SONOMA COUNTY -- Capacity continues to top the list of community concerns on Sutter’s smaller, 70-bed hospital plan, according to a summary of comments presented during a Board of Supervisors’ workshop this morning.

District hospital officials announced during the meeting intentions to commence a study on the fiscal impact of the plan on the area’s district-run facilities.

Tuesday’s 9 a.m., two-hour meeting was the supervisors’ third workshop focused on Sutter Medical Center of Santa Rosa’s revised business plan submitted last November. The proposal includes the construction of a 70-bed hospital with a possible 29-bed expansion, as well as neighboring medical offices and a 28-bed, physician-owned hospital.

The Board of Supervisors will approve or disapprove the plan based on whether it meets Health Care Access Agreement obligations, which mandate Sutter provide certain services through 2016, or 2021 if the new hospital is built.

Today’s meeting was the smallest by far of previous standing-room-only gatherings on the topic. A majority speakers were in favor of the plan, though most were affiliated with Sutter either in construction of the new hospital or as an employee.

Dr. Dick Kirk, chairman ofthe Northern California Health Care Authority that represents the county’s district hospitals, as well as Healdsburg District Hospital Chief Executive Officer Evan Rayner, spoke about concerns similar to those stated in a letter to the board earlier this summer.  Mr. Rayner also announced the beginning of a study looking at the fiscal impact of Sutter’s plan on the finances of other Sonoma County hospitals. Dr. Kirk asked the board to introduce a “pay-or-play” kind of system related to indigent care and that a county-wide electronic health records system be implemented.

In addition to the Board of Supervisors’ workshops, Sonoma County Department of Health leaders have also convened nine, two-hour community focus groups that so far have collected more than 500 comments. The department also uploaded a link on the county Web site specifically devoted to the Sutter plan, which has experienced more than 3,000 hits.

Of the comments submitted to the department in focus groups, a majority, or 34 percent, were related to bed capacity. About 27 percent commented on access, and about 15 percent voiced an opinion about the impact on charity care, government programs or the uninsured. Another 15 percent touched on the health care access agreement, and about 9 percent related to other issues including the residency program.

Positive comments commended Sutter for seeking a sustainable business model and looking to projections that show inpatient need declining and preventative care increasing. Others expressed concern for capacity, saying the smaller number of beds will not meet future demand. Related to access, some spoke in favor of the location citing its proximity to Highway 101, while others were concerned public transit would be made more difficult. Others said the smaller hospital would redistribute more uninsured patients to surrounding hospitals and threaten those institutions’ financial vitality.

Sutter Chief Executive Officer Mike Cohill pointed out that about 75 percent of ICU and patients needing surgery beds have an insurer and that the health care access agreement does not require the organization to provide for all indigent patients.

“All of Sonoma County’s nonprofit hospitals, not just Sutter, have an obligation to provide access to care for the uninsured, indigent and Medi-Cal patients in this county,” he said.

First District Supervisor Valerie Brown said transportation is not among her concerns about the plan, saying the transit system will soon need reorganization because of state budget cuts, and at that time routes can be moved to better transfer patients to the new hospital. Supervisor Shirlee Zane of the Third District expressed concerns with capacity as it relates the aging population and the uninsured. Fifth District Supervisor Efren Carillo asked what would trigger Sutter’s decision to implement the proposed 29-bed expansion, to which Mr. Cohill said, “It would have to make good financial sense,” for instance if the market share changed in response to health care reform.

Sutter and the county health department both completed consultant studies to determine if the 70-bed hospital would meet future inpatient demand. The preliminary health department assessment shows some redistribution of patients to other hospitals. Sutter officials said the county report assumes no change in market share or a decrease in need for inpatient care as a result of technology, a managed Medi-Cal system and other factors. The analysis also does not consider data from the past two years, which show an average daily census drop of 30 percent. That number has declined about 55 percent since 2002.

The Sutter plan is currently undergoing environmental review, which is expected to conclude in about a year. The health department will continue to convene focus groups and present a final analysis of the plan during a future board workshop.

Sonoma County Health Services Director Rita Scardaci said the final report will incorporate data from the study by the district hospitals, as well as 2008 and 2009 Sutter census data and added research about the impact of technology, the aging population and health care reform.