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Heart Murmurs 

Last year, Sacred Heart worried about having too many patients — now, they have too few.

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Thirty-one employees at Providence Health and Services’ Sacred Heart Medical Center received pink slips last week. Two more employees had their hours slashed. And the layoffs aren’t over yet.

This is only the first Band-Aid to treat the $7 million budget wound the largest hospital in Spokane is suffering. Unfortunately, it looks like things will only get worse.

To begin with, 59 full-time nursing positions are slotted to be eliminated, says registered nurse Kathy Ormsby.

Bargaining and schedule-swapping will determine how many employees will be actually laid off.

So why has Sacred Heart, which last year seemed to be soaring while competitor Deaconess Medical Center floundered financially, run into such monetary distress?

The first answer is a tired one: the economy. Several years ago, health care was thought to be largely resistant to economic downturns, Sacred Heart CEO Elaine Couture says. People get sick no matter the economic outlook. But this recession dug deeper. People were unemployed long enough to lose the option to continue to pay for health insurance through their former employer. Struggling businesses began to reduce their contribution to their employees’ health care plan, kicking up the price of premiums and co-pays.

More people without health insurance meant more patients Sacred Heart had to write off expenses for. This year, Couture says, the cost of Sacred Heart’s charity care went $6.9 million over budget.

The second answer is one of volume: A little more than a year ago, in June 2009, Sacred Heart was worrying they’d exceed their 623-bed capacity. “There were many days when … we had more than 600 patients with their heads on pillows,” Couture says.

Providence had requested, unsuccessfully, for the state to allow Sacred Heart to add 152 new beds. But now, the number of patients has fallen.

“Now we’re [ranging] from 470 to 550 patients per day. … We [didn’t] predict that there was going to be a major recession that was going to happen as deep as it was,” Couture says. “[And] we didn’t have any indication that one of our partners was going to align with Community Health Systems.”

Amid protest from Providence, rival Community Health Systems purchased the independent Rockwood Clinic. Suddenly, a conduit that had been consistently channeling patients to Sacred Heart started diverting them toward Deaconess and Valley Medical Center, also owned by CHS. There’s been about a 2.2 percent decline in admissions since.

The layoffs have meant the closure of two programs: maternity support services and Cuddles and Care. The effect on staff, like the ultimate number of layoffs, remains to be seen. Couture promises nurses will not be asked to increase their patient-load. But Ormsby worries reductions in nursing staff will still cause problems.

“If you are stressing a nurse thinner and thinner, patient safety is an issue,” Ormsby says. “That’s a situation that’s really ripe for medical error.”

Major hospitals in Spokane have seen several rounds of layoffs this decade. In 2004 and 2005, Sacred Heart cut 350 full-time positions. In 2009, Sacred Heart laid off another 33 employees, mainly due to merging management teams with Holy Family. Deaconess Medical Center, meanwhile, cut 130 positions in 2008 and laid off 90 employees in 2009.

Couture can’t promise the end of staffing reductions.

But she’s sure of one thing: Health care is a morphing industry. She expects care to continually shift to an outpatient setting and health care reform to result in fewer patients landing in the ER.

But won’t that reduce Sacred Heart admissions even further? Perhaps, says Couture.

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