Proposed Hospital Spurs Opposition

A new specialty hospital proposed for Loma Linda would treat only a sliver of patients in Southern California’s rapidly growing Inland region, but it has touched off a firestorm in this small city known worldwide for its cutting-edge medical center.

Hospital administrators in Riverside and San Bernardino counties are campaigning against the $50-million California Heart and Surgical Hospital, adding to the nationwide debate about the effect of so-called specialty, or boutique, hospitals on nearby general-care hospitals.

The opponents, including Loma Linda University Medical Center officials, contend the for-profit hospital’s 28 beds could take away many of the high-end surgeries that subsidize the treatment of their facilities’ poorest patients.

But the proposed hospital’s backers said the physician-owned facility would offer a top-notch choice to residents in San Bernardino and Riverside counties and would be too small to affect local medical centers.

As the Loma Linda City Council prepares to vote tonight on whether to approve plans to build the surgical center, at least one group is planning a rally against it.

The group, Save Our Community Healthcare Access, whose members include several area hospitals, has blanketed the town of 20,000 with petitions and cable, newspaper and direct-mail ads.

The City Council has struggled to get a quorum to vote on the matter because most of its members have ties to the Loma Linda University hospital and have recused themselves.

“They’re trying to push off these national healthcare issues on little Loma Linda,” said Mayor Floyd Petersen, a council member for 15 years. “It’s turned into the biggest issue I’ve ever seen here.”

The 70,000-square-foot California Heart and Surgical Hospital’s services would include radiology, cardiology and neurology, and the facility would have six operating rooms. The owners hope to tap into the region’s soaring population, which could strain local medical resources in the coming years, according to a study commissioned by the hospital’s backers.

“This is a small town, and there’s only one way of doing business. Now this young upstart is coming in, and they don’t like that,” said orthopedic surgeon Allen Gustafson, one of 36 physicians who would share ownership in the hospital.

Boutique hospitals generally treat patients who need procedures that supply high insurance reimbursements to cardiologists, orthopedists or other specialized physicians. The proposed Loma Linda hospital would accept patients covered by Medicare and Medi-Cal.

In 2003, the U.S. General Accounting Office reported there were nearly a dozen specialty hospitals in California and about 100 nationwide and told Congress this year that it expected those numbers to increase.

Opponents deride specialty hospitals as profiteers that could force community hospitals to downgrade their emergency rooms and slash outreach programs such as health screenings because they would no longer profit from wealthy or well-insured patients.

They are also concerned that doctors who treat patients in community hospitals could direct patients to boutique facilities in which they have an ownership stake.

“We’re all watching Loma Linda, because the floodgates could open depending on what happens there,” said Jan Emerson, spokeswoman for the California Hospital Assn., which represents nearly 500 hospitals and opposes the project.

In 2003, Congress imposed a moratorium on new boutique hospitals while their effects on community healthcare were studied. The ban expired in June.

According to a GAO study, the facilities are less likely to have emergency departments and treat patients who qualify for Medicaid. Within their niches, such as cardiology, boutique hospitals tend to care for more patients than general hospitals but treat fewer people who are severely ill, the agency found.

Another federal study released in March found only slight financial losses at local hospitals when specialty hospitals opened nearby, although some cut staff while others expanded their moneymaking enterprises, such as rehabilitation and neurosurgery. The Medicare Payment Advisory Commission, which advises Congress, conducted that study.

The study also cautioned that community hospitals -- particularly in rural areas -- could be hampered as more specialty centers open.

In Loma Linda, where the medical center is renowned for groundbreaking procedures such as infant heart transplants, some residents have met the California Heart and Surgical Hospital proposal with vitriol. Several hundred people have showered the City Council with calls or letters about tonight’s vote, the mayor said.

“It’s mission versus money. Our mission is serving everyone. What we make goes back to the community, not someone’s pocketbook,” said Michael Jackson, senior vice president at the nonprofit Loma Linda University Medical Center, an area hospital involved in Save Our Community Healthcare Access.

Gustafson defended the proposed hospital as a place where doctors could personalize care and try innovative procedures. He said it shouldn’t hurt local hospitals because doctors would still schedule surgeries at those facilities; the specialty hospital would be too tiny to hold all their patients.

“They’re screaming like Chicken Little, and the sky has yet to fall,” said Bill Arsenault, a consultant for the California Heart and Surgical Hospital.

Still, San Bernardino County supervisors in April passed a resolution denouncing the specialty hospital, though they have no power to bar its construction on a 6-acre site near Barton Road and New Jersey Street.

The latest twist came when three of five Loma Linda City Council members recused themselves from deciding the hospital’s fate. The three drew straws to determine that Petersen would cast tonight’s third vote, even though he teaches at Loma Linda University.