Time for a Truce in Ventura

It’s always sad to see a proud community being torn apart by a divisive battle between local institutions that ought to be working together. And that is why the seemingly endless war between Community Memorial Hospital and the Ventura County Medical Center is so unfortunate.

These two hospitals cooperated for decades to give Ventura high-quality medical care--and, not incidentally, a strong employment base in medicine and related industries that has helped our local economy a lot.

But faced with a shrinking market for patients, these two hospitals have been in an all-out war for years. They have talked; they have sued; they have battled in electoral campaigns--and they are still at it.

The hospital war has even brought Ventura a perverse kind of fame. No other city in the country is in the middle of such a mean-spirited hospital fight. It’s such a good story that many magazine and newspaper writers (including this one) have spread the tale to audiences around the country.

Maybe the hospital war has gotten too mean and too personal to ever be resolved, but I think it’s time to stop the name-calling and give it a try. Because there is a way to resolve the conflict--if you break the problem down to its component parts and attack the issues one by one.

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Underneath the nastiness, there are two basic community issues that need to be dealt with:

* Who will provide hospital care for paying customers, including those with insurance and Medi-Cal, in the Ventura area?

* How will the county government fulfill its obligation under state law to provide medical care to indigent patients everywhere in the county?

It’s inevitable that these two issues will get somewhat intertwined. Because of health insurance, Medi-Cal and the legal obligation to serve the poor, the whole health-care finance system is linked together like some cumbersome Rube Goldberg contraption.

But in Ventura, these two issues have been more closely linked by the county’s approach to covering the cost of medical care for the poor. And by unraveling these two issues at least somewhat, and dealing with them as separately as possible, the problem can be solved.

Like its counterparts around the state, our county government doesn’t have enough tax revenue to cover its basic costs. That isn’t the fault of the county; all counties have been in this bind since 1992, when the state started taking away property tax revenue to balance its own budget. So to cover the cost of indigent medical care, Pierre Durand, the county’s health-care chief, has instituted a series of clever changes.

He has, for example, created a health-maintenance organization for county employees, so they can get treated at the county hospital. And he has competed aggressively for paying hospital and clinic customers. His goal has been to find ways to grab hold of money that is already flowing through the county’s medical community (provided by Medi-Cal and insurance companies) and direct it toward the county hospital. By bringing more health-care dollars in, he can reduce the number of county tax dollars required.

Durand often states that he is competing effectively with private hospitals, and he is right. But the hidden subtlety in this remark is that he is not competing with all private hospitals in the county.

A hospital’s market area is driven largely by geography. People generally prefer a hospital close to their residence. Realistically, then, Durand’s hospital isn’t competing for paying customers with Simi Valley Adventist or Las Robles/Columbia Medical Center in Westlake Village. It is competing mostly with Community Memorial Hospital--located two blocks away from his office--for paying customers from the Ventura area, and using the revenue from those customers to subsidize health care for poor people from all over the county.

That is why Community Memorial is so mad and the other hospitals don’t seem to care. If the county hospital were located in Simi Valley, it’s likely that Adventist would be suing and Community Memorial would be complacent.

Of course, Community Memorial hasn’t made the situation any better with its street-fighting response. All the lawsuits, the ballot initiative and the combative attitude have helped to poison the atmosphere and make resolution even more difficult.

Suffice it to say, however, that the actions of both the county and Community Memorial make sense from their own, narrowly defined point of view. It’s time to solve the problem by leaving those narrowly defined points of view behind.

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The first step, then, is to solve Problem No. 1: How should Community Memorial and VCMC split up the declining market for hospital care in the Ventura area? The city clearly doesn’t need two hospitals for local patients, and for years--at least before the war--the two institutions discussed how to divvy things up.

Not being a medical expert, I don’t know what the answer would be. Clearly, some “downsizing” is needed. Each hospital would give up some functions, and many people up and down Loma Vista would lose their jobs. But at least this process would give the Ventura community the opportunity to step back and do what it should have done in the first place: build consensus on how to manage this downsizing while building the foundation for a strong medical district in the future. Our failure to take on this task as a proactive community is one of the reasons the war started in the first place.

Once a solution to Problem No. 1 is hammered out, the county can move on to Problem No. 2: working with all county medical providers (and, if possible, with the county’s 10 cities) to determine the best way to provide indigent care.

Again, I don’t know what the specific solution is. Perhaps all hospitals everywhere in the county, including Community Memorial, should take on a greater indigent patient load. Or, if the county believes private health-care dollars must be used instead of tax revenue, perhaps all the other providers--again including Community Memorial--should contribute to the cost of indigent care at VCMC.

The point is that once the Ventura hospital war is resolved at its root, a broader and more thoughtful discussion about indigent care can finally begin.

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Clearly, these two issues are not completely separable. The future of Ventura’s medical district depends in part on the county hospital’s role in indigent care, and the solution to indigent care countywide inevitably lies, at least in part, in effectively using all the resources available on Loma Vista Avenue.

But contrary to the prevailing wisdom, these problems are not unsolvable. They have been confronted and solved in county after county throughout California, thanks to the visionary leadership of elected leaders and health-care providers who have been willing to put aside old hostilities and work together.

In most of these counties, the breakthrough has come when some high-ranking official recognizes that old ways must change or the community will suffer in the long run. In many cases, the breakthrough has come from the action of an official in city government--someone who has no direct responsibility for medical care but realizes that the future of the community is at stake.

Whether such a breakthrough will come from a Ventura city official or not, I don’t know. But clearly it’s time for someone with political clout to step forward and stop the insanity.

For many years, our once-proud town has floundered from lack of leadership, and our community institutions have been in decline as a result. As a Ventura resident, I’m proud that we have begun to tackle the most obvious problems--libraries and new schools among them. But I’m tired of being embarrassed that my town is home to “the nastiest little hospital war in America,” as one medical magazine called it.

It’s time to make peace on Loma Vista Avenue and get on with the business of making our community a better place.