Dignity Health recently announced plans to build a $125 million addition to French Hospital in San Luis Obispo. The project would add 95 new private patient rooms, bringing the licensed bed count to 195 and add some new services as well.
Like most people in the community, I was impressed.
French Hospital has been making news recently with its beautiful education building and emergency department expansion. Updating the old facility is overdue and the added modern space is a needed improvement.
Then it occurred to me, do we really need more medical-surgical beds?
I found myself thinking back to when I was a young physician in town, serving on the Board of the Midcoast Health Systems Agency, a regional planning body created to oversee capital expenditures by hospitals. The thinking at the time was that one way to limit rapidly rising healthcare costs was to control unnecessary duplication of hospital services. For a period in the ‘80s, a hospital could not add to its facility without obtaining a certificate of need. Though the agency eventually went away (yes, it was government sponsored), the basic principle remains valid.
Multiple studies, including a landmark article by Atul Gwande in the New Yorker in 2009, (“The Cost Conundrum; What a Texas town can teach us about health care”), have shown that excess capacity only leads to excess utilization and costly duplication. This planned expansion is clearly a case in point.
Neither of the two hospitals in San Luis Obispo has a daily census that approaches its licensed bed capacity. Both, in fact, do not even have as many physical beds as their current license would permit, as beds have been removed to reduce crowding. Inpatient utilization nationwide has been falling for years and San Luis Obispo is no exception.
I cannot speak to the motivation for adding more beds where there appears to be no real need, but I can speak to something we can all agree on: What San Luis Obispo needs are mental health beds. If you ask physicians and family members of people suffering from a mental illness, they will tell you that the nearest in-patient psychiatric hospital is 130 miles away in Ventura and is frequently unable to accept patients. Individuals requiring hospitalization and their families often travel to Los Angeles, the San Joaquin Valley or the Bay Area to receive help. The reality is that the long distance from facilities means care is not practically available to many here who urgently need it.
Additionally, patients with mental health needs have been seeking help in local emergency departments, often causing temporary stays of hours or even days until out-of-area beds become available and transportation is arranged. In many ways psychiatric care in San Luis Obispo County is the same today as it was in the mid-twentieth century when we were a rural county with fewer than 100,000 residents (today’s population is around 280,00).
Hospital management might argue that mental health isn’t compatible with other hospital services, but in fact French Hospital had both a psychiatric unit and a drug and alcohol treatment unit in the ‘80s.
Both programs were closed because insurance stopped paying, not due to incompatibility with the rest of the hospital. Recent legislation has improved reimbursement so that it is no longer a losing proposition.
I would propose that Dignity Health consider changing its plan to include an inpatient psychiatric unit. Construction hasn’t started yet and, according to news sources, the hospital will need more than $20 million of additional private donations to be able to fund the project. Raising that money will be much easier if a badly needed service is included in the plan.
When Transitions Mental Health went to the community to raise $2 million dollars for its new Bishop Street Studios project, it was able to meet the goal in a timely fashion. There appears to be a deep interest in improving mental health services in the county and tapping that interest could benefit the hospital and the community.
Leaders at French Hospital have emphasized publicly that as the only not-for-profit hospital in the city of San Luis Obispo, they are able to provide services to the community without regard to stockholder and corporate needs. This is an opportunity to leverage their advantage for the benefit of that community.
Dr. David Bernhardt was a practicing physician for 32 years, during which time he served on the boards of several local medical organizations. He was named Citizen of the Year by the San Luis Obispo Chamber of Commerce in 1988. He currently serves on the boards of several community organizations, including the San Luis Coastal Education Foundation and Transitions Mental Health Association.