For decades, Berkeley, Calif., has been a refuge for radical thinkers and the homeless. But the city's concern for social services apparently doesn't extend to its largest hospital's plan to expand its obstetrics services.
The Berkeley city attorney's office has filed a lawsuit to keep 507-bed Alta Bates Medical Center from opening an enlarged obstetrics ward.
The city claims the $1.4 million renovation-intended to handle an additional 3,000 more deliveries a year to be diverted from Kaiser Permanente's soon-to-be-closed hospital in Oakland-was performed in violation of zoning ordinances and without the input of neighbors. The city fears traffic would increase on already congested Ashby Avenue, a main thoroughfare where Alta Bates is located.
"What they do within those four walls can affect what happens outside," said Zach Cowan, the assistant city attorney handling the suit for Berkeley. "If they're just using space for storage, that maybe would generate five trips to and from the hospital a day. But when you're talking about expanding patient services, that can generate a lot more."
The hospital entered a consent decree in 1983 with the surrounding neighborhood to limit expansion and keep residents apprised of any changes that might alter traffic patterns.
But hospital officials counter that interior renovations are governed by state agencies rather than local jurisdictions. They also cite studies claiming trips to and from the hospital have waned by 1,800 in the past decade. "The fact of the matter is we've been moving services out of the main campus for 10 years," said Alta Bates spokeswoman Carolyn Kemp.
How the varying points in this case have been argued seems to fit Berkeley's reputation as a harbor for freewheeling rhetoric. Cowan has bluntly criticized the opinions of a city-employed doctor. A legal brief filed on behalf of the hospital's neighbors was signed by a municipal court judge, forcing every judge in Alameda County to recuse himself from hearing the case. (The California Judicial Council has yet to appoint a new judge.) And questions also have been raised as to whether hospital unions striving to keep Kaiser's hospital in Oakland open have exerted political influence against the Alta Bates expansion.
Kaiser announced early last year that it would shut down its 335-bed Oakland Medical Center as part of a cost-saving measure. Services would be contracted out to other hospitals, including Alta Bates. Published reports say Alta Bates' obstetrics pact with the HMO is worth more than $100 million.
Kaiser officials did not immediately return phone calls seeking comment.
Meanwhile, the expanded Alta Bates facility, including a surgical suite, sits unused. Although the city lost an attempt to obtain a restraining order blocking the addition's opening, state regulators have declined to issue permits for its opening until the legal wrangling is resolved. Expectant mothers who experience complications must be transported down a floor for emergency surgery. Alta Bates officials are biting their nails over the potential legal liability.
"We can't limit access to pregnant women; we have a very vulnerable population. It creates a lot of chaos," said Paul Braunstein, M.D., Alta Bates' vice president in charge of medical affairs. The hospital handles two-thirds of the city births and 39% of the births under Medi-Cal, the state's Medicaid program.
The most puzzling aspect of this matter is that high-ranking city officials have done an about-face since Alta Bates began the renovations 18 months ago.
Berkeley Mayor Shirley Dean praised Kaiser's plans in a December 1995 letter to Kaiser Executive Vice President David Pockell. "Your business would mean a great deal to both Alta Bates and Berkeley . . . I congratulate you and your organization for the courage you have shown in evaluating alternatives to better serve your membership."
Berkeley's city health officer, Poki Stewart Namkung, M.D., had concurred with Braunstein's evaluation. In a January memo she wrote to City Manager James Keene just before the lawsuit was filed, she warned that "no agency can restrict a medical provider from delivering medical services unless there is proven disregard for medical standards of care.
"There is no medical emergency equivalent to an obstetrical emergency because there are two or more lives involved," added Namkung, who is trained as an obstetrician and holds a master's degree in public health. "To impose a physical situation that would impair obstetricians' and neonatologists' abilities to perform medical procedures in the most beneficial and speedy manner . . . is indefensible."
Cowan dismissed the memo, asserting that Namkung was unduly influenced by Alta Bates and has since changed her position.
"Anyway, her opinion (isn't) worth much in our view," he said.
Namkung refuted Cowan.
"In no way have I recanted my opinion," she said. Citing the litigation, she did not wish to comment further.
Cowan also questioned Alta Bates' mission to serve the community.
"They're a nonprofit entity in name only. They pay their executives high salaries, and we should not give them any slack," he said, after incorrectly stating that Alta Bates' parent company, Sacramento-based Sutter Health, was a for-profit corporation. "We're treating them like anyone else," Cowan said. "They got caught with their pants down, and it's going to cost them money. Maybe they could operate this way in Adam Smith's era, but not anymore."
Observers have their own theories as to why the city has taken such a stance.
Wanda Jones, president of the New Century Healthcare Institute, a San Francisco-based consulting firm, believes the hospital's unions are behind the legal entanglements.
"This has really been engineered by them," Jones said. "It's about jobs at Kaiser. If they can block Alta Bates, they think they can force Kaiser to keep its hospital open. The traffic and zoning issues are specious." She noted that Rose Ann DeMoro, executive director of the vocal California Nurses Association-a union that has had repeated conflicts with Sutter-has been spotted entering the Berkeley city planning office in recent weeks. Attorney Cowan did not deny the contention.
"It doesn't make a difference who has been seen coming into the offices. Alta Bates officials have come in as well," he said.
CNA spokesman Charles Idelson confirmed his union is "adamantly opposed" to closing Kaiser's Oakland hospital, but for public safety reasons rather than jobs.
"The closure would create a medical emergency," Idelson added, insisting it would scatter the East Bay's emergency rooms over too wide an area.
However, he labeled contentions about DeMoro conferring with city officials as "laughable.
"All I can say is that (Jones) must be watching too many episodes of the `X-Files.' Not everything is a conspiracy," he said.
And despite the heated words, Cowan is optimistic the city can eventually reach an agreement with Alta Bates.
"The problem is here that (Alta Bates executives) just have to acknowledge, in some meaningful way, that we're the government, and they're not," he said. "And that they're willing to submit themselves to the authority of the civil elected government."