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Hospital officials – who called the decision “extremely difficult” – said the layoffs go into effect Jan. 15.
Siri Nelson, who joined the hospital last year as its newest chief administrative officer, said no direct patient caregiver positions were eliminated.
“All were support and administrative in nature,” she said.
The jobs affected included six managerial positions and 13 others across all areas of the hospital, including union and exempt positions, Nelson explained.
Nelson said the staffers who were laid off will be offered the chance to take open jobs in the Sutter system or be placed on a hiring list that would give them hiring preference.
SEIU United Healthcare Workers-West, which represents some of the workers at Sutter Lakeside, did not have a response on the situation this week.
Jan Emerson, spokesperson for the California Hospital Association, said they're seeing hospitals across the state having to lay off employees, halt wage increases, implement hiring freezes and even shut down programs because of the current economy.
“It's not uncommon,” she said. “It's been happening across the state in large hospitals and small hospitals as a result of the economy.”
Nelson and Tammi Silva, director of the hospital's marketing department as well as the Sutter Lakeside Foundation, explained that the hospital has had significant decreases in patient volumes, which they attribute to a mix of factors – population trends, patient mix, decreased insured patient market and duplication of services by providers in the area.
Early in 2008 the hospital was granted Critical Access Hospital designation, which capped the hospital's number of beds at 25. Although at one point they had as many as 69 beds, the hospital reported that it had never been close to that high number.
Nelson said that critical access designation didn't affect the current situation. Sutter Lakeside, she said, made sure patients had the right level of care, whether it was at the hospital, at home or in other care facilities.
She added that the designation actually helped Sutter Lakeside's financial situation, because it provided significant reimbursement for services provided for some patients.
Across the lake, at St. Helena Hospital Clearlake – also a Critical Access Hospital – the situation regarding patient population looks better.
Jeff Davis, spokesman for the St. Helena Hospital Clearlake, said they had an increase in patient census during the last half of 2009.
“Based on our volumes continuing to rise, we have no plans for staffing reductions at this time,” Davis said this week.
Sutter Lakeside's inpatient numbers trending down
The issue of patient numbers isn't new, and Sutter Lakeside's patient population hasn't kept pace with the growth in the county's population, Nelson said.
“This has been a challenge for Lakeside for the last couple of years,” she said. “Our volume has continued to decline.”
Based on a historical review, Nelson said the current hospital patient population is the same as it was in the 1970s, when Lake County's population was half of the current estimate of close to 65,000.
Sutter Lakeside's goal for 2009 was that the average census would level out at 23, but during the past year the average hospital census was 19.6 patients, which was 9.2 percent less than the hospital's budget estimated, according to Silva.
She explained that the 2009 budget already showed a 23.1-percent decrease to account for the 2008 census drop.
Overall, the hospital census was down in 2009 by 28.1 percent from its 2007 levels, said Silva. That is a change of approximately 9,937 patient days in 2007 to 7,144 patient days in 2009.
That put the employee-to-patient ratio at a higher number than budgeted. Sutter Lakeside reported that its number of full-time employees per patient was 7.13 in 2009, higher than budget of 6.51. For 2010, they've budgeted 6.2.
Still, based on the drop on patients, the hospital's latest benchmarking report showed that they were 38 full-time employees higher than their compare group, and were using considerably more staff hours than most hospitals to do similar volumes of work, which resulted in added costs.
So far, they've reduced staff by attrition – leaving positions unfilled after people resign or retire – and recently implemented a voluntary layoff option. However, more staff cuts were needed, especially in departments that didn't flex to adjust with patient loads, Nelsons aid.
Silva said the overarching message is that the reduction wasn't the fault of hospital staff members. “There are forces outside of their control that led to this.”
Another factor affecting patient numbers is technology, which has resulted in procedures that once required hospitalization becoming outpatient procedures, and also has raised the standard of care but at a higher cost. Where, in the 1970s, an x-ray was the standard, today it's CT scans, MRIs and PET Scans, which require multimillion-dollar machines, Nelsons aid.
The hospital no longer offers some services, like dialysis, which Nelson said isn't a core hospital competency and which is offered by other local health service providers.
As for emergency room numbers, both Sutter Lakeside and St. Helena Hospital Clearlake show increases between 2000 and 2008, according to data provided to Lake County News by the Office of Statewide Health Planning and Development.
Between 2008 and 2008, Sutter Lakeside grew from 1,002 to 1,411, while St. Helena Hospital Clearlake rose from 565 in 1000 to 778 in 2008, with a peak of 1,019 in 2002, according to the data.
Economic factors become more exacerbated
The economy and the local jobless rate – edging toward 18 percent – also are believed to have an impact on who is, and isn't, seeking care, Nelson said.
Anecdotally, she's hearing of people putting off procedures because they don't have insurance or simply can't afford it. That includes not only major surgery but preventive services, like mammograms and colonoscopies.
The hospital's nonprofit mission guarantees care. “We take anybody, regardless of their ability to pay,” she said.
They also have hard evidence of economic impacts on patients.
This past November, the hospital's dollar amount for uninsured care doubled from the average that had been established during the year's previous 10 months, Nelson said. In other words, twice the number of people were paying for their own services out of pocket in November.
“That's significant,” said Nelson.
Nelson added, “I don't know if that's going to be a trend.”
They said they believe that hospitals around the state and the country are facing similar challenges because of the economy and the growing number of uninsured.
Emerson said a study conducted last spring showed that hospitals across the state have been affected by the economic downturn in several ways.
“We've seen a substantial increase in uninsured patients,” Emerson said, with many of those people turning to emergency rooms.
They're also seeing a decline in elective procedures, said Emerson, which often are the money making procedures for hospitals, helping to offset the costs incurred in emergency rooms.
Lake County Health Officer Dr. Karen Tait said her office attempts to track the complex issues of utilization of the local health care system.
“Public Health has a general, overall interest in access to care issues but we don't really have a method of systematically tracking or analyzing all of the different angles to it,” she said.
The California Department of Public Health also told Lake County News this week that they also don't track the impact of the economy on health care access.
Tait said a local collaborative process is getting under way to do a countywide health needs assessment. A request for proposals has just been put out to seek a consultant.
“That process is the way that we in public health as well as others will be able to get a handle on what is impacting local people here,” said Tait.
She added, “The economy has to be a big factor,” regarding the kinds of trends Sutter Lakeside is seeing.
Tait said the information about Sutter Lakeside's patient trends is the kind of information that would go into the needs assessment.
“It really needs to be looked at systemically,” Tait said.
“Now is a really interesting time to do a needs assessment due to the changing conditions,” she continued. “It's sort of a moving target.”
Nelson and Silva said they didn't know yet if further staffing reductions would have to be made. Silva said they have to be good stewards of resources in order to preserve health care for the community.
Nelson said they have to always staff for patient volume.
“It's a conversation we have every day,” she said. “Our hope is to not have to do a reduction in force but we need to be very diligent to staff every day to every patient that we have.”
She added, “Sutter Lakeside is not alone in this conversation.”
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