Patient and Hospital Are in a Test of Wills

Ever since anyone around here can remember, Sarah Nome has been the quintessential community gadfly, jousting with public officials in Marin County over issues big and small.

Now, at 82, she’s in a quixotic fight over her hospital bed.

For more than a year, Nome has pugnaciously refused to budge from her fifth-floor room at Kaiser Permanente’s San Rafael Medical Center. In the process, she has racked up $1.3 million in bills.

Kaiser tried to fix the mess by proposing to move her to a nursing facility across San Francisco Bay. No way, she said -- too far from friends. But, so far, no Marin County facility has been willing to take her.

As the stalemate has dragged on, irked hospital officials have taken away Nome’s TV privileges and newspaper. They’ve gone to court to win an eviction notice and asked the sheriff to forcibly uproot the white-haired invalid.

Now attorneys with the health maintenance organization are attempting to seize Nome’s San Anselmo home, recently deeded to her daughter, in hopes of recovering some of the rising mountain of debt.

But the retired gadfly won’t loosen her grip on the hospital bedsheets.

Instead, she’s managed to thwart every attempt to oust her, prompting one Kaiser attorney to lament that the healthcare giant had been played like a banjo.

Nome sees the deadlock differently.

She can’t walk and needs help but readily admits she doesn’t warrant the sort of acute care she’s getting in a $3,090-a-day hospital bed.

The dispute could have been settled long ago, she said, if Kaiser had simply found a spot for her in a more thrifty general-care center in Marin County.

“I was born here. I went to school here. I married here,” Nome said. “I’ve lived here all my life here, and I expect to die here.”

The impossible fight has always been her forte.

Over the years Nome has waged neighborhood battles over improper fences, balky property lines, overgrown trees. She ran for Town Council five times and was drubbed each election.

During the 1980s and ‘90s, she battled San Anselmo leaders repeatedly over the budget, line item by line item. The town administrator grew so vexed by her questions that he ordered his staff to answer Nome only in writing because he said she wasted so much of their time.

The roots of her standoff with Kaiser date to an ominous day in her kitchen during the summer of 2002.

Nome heard a cracking sound as both legs gave way. She blames the spontaneous breaks on blood-thinning medicine prescribed by Kaiser doctors.

Nome said she languished in Kaiser’s San Rafael hospital for eight weeks, rejecting a suggestion that her legs be amputated. Kaiser, which she has sued, refuses to talk about the quality of her care, citing patient confidentiality.

She ultimately had surgery at UC San Francisco Medical Center to repair the breaks. She ended up at Hillside Care Center in San Rafael.

Trouble followed. She complained about the quality of care. Hillside, which declined to comment, reportedly said that Nome had created a fire hazard by letting newspapers pile up and that she once scoffed at the complaint, saying she could clean them up by lighting a match. Nome denies having made that remark.

In January 2004, she was abruptly returned to the San Rafael hospital for a psychiatric evaluation. Nome refers to it as a “kidnapping.”

She passed all the tests but said officials at Hillside refused to let her return, even though the state Department of Health Services repeatedly fined the care facility for not taking her back.

Thus began Nome’s long hospital stay.

Stan Watson, senior counsel for Kaiser in Oakland, said the hospital chain found several suitable places where Nome could get custodial care. But in each instance, he said, Nome and her family refused to cooperate.

“We’ve really tried to approach this in a compassionate manner,” he said.

Kaiser went on the offensive in earnest last month, going to court to obtain an eviction order. A Superior Court judge granted the order but then blocked it after the county sheriff argued that he didn’t want to dump a patient who wasn’t ambulatory on the sidewalk.

At a court hearing Monday, Judge John Sutro Jr. continued the delay until April 1 to allow a hearing to determine whether Nome needed a conservator to take over her affairs.

A similar request by the Marin County public guardian was rejected a year ago. Ian Sammis, Nome’s attorney in the conservatorship case, doesn’t see any reason for such an intrusion, calling the octogenarian “articulate and well-reasoned.”

But Sutro has clearly grown frustrated. He declared that Nome’s “intransigence” had created “a most unfortunate and inexcusable situation.”

Nome’s daughter, Janie Sands, said she would be willing to move back into the San Anselmo home to help take care of her mother. But she said the house was, for now, uninhabitable because of damage from storm-felled trees.

Sands presented a settlement offer Monday to Kaiser, asking that the healthcare group pay for six years of custodial care for her mother. Sands also said she had found a Marin County nursing home that would accept her mother.

Sitting up in bed in her blue hospital gown, Nome displayed a handful of letters from people around the country who have learned of her sit-in.

A Kentucky woman on disability sent a $25 check, which Nome plans to return.

But an anonymous letter described Nome as “a disgrace to the American population, sponging off others and using your liberal rights to cause problems for others.”

She calls the absence of a TV and daily paper “a vendetta” by hospital officials. She is surviving on old papers delivered by a friend, catching up on week-old news and the crossword puzzles.

“I was kidnapped here,” Nome said. “And I don’t know how to kidnap myself out of here.”

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Donna Horowitz, a special correspondent, reported from San Rafael. Times staff writer Eric Bailey reported from San Francisco.