SANTA ROSA -- Two Sonoma County health care districts say they plan on appealing a recent court ruling that mostly sided with Sutter Health over objections to Sutter's new $284 million hospital, now under construction just north of Santa Rosa.

Healdsburg District Hospital and the Palm Drive Healthcare District also laid out grounds for a potential settlement, calling for the county of Sonoma to create a countywide health care provider planning process.

Meanwhile, the Sonoma County Board of Supervisors last week added additional measures for Sutter to further offset greenhouse gas emissions from the construction of its new 82-bed hospital next to the Wells Fargo Center for the Arts.  Although the recent court ruling mostly sided with Sutter, Sonoma County Superior Court Judge Rene Chouteau faulted the county for its approval of the hospital on two conditions, one of which said the closure of Sutter's current, seismically unfit Chanate facility could not count as an offsetting measure.

The North Sonoma County Healthcare District, which oversees Healdsburg Hospital, the Palm Drive Healthcare District and an environmental nonprofit, San Rafael-based Transportation Solutions Defense and Education Fund, had challenged the county's certification of Sutter's environmental impact review of the project. The parties alleged that the EIR did not meet the California Environmental Quality Act, while also saying  the delivery of health care  would be negatively impacted.

The board approved a measure that requires Sutter to work on developing a public shuttle from the Sonoma-Marin Area Rail Transit (SMART) station in Santa Rosa, when it is built, to link northern Sonoma County with the commuter rail.  Sutter Spokeswoman Lisa Amador said the hospital has always intended on working with SMART and that the new ruling wouldn't affect construction.

The health care districts said their concerns remained unchanged.

"We remain concerned with health care in the region, and, in particular, the health care access agreement and its impacts on the future of health care," said Evan Rayner, chief executive officer of Healdsburg District Hospital. "This is even more problematic with the latest developments in health care reform over the last year, including exchanges, accountable care organizations, mandated coverage, etc.

"Accordingly, the district hospitals believe there are opportunities to improve the health care delivery system in Sonoma County, even if the Sutter project proceeds to completion," Mr. Rayner added.

In a statement, Sutter's Ms. Amador said the planned appeal was "misguided" and that the lawsuit was no longer about environmental concerns.

"Their lawsuit is not about the environment; they are asking the county to reconsider health care decisions that were made 15 years ago," Ms. Amador said, referring to agreements that permitted Sutter to take over operations of the former Community Hospital from the County in 1996.  "This is an abuse of the CEQA process and taxpayer funds."

"Healdsburg and Palm Drive District hospitals have now filed an appeal, and they have said they want to litigate court costs and attorneys fees for the case.  That means that two hospital districts, Sutter, a nonprofit health provider, and the county, all have to pay attorneys to keep litigating this misguided case.  This is a waste of taxpayer dollars," Ms. Amador said.

The district hospitals say the countywide health plan they seek would settle the lawsuit, according to a letter from the districts' attorneys accompanying the announcement.

The appellants want such a plan to include the following elements:

Allocation of uncompensated care fairly, perhaps in the way of an uncompensated care funding pool.

Confirm roles of district hospitals, including their roles in emergency care and pandemic response.

Define responsibilities for indigent care in their districts.

Examine possible modifications  to the health care access agreement.

Increase availability of health care specialists.

Cooperate on maximizing access to new federal revenue sources and adapting to Affordable Care Act of 2010 modifications.

A review of other county models of similar scope for best practices and possible augmentations,

The hospital districts also want a settlement to have a stipulated reversal of standing ruling, court fees and costs, and a nondisparagement clause.

Sutter said it would respond to the settlement offer confidentially.

The judge in June  ruled that the health care districts did not have legal standing to sue. That's what the districts are appealing.

"The judge's determination that the hospital districts do not have standing was wrongly decided," Mr. Rayner said.

The districts contended that general plan consistency, environmental impact and socio-economic impacts of the hospital would have a broad negative affect on the health care delivery in Sonoma County, particularly with the health care access agreement, which permitted Sutter to take over operations of the former Community Hospital from the county on the condition certain levels of care are provided.