County officials acknowledge that there might be tough times ahead for health care due to expected state budget cutbacks at the same time East County's population continues to grow. But county and Kaiser officials say they are doing their part, and everyone needs to work together to find solutions.
Rapaport, who took the helm at Sutter Delta two years ago, made his case recently at the Delta 6 meeting, a consortium made up of the leaders of the four East County cities and two county supervisors.
In a report, he outlined "the challenges we face in the growing provision of care to our East County residents. We look forward to bringing you into the loop in the hope that you can assist us in elevating the discussion, and more importantly the solutions, before we reach a crisis. We ask that the East County mayors' group recognize the importance of our community's health rests also with the health of its providers."
Specifically, regarding the county, Rapaport says that Sutter Delta:
• Has asked the county to strengthen its clinic system by adding urgent-care and after-hour services or pay providers to fill in the gap in coverage.
• Has asked the county to provide eligibility workers in East County who will come to the hospital to enroll qualified patients in the county's Basic Adult Care Services program. Currently, the county will not allow Sutter patients to register for the program until they are discharged from Sutter, which is not the case with the Contra Costa Regional Medical Center in Martinez.
• Would like the county to direct the ambulance system to transport patients more equally to both Sutter and Kaiser emergency rooms.
• Is asking the county to distribute more care resources to East County, where most of the county's growth has occurred in the past decade.
• Is frustrated that other local health care providers, including the county, have not engaged with the same effort as Sutter in working to provide a clinic in Oakley, resulting in not much progress being made.
The financial situation at Sutter has worsened since the opening of the Kaiser hospital in November. Kaiser used to reimburse Sutter for treating Kaiser patients in Sutter's emergency department. Now those patients are going to Kaiser, resulting in a significant loss of revenue for Sutter.
Several other factors are adding to the fiscal strain, according to Rapaport. Sutter's Urgent Care clinic had 6,280 visits last year, treating the uninsured for free. In the county, 15 percent of the population is uninsured. About 16 percent of people treated at Sutter's emergency room are uninsured. In 2007, Sutter provided more than $9 million in care to the uninsured.
His report to Delta 6 states that Sutter has asked Kaiser to share in the cost of caring for the uninsured, alleging that Kaiser officials have declined to share information or seek a system that would balance out the cost of health care between the two hospitals.
Rapaport also charged that Kaiser has refused to have the county-run ambulance system more equally distribute patients between the two hospitals' emergency rooms.
Jim Caroompas, a Kaiser spokesman, disputes several of Rapaport's contentions. Via e-mail, he stated:
"Kaiser Permanente's Emergency Departments are open to all, regardless of a patient's ability to pay. This is both our legal responsibility and an essential part of our mission to improve the health of the communities we serve.
"In addition, we provide low-cost Kaiser Permanente coverage to people in need, and offer comprehensive health insurance to low-income families through publicly funded programs such as Medi-Cal and Healthy Families.
"Kaiser Permanente has been instrumental in the formation of an East County Health Access Group, along with the other hospital CEOs and Dr. William Walker, director of Contra Costa County Health Services. We are sharing our data openly with this group.
"We follow all regulations and protocols for Contra Costa County (ambulance service).
"Kaiser Permanente provides significant funding, in the form of grants, to nonprofit groups in East Contra Costa County. Our local 2007 community benefit grants that serve East County total $306,000."
Walker, in a phone interview, said the county has been doing what it can within its budget to get more health care services to East County.
"Obviously, it's the fastest-growing area of the county," he said. "The county has been trying to keep up by putting more clinics and staff out there. We have clinics in Pittsburg, Antioch and Brentwood. We are working to increase the capacity and putting more providers in Antioch and Brentwood. We are also recruiting physicians to work out there.
"Beyond that, the county can't fix the problem by itself. We have to have partners. John Muir does a mobile van. La Clinica has a presence in Pittsburg, and is looking at the possibility of opening an extension of their clinic in Oakley or some other site that would expand further east."
Regarding Rapaport's request to more evenly divide the emergency room destination for ambulance patients between Sutter and Kaiser, Walker said there are rules in place based on the best interest of the patient.
Those suffering from trauma are taken to John Muir Medical Center in Walnut Creek. If the emergency is not due to trauma but is life-threatening (such as a heart attack), the ambulance driver must take the patient to the nearest hospital. If it's neither of those, the patient chooses the hospital.
"Gary Rapaport's concern is now that Kaiser has opened up, more of Kaiser's patients go to Kaiser," said Walker. "This is a revenue issue for him. There's not an easy solution to that without having a system in place that (overrides) patients' choice.
"We know right now there aren't sufficient funds to do everything we want to do. It's probably going to get worse. Not only with the county's budget but the governor's budget. Making people ineligible for Medi-Cal would impact us at the county level.
"Hopefully, we get through this by working together as partners. That's my hope. I understand that Gary is anxious and concerned for an immediate solution. There's probably not an easy solution."
County Supervisor Mary Piepho said in a phone interview, "Sutter Delta's been a great provider to East County, and I certainly recognize their long-standing relationship. But there is a competitive environment that is developing."
She said a meeting is scheduled in the coming weeks with East County leaders and health care providers to bring "the stakeholders to the table to talk it through. So they hear all of the information at once, as opposed to (just) Gary's concerns from the Sutter Delta perspective. It's important that we keep the dialogue going and understand each party's interests and concerns.
"We are all concerned. The cities are concerned. I am concerned because I need to make sure we (in county government) are doing our best to serve the public. Gary is raising the flag (on these) problems. We want to address them early on rather than later."