SAN PABLO -- With cash fast running out and hospital staff morale sinking to new lows, county health experts told the West Contra Costa Healthcare District Board on Tuesday that they had two last-ditch plans to save some level of services at Doctors Medical Center San Pablo.
"We have to look at scenarios other than a full service hospital," said Dr. William Walker, the director of Contra Costa Health Services. "We don't have firm plans, we have options."
The board will consider within the next month two scenarios presented by Walker that were developed by a stakeholder group formed in June. Its members include hospitals that would be affected if DMC closed.
The first scenario would be a much smaller hospital with 15 beds and an emergency department, Walker said. The second would be a free-standing emergency department without in-patient beds, coupled with expanded primary care capacity in the area.
Both options have been roundly criticized by nurses unions and physicians at the hospital, who say the options are inadequate given the needs of more than 250,000 residents in the West County Healthcare District and would result in a public health crisis.
While the meeting convened in the hospital's auditorium, nursing unions demonstrated from Richmond City Hall to DMC calling on the county to step in and save the hospital and its hundreds of employees. The hospital's emergency room sees 40,000 patients per year.
But board members and health experts said Tuesday they have no choice but to look to avert a complete loss of medical care at the site in the face of continued cash flow problems at the hospital. The county last month agreed to loan $6 million to keep the hospital afloat until October while other options are explored. The hospital is running an $18 million annual deficit, mostly due to poor reimbursement rates for its predominately Medicare and Medi-Cal patient base.
"Cash continues to be tight and staffing is becoming a challenge as well," said Dawn Gideon, the hospital's CEO.
Gideon went on to say that as other options are explored, planning for an orderly hospital shutdown must continue.
While the hospital continues to run on budget fumes, county leaders Tuesday described what the area may face if the scaled down versions of the hospital are implemented.
If the hospital was maintained as a standalone emergency department only -- an option that has additional state regulatory hurdles since there are no such facilities in California -- patients with life-threatening conditions could be stabilized there but would need to be moved to other hospitals using county emergency transport services, said Dr. Joseph Barger, medical director of Contra Costa Emergency Services.
The other option, a smaller hospital with 15 beds, would have more capabilities, including surgery and intensive care, but would probably lose some of the specialized services the current hospital has. Health officials admitted that the smaller hospital option was less likely in the absence of new funding sources.
As part of its vote in June to transfer a loan in property taxes to DMC, the county Board of Supervisors acknowledged the county's interest in helping DMC's long-term recovery to protect the health of the general public and to maintain a crucial component of the county's Emergency Medical System. But efforts to float a county sales tax measure to save the hospital have stalled.
The hospital has 25 of West Contra Costa's 40 emergency room beds, out of a countywide total of 267.
Measure C, a parcel tax measure in May that would have raised about $20 million a year, got only 52 percent approval from health care district voters, far short of the two-thirds majority required for passage.
Walker expressed hope that other area hospitals could be part of a solution that would save at least part of the hospital.
"They're going to get (DMC's patients) anyway, they would just get more of them in a less organized way" if a scaled down version of the hospital is not maintained, Walker said.
The full stakeholder group is expected to make its recommendation to the West Contra Costa Healthcare District Board within one month, with the goal of having an interim care alternative in place by Sept. 1.