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Providence Medical Group Eureka, which employs Humboldt County’s only specialists offering such vital services as cardiology, gastroenterology and more, has stopped accepting patient referrals for many routine procedures from offices they don’t own and operate, forcing many local patients to travel to Santa Rosa, Napa or beyond.

Angela Smith, founder and managing director of the independently owned Kidney Care Services of Humboldt, learned about this new policy indirectly back in September after she made three separate referrals to Providence’s gastroenterologist specialty group, only to have them declined. She was told that the office was only accepting referrals from within Providence Medical Group.

In a phone interview, Smith said she called the office to voice her concerns: namely, that this policy will exclude a significant number of local patients from receiving necessary services such as colonoscopies. Many of her patients require a colonoscopy before they get placed on the list to receive a kidney transplant.

“The office manager explained that the decision had come from administration,” Smith told the Outpost. “They had been advised to recommend referring patients to Santa Rosa or asking a medical provider employed by Providence if they would create the referral themselves.”

Smith found these suggested work-arounds ridiculous.

“No provider is going to regularly absorb this extra work,” she said, “and many of these affected patients do not have the means to travel to Santa Rosa for services.”

Ia Thao is one such patient. When we spoke with her in September, she was undergoing dialysis three days per week. Her referral to Providence’s local gastroenterology office was declined, and she was instead referred to the Providence-owned office in Santa Rosa. Squeezing such a trip between her dialysis appointments on Tuesdays, Thursdays and Saturdays would be a challenge.

“If I drive down there and come back the same day it’s going to be hard for me,” she said. “The traffic down there, too, it’s kind of hard for me.” Plus, the procedure typically requires sedation, which prevents the patient from legally driving for hours afterward.

Another of Smith’s patients, a man who asked not to be identified while discussing medical issues, said he, too, was denied a local colonoscopy appointment. He needs the procedure before he can get a kidney transplant. The longer he has to wait, he said, “it’s that much longer that I’m on dialysis, and it’s that much longer before I get a kidney transplant. So, yeah, it’s quality of life issue.”

Fortunately for him, he has the resources to fly to the Mayo Clinic in Phoenix.

“We’re fortunate that we can,” he said. “I feel bad for the people that can’t … . All of a sudden it turns our society into an elitist [one] because only the people with the right insurance and enough financial wherewithal are allowed to get the treatment they need.”

Local family medicine practitioner Dr. Stephanie Dittmer has also been frustrated by this new policy and its impacts on her patients.

“I’m getting my referrals rejected, and the reason that’s being communicated to my office staff and my patients is that they are no longer accepting referrals from non-Providence physicians,” Dittmer said in a recent phone interview. “It directly impacts patients, so it becomes a discriminatory thing in the sense of who can financially afford to stop work and go out of the area for something and come back.”

In response to a list of questions, Providence, the not-for-profit Catholic health care system that took over St. Joseph Health in 2016, emailed a media statement saying that the new policy was forced upon them due to “a critical shortage of physicians and advanced practice clinicians” nationwide.

“The inability to accept every referral, especially those which are not urgent or time sensitive, is an unfortunate reality of healthcare today, especially in rural communities like Humboldt County,” the statement says.

But Smith said the urgency of any given patient’s situation should be determined by their doctor.

“General surgery [at Providence] has said it will be eight months out before they can get a colonoscopy because it’s not considered an urgent procedure, necessarily,” she said. “But in terms of my patients, that’s a big deal because that’s eight months of potentially missing a kidney.”

Providence’s new policy appears to have been made at the corporate administrative level, which Smith considers inappropriate.

“The way that they made the decision… is not in line with how medical offices review medical referrals,” she said, adding that such decisions should be made by medical professionals. Smith is well aware of the shortage of specialists here but said a blanket refusal to accept out-of-network referrals from practices they don’t own is not the ethical approach.

“We’re not saying that they don’t have a provider shortage; we’re saying that the way they’ve decided which patients they’re not going to see is not in line with how medical offices do this,” she said. “It sounds like an administrative decision that was taken out of the hands of a medical provider, where it’s supposed to be. .. This decision should not have come from administration. … Nobody else does that.”

Providence’s media statement goes on to say that its medical group is willing to coordinate directly with referring providers to ensure that urgent or special needs are met and the patient’s health remains a top priority.

“We also work closely with our Santa Rosa and Napa medical group providers to provide telehealth visits as an additional option to improve access to care whenever possible,” the statement reads.

Dittmer said such telehealth visits are very rarely possible, and she noted that cardiology is another specialty that has been affected by physician shortages.

“I’ve had to send people literally out of the area to Santa Rosa to get their cardiac angiograms done because the wait time to get into cardiology is excessive, even when people have abnormal studies,” she said.

Rosemary Den Ouden, CEO of the Humboldt Independent Practice Association, said the agency is in the process of credentialing a “desperately needed” cardiologist, but the shortage of medical specialists is simply a harsh reality.

“It’s hard to get some of the most basic things right now because we just don’t have the bodies here in Humboldt County,” Den Ouden said. For example, the county has a severe shortage of gastroenterologists. “We  know that for some of our members, the wait time could be up to a year, especially if it’s for routine screening.”

Dittmer said this situation is not new. 

“I’ve had to refer people out of town on the regular for the last, like, literally two years, because Providence hasn’t been able to meet the volume needs of the people here locally,” she said.

Den Ouden said the shortage is not for lack of recruitment efforts. She said Providence is doing a great job of recruiting, and every single practice in the county is continually working on both recruitment and retention of physicians. In its media statement, Providence Medical Group said that since its inception it has brought “well over 100 primary, specialty, and hospital-based providers to the community.”

However, it doesn’t say how many of those have since left the area. 

This afternoon, shortly before this post was published, Providence Medical Group sent an updated statement that included one new paragraph:

There has been a significant financial investment and time/energy spent to improve the overall access to gastroenterology care in Humboldt County. To tackle the backlog of endoscopy procedures and increase access to crucial, lifesaving GI screenings, Providence has contracted with three additional gastroenterologists and secured the commitment of five other physicians who are qualified to perform GI procedures. These concerted efforts are aimed at reducing wait times and ensuring more patients receive timely and essential gastrointestinal screenings, ultimately improving patient outcomes and overall community health.

Den Ouden said that, to a certain extent, local residents may simply have to accept that we won’t have local access to all of the care we may need.

”This might come off a little curt, but a  place like Humboldt County, we’re never going to have a left eyeball specialist,” she said. “We work hard just to have a cardiologist, an orthopedic surgeon, some GI and primary care, but there will never be a time when we have all these super-specialized positions. There will always be reasons people have to travel outside the area. I don’t think that will ever change.”

Smith didn’t argue with that notion, but she reiterated that Providence shouldn’t make executive decisions affecting broad swaths of the public without consulting with local providers and working with them to develop plans for how best to serve the community.

“It’s as if we’ve all just resigned ourselves to this powerless situation that we have,” she said. “The primary concern I have is that it doesn’t need to be that way. It shouldn’t be that way. And the clout and the size that Providence has in our community, although we’re all deeply appreciative of it, they’re not willing to sit down and have any kind of discussion at the table.”

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CORRECTION: The headline of this post has been corrected from its original version to reflect that Providence is refusing referrals from practices it does not own, rather than from patients who are out of network.