Back in May it may have seemed simple: The Board of Supervisors at that time voted to eliminate acute medical services at Tuolumne General Hospital.
Aimed at stanching the hospital's epic annual losses and its relentless drain on the county's general fund, the move was necessary and overdue.
The casual observer may have then assumed the hard part was over.
Maybe it was political, as critics of the board's move had steadfastly insisted that a full-service TGH could continue operation without bankrupting the county.
But logistically, the hard work is just beginning.
To their credit, supervisors are still focused on the May plan, which calls for closure of the county hospital's intensive and acute care wings and its emergency room. TGH's psychiatric ward, long-term care unit and outpatient clinics would remain open, as would a new 12-hour-a-day urgent care center.
But a bureaucratic thicket of state and federal agencies, licenses, permits and agreements lie between strategy and reality. What sounded good last spring may by early next year prove difficult or impossible. And what looked like it could be done in two years might take a little longer.
Normally we are no great advocates of outside consultants, but the county's hiring of the Los Angeles-based Camden Group to both handle the transition and administer TGH while it happens is well advised.
We also commend Camden's first move, taking a final, definitive look at maintaining Tuolumne General as a full-service hospital. Its conclusion: That at best TGH would lose more than $40 million in the next five years.
The results are in line with a previous study by the Lewin Group and seem to have silenced even the most strident of critics.
Still, negotiating the minefield of issues that lies ahead is not for the timid or inexperienced. Camden's John Wilson and Becki Bales, TGH's interim CEO and chief financial officer respectively, worked together in repairing the finances of San Luis Obispo County's public hospital. They know the turf and are already hard at work.
A few of the complex issues Camden is dealing with:
? Licensing TGH's full-service state license will not carry over to the trimmed-down hospital. New licenses, most importantly one for a psychiatric hospital, will be needed.
? Reimbursements The cash TGH gets back from state and federal agencies is a key to its financial success, but getting the necessary written guarantees and answers is not easy.
? Buildings A state decision that Tuolumne General's changes mean all its buildings must be brought up to current code could create major problems.
? Employees With the transition looming, many TGH employees are understandably edgy. Because an exodus before the change is complete would be disastrous, keeping the staff members on the job as long as possible, then helping find them new jobs is a key priority.
? Sonora Regional Without the ongoing and full cooperation that Sonora Regional Medical Center is already providing, changes at Tuolumne General could leave parts of the community with unsatisfactory medical care.
? Health care As important as county finances are, Camden and County Administrator Craig Pedro have pledged to put the quality and availability of health care first in planning the coming transition.
Given what is ahead, Pedro is providing no timelines. But as long as he and the board stay focused on the goals voted on back in May, there are no grounds to complain.
Union Democrat editorial positions are formed through regular meetings of the newspaper's editorial board Publisher Geoff White, Managing Editor Patty Fuller and senior reporter-columnist Chris Bateman.