County hospital needs life support

The county-owned San Mateo Medical Center cares for most of the Peninsula’s medically indigent residents. About half of its patients and half of its funding are on Medi-Cal. For years, the hospital has been the county government’s biggest budget drain, and this year it is on track to overspend its $232 million allocation by $5 million.

Medical center officials largely blame the current shortfall on a competitive new labor contract and an unusually high number of patients. But the situation is looking even more desperate for next fiscal year. Gov. Arnold Schwarzenegger has proposed a 10 percent cut in Medi-Cal reimbursements as part of an austerity budget to balance California’s projected $16 billion deficit.

To cope with the immediate shortfall, medical center administration is urging the staff to use as few supplies as safely possible. Much more dramatically, it will probably have to start turning some patients away for the first time. The hospital is looking at “capping” the number of patients it accepts into its acute care and intensive care units, where the most serious cases are treated.

The medical center has a capacity of about 70 acute care and intensive care patients. On average, 47 people were hospitalized each day in these units during January, but the cap being considered could be in the 30s. Once the hospital reaches that limit, patients would be turned away.

Some cases might be sent to other Peninsula hospitals or lower-level care facilities. Patients already admitted into the acute care unit who cannot be released might be shifted to a less expensive long-term facility.

County Supervisor Jerry Hill chairs the medical center’s board of directors, and for at least the last four years he has been attempting to persuade the Peninsula’s nonprofit hospitals — which receive attractive tax breaks — to step up and do more to share the county’s burden of indigent care. To date, those hospitals have been less than enthusiastic about opening their facilities to more nonpaying patients.

San Mateo Medical Center is generally well-rated for the quality of its medical care. But what is happening there now could well be an early warning for the varied fiscal challenges facing most other public health hospitals in the ultra-high-cost Bay Area. This roster includes the aging San Francisco General Hospital, which is hoping to place an $800 million seismic upgrade bond on The City’s November ballot.

Unfortunately, there seems to be no clear and immediate remedy for curing San Mateo County’s public hospital funding problem — as long as medical costs balloon while state and county budgets are especially hard-pressed. But Peninsula leadership must somehow begin seeking a long-term fix for San Mateo Medical Center’s money bleed, and any realistic solution would likely require a genuine public/private partnership.

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