Closing Stanislaus Medical Center is sad, but the Board of Supervisors put sentimentality aside Tuesday when it unanimously approved shutting down the hospital Nov. 30. As part of their decision, supervisors approved a contract with Tenet Healthcare, parent company of Doctors Medical Center, where indigent patients will be seen beginning Dec. 1.

People who are medically indigent are often the working poor; they make too much money for Medi-Cal but don't receive medical benefits at their jobs.

Closing Stan Med doesn't mean the county is getting out of the health care business entirely. It will continue to operate 10 health clinics and has plans to add more. The clinics -- in Modesto, Oakdale, Turlock, Hughson and Ceres -- provide family practice physicians, immunizations, prenatal, women's services and preventive health care.

Stanislaus Medical Center has served the county since 1856. And although supervisors said they regretted having to close the hospital, they were convinced they had no choice.

The county anticipated that by 1999, the medical center would lose $4 million to $6 million a year because fewer people are being hospitalized and, when they are, their stays are shorter.

"We represent more than just the patients. We represent all the taxpayers. We had to look at how long we could keep it open and stay fiscally healthy," Supervisor Ray Simon said.

Said Supervisor Pat Paul: "We're a business board and this is a business decision."

Nine months ago, Paul and Supervisor Paul Caruso voted against negotiating with Tenet, preferring that the county consider Catholic Health Care West as its future health care partner. But Tuesday, neither Paul, Caruso, nor many other people objected to the agreement that turns over hospital and emergency room care to the private, for-profit medical center.

The board appeared to be convinced that the patients would receive as good or better care at Doctors, which already provides cardiac and obstetric and gynecologic services to Stan Med patients.

The board also was assured that Stan Med's employees had been treated fairly.

"My biggest fear," said Simon, "was consideration for the employees."

As of Tuesday, 45 full-time workers had accepted jobs at Doctors, 29 accepted early retirement and 19 transferred to other positions.

"Only 10 full-time employees are without jobs, and we expect that to be zero as of next Tuesday," Bev Finley, the county's Health Services Agency director, said after the hearing.

At full staff, Stan Med had a total of 208 full-time positions, but 115 are vacant. It also has about 300 part-time employees, many of whom have also found other work or were trained for other jobs.

Five agreements covering the transfer of care and other aspects of the partnership were approved. They include:

• Tenet will pay the county $12 million. The money, which can be used for any purpose, probably will be placed in a trust to improve the county's health care system.
  
  "We could build a clinic on the West Side," county Chief Executive Officer Reagan Wilson said earlier this week.
  
  The county, however, also will lose money in the deal. If it doesn't operate a hospital, it will lose up to $4.5 million a year in state and federal funding.
  
  Some of the money may be made up by increased tax revenues that are allocated to health services and other health programs, Wilson said.
  
• Tenet promises to pay for the hospital and surgical services for up to 2,000 medically indigent individuals a year.
• The county and DMC will jointly operate the Family Practice Residency Program to train new doctors. DMC will provide the facilities, support staff, medical staff oversight and cover all costs, though it will be able to bill Medi-Cal for services rendered by the residents.
• Stanislaus Behavioral Health Center, the psychiatric hospital operated by the county, will be leased to DMC. This agreement is critical, because the behavioral center can't receive Medi-Cal and Medicare reimbursement if it's not affiliated with a hospital.

Reprinted by permission of Modesto Bee