Hospice Loses License Plea; Funds Jeopardized

San Diego Hospice is back to square one in its bid to build a free-standing inpatient care center for the terminally ill because the state has refused an appeal that it waive some requirements for licensing the facility.

The move could cause the Joan B. Kroc Foundation to withdraw its commitment of up to $18 million to build the center on Vauclain Point above Mission Valley.

“I certainly support the concept of hospice care for the terminally ill, but, unfortunately, the department cannot legally license the San Diego hospice as an acute care facility, since it is not yet built and has no operating policies and procedures,” Dr. Kenneth W. Kizer, director of the state Department of Health Services, said in a Nov. 4 letter to the hospice director.

Prohibited by Law

Furthermore, Kizer said, state law specifically prohibits licensing the facility as an acute-care hospital unless it meets the same requirements as a hospital. These include having surgery and anesthesiology facilities.

That is despite the fact that a hospice does not share the hospital’s mission of preventing death, but instead emphasizes easing the physical and emotional pain of the dying.

This dispute has stalled licensing of the facility since 1985. Two legislative attempts to create an exemption to the law failed, in 1987 and again in August this year.

Faced with the delays, the Kroc Foundation declined Oct. 1 to finance the start of construction on the building. It notified hospice administrators that the matter would have to be resolved before any further money can be spent. Hospice officials then appealed last month to the state for a waiver, which they first sought in 1985.

Disappointment Voiced

The rejection is both disappointing and an example of how ill-equipped the state is to deal with a new concept that doesn’t fit any of its categories for health care facilities, hospice director Holly Lorentson said.

“What’s frustrating for me is that we are in a country with rising health care costs and, as responsible health care providers, we’ve been challenged to provide more cost-effective care,” she said. “Cost effectiveness benefits the individual, it benefits the state Medi-Cal program, it benefits Medicare. So we’re challenged with being cost effective, yet . . . the bureaucracy isn’t ready to be flexible enough to help promote that endeavor.”

Lorentson said the hospice board will meet by the end of next week and consider whether the project can be pursued. Construction delays could drive the cost of the building beyond the $18 million Kroc had committed, she said.

The Kroc Foundation also has said that, if the license is delayed beyond December, it might have to withdraw the grant. A spokeswoman for Kroc could not be reached Wednesday for comment on the status of the donation.

“We’re looking at moving ahead with this. We just have to make sure we evaluate what those costs are and make sure we still have a commitment from the donor,” Lorentson said.

Kizer suggested in his letter that hospice officials try again for quick passage of legislation creating a licensing category for a facility like theirs, but Lorentson said that would put off the beginning of construction until March at the earliest. And the outcome is not guaranteed.

“With urgency legislation we’re going to need a two-thirds vote in both houses in order to get through. So we’ll have to have all our ducks lined up,” Lorentson said. “And there’s still no guarantee that the governor’s going to sign it.”

In 1987, Gov. George Deukmejian vetoed a bill that would have allowed the facility to be licensed.