SAN PABLO -- Fiscal matters have reached a crisis stage again for Doctors Medical Center, and employees and union leaders implored the hospital's board of directors Wednesday evening to find a way to preserve services and keep the doors open.

Unless it can partner or merge with a larger health care organization or raise more revenue, the hospital will likely close within a year, Supervisor John Gioia of Richmond told meeting attendees.

"It's hard for a stand-alone urban hospital to succeed with large numbers of low-reimbursement Medi-Cal and Medicare patients," said Gioia, a key player in saving Doctors in 2006. "We have a challenging payer mix."

The hospital, which was saved from bankruptcy in 2006, has a projected $10 million deficit for 2013 and is running out of reserves to keep operating, according to interim CEO Dawn Gideon.

Although revenue from reimbursements rose, Doctors had a $1.2 million deficit in January and $16.4 million cash on hand, enough for 45 days of operations, according to a financial report presented at the meeting.

The hospital is taking additional steps to reduce the deficit by consolidating two patient care floors into one, saving about $400,000, and laying off 22 of its roughly 1,000 employees.

Gioia said the board has commissioned a poll to determine whether West Contra Costa voters would support another hospital parcel tax.

Homeowners pay $99 annually on two existing parcel taxes, accounting for $10 million of Doctors' $138 million annual budget.

Doctors has been operating for more than 55 years, but services have shrunk as its costs have risen, and reimbursements have not kept up.

The hospital has closed its obstetrics department, burn unit and other facilities, but the loss of its 25-bed emergency room if the entire hospital closed would create a critical gap in West Contra Costa, Gioia said.

Gioia said other hospitals in the county should share the cost of caring for low-income and indigent patients.

"Where (a hospital) is located should not determine how much it pays for charity care," he said.

Robert McCauley, an organizer with the National Union of Healthcare Workers in Emeryville, said he thinks Doctors needs to do a better job of enlisting help from elected representatives.

McCauley said he contacted Rep. George Miller, D-Martinez, Assemblywoman Nancy Skinner, D-Berkeley, and Richmond Mayor Gayle McLaughlin about the hospital's financial plight and the danger it presents for critical emergency care and local jobs.

"Nobody knew anything because no one had reached out," McCauley said.

Board President Eric Zell disagreed.

"We've gone to everyone we can go to," he said.

Several hospital employees reflected McCauley's remarks, urging the board to reconsider the cuts and layoffs.

"DMC once stood for 'dedicated medical care,'" said Anthony Brown, an emergency room technician. "Now it stands for 'we need money.'"

In response to the complaints, Contra Costa Health Services Director William Walker said layoffs and cost containment are going on in medical centers throughout the country because of health care reform, "including hospitals that are not running $10 million deficits."

"County hospital (in Martinez) consolidated wards and had good cost savings," Walker said.