Martin Brotman, M.D., practices internal medicine and gastroenterology. “First and foremost,” he says, “I’m a physician.” The fit and distinguished-looking 70-year-old spends most of his Mondays seeing patients, frequently performing endoscopy procedures.
During his remaining working hours, Dr. Brotman is president of Sutter Health’s West Bay Region, wherein he oversees the operations of San Francisco’s massive California Pacific Medical Center, Sutter Medical Center of Santa Rosa, Sutter Lakeside Hospital in Lake County, Novato Community Hospital and, until June 30, Marin General Hospital in Greenbrae. It is important here to note that Sutter Health is a not-for-profit network of community hospitals, whose revenues in excess of expenses are managed centrally, then distributed to member hospitals and the communities they serve.
The years of rancor and political infighting leading up to Sutter Health and Marin General’s parting of ways are lengthy and legendary. And Brotman, who has been with Sutter Health for 15 years in a position unrelated to MGH, acknowledges his organization is not blame-free. “Where Sutter got itself in trouble was, we didn’t aggressively confront our critics,” he says. “So we came out looking both less-than-adequate and above the fray.”
Now that he is working closely with Marin General—even if to help guide its disengagement from Sutter Health’s network of 27 Northern California hospitals—the soft-spoken Brotman is anxious to set the record straight. “Sutter Health is truly a first-class health care delivery organization,” he says. “And the reputation we had in this community was simply (due to) a misrepresentation of demonstrable facts.”
In 1962, at age 22, Brotman graduated first in his class from Canada’s Manitoba Medical College. He arrived in the Bay Area in 1967 and lived in Tiburon for 29 years (he now lives in San Francisco). Brotman and Farron, his wife of 50 years and a practicing psychotherapist, raised three children in Marin and now have six grandchildren who live throughout the Bay Area, including a pair of twins in Ross. “I have all kinds of selfish interests in Marin,” he says.
In a Bay Area newspaper ad, you signed a statement reading, “Sutter Health plans plan to focus on making health care more accessible for Marin residents. We will recruit more physicians, build new medical office buildings and expand our outpatient services, labs and diagnostics.” You’re leaving MGH, but staying in Marin—please explain. Sutter wants to continue to provide its kind of health care delivery in Marin. Sutter didn’t want to leave Marin General. For 14 years, we responsibly managed Marin General and that is the way we will leave it on June 30th. In 2006, at the request of the Marin Healthcare District, we agreed to leave when our contract ran out in 2015. However, the district’s board said they wanted their hospital back sooner, so we agreed to (that). What we were asked to do—and what we did—was walk away from a very, very important asset that we had a contractual right to retain. However, we did not agree to leave Marin County. And let me add, if I’d had the power, which at the time I didn’t have, I would have done everything possible to keep Sutter Health and Marin General together.
The ad also states, “Sutter Health has no plans in the foreseeable future to build an acute care hospital in Marin County.” Why is the word “foreseeable” included? Will Sutter someday compete with MGH? In 2005, provided our lease was extended to 50 years, Sutter offered to build a new $400 million hospital for Marin—at no cost to taxpayers or the Healthcare District. However, in their judgment, the district decided not to do that. Moreover, at present, Sutter has absolutely no plans to build a competitive hospital in Marin. However, the reason I said “foreseeable” was I didn’t want to prematurely lock out any options. In this business we never say never. We all know California has a law stating that hospitals that are not seismically stable must be retrofitted, built anew or closed down. Marin General is not up to seismic law; it will have to be rebuilt, and planning for that process must start at least five years in advance.
Fortunately, the deadline for that mandate was extended until 2015. And Marin voters must first pass a multimillion-dollar bond measure to provide for their new or retrofitted hospital. Sutter Health will support that bond measure. Moreover, if Marin General is successful with their program, as I hope they will be—they have a very competent manager in Lee Domanico—Sutter will not build a hospital in Marin in the near future. In that case, we will build a medical office building and outpatient facility at Marin Square (off Bellum Boulevard at the convergence of Highways 580 and 101), where, by the way, it’s public knowledge we’ve acquired over $50 million in commercial real estate. We believe this is a strategic location just crying for redevelopment—and what better use than as a site for
health care delivery?
Finally, Sutter has been accused of questionably “transferring” some $130 million out of Marin General in the past few years. Your comments, please? As was mentioned earlier, Sutter Health is a not-for-profit organization wherein excess revenues are transferred into a common treasury; ours happens to be in Sacramento. We then take that money and—after managing it as carefully and efficiently as possible—allocate it according to need on a prioritized basis among our member hospitals. For example, historically, CPMC has been a net contributor to the system. And currently, Sutter Health is building Mills Peninsula Hospital on the Peninsula along with hospitals in Santa Rosa, Castro Valley and Sacramento. Soon, when we get the entitlements, CPMC will embark on a $2.2 billion building program In San Francisco and then … Do you get the idea? That is how systems like ours all across the United States handle their reserves. The assets do not belong to any particular entity.
Moreover, Sutter has contributed more to Marin health care than the dollar value of the depreciation of Marin General Hospital. We have also paid off all the hospital’s debts, fully funded its pension plan, built the state-of-the-art Marin Cancer Institute, invested $50 million in Marin Square, and we will leave Marin General with $30 million in operating funds.
In addition, Sutter Health donated $10 million to the Marin Community Foundation to support the county’s underinsured and uninsured health care needs over the next five years—and recently, the foundation announced the first series of grants: $1.25 million for dental health, immunizations and mental health programs. Regarding the $130 million, that was our money, we earned it and have a legal right to it—as stated in our Marin General lease agreement and restated in court rulings.
Yet we aren’t, in so many words, “taking it”—we have and we will continue to reinvest it in providing health care services for Marin and communities throughout Northern California. Furthermore, and to summarize, let’s imagine that some years back the Marin Healthcare District accepted Sutter’s offer to build a $400 million hospital. I do not think there would have been an uprising of objectors stating, “Don’t you dare bring any money from San Francisco or Sacramento to build a hospital here in Marin. We want to use our own money, even if it takes us 30 years to raise it.”
Editors note: For our Conversation with Lee Domanico, Marin Healthcare District CEO, go to marinmagazine.com/domanico