Editorial: California hospital services definition harms patient health

Santa Clara County residents who need emergency medical services should not have their treatment threatened because the closest hospital is miles away.

It seems inconceivable that such a problem could exist in a county of such stature, and yet it does, because California’s definition of “general acute care hospital services” has no teeth. What it does have is a glaring loophole in the definition that enables private and publicly traded companies that own hospitals to easily gut services that don’t turn a profit. The language sits in the state’s code of regulations like an unknown cancer that silently metastasizes.

The California Department of Public Health defines the requirements for every general acute care hospital by eight basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy and dietary services. But the definition does not require these hospitals to provide emergency medical services, maternity care, pediatric care — including neonatal ICU — psychiatric care and stroke services. All these critical services are defined by the state as supplemental.

Under these requirements the state considers dietary services more important than any of the five critical services above. When was the last time hospitals addressed dietary requirements in their food? How does a pharmacy rank higher than taking care of severely ill children, pregnant women and those having a heart attack, stroke or some other traumatic event? Yes, access to medicine matters, but it doesn’t help if the person who needs it dies en route to the hospital.

Everything about this definition is disparaging, discriminatory and outdated. For a state that touts itself as being progressive, its hospital health care regulations are mind-boggling.

Years ago, this might have not mattered because there was little distinction between private, public and nonprofit hospital services. Hospitals were numerous, even if the quality varied. They offered most of those supplemental services and had the public’s trust. These institutions were there to serve the community, not to make money off the community.

There is legislation at the state level, Assembly Bill 3129, worming its way through Sacramento. It would give state Attorney General Rob Bonta oversight to prevent hedge funds and private equity groups from buying health care institutions and sucking out the profits.

But that doesn’t resolve the definition loophole, which leaves local hospitals at the mercy of for-profit entities, even if this bill passed. It’s the lack of accountability that allows publicly traded companies like HCA Healthcare, which operates Regional Medical Center in East San Jose, to gut whatever it wants — and it’s been having a field day.

The evisceration began in 2004 when HCA closed San Jose Medical Center, the city’s only downtown hospital. In 2020, the corporation shut down the maternity ward at Regional. In 2023, HCA shuttered its acute care psychiatrist services and neonatal intensive care unit at Good Samaritan Hospital in San Jose. Now, HCA plans to shutter Regional’s trauma center in a little more than a month.

If the definition of those eight basic services had been updated years ago would we be even facing this fiasco? Chances are Tennessee-based HCA would have never come to California.

After this next round of cuts there will be only three general acute care hospitals in Santa Clara County providing those “supplemental” lifesaving services: the Santa Clara County medical system, which includes Valley Medical Center, El Camino and Stanford hospitals. All three are non-profit making hospitals in the county, with a population of close to 2 million people.

A state public health spokesperson told San José Spotlight the “reduction of supplemental services is concerning,” but the state’s hands are tied. That’s a poor excuse for lack of oversight in updating regulations to meet today’s requirements.

California needs to review its eight basic hospital services and amend them to appropriate standards, so residents who need lifesaving treatment get the help they deserve — and the health care companies that only care about their bottom line stop getting a lifetime pass for unethical behavior.

Moryt Milo is an editor at San José Spotlight. Contact Moryt at [email protected] or follow her at @morytmilo on X, formerly known as Twitter. Catch up on her monthly editorials here.