Enloe pulls the plug

The Jan. 31 town hall meeting in the Willows Memorial Hall auditorium was titled “Glenn Medical Center in Transition.” But for the 200-plus people who attended, the gathering felt more like a funeral service for the community’s 50-year-old hospital, the only one in Glenn County. The pain and loss they felt was almost palpable.

Just a week earlier, Chico’s Enloe Health System, which took over operations of the financially ill Glenn General Hospital in 1995 under the name Superior California Medical Services, had announced it would close the hospital in five weeks.

On March 1 the facility would be transformed into an outpatient clinic open 10 hours per day, with no emergency room services. Emergency and off-hour patients with injuries and illnesses would be transported to Chico’s Enloe Medical Center, 45 minutes away by ambulance and 20 minutes by helicopter, assuming the weather allowed and the chopper was available.

A woman at that town hall meeting stood and verbalized what most in the audience were probably thinking: Without a 24-hour emergency room available in Glenn County, what would happen to someone like her husband, who had suffered a heart attack a few years ago and was rushed to the Glenn emergency room, where doctors saved his life? What, she wanted to know, should she do were he to have another attack during the new clinic’s “after-hours"?

“What are we supposed to do then?” she asked.

Enloe Health System’s CEO Philip Wolfe answered with a phrase he would repeat throughout the evening: “We share your concern.”

Another woman said that on July 31, 1997, she suffered a major hemorrhage and was taken to the Glenn emergency room.

“The doctors told me I probably wouldn’t have made it on the [Enloe helicopter] LifeFlight,” she said. “I’m here today because of that emergency room. Without it, you’re going to be losing one or two citizens a year.”

Initial word of the closure, at least to most county officials, came a week earlier at one of the regular get-togethers of the Willows and Orland city councils and the Glenn County Board of Supervisors. These meetings are usually informal affairs, often held in a local restaurant with reports and updates delivered during dinner.

This one was held at the River Bend Bar and Grill, 10 miles east of Willows on the banks of the Sacramento River. And it was here that Glenn Medical Center Chief Operating Officer Bernie Hietpas announced Enloe’s plans to pull the plug on the hospital.

“It was a dinner meeting, and on the agenda was something about funding expenditures for the hospital,” said Glenn County Counsel Belinda Blacketer. “The whole time people are eating, someone is up front talking.”

When it came time for Hietpas to talk, nobody, apparently, was ready for what he had to say.

“Bernie gets up and drops the news that ‘We’re closing on March 1,’ “ Blacketer said. “Everybody just about dropped their forks.”

The hospital’s 103 employees had been given the bad news earlier that day.

Blacketer was hired as county counsel last June, after a career in private practice spanning back to 1972. She hails from Laguna Beach, where her family has lived for four generations. A lot of her legal experience, she said, has come from representing neighborhoods.

“I’ve seen this kind of thing happen before,” she explained. “Usually the officials in charge release a report announcing something like, ‘We’re going under unless we do something.’ Then there will be another letter, then they’ll come and try to work with the community, and then they’ll come back and give the final announcement. But it’s done over time to allow people to prepare or try to fix things.

“The way Enloe did it, their model ought to be taught at business school as how not to do things.”

A week later, at the town hall meeting in the stately Willows Memorial Hall, four representatives of Enloe Health System—CEO Wolfe, Beverly Heath, head of nursing at the Glenn facility, Marty Marshall, Enloe’s head of emergency medical services, and Hietpas—found themselves in the uncomfortable position of explaining Enloe’s decision and trying to answer the difficult questions that followed.

“We didn’t have to [hold this meeting],” Wolfe told a reporter just before the meeting got underway. “But,” he added, after a pause, “it’s the right thing to do.”

Wolfe, looking like man about to face a firing squad, walked to the front of the cavernous, wooden-floored hall and the 200 or so people packed into it. The audience, sitting in rows of chairs or standing along the sides and back of the auditorium, was made up of the elderly and the young, working people, middle-aged couples, the hospital employees about to lose their jobs, former hospital workers, pregnant women and young mothers carrying babies.

Perhaps sensing a campaign issue, state Senate candidate and Assemblyman Dick Dickerson, R-Redding, wearing a green jacket with his name embroidered in gold across the breast pocket, sat quietly in the back. Two uniformed California Highway Patrol officers, who said they were there to “absorb some of the information and try to find out what’s happening,” sat to one side.

Without the 24-hour local hospital, the CHP would have to shuttle suspected drunk drivers all the way Enloe Medical Center in Chico—a 90-minute round-trip drive—to test blood-alcohol levels. The CHP and residents of Willows are also concerned about the horrific automobile accidents that can and do occur along Interstate 5, which passes through this community of 10,000.

“Many of you know by now, I think,” Wolfe said, “that we came to the conclusion that the best thing for Willows, health-care-wise, was to close the inpatient facilities and to close the emergency room. We also believe that there is a need for outpatient services and an urgent-care clinic as well as a clinic. We think the best we could do to provide those services would be 10 hours a day, seven days a week. We came to that conclusion for a number of reasons, not the least of which was financial.”

Enloe says it has lost $3.8 million since taking over operations in 1995 and another $1.5 million initial loan that it has yet to recoup. Enloe’s figures show a $566,253 loss the first year, followed by a dip of $479,705 in 1997, $876,871 in ‘98 and $1.2 million in ‘99.

The last two years have shown bottom line improvements, though the budget remained in the red. Internal Revenue Service records show that for fiscal year 2000 Glenn Medical Center had $5,628,767 in revenues but $5,971,107 in expenditures, resulting in a loss of $342,340. The hospital’s expenditures included $658,133 in administration costs, and its revenue included $300,000 that Glenn County pays each year to keep the emergency room open.

Operating an outpatient clinic 10 hours a day, Wolfe said, means Superior California Medical Services, the nonprofit organization that runs the hospital, would break even. At 16 hours a day, he went on, SCMS would lose $300,000 annually, and a 24-hour-a-day operation would result in the loss of $700,000 a year. That would be without the county’s annual $300,000 suppliment.

Wolfe said that, if changes were not made now, the health services provided to the people in Willows and Glenn County “would be far fewer than we could provide if we don’t close emergency services now, close the emergency room and provide as much as we can on an outpatient basis.”

Currently there is an average, he said, of less than one patient in the hospital on any given day. And while the use of the emergency room has been higher than that, “it has not been of sufficient size to warrant an emergency room. So we’re stuck.”

If there was a way to keep it open, he told the crowd, he was willing to listen.

Rick Thomas, president of the Willows Chamber of Commerce, read a letter drafted by the chamber condemning the short notice Enloe issued, calling it a “grave concern.”

“We feel your recent actions have broken the covenant of trust placed upon you by our citizens,” he said. He went on to voice a series of concerns and questions and wanted some reassurance that those services remaining would not be lost should they not prove profitable.

“Our hope once this is in place is that we become financially healthy and we start looking to the future and trying to figure out ways we can grow,” Wolfe said.

Thomas asked, among other things, for a list of services provided by both the Enloe and Glenn hospitals and wondered aloud why patients, including his wife and daughter, had been sent to Chico for medical tests that could just as well have been done in Willows. That practice, he suggested, would result in a direct loss of revenue for the Willows facility.

“Why is that happening?” Thomas asked.

Wolfe said he was not sure but noted physicians order the tests and direct the patients.

Nursing Supervisor Heath stepped in and explained that, while it was true that many residents of Glenn County do go to Chico for medical tests, many primary-care physicians live and practice in Chico.

Thomas wasn’t buying it. He said the doctor who ordered the tests for his family works out of Willows.

“It’s hard for me to answer that question,” Heath responded. “It may have been a piece of equipment was down at that time. We do on a whole try to keep local residents here in the community to have the tests if we can provide them.”

Later, when another person asked the same question, Hietpas suggested the trip to Chico provided a chance to “take a test and catch a movie.”

Marty Marshall, the emergency-medical-services director, who was dressed in a blue flight suit, said that Enloe’s LifeFlight helicopter would be utilized more often now in Glenn County to transport the seriously injured and heart attack victims. The flight, he said, is 20 minutes round trip, and emergency crews would be waiting on the Enloe Medical Center rooftop when the chopper returned.

“Any seriously sick patients will be taken directly to Enloe by either helicopter or ambulance,” he said.

But the thought of no more 24-hour emergency care caused these probably otherwise reticent Glenn County residents to ask bold, direct questions.

“Are you willing to take pay cuts to help our hospital?” one man fairly shouted to Wolfe at point-blank range. This brought a round of hoots and hollers and applause from the crowd. (According to Enloe’s tax files, Wolfe made $374,247 in compensation and another $146,940 in benefits in 2000.)

“It is not a pleasant situation for you folks or for us,” the man pointed out. “Some of us understand that, but some of you make big dollars. What do you pay ambulance drivers, the people who answer the phones, the people who take the blood pressures?”

Before anyone could answer, a man from the back of the auditorium shouted: “I thought Enloe signed a contract. Is that right or wrong? Were you there when they signed it?”

Again applause rippled through the hall.

Elizabeth Kelly, a short, dark-haired woman who looks like she might have been a cheerleader in high school, scolded Wolfe for not being straightforward with the community and letting it know how dire the situation was before pulling the plug.

“Because you gave the community such little notice, I suspect Enloe had an idea they were going to be coming to this place, and I don’t think it was just last week,” she said. “My concern is, as you can see, the community cares. There are people here concerned and afraid. Fear has brought them here.

“If you had given this community a little more time, I suspect the community might have taken some action to come up with some fund-raising to try to save their hospital. You’re taking it away, and you never even gave them a chance to try to save it for their own community.”

Wolfe acknowledged that the conclusion to close was made much earlier, but that after years of bleeding red ink Enloe officials had to ask themselves if their “ego was bigger than our brain and is this something that is ever going to work or is this just too small of a community to support a hospital?”

He also cast doubts on how willing the community was to support the local hospital, asking for a show of hands of those willing to “double their taxes” to keep the hospital open.

“If you’ll take a cut in pay,” a woman shouted to another round of applause.

At that point Hietpas, who in 2000 was paid $169,000 in compensation and benefits, reminded the audience that in 1995 Enloe had been asked by the county to take over the hospital’s operations. At that time, he said, the county was losing more than $1 million a year trying to keep the hospital open.

“We felt at that point in time that, given some community support and increased activity at the hospital, we could make that a viable operation,” Hietpas said. “Over the years the figures have spoken to the fact that there has not been an increase in the volume of business. So we find ourselves now in the same position that Glenn County and you all found yourselves in in 1995.”

Clint Millsaps, a 15-year employee and registration clerk in the hospital’s emergency room, asked why certain members of the hospital management knew of the impending closure months before the rest of the employees.

He said Heath, the nursing director, had time to find a job teaching at Yuba College because she knew of the closing at least three months before the rest of the employees. And Hietpas has an administration job waiting for him back at Enloe, Ann Prater said after the meeting.

“I’m losing my job,” Millsaps said. “Will I still be able to work at Enloe?”

Wolfe said part of the reason for the short notice to employees was an effort to avoid loss of worker morale and workers quitting. And, in fact, when Enloe announced last fall that it was closing its same-day surgery clinic on Bruce Road in Chico, a number of employees made an early exit.

(Later Millsaps said that worker morale at Glenn Medical Center is low and there is a lot of tension in the air. He said he tried to get other employees to talk to us and pose for a photo, but most declined, citing fear of employer retribution. “They are afraid they’ll lose their three weeks’ severance pay,” said Millsaps.)

Then Millsaps cast doubt on figures Enloe provided prior to the meeting that showed a significant drop in the number of emergency room visits from 1995 to last year.

“I have access to the books because I enter people’s names into the books,” he explained.

Millsaps said that Enloe’s graph showing a drop of emergency room visits at the Glenn Medical Center from 5,187 in ‘95 to 2,651 last year is misleading. At least 2,000 ER patients a year, he said, were not recorded on the graph even though they came into the emergency room. Those patients referred to urgent rather than emergency care are not recorded.

Enloe’s public relations director, Prater, later explained the mix-up was her fault and that her numbers reflect the number of patients treated in the emergency room, while Millsaps numbers refer to the total number of visits to the emergency room, including those with sore throats, sprained ankles and other non-life-threatening injuries and illnesses.

Enloe says that factors beyond its control—low state and federal reimbursements for Medi-Cal and Medicare patients, a national shortage of hospital workers driving up labor costs, and a fall-off in use of the facilities by Glenn County’s 27,000 residents—have conspired to force Enloe to make this painful decision.

Glenn County is one of the poorest in the state, with 20 percent of its residents and nearly 30 percent of its children living below the state poverty level. As a result, the Glenn County facility sees more than its share of Medi-Cal patients.

Prater describes the overall effect of these outside factors as a brewing “perfect storm” that has affected rural hospitals across the state. She said that, according to the California Health Care Association, eight rural hospitals in the state have closed since 1996 and another 11 have filed or are about to file for bankruptcy.

“The county has to figure out how this is going to go,” Prater said. “Enloe can’t continue to lose money—we’ll do anything we can as long as it doesn’t include losing money.”

More than half of the hospital’s 103 employees will be let go March 1, the day the emergency room license is relinquished.

Those employees, like 38-year-old respiratory therapist Bill Robinson, will receive the equivalent of three weeks’ pay as part of their severance package. Robinson, who also works at Oroville Hospital, says for the past six years he’s commuted to Willows from his home in Berry Creek every other week for a 24-hour shift and does it to add about $10,000 to his yearly income.

“I do this because my wife was disabled in a car accident a few years ago,” he said. “That is why I took this job. She can’t work.”

He also says there was absolutely no sign or even rumor among workers that the hospital was in danger of closing.

“Not a word,” he said. “It came right out of the blue.”

On Feb. 5, five days after the town hall gathering, across Sycamore Street from the auditorium, on the second floor of the county courthouse, the Glenn County Board of Supervisors held its bi-monthly meeting. Like the auditorium, the courthouse is a handsome building built before the turn of the century, with large pillars out front, a marble floor and high ceilings.

Willows is the kind of town where, in the wake of Sept. 11, security has increased in appropriate fashion, in this case a shaven-headed sheriff’s deputy who nonchalantly asks visitors to the courthouse, “Do you have any guns or knives?”

Upstairs in the board chambers, Hietpas offered a deal that he termed “win, win, win.” If the county were willing to continue to put forth the $300,000 it ponies up annually to keep the emergency room operating, Enloe would ask the state to “suspend” rather than retire the license to operate. The license could remain in suspension for one year, and for $300,000 Enloe would run a 24-hour outpatient service.

Hietpas said the county wins because it gains more time to work something out with another provider; the community wins because 24-hour service not unlike its emergency room is still available for a time; and Enloe wins because it would stem the bleeding of red ink on its budget.

The board said it would consider the matter in closed session. Board Chairman Tom McGowen wanted it known that the board was “exploring many options. We’re not sitting idle.”

County Counsel Blacketer, however, cautioned the board about what it would be getting in the deal.

“An urgent-care facility is not much more than your doctor’s office,” she said. “Mr. Hietpas made the statement that you wouldn’t see any difference [between an emergency room and an urgent-care clinic]. Well, there is an incredible difference.”

In closed session, the board voted to hire set aside $50,000 as a retainer for a Sacramento law firm, should it decide to take legal action against Enloe.

The ramifications of Enloe’s decision in the Willows area and the rest of Glenn County may be extensive, particularly for local law enforcement.

“This is going to have a big impact on the county’s general fund,” predicted Glenn County Sheriff Bob Shadley, noting that the county might well lose its contract with the federal Immigration and Naturalization Services, for which it incarcerates aliens charged with crimes and awaiting deportation or contesting a deportation order.

One requirement for the contract is access to 24-hour health care, which disappears once the hospital license is pulled. “That contract means more than $1 million to this county,” Shadley said.

Lt. Bruce McLeod said that, even with a 24-hour outpatient clinic, the contract might still be in jeopardy. “Any plan would have to be reviewed by the INS,” he said.

Then there are the DUI and drug tests, which will have to be done in Chico, as well as tests of rape and child molestation case evidence. Off-duty deputies will have to be placed on standby as officers’ time out of county increases.

“I really can’t do anything here,” said Shadley. “But it seems there should be some sort of social responsibility here [on the part of Enloe].”

Sharing Shadley’s frustration is Glenn County Health Director Mike Cassetta.

“It’s really tough to know the real outcome here because I’m not sure what kind of level of service to expect,” he said. “I am assuming they will not be operating during the evening hours, that we’ll be all by ourselves. In mental health we have to admit people 24 hours a day, seven days a week. The local hospital must give the individuals who come to us or are brought to us physicals before they are cleared for the psychiatric ward.”

Like most affected by the closure, it is the short notice offered by Enloe that most bothers Cassetta.

“If you are having a hard time and you are not going to make it, well, that’s one thing,” he said. “But in a partnership one partner doesn’t spring the news without warning that you only have one month to react. That’s not enough time to make a transition.”

County Counsel Blacketer said the county is “exploring all its options, including legal. The contract is pretty clear.”

That contract, signed in 1995, says that Enloe will “operate the hospital … and make available to the general public Primary Care, Medical Services and Basic Emergency and Impatient Acute Care Services, consistent with the standards of the community and with maximum efficiency. The parties acknowledge that County is terminating its licenses and certification for and the provisions of medical and related services by and through Glenn General Hospital as of June 30, 1995.”

The section of the contract dealing with the rental terms gives the impression that this was to be a long and fruitful relationship. The county agreed to lease the hospital facility and property to Enloe beginning July 1, 1995, and terminating June 30, 2045, for $100 per year, provided neither side defaulted. The agreement provided Enloe with the right to renew the contract for an additional 25 years if it so desired.

“What’s amazing,” Blacketer said, “is that they didn’t even have the courtesy to let the board know they were having problems. What they said was, ‘We’re not making beaucoup bucks, but we’re not doing bad.’ I’ve heard what they do is come in to a community, promise it the moon, then in two to three years run the place into the ground and then send all the patients to the mother ship.”

She said that when the county ran the hospital there was an advisory board helping to oversee operations.

“It was not in the contract, but there was an understanding the advisory board would continue on,” Blacketer said. “But after the first year or so, they quit calling meetings of the advisory board, and that was it.”

Enloe formed a new committee that includes Glenn County Supervisor Forrest Sprague, former Supervisor Richard Mudd and a three or four others whom the hospital refuses to name.

“They won’t tell me,” says Tim Crews, publisher of the Sacramento Valley Mirror. “It’s some sort of secret.”

Crews, who’s written extensively on the issue since it first surfaced, argues that as a medical provider Enloe should be held to a higher standard than other businesses.

“They don’t make widgets, they provide a necessary service," he says. "And just like PG&E, they have a monopoly. They provide the only service of their kind. Now they are threatening to take it away."