Remote Hospitals Face Tough Road Ahead with Budget Cuts

Governor Schwarzenegger backed off many of the budget cuts he proposed in January to offset the state's $15 billion deficit. He dropped most cuts to education and a threat to close state parks. Schwarzenegger released his revised budget proposal last week and it included deepened cuts to health care providers. They're already reeling from a 10 percent cut in Medi-Cal, the state's health insurance for the poor. It'll be tough enough for urban hospitals to cope with that. KPCC's Julie Small says it'll be nearly impossible for remote hospitals, like one at Lake Arrowhead.

Julie Small: Tens of thousands of people visit Lake Arrowhead to enjoy boating on the clear blue water in the summer, or skiing in the fresh mountain air in the winter. Year round, Lake Arrowhead is home to 30,000 people. And when anyone, tourist or resident, gets sick or hurt, there's just one place to go: Mountains Community Hospital.

Emergency room visitor: It's my fiance. I think she has a couple of cysts that have burst.
Dr. Bijan Motamedi: OK, OK, OK.
Emergency room visitor: So she's right outside that door.
Motamedi: OK, OK.

Small: A man has brought his fiance to the emergency room. She's having seizures. Dr. Bijan Motamedi is on duty.

Motamedi: ER by nature is unpredictable. Anything can walk through the door.

Small: Motamedi drives to Lake Arrowhead all the way from the San Fernando Valley to work a couple of 24-hour shifts each week. He sees it all.

Motamedi: Anything from, you know, just a sore throat, or a rash, to life-threatening injuries, and trauma, and aortic dissection, heart attacks, and all kinds of stuff.

Small: The ER's critical function is to stabilize patients for transfer to full-service hospitals. The nearest one is almost an hour away. During the Grass Valley Fire last October, Dr. Motamedi treated firefighters for burns and smoke inhalation. This month, a little girl attacked by a coyote was treated first at Mountains Community before she was transferred to the much bigger Loma Linda Medical Center down the mountain.

Jim Hoss: This really is a state-of-the-art emergency room. It's got all of the capabilities of...

Small: Mountain Community's chief executive officer Jim Hoss says the six-bed emergency room treats more than 500 patients a month. The hospital pays a physicians group $200,000 a year to staff the ER. That physicians group just asked for more.

Hoss: We've told them that, with the cuts that we're facing, there's just no way that we can do that. So we run the risk of losing that ER group.

Small: Lawmakers cut Medi-Cal by 10% to help fill in the state budget deficit. That blew a $650 million hole in Mountains Community Hospital's budget, and it takes effect in less than two months.

Hoss: Eventually, and very quickly in my opinion, we'd wind up being forced to selectively identify services that we would close.

Small: Jim Hoss says he'll ask the people in Lake Arrowhead what should close. It won't be the ER. But what about obstetrics, or the long-term nursing facility, or outpatient procedures? Carol Banner doesn't like any of the choices.

Carol Banner: I had three children. They were all born here at Mountains Community. (chokes up) It's a huge part of our community.

Small: Two major fires in the last five years have left her, and a lot of residents, on edge.

Banner: Frankly, none of us want to have to face this. You know, we've been through a lot here, and our hospital was here for us. So, you know, governor, find some other place to tighten your belt. (laughs)

Small: But Jim Hoss doubts Sacramento will do that, so that begs the question...

Small: How long can you sustain these cuts before you're in trouble?
Hoss: That's a good question. I think we've got a perfect storm brewing, and I could see us being in a very compromised situation financially within three to six months.

Small: Hoss says other hospitals in remote places are worse off.

Hoss: There's no question in my mind that there will be some hospitals in rural California that will fail, or be forced to operate under the protection of bankruptcy, because of these cuts.

Small: Lake Arrowhead residents have voted before to tax themselves to pay for hospital services. Mountain Community's Jim Hoss says he could ask them to pay a little more, though he doubts many could afford it. At least he has an option; many of California's smaller hospitals don't.

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