ARTICLES
February 2004 ARTICLES
Contents © 2004
by Jim Holman.
All rights reserved.
On the Brink of Crisis
Santa Teresita Hospital Closes
BY CHARLES A. COULOMBE
Santa Teresita Hospital in Duarte is strategically situated in the San Gabriel Valley; its emergency room has tended thousands of sufferers. Still more important is the role its chapel plays in the spiritual lives of so many. The Carmelite Sisters of the Sacred Heart of Los Angeles, who own the facility, have been hostesses to innumerable processions, First Friday and Saturday devotions, a monthly Tridentine Mass, the relics of Saint Therese, and other such events. In their full habits, the sisters remind those who deal with them of the richness of the religious life when zealously led. In keeping with this zeal, Santa Teresita does not hire abortion doctors. Not suprisingly, the sisters have no problem with vocations, in contrast with other orders in the archdiocese who have more or less strayed from their original charisms.
Thus, worshippers at the 8:30 a.m. Mass on Wednesday, January 7, were taken aback when, in the course of his homily, Jesuit father Cornelius Buckley counseled his listeners to read the headlines of the San Gabriel Valley Tribune. Those who did so found the banner headline, "Duarte Hospital to Close -- Santa Teresita Will Shut Down Over Staffing Costs." The article opened: "Santa Teresita Hospital officials shocked this small community Wednesday by telling their staff and local officials they will close the medical facility this week, blaming new, higher staff costs."
The piece went on to say that the 24 or so patients remaining at the hospital were to be released or sent to other facilities; all would be gone by Friday, January 9, when the emergency room would shut down.
The move caught everyone outside the top level of hospital management by surprise. Monrovia fire chief Sam DiGiovanna, showed up at the hospital in person on Wednesday, January 7, to voice his concerns; because of the closing, paramedics and other emergency workers would have to alter their plans immediately. Hearing a rumor about the closure, he immediately set off for the hospital, interrupting a closed-door meeting where administrators were discussing the decision. DiGiovanna later told the Tribune, "as a fire chief, I'm extremely disappointed. No. 1, that they're closing. No. 2, the lack of notification." He further informed the paper that no local paramedics had been officially informed about the emergency-room closure. "This does have an impact on all paramedic and emergency services. I would have fully anticipated more advance notification." The chief said that Monrovia paramedics average seven or eight emergency medical calls a day, divided between Santa Teresita and Methodist Hospital in Arcadia. He added that since St. Luke Medical Center in Pasadena closed in early 2002, pressure has increased on Monrovia's emergency services. A second emergency room closure forces the city's ambulances to drive farther away, to Foothill Presbyterian Hospital in Glendora, Greater El Monte Community Hospital, or Huntington Hospital in Pasadena. "This is going to be rough," he added. "We don't need another one. That's just one less option we have available to us." His concerns were shared by brother fire chiefs in a number of neighboring cities.
Nor were employees much better informed; hospital nursing supervisor Mark Cline said an administrator only told him on the afternoon of January 7 to move all the hospital's patients by Friday.
There had, however, been signs of trouble in the week prior, when the hospital reduced its services twice. CEO Michael Costello and Sister Michelle, chairman of the board of directors, had sent a Dec. 31 memo stating that a new state law mandating higher nurse-to-patient ratios was causing the cutbacks. It further said that the hospital would stop accepting new obstetric admissions, decrease its number of intensive care unit beds to two, and reduce its capacity on the medical-surgical floor to 12 beds.
Tuesday, January 6, Costello sent another memo that said Santa Teresita would not be accepting any elective admissions. The memo added that "admission through the Emergency Room will continue to be accepted provided that the Emergency Room is open to receiving patients."
At a 3:30 p.m. press conference on Thursday the 8th, Costello declared that "the challenges of the health-care industry have forced Santa Teresita to the brink of financial ruin." Costello added that the 39-bed hospital will close to save Santa Teresita's 150-patient nursing home facility and stave off bankruptcy. "We are faced with a catastrophic situation. The entire county is on the precipice of a significant meltdown. About 100 employees will lose their jobs."
The press conference was conducted while nurses peered into the room through small windows in the doors. Hospital employees hadn't been notified about the closure and were barred from the meeting. About a dozen were forced out by security guards and sheriff's deputies had to remove one man. "We don't even know if we have jobs and they're throwing us out!" one nurse said as she was escorted to the door. In the event, 100 hospital employees will lose their jobs.
Meanwhile, Costello explained that the hospital is an independent institution supported only by its services, benefactors, and the nuns. "For the past three years," Costello said, "Santa Teresita's finances have been teetering on the brink of crisis. Now, the hospital has no reserves and no ability to borrow funds." According to the CEO, in past weeks, the hospital's cash flow plunged so low administrators could barely meet their payroll. Christmas and New Year's Day being both mid-week meant that insurance companies and MediCal could not make payment promptly; Costello declared that this almost made it impossible to pay bills.
A recent state-mandated increase in the ratio of nurses to patients also put financial strains on the hospital, Costello said. The need for nurses came when they are in short supply and being heavily recruited with signing bonuses and other incentives.
Costello said that the decision to close was made Tuesday, January 6, but was kept under wraps for two days; had DiGiovanna not gone into the meeting on Wednesday, January 7, the press conference would have been the first news that employees, civic officials, and the community at large received of the decision. Costello said there was no chance the building would be sold and that a strategic planning process would determine its use.
While employees and civic officials were shocked and angered, the state weighed in more forcefully. According to state authorities, the rapid closure was a violation of California department of health services regulations. Under those provisions, hospitals with emergency rooms must provide 90 days' notice and hold a public hearing before placing their beds on "suspense status," the designation requested by Santa Teresita, said Lea Brooks, spokeswoman for the department of health services. A hospital on suspense status could reopen, but CEO Costello indicated that the closure is permanent. Brooks said the department of health has no authority to require a hospital to stay open. But state officials can find Santa Teresita deficient and require it to come into compliance with state or federal laws, she said. "Our No. 1 priority right now is monitoring the situation to ensure patient safety," Brooks added.
There was also fall-out amongst civic officials in Duarte itself. Employing more than 400 employees, Santa Teresita is the city's third- largest employer, according to Sandi Shannon, the city's redevelopment coordinator. The presence of City of Hope and Santa Teresita hospitals gave Duarte her motto, "City of Health." Duarte mayor John Fasana said he had not "realized the hospital's financial situation was so dire." According to Fasana, city manager Jesse Duff had attended a Santa Teresita board meeting just a few weeks ago and said they had a business plan. "This was not something he anticipated," Fasana added. The mayor said he had heard the Carmelite Sisters had decided to reduce the amount of money they gave to the hospital.
Santa Teresita's closing creates challenges for local health-care providers, officials said. Dennis Lee, president and CEO of Arcadia Methodist Hospital, said he had not heard anything official about Santa Teresita closing. He had heard unofficially and was preparing for an increased volume of patients in the emergency room by finding additional doctors and nurses. Lee added that hiring nurses is especially challenging because there's a local shortage; "we're going to do whatever we possibly can so that the community is not adversely affected by this," he said. Local rumor maintained that all 100 dismissed employees would be welcome at Arcadia Methodist; many were nevertheless dismayed as they had wished to work at a Catholic hospital. Arcadia Methodist is a major provider of abortion services.
But the fallout is not restricted to government officials and employees. The hospital was averaging about 1,200 emergency-room visits per month, although recently its number of in-patient beds was reduced to about 30. The hospital's 133-bed skilled nursing facility will remain open. According to the article in the Tribune, "the closure will also affect anyone who has tests done at Santa Teresita. Depending on their insurance, patients may have to drive as far as Glendora or West Covina for lab testing, a nurse at the hospital said."
The closing of Santa Teresita ends a proud Catholic tradition in the area. In 1927, Mother Maria Luisa Josefa and Mother Margarita Maria, the foundress of the Carmelite Sisters of the Most Sacred Heart of Los Angeles, had fled religious persecution in Mexico and come to California. Monsignor Francis Ott invited the sisters to the archdiocese of Los Angeles, where they did religious and social work among the Mexican immigrants in Long Beach for two years. In 1928 they established a boarding home for girls ages six to fourteen. Two years later, before she returned to Mexico, the foundress gave permission for the remaining sisters to start a tuberculosis sanitarium. In the course of their social work, the sisters had noticed how many children were suffering from tuberculosis, in those days very prevalent among the poorer Spanish-speaking people. Father Leroy Callahan had asked if their community could undertake the care of young girls ill with this disease in a suitable place away from the children's homes.
Father Callahan found such a site in Duarte. Mother Margarita Maria and two sisters went to Duarte to see the property. Undaunted by inadequate quarters and lack of funds, they dedicated their project to Santa Teresita -- St. Therese of the Child Jesus -- a sister-Carmelite who had died of tuberculosis. (It was very fitting that seventy years later St. Therese's relics would be exposed for veneration at the hospital chapel, as part of the Jubilee 2000 celebrations). Nine sisters received their first patients, five young girls from Olive View Sanitarium.
According to the sisters' website, "as the patients had a communicable disease, it was necessary for the Sisters to sterilize their dishes and everything else they used, by boiling in pots on wood stoves out of doors. Dishwashers and other sterilizing equipment were not yet available to them. The dead wood from the numerous orange trees on the property came in very handy for their chore. The sisters did everything themselves, from nursing to janitorial work. They had one employee who was maintenance man, chauffeur, and errand boy."
Despite many difficulties, the sisters began building in 1931 and have never ceased. Each year has seen additional new cottages and facilities. "Santa Teresita School was established and produced scores of grammar and high school graduates. In 1934, the sisters were able to start construction for the chapel. Until it was finished, the Sisters walked to Monrovia every morning for 6:30 mass, come rain or shine. Due to the demand for the devoted care given by the Carmelite Sisters, expansion of Santa Teresita rolled into full swing in 1936." Due to advances in technology, by 1955, long term care for tuberculosis patients was unnecessary; encouraged by their great friend, James Francis Cardinal McIntyre, the Sister made the switch to a full-term hospital. Full accreditation was granted the new Hospital in 1956, which, until now, has offered high quality health care.
Just as important, however, has been the spiritual guidance offered at the chapel. The hospital foundress, Mother Maria Luisita (d. 1988), was declared "venerable" on July 1, 2000 by Pope John Paul II. This means that she has been proved to have lived a life of heroic virtue. She is now a candidate for beatification which requires one miracle through her intercession. Her spirit has been carried on in the devotional life of the sisters and their chapel. The result has been large numbers of the faithful flocking to its various services to enjoy religious exercises in keeping with the magisterium. Fears that the chapel might close as well have been allayed by the announcement that it will remain open.
But questions remain. Employees have alleged to the media that whatever reasons there might be for closing, they were not financial. "They could have simply reduced the number of beds further," said one nurse. If these allegations are true, could the recent state assembly measure to force Catholic hospitals to pay for employees' contraceptive and abortion coverage have played a role? Will this affect other Catholic health care facilities? Would the affected cities or the archdiocese have helped out financially, had they been consulted? Were they?
Neither the archdiocese of Los Angeles nor Sister Michelle of the Carmelite Sisters returned calls for comment.