SAN PABLO -- Kaiser Permanente warned Friday that the diversion of emergency ambulance traffic from Doctors Medical Center that started last week is burdening its Richmond emergency department and threatens to compromise patient care.
"Since the change in ambulance traffic, our ED is consistently full," the Kaiser statement read. "... we clearly cannot assume all of the ambulance traffic that is now being diverted from DMC while maintaining the quality care we are responsible for providing our members and our communities."
In the week since the diversion began Aug. 7, about 21 ambulances per day that normally would have gone to Doctors Medical Center were sent to area hospitals. The troubled San Pablo hospital, which faces imminent closure without new funding, stopped taking ambulance traffic earlier than scheduled because of staffing shortfalls.
About two-thirds of the diverted traffic landed at Kaiser Richmond. County health officials said the diversion had gone relatively smooth, but Kaiser expressed serious concern.
"That volume to Kaiser Richmond is significant given their small size (15 emergency beds), but heretofore they have been able to manage this," said Dr. Joseph Barger, medical director of Contra Costa Emergency Medical Services. "There hasn't been a diversion away from Kaiser, but we have developed a contingency plan to inform patients they have to go elsewhere if Kaiser says they are overwhelmed."
Kaiser said in Friday's statement it is "deeply concerned" about the diversion and noted that the portion of non-Kaiser insurance patients treated in its emergency department had jumped from 38 percent to 48 percent in the past week.
While emergency ambulance traffic has been diverted, Doctors Medical Center averaged about 100 walk-in patients to its emergency department daily prior to Aug. 7, Barger said, numbers that could not be so easily absorbed by other hospitals. A 2011 study commissioned to analyze the impact of closing Doctors Medical Center found that Kaiser Richmond, and other nearby hospitals, would be overwhelmed if they had to absorb all patients from the¿ center, leading to lengthy wait times and, in some cases, death of emergency patients.
Meanwhile, nurses, doctors, patients and community members sued in U.S. District Court in San Francisco on Tuesday seeking to stop the possible closure or downsizing of Doctors Medical Center, arguing that it would be a civil rights violation in a community with high proportions of elderly and minority residents. The judge denied their motion for a temporary restraining order against the county and the West Contra Costa Healthcare District, which operates the hospital, to stop ambulance diversions but said he would hear the case Aug. 27.
The attorney for the advocacy groups, Pamela Price, argued that the alleged staffing crisis has been manufactured by hospital officials to justify their efforts to close or downsize the hospital.
A spokesman for the county and district released a statement Thursday denying those claims, saying the diversion was necessitated by "the hospital's worsening fiscal crisis, ensuing losses of personnel, declining patient volume, and the requirement that adequate staffing and resources are available 24 hours a day to meet our patient medical and health care needs."
More than 80 workers -- more than 10 percent of overall staff -- have resigned, according to hospital CEO Dawn Gideon.
Doctors Medical Center is burdened by a heavy proportion of Medicare patients -- more than half its patient mix -- resulting in a low reimbursement rate and is a district hospital, meaning it relies on funds from West County residents rather than subsidies from Contra Costa County government. District voters rejected a parcel tax ballot measure to provide additional funding to the hospital in May, leaving it with an $18 million annual deficit and rapidly dwindling cash on hand.
Advocates for the hospital, led by nurses unions, demand that the county absorb the hospital into its system and keep it open, noting that it sees 40,000 patients per year and contains 25 of the 40 emergency beds in West County, an area that comprises 250,000 residents. They've galvanized community support with a series of rallies and town hall meetings.
Hospital officials have floated the idea of restructuring the hospital, possibly as a free-standing emergency department, and drastically curtailing services.
According to minutes from Tuesday's federal court hearing, Judge William Orrick was not persuaded by the arguments for a restraining order, finding that the center's "deteriorating status" clearly impacts the community negatively but that it is not clear that the fault lies with the county or the health care district.
County officials have long maintained that their $1 billion-plus budget is already stretched too thin and they don't have the funds to take on Doctors Medical Center. Pat Godley, chief financial officer of Contra Costa's health services department, said the county spends $26.7 million annually on outpatient clinics and hospital services, including $13.53 million at the county medical center in Martinez.
Godley said that while the center appears to deliver services efficiently, its high Medicare payer mix and lack of additional subsidies doom it to running a deficit. Asked whether his health budget could absorb the cost of Doctors Medical Center -- which might drop from $18 million to about $14 million if under the county license thanks to better reimbursement rates -- Godley said "absolutely not."
"There is no way we could absorb that type of loss, and the county hasn't shown a willingness to increase the subsidy."
Contact Robert Rogers at 510-262-2726. Follow him at Twitter.com/sfbaynewsrogers.