Merger Plans Leave Staff of Clinic Stunned : Health care: Laguna Beach facility’s employees wanted to be linked with UCI Medical Center. Instead, proposal is for it to be joined with San Juan Capistrano operation.

Those who run the Laguna Beach Community Clinic said Wednesday they are stunned and dismayed that their board of directors has voted without consulting with them or the community on a proposal to merge with South County Community Clinic in San Juan Capistrano.

Diana Lithgow, a family nurse practitioner who coordinates the Laguna Beach clinic’s medical services, said the board of directors informed the staff by a faxed message on Dec. 20 that the merger was in the offing and that they would receive more information next Wednesday, when board members return from holiday vacations.

The staff members “stood with their mouths open and some were crying,” Lithgow said. The next day they shot back a letter of objection to the board.

The letter acknowledged the need for the Laguna Beach clinic to affiliate with other health providers to meet the new full-service requirements of OPTIMA, the county’s emerging managed-care program for Medi-Cal recipients.

But the letter, which Lithgow said was signed by 24 staff members, said the staff had anticipated that the Laguna Beach clinic would merge with UCI Medical Center in Orange, with which it already has “a strong and healthy referral relationship,” rather than with another nonprofit community clinic.

Art Birtcher, a developer who chairs the South County Community Clinic and serves on the OPTIMA board of directors, said any affiliation between the two clinics is still tentative and would hinge upon a feasibility study. “The only advantage is if we could bring stronger management and financial sources,” he said, noting that the San Juan Capistrano clinic is “one of the more financially stable clinics in Orange County.” He called the proposal an affiliation rather than a merger or takeover.

Joan Cobin, the Laguna Beach clinic’s executive director, said an underlying concern of the staff involves the San Juan Capistrano clinic’s close working relationship with Mission Hospital Regional Medical Center in Mission Viejo. Mission Hospital recently merged with St. Joseph Health System, which is owned and operated by Catholic nuns, the Sisters of St. Joseph of Orange.

Cobin said her staff fears that the Catholic Church’s philosophical opposition to birth control could adversely impact the Laguna Beach clinic’s family planning service.

If Laguna Beach Community Clinic affiliated with UCI, while the San Juan Capistrano clinic was linked with St. Joseph Health System, Cobin argues, the poor of south Orange County would have a choice of hospitals and philosophies.

Moreover, she said, the staff of the Laguna Beach clinic wanted the advantages of joining with an educational hospital, such as UCI, that could assign medical students and resident physicians to work at the clinic.

Cobin said she believes the Laguna Beach community and the staff of the local clinic should have had an opportunity to voice their opinions before the clinic’s board voted.

“If they are going to change a 25-year-old institution, they should have consulted the community and the staff should have somehow been brought into it,” she said.

Mary Piccione, executive director of UCI Medical Center, said the hospital’s representatives had been discussing a possible affiliation with the Laguna Beach clinic for at least two months. She said she believed it would have been a good opportunity for the clinic because of UCI’s “long history of supporting the Medi-Cal population.”

Two members of the Laguna Beach clinic’s board of directors, Maureen La Bonte and board President Gwen Barry, refused to publicly comment on the proposed merger until Wednesday’s meeting with the staff.

Dr. George Kallins, a Mission Viejo physician and member of the Laguna Beach clinic board, said: “The staff is biased and doesn’t understand what is best for them. They haven’t been properly informed.”

Kallins said if the clinics merge, they will be governed by a single board of directors and executive director. It is uncertain, he said, whether the name of the clinic would change. He denied that the clinic’s family planning service would be harmed, noting that any health system that contracts with OPTIMA must provide all such Medi-Cal approved services.

Kallins said the Laguna Beach clinic is financially troubled and would benefit from the South County Community Clinic’s superior financial management. “The Laguna Beach clinic is not strong enough to survive as it is right now,” he said.

Cobin agreed that the Laguna Beach clinic is under pressure to meet OPTIMA’s Feb. 15 deadline to report how the clinic will expand its systems for quality assurance, utilization review and physician credentials. These systems, she said, are costly and could be more easily supported by a larger clientele.

Last year, the Laguna Beach clinic recorded about 20,000 patient visits, Cobin said, a third of which were reimbursed by Medi-Cal. A spokeswoman for the South County Community Clinic said the clinic will handle about 17,000 patient visits this year, one-quarter of them Medi-Cal patients.

Responding to worries that Laguna’s family planning program might be in jeopardy, Birtcher said that if the San Juan Capistrano clinic agrees to the affiliation, “I don’t want to scrap any of their programs. . . . They have a long tradition of serving the people of Laguna Beach and the last thing you want to do is interrupt that.”