California ER in Limbo

Sep. 15--A deadlock over a proposal to downgrade the emergency room at Doctors Medical Center San Pablo to an urgent care unit leaves the hospital with the worst of two worlds, medical experts say: an emergency room in limbo.

That is because the Doctors emergency room, though still licensed as such, is diverting ambulances to other hospitals because of a lack of staffing.

Yet it remains open to walk-in patients, many of whom have no insurance and who use the emergency room for primary care.

That leaves unaddressed one of the major factors in the hospital's impending bankruptcy filing: the large number of uninsured patients -- about 30 percent of the emergency room's 47,000 annual visits, according to CEO Irwin Hansen. And it entails a level of staffing and services that thwart the hospital's new policy of "rational downsizing," as Hansen characterized it, on the way to a hoped-for financial "break-even point."

"By remaining as a basic ER, we have to have 24-hour general surgery backup ... anesthesiology, pathology, orthopedics, cardiology," and other services, said Martha Iwaihara, vice president of nursing. "And we have to pay for that."

The board of the West Contra Costa Healthcare District, which owns Doctors Medical Center San Pablo/Pinole, voted Wednesday to go into bankruptcy and downsize the hospital. It voted to close the Pinole campus and eliminate the obstetrics department at the San Pablo campus. But it deadlocked 2-2 on a motion to convert the emergency room to an urgent care facility.

Board member Desmond Carson recused himself because he is an emergency doctor at the hospital. Board member Nancy Casazza and Chairwoman Beverly Wallace voted in favor of downgrading, and members Bettye Moore-Cash and Deborah Campbell voted no.

"Apparently, we're in a period of nondecision now," said Dr. William Walker, the health officer for Contra Costa County and the director of the county Health Services Department, commenting on the deadlock.

Doctors' ER has been on "divert status" since Monday night after nurses called in sick, leaving it understaffed.

Several nurses interviewed by the Times said they are looking for jobs and that some emergency room nurses may already have gotten new jobs. They declined to give their names, saying they did not want to jeopardize their job options or that they feared retaliation.

Meanwhile, other hospitals have scrambled to accommodate the ambulance patients that normally would go to Doctors San Pablo.

"Those hospitals are often running at the brink as well," Walker said. "Now they have to gear up to handle the extra traffic."

American Medical Response, the county's ambulance service contractor, averages about 30 patient transports daily in West County, including 21 to the San Pablo ER, said Leslie Mueller, AMR's director of Contra Costa operations.

Kaiser Permanente's Richmond emergency room has taken "the lion's share" of Doctors San Pablo's ambulance patients, Mueller said. The county Regional Medical Center in Martinez has taken the next-biggest share, followed by Alta Bates Summit Medical Center in Berkeley. At least one patient was transported to Kaiser in Vallejo, Mueller said.

AMR at times has had to "backfill" West Contra Costa with ambulances from elsewhere in the county as ambulances normally destined for Doctors San Pablo traveled out of the area, Mueller said.

At 5 p.m. Tuesday, the county stopped allowing hospitals to divert ambulances -- except, of course, for Doctors San Pablo -- "while we sift out what's happening," Walker said.

"This is a unique situation."

Reach Tom Lochner at 510-262-2760 or .

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