Yearlong negotiations about forming an alliance between Kaiser Permanente and Doctors Medical Center in the East Bay region near San Francisco have collapsed, leaving Kaiser without a clear option for treating its acute-care patients in Richmond, Calif.
Kaiser had hoped for an agreement that would allow it to close its 3-year-old Richmond Medical Center and instead have its local enrollees treated at Doctors Medical Center, which has campuses in Pinole and San Pablo. More broadly, Kaiser continues to discuss similar plans with several other competing East Bay hospitals.
Officials on both sides declined to give an explanation for the breakdown in talks, but sources say disagreements about the transfer program's costs and integrating the two systems' physicians and protocols proved to be insurmountable.
"The complexity and scope of the challenges prevented both organizations from pursuing an alliance at this time," said Richard Cordova, Kaiser's senior vice president in charge of the East Bay region.
Kaiser halted inpatient services at its $50 million Richmond Medical Center in April 1997, because of low patient volume, but continues to offer outpatient care at the 50-bed facility.
Complicating matters is Kaiser's tentative plan to close its largest hospital in the East Bay market, 344-bed Kaiser Permanente Medical Center in Oakland, because the aging facility needs more seismic retrofitting and other work than Kaiser is willing to undertake. The closure would leave Kaiser without an inpatient facility to handle many of its enrollees in the Oakland-Berkeley region, a gap that prompted its decision to seek deals with non-Kaiser hospitals.
Overall, Kaiser has more than 1 million enrollees in the East Bay, including more than half a million in the area lining the Bay from Richmond in the north to Fremont in the south.
Under the deal that was being considered by Kaiser and Doctors Medical Center's owner, Santa Barbara, Calif.-based Tenet Healthcare Corp., Kaiser enrollees would have been able to receive inpatient care at Doctors from their Kaiser physicians.
Kaiser is already sending its maternity patients from Oakland to Alta Bates Medical Center in Berkeley, and is working on deals to send other Kaiser patients to Summit Medical Center in Oakland and Children's Hospital Oakland.
Following the collapse of Kaiser's talks with Tenet, Rose Ann DeMoro, executive director of the California Nurses Association and a frequent Kaiser critic, called on Kaiser to immediately reopen the Richmond facility's emergency and acute-care units. That would "provide assurances for Kaiser members and the Richmond community that they will have hospital services when and where they need them," DeMoro said.
The CNA and other critics say that Richmond, a predominantly low-income, African-American community, is the victim of "medical redlining."
The nurses union has filed a lawsuit in Contra Costa County Superior Court challenging Kaiser's closure of inpatient services at its Martinez facility, about 15 miles east of Richmond, on similar grounds.
Although the CNA isn't challenging Kaiser's Richmond plans in court, a spokesman said it is concerned about similar issues there.
Kaiser officials frequently contend that the CNA's comments are a smokescreen to hide its real concern that the shutdowns are putting nurses out of work. The CNA represents about 7,600 Kaiser nurses.
"We're looking at all possible alternatives, solutions and options," said Kaiser spokeswoman Kim Nguyen.
For several years Kaiser has been pursuing an alliance strategy in California that calls for signing multiyear patient-care arrangements with non-Kaiser hospitals so Kaiser can avoid the cost of building new acute-care facilities or upgrading its older hospitals. Kaiser's enrollment in California is burgeoning, having recently topped 5.5 million, after stalling for years at about 4.6 million.
But attempts to work out such an alliance agreement in Los Angeles with Catholic Healthcare West also have fallen apart, and now Kaiser appears to be rethinking the strategy.
Skeptics, meanwhile, are far from convinced that Kaiser will be able to piece together an East Bay system to replace its Oakland hospital by mid-1999.