SAN PABLO -- The growing exodus of workers from Doctors Medical Center forced the hospital to turn away emergency ambulance traffic Thursday morning, diverting some patients with heart attacks and other critical cases to hospitals farther away.
DMC and county health officials had originally planned to begin rerouting emergency ambulances on Tuesday but decided to move sooner because emergency room staff had dropped to dangerously low levels as the hospital scrambles to stay open amid a fiscal crisis.
"Tuesday was a difficult day, and it became apparent that we were overwhelmed," hospital CEO Dawn Gideon said. "Offload times for ambulances were increasing, and our beds were full, so we accelerated the plan to divert ambulance traffic in an abundance of caution."
More than 80 employees have resigned at West Contra Costa's largest hospital, which is running an $18 million deficit and has been unsuccessful in asking district taxpayers and the county for new funding.
"Hospital administration feels it's unsafe to continue to receive 911 emergency ambulances, and county (emergency services) is respecting their request," county health services director Dr. William Walker said. "We were on the phone with other facilities in preparation all day (Wednesday)."
Walker said an average of 22 ambulances come to DMC every day, with more than four emergency critical care transports, many of which are heart attacks and strokes. Those patients will now be taken to other nearby hospitals. Transport times will increase, as will the accompanying costs, Walker said.
Most heart attack emergencies will now go to Alta Bates Summit in Oakland, Walker said, with others going to Kaiser Permanente in Vallejo and John Muir in Concord. Those suffering strokes will have a shorter ride, to Kaiser Richmond, but emergency services staff has to be careful not to overwhelm that facility's 15-bed emergency department. Marin General Hospital across the Richmond-San Rafael Bridge can also treat emergency strokes and heart attacks.
"Kaiser Richmond will be most impacted in the short term," Walker said. "We'll try to make sure they don't get overwhelmed."
DMC's emergency department will remain open for walk-ins and continue to receive transported nursing home patients who need noncritical care, according to a news release.
Staff at the hospital was split Thursday about whether discontinuing ambulance traffic was the right decision.
Dr. Richard Stern, a cardiologist and chief of medical staff at DMC, said Thursday's decision was forced by the staffing loss.
"Once you start losing personnel, it becomes a mass exit, and in this situation, you have to deal with the resources you have left," Stern said. "If county or state steps up in the next week, the hospital can be saved. We are down to the wire here."
But some nurses disagree, and say the move to divert ambulances was premature. California Nurses Association/National Nurses United issued a news release Thursday condemning Contra Costa County officials for capping inpatient hospital beds at 50 and diverting ambulances.
"The biggest danger to patients is long ambulance trips. Patients should not be diverted from DMC," Seung Choo, an intensive care nurse, said in an email.
Established 60 years ago as Brookside Hospital, DMC has provided roughly 80 percent of inpatient hospital beds and nearly 60 percent of emergency-room care within its West Contra Costa service area of 250,000 residents.
Without new funding, the hospital faces closure later this year. County health officials have been exploring smaller models to save some level of care, including a free-standing emergency department.
Stern said morale at the hospital Thursday remained surprisingly strong, and commended the core group of nurses and other professionals who continue to do their jobs. Cardiologists and the administration brokered a last-minute deal Wednesday to keep the hospital's emergency heart attack unit open for patients who walk in or are brought by car.
"We saved it, but that could change any time," Stern said.
Nurses unions have held several rallies in recent weeks to call for the county to step in and urge the community to support the hospital. As a hospital overseen by a health care district, DMC does not get the benefit of a subsidy from the county general fund like the medical center in Martinez, and its reimbursement rates for Medicare and Medi-Cal patients are also lower, officials say.
"If DMC got reimbursement rates that the county gets as a safety net hospital, the hospital would be in much better shape," Stern said.
Gideon said the faster-than-expected diversion plan has no impact on the hospital's future.
"It was our hope that we would be able to continue (emergency) ambulances until we moved to a new model," Gideon said. "The diversion was inevitable, but the timing was earlier than we wanted or expected."
A stakeholder group convened to study the hospital funding crisis is expected to recommend a path forward to the hospital's governing board before the end of the month.
Gideon said three scenarios are on the table: A free standing emergency department, a scaled down 15-bed hospital, or complete closure.