Sutter/SR Already Cited by State

The situation at Community Hospital reflects the crisis in health care, now that insurance companies, large HMO's and large hospital affiliates run the show. Health care has become the bottom-line managed care industry, where efficiency and profit takes precedence.

"We used to be able to give massages," said Glenda. "We don't have time for that anymore."

If the proponents of Measure E are right, it's the quality of care and its accessibility to working people that will decline with Sutter/CHS on board. And a recent state report on staffing at Community Hospital confirms the nurses are justified to fear for their future.

That is one of three basic areas of complaint for which Community Hospital has been cited since Sutter assumed management. State Health Department investigator Diana Noffke found inadequate staffing, such as one case where no staff members watched monitors by which two heart patients were to be observed.

That assignment had been turned over to unlicensed staff who was not sufficiently trained, the report notes, and had not been informed that "a person trained in interpreting telemetry heart rhythms is to remain at the station 24 hours a day while patients are on telemetry monitoring."

The person, a medical unit clerk, responsible for watching the monitors, was found assisting with patient dinner trays. The state report concluded that the facility failed to develop written personnel policies concerning the clerk's responsibilities.

Hospital staffing is regulated by Title 22, which requires staffing to be done by acuity -- that is, adjusting the patient-nurse ratio for the severity of patient illness. Community has been staffing by numbers, using ratios that were developed before managed care started moving patients out of the hospital as quickly as possible, leaving only the very ill on the floor.

Staffing in the perinatal and pediatric units was not provided in accord with the level of care needed, the report says. Review of education personnel files revealed no evaluation of evaluation of a nurse's competency to work in the intensive care unit. The hospital has been notified of these findings and has responded as required with its plan of correction for each item.

It was not possible to find out how union representatives view staffing at the hospital because they are engaged in contract negotiations and are not free to speak publicly about management. hospital Director Coates also said that agreement has been reached in contract negotiations with labor, but the union says that is not so.

And it is also not possible for the press to investigate the charges alleged by the state and employees. Reporters are unwelcome to new management; Tom Chorneau, who has covered Community for the Press Democrat, was asked the leave the hospital last week when he went there to interview nurses.

"Now each of Sutter Roseville's nurses is in charge of patients in eight rooms, regardless of their conditions. And each nurse is head of a 'team' of other, mostly unlicensed personnel." Nurses complained that they were "too busy to give patients the care we want."

Asked whether Community would also reduce staff to cut costs, Cliff Coates replied, "All of us are faced with that struggle every day, and I can't tell you what will happen next month.

"If we do cut staff, it will not be through layoffs but by other means such as voluntary retirement." Asked if that would not reduce the nurse-patient ratio, he repeated, "We won't compromise patient care through layoffs."

Regarding Roseville, Coates said only that "if you compare Sutter with Columbia/HCA, Kaiser, or even Catholic charities, ours is the best. This is a very tough service industry."

In response to questions about the huge profits in health care, Coates replied that was false information. "This facility will lose many millions of dollars this year. Doctors salaries are declining. The public is demanding higher quality for the dollar. Statistics don't bear out that we have lower quality in health care. We have more efficiency."