LB City Council conducts study session on saving Community Hospital

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Courtesy City of LB
A map from the City of Long Beach illustrates the areas of varying degress of seismic concern at Community Hospital. The buildings in red need to meet OSHPD’s compliance by Jan. 1, 2020, according to Diana Tang, manager of Government Affairs for Long Beach.

As MemorialCare, the healthcare system that has been operating Community Hospital since 2011, initiated a wave of layoff notifications this week, those seeking to keep the seismically challenged medical center open seemed to shift their focus from criticizing MemorialCare’s handling of the situation to moving forward with potential plans to address the problem.
However, local and state nurse unions this week were still vocal in criticizing MemorialCare for allegedly expediting the hospital’s closure for business goals that are unrelated to the seismic problems.

CNA/NNU allegations
A quorum of Long Beach City Council members met Tuesday afternoon for a study session on preserving services at Community Hospital, including Mayor Robert Garcia, Lena Gonzalez (1st District), Jeannine Pearce (2nd), Daryl Supernaw (4th), Roberto Uranga (7th) and Al Austin (8th). Third District Councilmember Suzie Price participated in the meeting via conference call.
Just before the study session, the California Nurses Association and National Nurses United (CNA/NNU), along with community leaders, conducted a press conference outside Long Beach City Hall in which nurses criticized MemorialCare for “accelerating the closure for business goals unrelated to the stated seismic reasons.” The nurse unions indicated that MemorialCare is seeking to circumvent growing public opposition with “trumped-up reasons” to hasten the shutdown.
“CNA/NNU contends that MemorialCare used bogus facts to fabricate an alleged understaffing situation that led to closing the emergency room on diversion prematurely and most likely in violation of state law,” states a press release the unions issued Tuesday. “The CNA is calling on the California Department of Public Health to require MemorialCare [to] comply with legal notice standards and not waive the 90-day notice requirement before instituting acute-life-support diversions.”
After the press conference, the Signal Tribune reached out to John Bishop, chief executive officer of MemorialCare Long Beach Medical Center, MemorialCare Miller Children’s & Women’s Hospital Long Beach and MemorialCare Community Medical Center Long Beach, for his reaction to the unions’ claims.
“These assertions are not true,” Bishop said. “In November 2017, Community Medical Center announced findings from independent seismic studies which revealed a wide, active earthquake fault zone under the hospital campus. The findings were supported by significant due diligence, including consulting with seismic experts, structural engineers and architects, and the findings were recently verified by seismic experts hired by the City of Long Beach.”
Bishop added that the California Office of Statewide Health Planning and Development (OSHPD) confirmed that, because of the active fault line and California’s legal requirements for acute-care hospitals, Community cannot meet seismic-compliance regulations.
“Since making the announcement in November of the impending closure, the number of Community Medical Center employees and staff leaving for other longer-term opportunities— 109 as of Tuesday, April 3— has grown significantly,” the CEO said. “While Community Medical Center continues to maintain patient staffing ratios, it has become increasingly challenging to maintain the depth of resources available and necessary to operate an acute-care hospital. As such, the 120-day lease termination notice was submitted in early March to the City of Long Beach, which is the owner of the land and facilities. The facility will remain appropriately staffed until the hospital has closed all acute-care services.”
Bishop also indicated that MemorialCare has guaranteed positions for 114 employees, including 72 registered nurses, within the health system once Community closes.
“The hospital is also offering substantial outplacement services, such as job fairs, preferential interviews within the health system, career-support workshops, one-on-one counseling assistance, and more,” Bishop said, “in addition to offering generous retention bonus plans, which were announced on Nov. 6, 2017, when Community Medical Center announced it would be closing as it cannot feasibly meet state seismic requirements for acute care hospitals due to the large, active earthquake fault running underneath it.”
In response to CNA/NNU’s allegation that MemorialCare orchestrated an understaffing situation that led to a premature closing of the ER on diversion, Bishop said his organization has complied with all laws and has worked closely with emergency medical services regarding advanced life-support (ALS) diversion, which has averaged about six patients a day.
“We are also working with EMS and [the California Department of Public Health] to address the ALS diversion, as our collective goal is to provide the best patient care for our community,” Bishop said. “A study that looked at local emergency departments learned that Community Medical Center’s emergency department visits represent only about 10 percent of total ER visits. Over half the area’s ER visits are considered low acuity, and these patients can be seen in other settings, such as at more than two dozen urgent-care centers and federally qualified health centers located in Long Beach. Community Medical Center and its emergency department is not a designated trauma center, stroke receiving center nor cardiovascular receiving center, and does not provide obstetrical services. All patients needing these services are referred to other hospitals within the city.”

Study session
At Tuesday’s study session, Diana Tang, manager of Government Affairs for Long Beach, said the primary aim of the meeting was to determine what can be done to preserve acute-care services at the hospital.
In presenting an overview of the issue, Tang explained that, in November 2017, MemorialCare had concluded it would be infeasible for it to meet State seismic requirements at Community.
“Accordingly, MemorialCare notified the City that they plan to cease services by June 30, 2019,” Tang said. Last month, MemorialCare announced that that date would instead be July 3, 2018.
Tang then presented a map of the City-owned Community Hospital property that showed the areas of varying degress of seismic concern.
“The map here shows where SPC-1-rated (structural performance category-1-rated) buildings are on site. These are the buildings that are in red and need to meet OSHPD’s compliance by Jan. 1, 2020,” Tang said. “The green and gray areas are buildings that are rated SPC-4 or 5 and not subject to the Jan. 1, 2020 compliance deadline. The challenge for us is that, while the emergency department is in the green zone, the utilities serving the green zone are in the red zone. This means that, in the event of an earthquake, the emergency department may still be standing, but services dependent on electricity or other utilities in the emergency department may not get those services.”
Tang added that, in California, acute-care hospitals are required to support eight basic services— medical, surgical, nursing, anesthesia, laboratory, radiology, pharmacy and dietary— so the site would need to be reconfigured in order to provide those services in the event of an earthquake.
John Keisler, economic-development director, used the hospital’s pharmacy as an example of a service that needs to be addressed.
“In the center of the building, the pharmacy, which is one of these eight basic services, is located in an area that would be considered seismically unsafe,” Keisler said. “So, that operation would either have to be moved to another area of the building that is seismically safe or there would have to be retrofitting to accommodate for the service to continue in that area.”
Tang then mentioned the steps the City has taken in the last few months to explore all available options for keeping acute-care services at Community, including initiating a peer review of the seismic study (which confirmed MemorialCare’s claims about the fault line), connecting with State agencies involved in hospital seismic safety and licensing, conducting a site visit, exploring all state legislative opportunities (determining that any legislation would face significant hurdles and that an extension would be the most viable proposal), formally sponsoring Assemblymember Patrick O’Donnell’s legislation to extend the OSHPD compliance deadline and declining MemorialCare’s original proposal to establish an expanded psychiatric-care facility and requesting it to renew its hospital license and provide the City with approval to engage with potential hospital partners.
Keisler said MemorialCare’s expedited date for ceasing operations at Community has necessitated “quick action” to identify another provider.
“But, ultimately, we can’t solidify a new provider until we have a long-term plan for the site, which we’re currently in the process of developing,” Keisler said. “We’ve engaged with a healthcare-management expert to represent the City in a request-for-information process, which involves targeted interviews with approximately eight to 10 hospitals or hospital providers that have both the financial capabilities and operational history of operating a facility of this sort. Our goal will be, through these targeted interviews, to whittle down to two or three legitimate proposals for the city council to consider, hopefully, within the next four to six weeks.”
The day after the study session, Matthew Faulkner, executive director of the Community Hospital Foundation, who had attended that meeting, told the Signal Tribune that MemorialCare has the right to exit the operations at the hospital, but he hopes that it does so with patients in mind.
“We would only ask that they ensure that, every step of the way, they’re considering patient safety first and foremost in all aspects of their winding down of operations,” Faulkner said. “We certainly respect that they’re moving on, but we want them to, as they’re operating the facility, continue to provide the optimal amount of care available.”
Faulkner said he concurs with the CNA/NNU’s criticisms that MemorialCare diverted too soon in winding down operations.
“They could have waited a little bit,” he said. “I mean, all of this is predicated by the fact that they had until June 30 of 2019 to exit the real estate, and, I think, we don’t want to kind of beat a dead horse now, because we’ve got to move on and resolve this issue, but that’s certainly part of this continuum of how they devised and implemented their exit strategy. Unfortunately, a lot of it didn’t seem to be respective of community and civic input, which was surprising to a lot of folks.”
Faulkner said the foundation is now fully focusing on what can indeed be done to sustain care in the interim while devising a “durable, more long-term solution” that could occur on the current campus or possibly at another location.
“Our fixation now is on the Community Hospital Long Beach site and what can be done there,” he said. “And we have some optimism to believe it could continue in the shorter term and then be repurposed in a way that meets multiple uses, including acute- and critical-care services. We think there’s a way forward. We’re optimistic. There hasn’t been a definitive ‘no’ on any of that, so, as far as we’re concerned, all those options are still wide open.”

Cory Bilicko | Signal Tribune
Just before a Long Beach City Council study session on preserving Community Hospital, the California Nurses Association and National Nurses United, along with community leaders, conducted a press conference outside Long Beach City Hall in which nurses criticized MemorialCare for “accelerating the closure for business goals unrelated to the stated seismic reasons.” John Bishop, CEO for MemorialCare, told the Signal Tribune that the allegations are not true.

In a phone interview Monday, Bishop told the Signal Tribune that notices of layoffs were being dispersed to dozens of Community employees. He said that, under the Worker Adjustment and Retraining Notification Act of 1988 (the WARN Act), MemorialCare must make a public notice and inform employees of its 60-day notice.
“There are about 21 FTEs [full-time equivalents]— 37 total individuals— a lot of per-diem and part-time— 17 full-time individuals, primarily non-patient-facing areas that are being told that June 1 will be their last day,” Bishop said. “So, it’s part of the intentional plan to wind down operations to have zero patients on July 3.”
Bishop explained that these layoffs include housekeepers, secretaries and patient-care assistants.
“With the anticipated wind-down of volume, we would not expect to need them beyond June 1,” he said. “We don’t think this is going to have any impact on current operations, but it’s part of the expected wind-down because we need to stop doing certain elective procedures in June. We sent a notice out to our physicians, and part of the planned wind-down is that we have to get care for all these patients with sufficient lead time.”
Bishop said the next phase of lay-offs will come 60 days before the hospital’s closure.
“[It will be] a very similar process. We would communicate to the employees and publicly that we have issued the 60-day WARN notification to the balance of the employees,” he said. “The 21 FTEs are less than 10 percent of the work force, and, so, the vast majority will receive similar notifications on May 3, or 60 days before the closure.”
Bishop emphasized that the layoffs will not interfere with services.
“It’s not expected to impact current operations in any way, and we have 114 employees that have guaranteed positions elsewhere in our system, and all the employees that are being given notice are going to receive a retention bonus, because we did put a retention bonus in place if they stayed through the date that they would no longer be needed,” he said. “In addition to outplacement assistance, we’ll continue to look for positions and give preferential review within the system and try to give them the softest landing possible.”
Of the 114 guaranteed positions, 72 are registered nurses. Bishop explained that they cannot be transferred yet because they are still needed at Community.
When asked for remarks on the efforts being made to keep the hospital open, Bishop expressed empathy but also stressed that the problems MemorialCare has faced will still exist.
“I understand the task force’s desire to maintain acute-care services, but the organizations that they’re reaching out to have the same exact fact pattern that we do, and we know that the facility can’t be brought into compliance with seismic law, and so I don’t expect there to be any solution for acute care, and I think that it would be best if we looked for a use that was in compliance with seismic law, that best met the community’s needs, and I think that we will get to that point,” he said. “We’re just not there yet.”

The Los Angeles County Department of Health Services’ Emergency Medical Services Commission will host a public hearing on the proposed closure of the emergency services at Community Hospital, on Wednesday, April 11, from 6pm to 9pm at the Grand Long Beach Event Center, in the Catalina Room, 4101 East Willow St.