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SANTA ROSA — Sutter Health next week faces one more key hurdle in getting its new hospital proposal passed – whether it meets certain requirements spelled out in the 1996 county Healthcare Access Agreement.

The Sonoma County Board of Supervisors last week tentatively approved Sutter‘s environmental impact review for a new $300 million medical campus off of Mark West Springs Road.

Now, the project’s fate is contingent upon whether the appropriate amount of beds are provided for acute care, whether Sutter will be able to provide care for a sizable portion of needed indigent care, and whether Sutter takes on an appropriate percentage of the county’s uninsured. A straw vote will be held on the health requirements Aug. 17, and a final vote is set for Aug. 24.

The requirements stem from Sutter taking over operations from the county at the current Chanate Road facility, which is now considered seismically unsafe by state requirements.

Supervisor Shirlee Zane said she thinks Sutter’s latest proposal will meet the required level of care and perhaps even exceed the previous level Sutter had been providing.

“From the analysis that the county did, they would provide the service within the contract with equal or better service,” she said. “We looked at the accessibility and services for indigent, the uninsured, women’s reproductive care. ... Based on the analysis, the hospital will meet the required agreements.”

Sutter’s plan, revised numerous times over several years, needed approval from the county Health and Human Services Department. In early July, the department recommended that the Board of Supervisors approve the plan.

But, Ms. Zane said, the plan was not always to the liking of county officials, and only recently was she persuaded.

Sutter’s original plan had called for a physician-owned facility as part of a 70-bed hospital. But the health care reform bill signed in March prevented physician-facilities that did not meet certain criteria by Dec. 31, 2010.

Shortly thereafter, Sutter amended its plan to include a total of 82 beds, with the possibility of a 27-bed expansion.

Ms. Zane said that while the number of beds isn’t the sole determining factor – a point Sutter has often made – the revised proposal was far more in tune with the county agreements.

“The thing about the hospital is that it’s not the beds as much as it is the staffing. You can expand services on staff ratio.” But, she added, “My top concern all along was that they were drastically reducing their medical surgery beds, and that’s needed for acute care,” she said.

Rita Scardaci, health and human services director for the county, echoed Ms. Zane’s point regarding the number of beds and other services. Of the revised plan, she said, “That moved them to a bed capacity that we believe Sutter’s proposal is a state-of-the-art facility that complies with the health care access agreement,” she said.

Ms. Zane said she thought Sutter’s revised plan ties in with the county’s goal of preventative care.

“It’s a paradigm shift in health care delivery towards preventative care and less acute care,” she said, noting that the need to stay in hospitals for extended periods of time is no longer the norm.

At the meeting last week, Supervisor Efren Carrillo expressed support for Sutter’s plan to address low-income patients, noting that the new hospital, while smaller than the Chanate facility, could play a role in preventative care that keeps the indigent and uninsured out of the hospital and within county safety nets such as health centers. He noted the proximity of Sutter’s proposed hospital on Mark West Road to the new Santa Rosa Community Health Center, which will open a 42,500-square-foot facility at Fountaingrove expected to serve 9,500 low-income patients. He also noted that a large percentage of the county’s uninsured reside in his district, which includes Roseland.

Evan Rayner, chief executive officer for Healdsburg District Hospital and the North Sonoma County Healthcare District, said he does not support the new location out of concern for the impact it may have on other hospitals. Whether or not it is consistent with the health access agreement is hard to say, he said, but it could still impact the delivery of health care.

“While the health care access agreement does not require the county to protect health care for all other hospitals, health care access for the region is a key tenet, and we believe anything that could affect that should be looked at with great concern,” he said.  The environmental impact review, he said “does not discuss any potential impacts to existing hospitals within the area.”

Ms. Scardaci said Sutter has consistently met its responsibility in providing care for lower-income county residents, and the new hospital would likely do the same.

Mike Cohill, senior vice president of Sutter Health, said at the meeting last week, “Sutter’s job is to care for patients regardless of their ability to pay and meet our obligations in the health care access agreement.”