JANN HENDRY/Acorn Newspapers HEALTH ON THE TABLE- CLU Breakfast Series moderator Barbara Bronson-Gray, RN, left, leads a discussion on healthcare with, from left, Michael Murray of St. John's Regional Medical Center; Jim Sherman of Los Robles Regional Medical Center, and Community Memorial Hospital's Gary Wilde. The shortage of nurses, the long waiting time in emergency rooms and the government's low reimbursement to hospitals for services provided were among the topics discussed at a recent California Lutheran University's Corporate Leaders Breakfast.

The Feb. 1 meeting began at 7:30 a.m. as about 130 welldressed business leaders gathered inside Lundring Events Center at CLU to listen to three executives from medical centers in Ventura County.

"I came to hear what the hospital CEOs have to say," said Barbara Carothers of Camarillo, who works for the Ventura County Medical Association. "It's good to keep up with the times and stay abreast of what they are doing."

The panelists were Michael Murray of St. John's Regional Medical Center; Jim Sherman of Los Robles Hospital and Medical Center and Gary Wilde of Community Memorial Hospital. Barbara Bronson-Gray, RN, was the moderator.

Sherman said the three hospitals together may represent the largest employer in the county. He began by pointing out two challenges hospitals face at this time.

"We buy the latest and greatest MRI and other technology and three years later the manufacturers no longer have parts for them," said Sherman, who came to Los Robles in 2004 with more than 20 years of healthcare management experience.

He also talked about hospitals having to rebuild their facilities every few years to keep up with seismic requirements.

Patients covered under government programs leave with the hospital getting paid for only about 87 percent of the actual cost of the care, said Murray, president of St. John's hospitals for five years.

"California is one of the lowest reimbursed states- we're 49th out of 50," Murray said.

Still the state continues to require hospitals to follow unfunded mandates such as the ratio of registered nurses to patients. It was one nurse to every seven patients then one to six, now it's one to five and in 2008 it will be one to four, Murray said.

"The cost is a challenge," Murray said.

But there is another problem.

"Where are we going to find the nurses?" he asked.

Newly graduated registered nurses earn about $75,000 to $80,000 a year, and with an extra shift a week, over $100,000 a year, Sherman said.

Local hospitals have been supporting student nursing programs at community colleges and Cal State Channel Islands with scholarships and other funding.

"We're trying to grow our own," said Wilde, president and CEO of Community Memorial Health System since April 2004. Still, it's hard to find nurses, Sherman said. The other panelists agreed.

When Bronson-Gray asked about long waits in emergency rooms, the panelists also focused on the need for staffing- not just for nurses, but for physicians.

Hospitals have begun to pay specialists to provide emergency room support, Sherman said. When one hospital does this, other hospitals have to match or increase the offer in order to get physicians to agree to be available for their emergency rooms.

The moderator asked why there are no 24-hour urgent care facilities in the area.

"It's a matter of work ethic. People want to work from 8 (a.m.) to 4:30 (p.m.). It's undesirable to work at 2 and 3 in the morning," Sherman said.

"There are also cost issues to be open 24/7," Murray said.

Wilde said he believed the root of the emergency room problem is that fewer patients have primary care physicians or insurance.

Physicians who don't accept low-income patients on Medi-Cal because it doesn't pay enough contribute to the problem, Murray said, because those patients don't get care early enough to prevent them from getting sicker.

"If someone has a sore throat they can go to their primary care physician for $50 to $100. If they wait until they have pneumonia and hit the emergency room, it could end up costing $20,000," Sherman said.

"There is roughly a 10 percent rise in emergency room use each year. The emergency rooms were built for a much smaller number, and we're working with every ounce of creativity we can," Wilde said.

Sherman said hospitals could double or quadruple the emergency room size, but that wouldn't solve the problem of not having sufficient staff available.

Sherman also cited the danger of a fragile system becoming even more vulnerable when centers that specialize in a particular surgery or diagnostic centers take the bestinsured customers.

"They skim off the cream and don't take Medicare patients. We have a burden they don't have," Murray said.

By law, hospitals must accept everyone who presents themselves at an emergency room, Murray said.

Murray is hoping there will be some reform in laws affecting payment methodology in the next five years. Wilde said he wants hospitals to get the word out to young people about how rewarding it is to work in the medical field.

"It's a good job, well paid, and at the end of the day you see the direct result of the effort and energy put out," Murray said.