TULARE COUNTY: Supervisors Vote on Contract to Provide Care to Poor
Moving closer to "closing a controversial chapter in the county's medical plan" for the poor, Tulare County leaders voted Tuesday, 4-1, to contract with Visalia-based Kaweah Delta Hospital to provide medical services for the area's poor. The decision comes about one month after the supervisors supported a similar contract with Porterville-based Sierra View Hospital, the Fresno Bee reports. The county's medical strategy for serving the poor calls for the "funneling of the area's poorest people" to these two hospitals. The lone dissenting vote came from Supervisor Mel Richmond, who suggested that no good would come from making the poor travel farther for care. Richmond stated, "I honestly believe a two-hospital plan is not in the best interest of the people of Tulare County." Under the county contracts, Kaweah Delta's indigent population is expected to increase from 830 to 884, while Sierra View's indigent patient load will climb from 225 to 419.
The two-hospital controversy began when Tulare County changed the reimbursement amounts -- money paid to hospitals for serving indigent patients -- three times between 1993 and 1998; the rates dropped from 72% to 56% during the period. Then, in 1998, the county implemented a flat-rate reimbursement system, which varied by hospital but dropped as low as 18%. Angered by the drastic cuts, administrators at Kaweah Delta, Sierra View and the Tulare District Hospital planned to sue the county. The threat prompted county supervisors to contract with two hospitals, allegedly selecting Kaweah Delta and Sierra View based on services and location. Although Tulare District Hospital sued the county for failing to provide adequate health care access, a Kings County Superior Court judge ruled last week that the county was not in the wrong. But the judge is mandating that the hospital and county resolve difficulties in caring for indigent patients who go to Tulare District rather than to one of the contracted facilities. While Tulare District CEO Robert Montion remains concerned that the county's poor will not be able to find transportation to the contract hospitals, Tulare County Health and Human Services Director Ron Probasco notes that the contracts will not prevent the county's poor from visiting non-contract hospitals. The non-contract hospitals, however, will receive a flat-rate reimbursement rather than the contracted rate (Olvera, Fresno Bee, 11/17).