another heavy component to the financial weight already bearing down on Valley hospitals.

Recognizing their potentially harmful impact on access to patient care, I tried a number of times through a number of avenues to prevent the ``at all times'' regulations from taking effect the first of this year. I am continuing those efforts, hoping the weight of evidence from the first three months of experience will convince the Department of Health Services the regulations are unreasonable, impractical and contrary to their stated purpose of improving patient care.

Based upon conversations with other San Fernando Valley medical leaders, I am very concerned that the high cost of meeting the ``at all times'' regulations will claim more victims. In fact, Sherman Oaks Hospital is struggling with the financial impact of this regulation. It would be a severe blow to lose its quality care, especially at the Grossman burn unit, the finest in our region.

Saving California hospitals and maintaining access to quality health care in our community needs to become a top priority. We must address the critical issues that place our hospitals on life support.