Divide emerges in effort to save Doctors Medical Center

By Jennifer Baires Contra Costa Times
POSTED: 11/07/2014

SAN PABLO -- The long-shot effort to preserve Doctors Medical Center as a full-service hospital hinges on buy-in from other health care chains that continue to insist that a new, scaled-down model is needed.

While officials this week pledged to try again to save DMC amid a continuing financial crisis, local hospitals that are part of a group exploring options for the 60-year-old facility stand by their position that the current model is unsustainable. Bridging that divide is crucial to officials' hopes of saving the hospital because the latest plan requires stakeholders to forgive between $3 million and $4.3 million a year in debt.

The hospital is on pace to run out of cash by the end of February.

At a meeting Tuesday, the board chairman of the West Contra Costa Healthcare District, which operates the hospital, presented a plan that would patch together yearly funding from a mix of public and private groups to keep the hospital afloat for five more years. But Eric Zell was clear that the solution, which includes debt forgiveness from nearby hospitals and the county and concessions from unions, wasn't a long-term fix and would be difficult to pull together.

In a statement after the meeting, one major potential contributor named in the plan, the Hospital Council of Northern and Central California, said it is staying focused on alternative models for DMC, including a satellite emergency department or variations of an urgent care clinic.

"Area hospitals of the Hospital Council have donated more than $19 million in operational funding to Doctors Medical Center in recent years to support the search for a sustainable solution," the statement read. "The Hospital Council agrees with the regional planning group's earlier conclusion that preserving a full-service hospital at Doctors Medical Center is cost-prohibitive and unsustainable in the long run. Based on the group's financial analysis of alternatives, we believe that one of the three identified urgent care proposals offers the best opportunity for continued care in West County."

West County officials also appeared to be on board with the conclusion that DMC couldn't continue as a full-service facility, before the Richmond City Council agreed last month to earmark $15 million from a Chevron community benefits agreement tied to its refinery modernization. That spurred city and hospital officials to take another shot at preserving the full-service model.

Zell said that without help from any of the key entities, the whole plan may fall apart. He said he realizes the request is a big one, and while he's optimistic, he's also realistic.

Other nearby emergency departments are absorbing increased traffic since DMC stopped receiving emergency ambulances in August because of its deteriorating situation. Before the redirect, Kaiser Permanente in Richmond received an average of 16 ambulances a day; in September, that number shot up to 28, and as of last month was at 21.

The Contra Costa Regional Medical Center in Martinez, which is run by the county, went from an average of eight ambulances each day to 12. <<<<Where's the crisis threatened by special interest groups trying to 'save DMC'????

"I am not convinced that they're going to change that position," Zell said of the hospital council's desire to focus on alternative care models instead of a temporary solution to keep the hospital full-service. "We're asking them to change that position. Kaiser has been hit hard with the closure (of emergency ambulance service), and so has John Muir (Health)."

In a statement released Friday, Kaiser, which operates the only other emergency room in West Contra Costa, said: "We believe there must be a redesigned, sustainable health care-delivery system in West Contra Costa. That is why we have been working with the regional planning group that includes the county, local hospital systems and other stakeholders toward a solution that increases access to primary and urgent care so residents don't have to rely on emergency services."

A statement from John Muir Health on Friday echoed Kaiser's sentiments. "Considering any additional assistance or support would be contingent on the development of a long-term, sustainable health care-delivery system for West County."

Under the urgent care scenarios, DMC would still lose a few million dollars a year, and it wouldn't be able to keep patients overnight -- a significant loss considering that when it was open to ambulances, DMC's emergency room represented 62 percent of the ER beds in West County.

Proponents of the plan argue that it's the closest thing to a self-sustaining model for DMC, while still providing some relief to nearby hospitals.

"Urgent care doesn't relieve the burden of surrounding hospitals having to deal with ambulances," said Dr. William Walker, director of the county's health services and a member of the stakeholders group. "It takes care of the 80 to 90 folks who are currently walking into DMC each day."

Since it filed for bankruptcy in 2006, the region's only public hospital has survived off one-time cash infusions, significant reductions and temporary Band-Aids over funding gaps. The model, hospital administrators say, of a stand-alone public hospital is outdated.

Add to that a mostly Medicare and Medi-Cal payer mix, for which the hospital receives low reimbursements, and it becomes clear why the facility comes up about $18 million short each year.

Zell said he hopes the health care model will change significantly enough in the next few years that new, sustainable funding opportunities will be available for DMC.

"We've kept the hospital open for seven years, and nobody thought we'd do that," Zell said. "Nobody thought it'd be open today. As long as I can keep saying that every day, then we're doing our job."

Contact Jennifer Baires at 925-943-8378. Follow her at twitter.com/jenniferbaires.