FROM STAFF REPORTS, ANG News Online

September 16, 2001

Two decades ago, a woman expecting a child could deliver her baby in one of six hospitals with maternity wards in Oakland. Now, under a newly approved proposal to close Summit Medical Center's maternity ward, only one will remain -- at county-run Highland Hospital.

Summit's maternity ward will be transferred to its sister campus, Alta Bates Medical Center in Berkeley, creating the West Coast's largest birthing center, where an anticipated 11,000 babies a year will be delivered. At Summit, 3,000 babies were being delivered annually.

For doctors long practicing in the East Bay, the closing of yet another maternity unit -- Alameda Hospital closed its ward in January, and Mt. Diablo Medical Center in Concord will close one this month -- marks another phase in a troubling trend of hospital consolidations and shrinking access to care in Alameda County.

"The patients that live locally here, many of them are indigent," said Dr. Magdy Girgis, an OB/GYN at Summit. "They find it very difficult to travel all the way to Alta Bates."
The transfer is part of a massive restructuring of the two-campus medical center, approved last weekend by the Alta Bates Summit Medical Center board of directors, that also might see psychiatric services ending at Alta Bates' Herrick facility in Berkeley.
"It is tough," agreed Carolyn Kemp, a spokeswoman for the medical center, adding that a need to stem financial losses are behind the proposal.
"But when it's all said and done, it's an incredible opportunity."

That proposal details a plan for creating five "centers of excellence," Kemp said. Women and infants' services, oncology and a new, minimally invasive surgery center will be based at the Alta Bates campus, and cardiology and orthopedic services will be concentrated at the Summit campus.

Psychiatric services at Herrick will be closed unless the hospital begins receiving higher reimbursements for mental health services from the government and private insurers.
The emergency departments will remain open at both campuses, according to Kemp, as will the intensive care units. The changes are scheduled for implementation by 2005.
Concentrating these services in each campus should save money and improve quality of care, Kemp said.

"We're on the verge of something that really could be extraordinary in these centers of excellence," Kemp said. "The studies that have been done show that quantity equals quality."

However, Summit's Girgis expressed concern about maintaining quality when caring for 11,000 maternity patients a year at one facility. He also said he is bothered by the fact that in 1999 Sacramento-based Sutter Health made an assurance during the contested merger of Alta Bates and Summit that maternity services would be maintained at both campuses.

State Attorney General Bill Lockyer sued to block the merger, citing antitrust concerns. In December 1999, a federal judge denied Lockyer's injunction against the merger. In May 2000, a federal appeals court upheld that decision.

"In my opinion, what is more important than money are broken promises to us," Girgis said. "When the merger was the subject of approval by the community, we as obstetricians were very concerned about the fact that when the merger takes place, they were going to move labor and delivery to Alta Bates."

"We all expressed that concern over and over. We were repeatedly and continuously assured that that would never happen," Girgis said. "And I do not believe that these promises were meant by Sutter."

County Supervisor Keith Carson also expressed dismay at the prospect of closing psychiatric services at Herrick. "Clearly the East Bay is overburdened with the number of people who are mentally challenged," he said. If Herrick closes, the county-run John George Psychiatric Pavilion in San Leandro will be the remaining psychiatric hospital in the northern part of the county.

The approved proposal was prepared by the Hunter Group, a Florida-based health care consulting firm famed for its austere cost-cutting recommendations. The Hunter Group is best known locally for advising the merger of Stanford Medical Center and the University of California, San Francisco, Medical Center. That merger fell apart in October 1999 after a tumultuous and money-losing two-year liaison.

But like many hospitals, Alta Bates Summit is caught in a squeeze between shrinking reimbursements and rising costs, said Donald W. Waters, the assistant executive director of the Alameda-Contra Costa Medical Association.

"The big picture story is that finances in health care are what's prompting this," Waters said. "That's what's creating the consolidation of hospitals."

With rising costs in supplies and pharmaceuticals, scant increases in state and federal reimbursements, pared down payments from HMOs, the new computer systems for electronic records, and meeting state-mandated seismic upgrade requirements, hospitals are struggling to stay afloat, Waters said.

That's no question that that's part of the equation," said Dr. Goldee Gross, an OB/GYN at Summit, and past chair of its OB/GYN unit. "My concern is they've taken one health care consultant's recommendation and they're making decisions that affect thousands of people. Bigger is not always better."

"There are many things that have changed that have impacted the medical centers," said Kemp. "First of all, it's the financial losses. No one could have projected that we could be sitting here right now." So far this year, Alta Bates Summit has lost more than $40 million, Kemp said.

But as a part the nonprofit Sutter Health group, Alta Bates Summit gets tax breaks, such as a waiver on property taxes, said Sherry Hirota, CEO of Asian Health Services in Oakland, a community clinic that cares for over 20,000 patients yearly.

"On one hand, to claim access to those kinds of dollars and then turn around and not be accountable for what services are provided to the community is unconscionable," she said.

The closure of maternity care at Summit, which has been in the community for many decades, also means the loss of an important part of Oakland's history, Summit's Girgis said.

"This labor and delivery unit here in the heart of Oakland is part of the history and culture of the city, like Lake Merritt," he said. "When you take that away from the city, I don't know how you can measure that in dollars and cents."