Events in 2003 created turmoil in the health field, whether it was SARS, the flu or the clash of health care giants.

Tenet Healthcare Corp., the nation's second-largest private hospital chain, sank deeper into trouble in the wake of charges that two doctors at its Redding hospital performed unnecessary heart surgeries.

Authorities looked into charges of Medicare billing fraud, Securities and Exchange Commission violations, physician recruitment schemes, improper Medi-Cal billings, and overcharging of the uninsured.

Tenet-owned Doctors Medical Center of Mo- desto came under state scrutiny for having some of the highest charges in California.

In February, Tom Kucera of Patterson, who was then-uninsured, testified before the Assembly Health Committee about being driven to financial ruin by a $48,000 bill for a two-day stay at Doctors Medical Center.

Tenet, to settle a Southern California lawsuit, agreed to provide discounted rates for the uninsured and vowed to stop suing the unemployed to collect on hospital bills.

Kucera said this month that he now is covered through a Medicare health maintenance organization, but that his wife, Cindy, recently applied for Medi-Cal and was turned down. They are struggling to purchase medication to treat her leukemia.

"We are trying to keep our heads above water," he said.

In other developments in 2003, health care organizations moved forward with building plans to address a shortage of hospital beds and an increased demand for services.

In Modesto, Memorial Medical Center launched the first phase of a $160 million expansion project, with the start of construction on a 40,000-square-foot medical office and six-story parking garage at its Briggsmore Avenue and Coffee Road campus. The medical office is a joint effort with Sutter Gould Medical Foundation.

Memorial is awaiting state approval for the project's second phase, which calls for a seven-story patient tower with 112 inpatient beds and additional operating rooms. That phase is slated for completion in 2006.

Kaiser Permanente continued to develop plans for a 200-bed hospital in northwest Modesto. Kaiser, which has 89,000 members in Stanislaus County, is shooting to open the hospital in 2007.

Kaiser opened a clinic on Bangs Road in north Modesto in January and later completed a 24-physician medical office on Dale Road, also in north Modesto.

Rift sends patients afar

Many cheered the Kaiser additions, but some were not pleased when the HMO and Sutter Health failed to renew an agreement under which Kaiser members received care at Memorial.

After March 31, Kaiser patients were referred for nonemergency care to Emanuel Medical Center of Turlock and Dameron Hospital of Stockton. Patients needing surgery were referred to Stanislaus Surgical Hospital of Modesto, while others needing certain types of specialty care were sent to Sacramento or the Bay Area.

Emanuel had beds available for the influx of Kaiser members but expanded its facilities for the youngest patients. A $3.5 million building project doubled the floor space of the hospital's birthing center and increased the number of delivery rooms from five to eight.

The expanded center greeted its first newborn Nov. 20, when Kendrick Gonzalez was born to Maria Zamora and her husband, Jorge Gonzalez, of Ceres.

During the year, officials in Stanislaus County dealt with one unusual health threat after another.

In February, officials reported that a Modesto High School student was diagnosed with active tuberculosis. The student was quarantined at home while receiving treatment.

In March, about 150 health workers were vaccinated for smallpox so they could serve as first responders in a biological terrorism attack. It was the first time in more than 25 years that smallpox serum had been administered in the county.

The response team included representatives from the county's five acute-care hospitals -- Doctors, Memorial, Stanislaus Surgical, Emanuel and Oakdale's Oak Valley Hospital.

In April, Stanislaus County health officials reported a suspected case of severe acute res- piratory syndrome, or SARS.

A Turlock elementary school student came down with SARS-like symptoms after her father returned from a province in China where the illness was rampant. Within a week, however, tests showed the girl had the flu.

SARS-fighting steps adopted

Even so, local agencies adopted measures designed to identify people infected with the SARS virus and to prevent the spread of the disease. The respiratory illness sickened 8,098 people and killed 774 worldwide.

"We have continued to work on it," said Dr. John Walker, the county's public health officer. "Some of those guidelines are what is helping to protect our hospitals from influenza."

This month, the community braced for the arrival of virulent strains of influenza, and the flu might have claimed one victim. Modesto police officer Michael DuFour, a former band director at Beyer High School, died Dec. 13 after suffering from flulike symptoms. A coroner's spokeswoman said Monday that results of toxicology tests on DuFour were not complete and his cause of death hadn't been determined.

County officials also worked with mosquito abatement districts to develop preventive measures for the West Nile virus.

The virus, which is spread by mosquitoes and is capable of causing encephalitis, arrived in Southern California this year, causing two people to become sick.

Walker said it's possible West Nile will make its way to Northern California in the spring or summer.

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com.

Reprinted by permission of the Modesto Bee.