In another potential blow to California's beleaguered hospital system, the CMS is threatening to cut off millions of dollars in payments to Alameda County Medical Center on Nov. 10 unless the public healthcare system corrects several quality and safety deficiencies uncovered by state and federal inspectors this year.
The dramatic move would effectively shut down the cash-strapped system, which includes 236-bed Highland Hospital, Oakland; 159-bed Fairmont Hospital and 80-bed John George Psychiatric Pavilion, both in San Leandro; and three outpatient clinics, all of which serve mostly low-income or uninsured residents in Northern California. Medicare and Medicaid reimbursements account for well over half the system's annual revenue.
The medical center's closure, which would strip the north part of the county of its largest emergency room and only trauma center, would strike a serious blow to California, where nine hospitals already have closed or announced plans to close this year, including San Jose Medical Center.
"Its role in the community can't be overestimated," said Rachel Kagan, spokeswoman for the California Association of Public Hospitals, adding that she does not expect the medical center to lose its funding. "There would an enormous gap in the county's emergency capacity, teaching (programs), outpatient services. ... It's a huge deal."
Officials at Alameda County Medical Center did not return phone calls seeking comment.
The threat of a funding halt follows two surprise inspections this year, triggered in part by the murder of a doctor in November 2003 and the suicide of a patient one month later, both at the John George psychiatric hospital.
The first inspection in February cited the psychiatric hospital for continuing to give patients access to dangerous objects, not properly monitoring and treating patients, failing to fix security systems, and neglecting to make corrections previously required by regulators, according to documents obtained by the Oakland Tribune.
A second inspection was conducted in August, this time of all the medical center's facilities. While noting significant improvements at John George, regulators found new problems, primarily at Highland Hospital, relating to medical records, pharmacy operations, physical environment and food.
Officials at Alameda County Medical Center submitted a correction plan in late September. But the CMS has asked the system to resubmit the plan with changes before the agency decides whether to approve it, said Steven Chickering, manager of hospital and community-care relations for the CMS' San Francisco office.
If the plan is accepted, regulators will conduct another unannounced inspection before the Nov. 10 deadline to "verify that all necessary corrections have been made," said Mary Francis Colvin, a nurse consultant for the CMS.
Setting a funding termination date is a serious action, Chickering said. Of the 550 hospitals in the four states covered by his branch, 50 to 60 are subject to inspections each year, but only 15 to 20 receive termination dates, he says. Most hospitals successfully complete a correction plan before losing their Medicare certification.
The CMS crackdown is the latest in a series of challenges that have plagued Alameda County Medical Center.
Last year, the medical center was forced to lay off 176 workers and close two clinics in an effort to plug a $62 million deficit. It was spared from financial ruin in March when county voters approved a half-cent sales tax increase designed to provide the medical center with an additional $70 million annually.