Business realities forced cuts at Carson Tahoe Regional Medical Center

The decision to restructure Carson Tahoe Regional Healthcare generated a lot of discussion this week throughout our community and beyond. Much of what you've heard or read is understandable emotional reaction to the elimination of staff and programs due to the restructure. I feel it's important to provide you a first-hand perspective on our decisions.

On Tuesday, May 30, we publicly announced a consolidation of management responsibilities, the phasing out of Outpatient Behavioral Health Services, the reorganization of the Wellness Program and the outsourcing of both Employee Assistance Program and Lifeline. More than 50 positions within our healthcare system were eliminated. These decisions were neither made lightly nor expeditiously.

From January 2005 and through the opening of Carson Tahoe Regional Medical Center in December 2005, 125 full-time clinical, support and management positions were added to our staff. As is common in business expansions, staffing levels were increased to support the opening of our new facility. The spike in full-time employees was sensible during our transition but not sustainable over time. Therefore we have streamlined our management level responsibilities and decreased some subsidized programs in order to maintain the fiscal viability our community deserves.

Carson Tahoe Regional Healthcare is a financially stable, growing healthcare system with a comprehensive, acute-care regional medical center and satellite facilities throughout the region. We serve a primary and secondary market of nearly 250,000 people. We are building a free-standing, comprehensive regional cancer center to accommodate a growing population of diagnosed cancer patients.

As your community healthcare provider we serve the greater good in ways that are not always publicized. In 2004 and 2005, Carson Tahoe provided a combined total of over $20 million in charitable care to people of all ages by treating the underinsured or uninsured citizens of our community. We will continue to meet our healthcare obligations for all our patients in a fiscally responsible way. It is imperative that we focus on service lines that serve the fundamental healthcare needs of our community and support the inpatient programs we offer.

I've received many phone calls and letters from patients upset that Outpatient BHS and Wellness were part of the recent restructuring. Programs these patients have come to rely on are offered through alternative resources in our region. In healthcare there is always a delicate balance between the formalities of business responsibilities and the compassion of delivering healthcare. Healthcare providers around the nation have had to do what Carson Tahoe did this past two weeks - focus on providing cost effective patient care.

As your community hospital since 1949 we've grown considerably. Through the years, our mission, 'to enhance the health and wellbeing of the communities we serve', gathered steam. If a need was identified Carson Tahoe stepped up to fill the gap. While our intentions were always good, our willingness to meet community needs cost us tremendously and some were ultimately determined to be fiscally unsustainable. Carson Tahoe subsidized our Outpatient Behavioral Health Services at a cost of more than $350,000 every year since 1999. The Carson Tahoe Wellness Program has always been subsidized; in 2005 the program cost more than $175,000 over what was collected from Wellness patients.

Our hope is that, through the pain of our restructure and subsequent loss of some beloved programs, our community can pull together to fill the gaps left behind. We remain committed to being a part of the ongoing discussion and to finding solutions to the issues at hand.

• Ed Epperson, is the president and CEO of Carson Tahoe Regional Healthcare.