Hard choices: what about TGH?

For the last decade, Tuolumne County’s hospital, TGH, has required an ever-increasing subsidy from the general fund and one-time monies. Tuolumne County has reached a time of reckoning. The decision we make on April 10th will impact this county and its residents for years to come in terms of the availability or lack of services and in terms of the costs to continue to provide or eliminate services.

The one-time funds that have allowed us to continue to fund TGH are used up and the amount of support it demands from the general fund is increasing. The only source from which the Board of Supervisors can take funds from here on out is the approximately $27 million general fund dollars that aren’t mandated by the state and federal government to be spent on other services.

Of that $27 million “discretionary pot,” the Board currently funds $13.6 million to justice and law enforcement, $642,00 to roads, $615,000 to fire, $5 million to other services including libraries, recreation, and departments like community development (planning, building, and related departments), and $7.8 million on TGH. Over the last few years, a significantly larger share has been diverted to TGH (up from $757,000 in FY 98).

On the other hand, TGH has a strong following of devoted employees and clients. Many worry about what will happen if TGH is no longer around to serve the indigent. Despite the existence of Sonora Regional Medical Center and its stated willingness to take on the provision of care to indigent residents, people worry about the future of health care in Tuolumne County.

What to do?

The options are few and their impacts will be debilitating, devastating, and disastrous, no matter which option is chosen. Despite that fact, 1 option will of necessity emerge as the lesser of evils, likely on April 10th.

If you’d like detailed information, background information and options can be found in a series of reports. Read about each of the options and their impacts in detail in the March 20th Camden reports entitled Healthcare Models: affordablity, impacts, and opportunities and TGH Transition on the county’s website at (http://portal.co.tuolumne.ca.us/psc/ps/TUP_ADMIN/ENTP/c/TU_DEPT_MENU.TU_DOC_LIST.GBL?Page=TU_DM_CONT_VIEWER&Action=U&CONTENT_PNM=EMPLOYEE&CATGID=1480&PortalNVContType=F&PortalNVContId=7253).

Depending on which option the Board chooses, TGH expenses will go up or down in the immediate future (see Option Choices table, below). A recent article in the Union Democrat, TGH puts 88 county jobs on the line, detailed the sobering reality: our economy be impacted as we cut jobs – either at TGH, in General Fund Departments, or both – depending on the funding option chosen by the Board of Supervisors.

In a nutshell, the options and some impacts are:

Option 1 – status quo model

Continue to operate TGH at the current level, eliminate 88 jobs in general fund departments and 0 jobs at TGH, figure out how to pay for upcoming years as we go (see Cost Table below), plan for and find funding for significant building upgrades and/or replacement to comply with state licensing requirements and handicapped access requirements, residents will continue to have access to 2 area hospitals.

Option 2 – non acute model

Continue to operate long-term care, adult day health care, the psychiatric facility, and the health and wellness clinics, eliminate all other TGH services, eliminate 68 general fund jobs and 50 (7 non-medical) TGH jobs, access to acute care will be limited to 1 hospital.

Option 3 – privatization model

Close acute care and in-patient psychiatric services, continue long-term care operations while identifying business or agency to assume responsibility for continued operations, turn over clinic services to private providers, eliminate 153 TGH jobs (79 non-medical), 0 general fund jobs, access limited to 1 hospital in Tuolumne County.
Option Costs through 2012 (does not include building costs) in millions (Source: see Camden Group report, TGH Transition here)

Option 1 – status quo

FY 2008 $ 8.3
FY 2009 $ 9.3
FY 2010 $ 19.2
FY 2011 $ 15.2
FY 2012 $ 16.2

Option 2- non-acute
FY 2008 $ 7.1
FY 2009 $ 4.8
FY 2010 $ 4.8
FY 2011 $ 4.8
FY 2012 $ 5.0

Option 3 – privatization
FY 2008 $ 4.5
FY 2009 $ 2.1
FY 2010 $ .9
FY 2011 $ 1.0
FY 2012 $ 1.0

County Administrator, Craig Pedro, has informed the Board that given existing conditions the general fund will only be able to divert $3.0-4.5 million to TGH next fiscal year…

Potential ballot measure turned down by BOS

Despite the fact that many have called for the opportunity to vote on the issue of creating a hospital district to operate and fund TGH, the Board voted not to allow for a ballot measure to do so. The Board (unanimously) did not feel the County has the time to wait the approximate 1.5 years before funding begins to be generated from a tax measure. Further, it seemed highly questionable and unlikely that 2/3 of Tuolumne County voters would agree to tax themselves to continue TGH since close to 30% of patients leave the county for hospital services and the historical trend of voters here has been to turn down tax measures resoundingly.

Weigh in, please

I encourage you to attend an upcoming Beilenson Hearing on either March 27 (1:30 pm) or April 2nd (6:00 pm) in the Board Chambers at 2 South Green Street in Sonora to weigh in on the decision. We need to hear from you. Our decision will have impacts that touch us all.

Hard choices. What would you do if you were on the Board?

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I was raised in Northern California on a sheep ranch. I'm passionate about working landscapes ā€“ balancing the interests of agriculture, thriving rural communities, and healthy natural resources. My husband Richard ā€“ the Professor - is a teacher. We live in Idaho with our horses, dogs, and close-by daughter and her family. I'm taking a trip soon and have attempted to introduce readers to some important backstories that will be helpful to understand the context for my observations. To read them, go to Topics in the sidebar and select Rambles with Ruby.

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