Monday, March 2, 2009

He called it "The message you hope never to send"

On July 5th, I read a message from a leader whom I greatly admire. He said hoped he would never need to send such a message. It was in the form of an email that was sent to the Beth Israel Deaconess Medical Center Community by their CEO, Paul Levy, about a medical error that had occurred.

Today I read another message from a leader I greatly admire, Dr. William Walker. With his permission, I have posted it below. It is a message I know he and all of us at the Medical Center wish never had to be sent.

I am confident that we will get through this time and eventually emerge stronger, but there is no mistaking that it is a painful time for our system and many others across the state and nation. In our planning and actions, we will follow the example set by systems like Beth Israel Deaconess Medical Center: in the face of adversity, they remained transparent and pushed to discover and improve. We will face this challenge, meeting it with innovation and creativity. Our mission will guide us.

Tomorrow morning, the Operations Leads of Contra Costa Regional Medical Center (CCRMC) will meet to discuss the challenges that lie ahead. We recognize the immediate need to review and revise our saturation plan and we have begun that process. We will continue to provide care for all who are in need at CCRMC and we will open the doors wider if we must. We will look for innovative ways to utilize the public's precious, limited, resources while improving quality for those whom we serve.

I can only imagine how difficult it was to send this message, and I intend to stand with Dr. Walker, the Board of Supervisors and all of you while we find our way forward.

Although it may be difficult to see, each day will offer us a new opportunity. We are not alone. We are a part of a much larger community; we are the nation's safety net. A frayed net, perhaps, as Dr. Walker described it, but it is our calling. For far too many, there is no one else.

We must draw on the strength of others and the determination of the many. We can learn new ways. Isolation, fear and anger will not serve us. Now, more than ever, we need effective communication. We must not forget that we need to talk, we need each other. The science of improvement, ingenuity, constancy of purpose and our mission are the tools and the guides we need to build our future.

Please, let us stand together.


Dr. Walker's message is as follows...

Tomorrow, the Board of Supervisors will discuss policies related to how to address the county deficit. As I told you in the Director's Report last week, the proposal I submitted was a very difficult one - $13.5 million with significant cuts in Public Health, Mental Health and the Medical Center. (A calendar of the upcoming Board actions is online at

It is never easy to cut expenses because those cuts generally mean a reduction of services and lay-offs of employees. This round of budget cuts is especially difficult because it contains both. Today we are posting the list of positions proposed for elimination. Some of you in the positions listed for elimination will have the right to "bump" to another position in the same classification or perhaps to a position you held previously. Our Personnel staff will begin meeting with impacted employees and their labor organizations shortly. Regardless of who ultimately will be laid off, the list represents cuts that will negatively impact a great many lives in our Department and in our community, and I wish that were not so.

Among the very painful decisions I've had to propose to the Board of Supervisors this year is to restrict eligibility to our services. Assuming the Board approves that plan, Contra Costa residents who are undocumented non-citizens will no longer be eligible for non-emergency outpatient services at our Health Centers. We will begin phasing in that policy shortly after Board approval. We will continue to provide services to pregnant women and children.

Along with all hospitals, we will continue, as required by law, to provide emergency services and related inpatient care to everyone. I will be working in the coming weeks to encourage our community partners to work with us to help all those who need care.

Restricting eligibility will save an estimated $6 million a year - county funds we spend for undocumented Contra Costans with no federal or state reimbursement. It will also free up critically needed appointment slots for Medi-Cal and Health Plan members and the newly unemployed who have lost their health insurance.

No one who has chosen to work in the public sector - for many of us, like me, who have devoted their entire careers in service to the people of Contra Costa - thinks this is good public policy or that rationing health care makes sense.

But this is a public agency and we have been directed to balance our budget. Across California, other counties are regrettably taking similar steps. In Sacramento last week, two Health Centers were approved for closure. The banks and car industry have been bailed out by Washington and I hope with all my heart that the health care system is next.

You can hear more of my thoughts about restricting eligibility in the Podcast on our website at Information about specific cuts and other material will be posted there also.

There will be public hearings about the proposal. The Board of Supervisors is responsible for making the final decision about each of the reductions we have proposed.

I can only ask that in the coming weeks as we move ahead with whatever they approve that we remain committed to our mission and to protecting the safety net - frayed though it may be. I ask you to treat our community with compassion, our partners with respect and understand how difficult these times are for those of us who are forced to choose between conflicting demands and distasteful strategies.

William B. Walker, M.D., Director and Health Officer, Contra Costa Health Services

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