SONOMA AND NAPA — Sonoma Valley Hospital is in negotiations with Napa State Hospital to take on acute-care patients from the psychiatric facility that could increase patient volume by as much as 10 percent and add a significant source of revenue.

The negotiations come as Sonoma Valley is undergoing leadership transitions.

Earlier this month, Kelly Mather replaced Carl Gerlach, who retired, as the hospital’s chief executive officer, and Chief Financial Officer Tim Noakes recently accepted a position in the Central Valley with Sutter Health.

Talks between the two hospitals have been ongoing since April 2009, and Mr. Noakes, who will remain with Sonoma Valley until Aug. 11, said a contract could be reached within 30 to 60 days. Both hospitals could benefit significantly, he said, and the 83-bed acute-care hospital could stand to see a six-figure dollar amount from providing the care for the new patients. An exact dollar amount has yet to be determined and could fluctuate depending on patient flow, Mr. Noakes said.

Napa State currently contracts with Queen of the Valley Medical Center, also in Napa, for similar services. A partnership with Sonoma Valley would not replace that contract, but Napa State said it anticipates sending 200 to 300 patients a year to SVH.

Sonoma Valley would provide services that Napa State does not offer. Napa State has as a skilled nursing facility, but traumas and other serious medical emergencies are not treated at the hospital, which provides services to more than 1,300 patients on an ongoing basis and had an average daily census of 1,153 in fiscal 2009 and 2010.

“This will be a very positive economic impact,” Mr. Noakes said. “The revenues will exceed the cost of any patient volume. At the same time, Napa State will see a reduction in their costs by sending patients. We’re both state entities, and this could save some cost to both Napa and Sonoma.”

While the economic benefit has been cited by both sides, some concern in Sonoma centered on the safety of hospital staff and the community in general, Mr. Noakes said. When the hospital presented the idea to the public recently, residents and the chief of police expressed concern about potentially transferred patients, many of whom are remanded by the court to Napa State Hospital because of mental illnesses.

Approximately 80 percent of Napa State’s patients are “forensic individuals,” meaning a majority are deemed not guilty for crimes by reason of insanity or are considered incompetent to stand trial, according to Napa State. The remaining 20 percent of patients is ”civilly committed,” meaning they are either gravely disabled; unable to provide for food, shelter and safety; or are a danger to themselves or others.

Mr. Noakes said the safety concern was appropriate but stressed that precautionary measures have been and will continue to be explored before finalizing any contract.

“The police chief raised a lot of very appropriate issues that we need to make clear we’ve addressed,” Mr. Noakes said. “We are working to coordinate law enforcement in Sonoma Valley to work with Napa State, which has its own police force. Napa State will provide psychiatric and clinical staff, as well as any police officer presence."

Officials at Napa State said it only admits patients “who are determined to be a low security risk.”

Napa State would also be responsible for transporting the patients, who will all be individually evaluated before any transfer. Sonoma Valley would not take on patients suffering from trauma or other severe medical emergencies such as cardiac arrest.

“If it’s life threatening as defined by either Napa State or by the EMT staff, the patient will go to Queen of the Valley,” which is a level III trauma center, or another appropriate hospital, Mr. Noakes said.

But for patients with other acute-care needs, Mr. Noakes said Sonoma Valley is well-equipped to handle more patients, and the needs of Napa State patients won’t be much different than the care already provided.

“Reviewing the patients they had to send out of Napa State last year, there were very few that needed to go beyond our services,” he said. “At the end of the day this is just a managed care contract. It just happens to be for a unique population of patients.”

The departments that will be most impacted by the increase in volume include the emergency department, which will be the primary point of entry. Others include imaging, medical surgery, the intensive care unit and lab services, Mr. Noakes said.

In a similar partnership pursuit, Mr. Noakes said the hospital has received a proposal from the Marin Healthcare District regarding a possible collaboration.

“They’ve put forward a proposal, and now it’s our turn to respond,” he said, adding “the benefit of a strong relationship with Marin is clearly in the millions of dollars,” though exact details are still being ironed out and that number could change depending on what sort of agreement is reached.

Regarding his departure, Mr. Noakes said his main reasoning for accepting the job in the Central Valley was to be closer to home and his family, who live near Modesto. He started with Sonoma Valley last September. In his new role, he will oversee financial matters at Sutter Tracy Community Hospital and Memorial Hospital Los Banos.