Killer Kanines in 4-D

GULP: The loud wet slurping sound you’re about to hear is that of the Cancer Center of Santa Barbara sliding down the gullet of Cottage Health Systems. While Cottage has clearly emerged as the $800-million gorilla (the cost of its current seismic retrofit and remodel) at the epicenter of Santa Barbara’s shrinking health-care universe, it should be acknowledged straight up that The Hospital did not initiate this proposed addition to its expanding empire. Cottage already has its hands full absorbing recent additions — like the rehab center — trying to buy out the Sansum Medical Clinic, or building its brand new workforce housing project on the former site of St. Francis Hospital. In this case, it was the Cancer Center — scrambling to secure a port in the economic storm of health-care financing — that approached Cottage nine months ago. In the interest of factual verisimilitude, it should be noted that this deal has yet to be officially consummated. Board subcommittees from both operations have been sniffing each other out for the past seven months. Sometime this September, the matter will go to the full boards of Cottage and the Cancer Center to see if the arranged marriage should proceed. Anything, presumably, can happen. But people in a position to know say it’s all but a done deal.

The fact that this may be financially necessary does not make it any less a shame. For those unfamiliar with the Cancer Center, it’s a kick-ass, five-star operation that sets the standard of health-care excellence to which — in any sane universe — we’d all aspire to become accustomed. That the Cancer Center exists as an independent medical entity is one of those classic Santa Barbara flukes. According to its institutional mythology, the Cancer Center started in 1949 shortly after Lillian Converse died of breast cancer, leaving Elisha Converse — a scion of the shoe-producing family that created the single most iconic brand of sneaker the world has yet to see — a widower. So that other Santa Barbarans would not have to endure the same trek to Los Angeles for cancer treatment that his wife did, Elisha created an endowment for the Cancer Center and bought it a million-volt linear accelerator — then a state-of-the-art tumor zapper — one of only seven in the world.

Right now, the Cancer Center handles roughly 33,000 patient visits a year, providing critical out-patient treatment with a degree of competence and compassion that’s hard to achieve, let alone duplicate in any setting where vast insurance bureaucracies call the tunes. I speak from firsthand experience. A few years ago, I discovered a small tumor on my tongue. Thankfully, it didn’t grow fast. What the creature lacked in ambition, it compensated for with persistence. After the growth survived several surgical strikes, we pulled out the big guns — chemo and radiation. They got the job done. In the process, I got an up-close and personal view of every health-care institution between Cottage Hospital and UCLA. I found hard-working, talented, dedicated health-care providers everywhere I went. But some operations seemed like orchestras without a conductor; if you weren’t careful — or insistent — you could slip through the cracks. That never seemed a risk at the Cancer Center. Everyone from the nurse taking your pulse to the radiation techs cooking your neck seemed focused on getting you the care you needed. If that involved navigating tricky jurisdictional boundaries of impenetrable bureaucracies, they made it look easy. Beyond the hand-holding prowess of its staff, the Cancer Center was also quick to recognize there’s a lot more to healing than dishing out nasty medicine and waiting for people’s hair to grow back. With cancer patients, recovering from treatment is at least half the battle. To that end, the center stressed nutrition, recognizing that what and how people eat is far more intimate and personal than the number of calories consumed and vitamins ingested. It comes as no revelation that sick people tend to get isolated and isolated people tend to get sick. But the Cancer Center actually takes concrete steps to combat this, hooking up people — via formal and informal means — who’ve already been through treatment with those in the early stages. And they’re very persistent about it. Likewise, the Cancer Center played a pioneering role in promoting what should have always been painfully obvious: that people who engage in physical exercise recover faster. When a cancer patient and fitness fanatic named Julie Main, then working for the Santa Barbara Athletic Club, first suggested a partnership between the gym and the center, Cancer Center docs had the good sense to listen. At the time, no other institutions were doing it. Today, it’s become commonplace. Since then, the Cancer Center’s wellness offerings have expanded to include free yoga, massage, and even glider plane rides.

But Cancer Center CEO Rick Scott reports that under current reimbursement formulas, hospitals get paid more for providing the exact same treatment and procedures than do outpatient operations — like the Cancer Center. For radiation oncology alone, he said the difference totals about $500,000. And it’s getting worse. Others have noted that under health-care reform, the big pharmacological manufacturers have been protected. Some new cancer medicines cost up to $8,000 for a single dose. Efforts have also been made to spare hospitals from further cuts. The fall-guy in this scenario will be outpatient providers like the Cancer Center. For the time being, Scott said, there’s no imminent threat to center services. Long term, though, he’s in a sinking ship. By getting taken over by Cottage, he’s hoping to secure a life boat.

But will it still remain the Cancer Center? Scott said the rehab center — recently bought out by Cottage — still retains its essential mission and character, noting that many of the same historic photos that adorned the lobby before Cottage are still there. Right now, the Center has one passion: cancer. Because of that — and its relatively small size — it’s been innovative and creative. The $64-million question isn’t what happens to the existing Wellness Program. Cottage administrators have already pledged their commitment to keeping it. The real question is what happens to the next innovative programs that none of us have ever heard about. Will we ever? Like I say, I’m definitely not dissing Cottage. It’s an impressive outfit with its own traditions and history. But it’s a much bigger machine than the Cancer Center, and getting bigger almost every day. And by necessity, the Cottage mission is much broader and diffuse than the Cancer Center’s. I’m not saying the spirit that’s driven the Cancer Center for 60 years is necessarily doomed. I’m only saying extraordinary care will be required to keep it alive. And that, I’m guessing, will require more than a few well-hung photos of Elisha and Lillian Converse in the lobby.