Residents of Ventura County, Calif., will vote March 26 on a ballot referendum that seeks to halt construction of a $51 million outpatient wing on Ventura County Medical Center.
It is the latest round of a public-private sector struggle precipitated by the coming of managed care and economic trends spawning increasing numbers of uninsured residents.
The referendum is sponsored by Taxpayers for Quality Health Care, a group financed by not-for-profit Community Memorial Hospital, which is located a block from the county facility in the city of Ventura. The group gathered almost 40,000 signatures to get the measure on the ballot.
Laura Dahlgren, a spokeswoman for the group, argues that the county doesn't need new outpatient facilities. Dahlgren is a nurse who took a leave from Community Memorial to work for the referendum.
The county hospital's interest "is purely to grow" by competing with the private sector, though that would mean duplication of services, she said. The county hasn't done a needs study to determine how existing facilities "could work together to provide a cost-effective system for everyone in the community," she said.
The county plans to issue "certificates of participation" rather than bonds to finance the construction in order to avoid putting the issue to a vote of the taxpayers, she said. Certificates of participation are bond-like financial instruments often used by municipalities. They usually pay higher interest rates and, unlike bonds, don't automatically require voter approval for issuance. But Dahl-gren charged that taxpayers will wind up paying for funding shortfalls, which are likely because the project depends on state and federal contributions.
The group also objects to the county setting up its own HMO for county employees and filing to obtain a state HMO license, ostensibly to serve patients in the state's Medi-Cal managed-care program, Dahlgren said. Medi-Cal is California's Medicaid program.
With that license "they can offer the HMO to small businesses," which form the backbone of the county's economy, and thus unfairly compete with the private sector, she said.
But Samuel Edwards, M.D., the county hospital's medical director, pointed out that the state ordered the county to get an HMO license in order to serve Medi-Cal patients.
Edwards also said "study after study" found that construction of the new wing is the most cost-effective way to serve the indigent. Many former patients of private facilities have lost private insurance over the years and now must receive their care at the county hospital.
"We are the safety net," he said.
Edwards said he understands that "these are terrible times for hospitals and they are desperate right now. It's brutal up here. Everybody's frightened and upset." But the county has embarked on the best course to care for the indigent, he said.
Faced with a huge deficit in 1986 and 1987 that threatened the survival of medical services provided by the county, officials "decided to change the model completely," Edwards said. Nine county clinics operated by private firms were established around the county.
Those outlying clinics "have to be supported centrally" by outpatient specialty services such as surgery and obstetrics/gynecology now located in expensive rental quarters around the hospital. That's because there is no suitable space at the hospital complex, where some of the old buildings already have been razed, he said.
The new wing would house the specialty clinics as well as hospital dietary facilities and a laboratory, which are now in "ramshackle facilities," he said.
Edwards denied the county is competing for private patients. Private doctors don't send their patients to the county hospital except for certain trauma and neonatal intensive-care cases, which account for only 10% of the hospital's patients, he said.
The HMO for county employees has cut their healthcare costs, he said.