License Snag Halts Building of Hospice : Tangle Threatens Funding of Facility Designed to Ease Plight of the Dying

An $18-million vision of providing a place in San Diego for terminally ill patients to die with dignity has been stopped cold by a licensing dispute that has led to a cutoff of funds to build the San Diego Hospice.

Construction was to have begun Oct. 1 on the hospice, situated on scenic Vauclain Point above Mission Valley, but no further site preparation will be done until the licensing issue is resolved, said Holly Lorentson, president of the hospice corporation.

The Joan B. Kroc Foundation notified hospice officials Monday that it would put no more money into the project until the state Department of Health Services licenses the facility as an acute-care hospital.

The foundation has made clear that it cannot wait for the next legislative session, which convenes in December, to resolve the dispute and, instead, is counting on an administrative solution, Lorentson said. The foundation will consider withdrawing the grant if the dispute is not settled, she said.

If a decision is not made by Dec. 1, the hospice corporation might be forced to cancel plans for the building because construction costs could escalate beyond the $18 million the Kroc Foundation has committed to the project.

The 24-bed hospice would be the only one in the state with an acute-care hospital rating--giving patients for the first time the option of dying in a homelike setting even when receiving specialized hospital services.

Two attempts failed to secure state legislation authorizing a special license for the hospice, most recently because of an apparent misunderstanding on Aug. 31 as the Assembly rushed toward a midnight adjournment.

Lorentson said she hopes the state can resolve the licensing delay administratively.

“We’ve been working on this since 1985 to get a license for our facility,” she said. “The donor has been kind enough to support us during the interim--that’s been to the tune of $4.5 million so far. And today we’re not sitting any closer to licensure than before.”

The foundation has spent $4.5 million so far on acquiring land, demolition of existing buildings and planning for the hospice, said Beth Benes, attorney for the foundation.

The San Diego City Council voted 8 to 0 Monday to direct city staff members to work with the state Department of Health Services to try to obtain a waiver from requirements that the hospice, as an acute-care hospital, have surgery and anesthesiology services on site.

Such services would not be needed, Lorentson said, because hospices do not provide heroic lifesaving efforts but instead concentrate on pain relief and other support services aimed at easing the death process.

If patients needed surgical care, they could be transferred to a nearby hospital, the hospice contends.

Elsewhere in the state, hospices are attached to existing hospitals or operate at the lower licensing designation of skilled nursing facility, Lorentson said. San Diego Hospice’s desire to pioneer with a free-standing but acute-care facility--a vision pursued for the past four years--created a need that current licensing categories couldn’t address.

Vetoed by Governor

In 1987, a bill passed both houses of the Legislature to create a new category, but Gov. George Deukmejian vetoed it as costing too much money since more regulators would be needed to oversee the category. This year, an amended version avoided the fiscal issue by setting up a pilot project to license the hospice under the acute-care hospital category but waiving the surgery-anesthesiology rules, Lorentson said.

The bill passed both houses of the Legislature once but needed a second vote because of amendments. In the last-minute crush to pass bills before the session ended Aug. 31, it narrowly failed in the Assembly, said Nancy Westergaard, consultant to Assemblywoman Lucy Killea (D-San Diego).

At one minute before midnight, as bills were being given just 30 seconds of consideration, Assemblyman Bill Leonard, R-Redlands, “stood up and said that there was a fiscal impact and that the state shouldn’t be spending money on this kind of legislation,” Westergaard recalled.

“There was no fiscal impact to the bill, which he must have misunderstood, and there wasn’t time to explain that. And all the Republicans voted against the bill and killed it,” she said.

San Diego Republicans have since expressed support for the legislation, Westergaard noted, “so I can’t draw any other conclusion than that they misunderstood it when it came up.”

Alternative to Hospital

The San Diego Hospice program, operating for 11 years, now provides services for about 150 dying patients in homes, nursing facilities or hospitals, Lorentson said. The free-standing hospice would provide a place for some people in the last days before death, when they have to enter hospitals for pain relief and other acute-hospital care.

The hospice is also seen as a site where nurses, medical residents and others could be trained in the specialized field of “palliative” care, which is aimed at supporting a dying patient rather than on prolonging life, Lorentson said.

Designation as an acute-care facility is essential if the hospice is to be reimbursed by Medicare or insurance companies for patient care, she said. A skilled nursing facility is reimbursed on a basis of each patient needing three hours of care a day, but the hospice expects its care will reach eight hours or more a day.