A federal judge issued a final ruling Friday allowing cash-strapped Doctors Medical Center in San Pablo to proceed with sharp cutbacks in emergency care, hospital representatives said.

And in more bad news for the beleaguered hospital, the state Senate failed to act on legislation that would have added the medical center to the state's public medical system. Such a designation would have netted as much as $4 million to $6 million more in reimbursements from government-sponsored plans.

Affirming a tentative ruling he made Wednesday, U.S. District Judge William H. Orrick denied an injunction to restore staffing levels and services at West Contra Costa's only public hospital.

Hospital staff and community members had filed the lawsuit earlier this month to stop the possible closure or downsizing of DMC. Amid mounting staff departures, the hospital stopped accepting emergency ambulance traffic earlier this month and this week closed one of its medical and surgical units.

After Orrick's ruling, Eric Zell, the hospital board's chairman, said in a prepared statement that work continued to keep the hospital open as long as possible and provide needed care.

"At the same time," he said, "we have a responsibility to our patients to deal with the reality of operating a hospital on a day-to-day basis with depleted financial resources and both voluntary and necessary reductions in personnel."


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Contra Costa County Supervisor John Gioia said in the wake of Friday's news that efforts should be concentrated on turning Doctors' emergency room into a satellite emergency department.

"I believe that the effect of these two actions essentially eliminates any hope that DMC can survive as a full service hospital," Gioia said in an email. "As a community, we need to unite behind one strategy that preserves most emergency services for West County under a model that has a chance of being financially sustainable."