A cri de coeur from Sebastopol Urgent Care
Docs say low patient visits and poor insurance reimbursements may cause them to reduce weekend hours
Sebastopol’s and western Sonoma County’s emergency and urgent health care services have been shrinking since the closure in 2018 of the Palm Drive Hospital. Now access to local urgent care may be facing more reductions with the threatened elimination of Sunday hours at the Sebastopol Urgent Care center on Petaluma Avenue due to low weekend patient traffic.
Local physicians Elizabeth Flower and Kathleen Whisman opened Sebastopol Urgent Care in August 2021. The Urgent Care offices are averaging 12 to 15 daily patients during the weekdays, but very low weekend patient traffic. This prompted Dr. Flower last week to post a community appeal on Nextdoor for more people to use the Urgent Care services and help support the only urgent care medical offices in Sonoma County west of Santa Rosa.
“Our real goal is to see 20 patients a day,” Dr. Flower told the Sebastopol Times. “We’ve been falling short of that goal pretty consistently but we’ve been managing this far.”
Dr. Flower said it costs $1,500 a day to keep her offices open on Sundays. On two Sundays last month, Dr. Flower had only a single patient each of those days, while a more recent Sunday saw nine urgent care visits.
“Our overhead in the urgent care offices is in the neighborhood of $45,000 a month,” said Dr. Flower. “That’s without paying me for my patient visits which I’ve never been paid for in the four years we’ve been here. I’m not here to get rich. I’m here for the community. Otherwise I could go practice at a larger or corporate hospital.”
Besides the very low weekend patient census, Dr. Flower said the continued decreases in health insurance reimbursements, including Medicare, are increasing the business challenges of keeping the doors open to Sebastopol Urgent Care.
Both Drs. Flower and Whisman also provide private concierge medicine services for individuals and families on an annual membership fee basis. Concierge medicine is a more patient-centric form of health care that accentuates prevention, comprehensive diagnostics and no-wait referrals to specialists.
Through their Bohemian Concierge Care (Dr. Flower) and Compassionate Concierge Care (Dr. Whisman), the two women have been able to supplement the urgent care portion of their practices. They also incorporated the Sebastopol Urgent Care Non-Profit, a 501(c)3 fund, which accepts tax-free donations and awards scholarships or fee reductions to low-income patients.
With the closure of the Palm Drive Hospital’s emergency room, Sebastopol and west county patients have had to rely on more distance trauma and urgent care services at Santa Rosa’s bigger hospitals with their longer trips and lengthy wait times.
Sebastopol Urgent Care has worked to fill as much of this void as possible since 2021. Because Dr. Flower is an experienced emergency room doctor, she can perform many treatments that most urgent care facilities do not, including in-house X-rays, setting bones, major wound treatment and strong patient advocacy. Dr. Flower has previously worked in the Palm Drive Hospital emergency room and also when it was operating as the Sonoma West Medical Center. She briefly worked for the current owners of the original Palm Drive, the Sonoma Specialty Hospital.
“Urgent care is my baby — it’s what I love,” said Dr. Flower, who goes by “Libby” to most of her regular patients. “I’ve seen 10,000 (urgent care) patients here (since August 2021) and I haven’t paid myself for a single one.”
That doesn’t mean patient services are free, because they are not. Someone has to pay for Sebastopol Urgent Care’s office staff, rent, medical supplies, malpractice insurance and other overhead.
“All patients everywhere are seeing these huge medical bills. We have to bill insurance companies three times higher than we expect to be paid,” explained Dr. Flower. “So, if we bill $150, we get paid $50. The insurance companies are in charge, and it’s getting worse. Our reimbursements have not gone up over the years while the insurance premiums the patients have to pay keep increasing every year. They are skyrocketing. People are being pushed into HMOs at big medical corporations like Sutter, Kaiser, Providence and Adventist.”
Seniors on Medicare are not exempt from this business pattern, Dr. Flower also warned. “The HMOs and others are pushing the Medicare Advantage plans which are really just PPOs in disguise. They limit the Medicare patients to a network and require extra paperwork and pre-authorization. These patients are getting a watered down version of their former coverage and we are seeing a much smaller number of community members than before.”
Dr. Flower said she hoped her recent social media blast might serve as a “marketing wake-up call” to attract more local patients to support and sustain her urgent care hours and services.
Currently, Sebastopol Urgent Care is open 8 a.m. to 7 p.m. weekdays and from 11 a.m. to 5 p.m. on weekends. The concierge medicine services are available weekdays by appointment. All services are available to both insured and non-insured individuals. The offices are located at 555 Palm Drive Avenue, just north of the site of the former Palm Drive Hospital that is now the location of Sonoma Specialty Hospital a 58-bed long-term acute care facility.
Wasn’t there another urgent care at Sonoma Specialty Hospital?
When American Advanced Management Group (AAMG) bought the former Palm Drive Hospital in 2019, part of the buy-sell agreement required AAMG to operate an urgent care center for west county patients through year 2029 as a requirement for receiving a $1.2 million loan. AAMG paid $2 million for the hospital and property that had been appraised for as much as $10 million in the midst of a protracted bankruptcy period for the Palm Drive Hospital. The $1.2 million loan was on top of the $2 million.
When the Palm Drive Health Care District was dissolved in 2018, the County of Sonoma took over the control of the original AAMG purchase agreement of Palm Drive.
On Jan. 12, 2024, the County notified AAMG, operating as Sonoma Specialty Hospital, that it was in breach of its contract for not operating an urgent care center. The county demanded full payment of the $1.2 million, plus interest.
Dr. Gupreet Singh, president and owner of Modesto-based AAMG told the County he could not afford to make the payment. He outlined his past efforts to open an urgent care center next to his hospital and he listed several reasons why he had been unsuccessful, including business disruptions during the COVID-19 pandemic.
After a second “demand letter” from the County in May 2024, AAMG offered to provide Dr. Flower and Sebastopol Urgent Care supportive advertising efforts to attract patients to the independent clinic. That arrangement was never put in place.
“They offered me $250,000 but when we finally had a meeting that had been reduced to just $110,00 in monthly $10,000 payments,” said Dr. Flower. The money offer was never finalized by AAMG. “After that they (AAMG) said they would post signs and arrows on their hospital to direct patients to our office. They never had any interest in doing a website or advertising like they had mentioned. The little that they did never really helped.”
This week, Deputy County Counsel Kristin Horrell told the Sebastopol Times that Sonoma Specialty Hospital remains in breach of the original contract and still owes the $1.3 million to the county. She said the county was currently “evaluating all our options.”
Matt Brown, a county government communications specialist, told the Sebastopol Times this week, “the County as successor agency to the Palm Drive Health Care District maintains that Sonoma Specialty Hospital is in breach of the promissory note.” Brown said he could not offer any additional comments because the topic involves “pending litigation.” Both Horrell and Brown declined to answer why the litigation has now been stretched out for almost two years.
 | A guest post by
|
Dr. Singh (who resides in Texas) has had his way with the county. He bought the hospital and equipment for far below appraisal value because the oversight group for Palm Drive was incompetent, to put it mildly. He then failed to provide emergency or at least urgent care and blamed it on Covid. But he took Covid patients at his 'hospital' (really an acute care nursing home) because it was extremely lucrative. His protocols were loudly criticized by his staff. I really don't understand why he isn't being sued by the county for breach of contact. He is making money and will make even more when he decides to sell the property. But the county just can't be bothered going after him?
While I don't doubt the difficulties of operating an urgent care facility or the stranglehold placed on doctors by insurance companies these days, I feel Sebastopol Times has done a disservice in writing an essentially hagiographic piece about Sebastopol Urgent Care and Dr. Flower in particular. Flower claims to "not (be) here to get rich, I'm here for the community," yet she operates a concierge practice clearly for the benefit of the 1% with its $1500/year membership fee (as of last year). She also claims to want to see 20 patients a day in urgent care. I find this curious because I took my elderly mother to see her at urgent care where (after a very slipshod exam) Flower didn't review my mother's list of prescriptions (all two of them!) and ended up prescribing one of the exact same medications my mother was already taking -- when I mentioned this to Flower, her petulant VERBATIM response was "Well I've seen 21 patients today and I'm tired." (So does that mean she can see the 20 she wants to see but you'd better not have the bad luck to be patient nos. 21 or 22?) She was unprofessional and rude, so maybe that's why people aren't flocking to her urgent care facility.
As for Sonoma Specialty Hospital being in breach of its contract to provide urgent care to Sebastopol, which is a whole other can of worms, it uses the excuse of not fulfilling that part of the contract because Sebastopol already has an urgent care facility in place, Dr. Flower's. So maybe Dr. Flower shouldn't have opened her urgent care in the first place, since it may have impeded Sonoma Specialty Hospital's ability to fulfill its contract and open its own.