Here are some highlights from a 2011 study by the Abaris Group in Walnut Creek that was commissioned by Contra Costa County to analyze impacts from the potential closure of Doctors Medical Center San Pablo.

* Much of the analysis surrounding the impact of DMC's potential closure comes from the 2011 report commissioned by the county. In it, the authors noted the particular danger facing Kaiser Richmond, which has only 15 emergency room beds.

"The resultant additional volume at Kaiser-Richmond will quickly overwhelm its small 15-bed ED and force extraordinary delays in the assessment, treatment and disposition of all patients arriving at that (emergency department)," the study read. "This will lead to significant public frustration, risk to patient safety."

While walk-up patients and other non life-threatening care shortages could conceivably be mitigated with careful planning and efficient use of other resources, averting loss of life because of the closure of a stroke and heart attack treatment center could be the biggest challenge.

The next closest options are 15 minutes away, according to the study, and that assumes relatively calm traffic conditions and that patients aren't first taken to another hospital for diagnosis before being transferred.

* The full closure of the emergency department at DMC should be the biggest concern for the community and other health care providers in the region. In the event of such a closure, Kaiser-Richmond will experience 80 to 100 new ED patients per day on top of the 78 it already sees daily. That is an increase of at least 102 percent. While there are 12 other EDS. in the region, Kaiser-Richmond will be disproportionately impacted.

* A likely increase of 12 to 13 ambulance patients per day at Kaiser-Richmond.

* The resultant additional volume at Kaiser-Richmond will quickly overwhelm its small 15-bed ED and force extraordinary delays in the assessment, treatment, and disposition of all patients arriving at that ED. This will lead to significant public frustration, risk to patient safety, and ultimately will discourage some patients from going to the ED when they need care. ED overload and ambulance offload delays will be pervasive, occurring consistently during peak hours of the day at Kaiser-Richmond.

* Waiting times at Kaiser-Richmond will likely reach 10—12 hours for walk-in patients.

* It is unlikely that all ambulances could be safely diverted to other regional EDS. without some risk to patient care.

* There is insufficient intensive care unit (ICU) bed capacity in the region to handle the potential new volume of admissions from DMC. DMC is licensed for 189 beds, 25 ED treatment stations and 35 ICU beds.

* DMC is the busiest emergency department in West County with a 2009 ED volume of 40,473 visits, and has the second-highest ambulance volume countywide with 8,186 ambulance arrivals.

* DMC is the only hospital in West County with a STEMI (ST-Elevated Myocardial Infarction) Center; the next closest is 15 minutes away.

* DMC provides 25 percent of the STEMI care in the county. Patient outcomes would be threatened, and longer lengths of stay expected because of the resulting delays in arranging for interfacility transfer or transporting patients to more distant STEMI centers. This critical asset would be a substantial loss to the health care system.

* The hospital and ED resources in West County are already strained with the past closure of Doctors Medical Center Pinole. This is evidenced by the need for the past expansion of the ED at DMC and in/outpatient services at Kaiser-Richmond.

* The next closest hospital to DMC is Kaiser-Richmond with 42 acute care beds, eight ICU beds and 15 ED treatment stations.

* Other hospitals in adjacent communities with travel times from DMC include: Kaiser-Richmond (8 minutes), Alta Bates Summit-Oakland (15), Alta Bates Summit-Berkeley (16), Children's Oakland (16), Kaiser-Oakland (16), Alameda County-Highland (19), Sutter Solano (25), Kaiser-Vallejo (23), Contra Costa Regional (23), Marin General (27), John Muir Concord (27) and Kaiser Walnut Creek (31).

* In particular, Kaiser-Richmond would be the most impacted, with an expected full-year impact of 30,315 new ED patients (83 per day), including 4,633 new ambulance patients (12.3 per day). In 2009, the Kaiser-Richmond ED saw 28,538 patients, with 4,412 arriving by ambulance.

* The closure of DMC would cause a net increase in the cost of health care for West County residents. Access to primary and ED care will be more difficult, resulting in significant impacts for Contra Costa Regional and Kaiser-Richmond. As access to care becomes more restricted, West County residents are likely to delay care for treatable conditions until they become emergent. Residents will have to travel further (if they have

transportation) for even the most minor of conditions to use their insurance providers. West County ambulance transport times would be longer and cost more, residents transported to non-plan hospitals would incur treatment charges until they could be safely transferred to complete their care, requiring more doctors, nurses, and staff to cover the longer length of stays, frequent readmissions and increased volume caused by the disruption in West County health care.

* DMC is an acute care hospital licensed for 189 beds, 25 ED treatment stations and 35 ICU beds. The 2009 ED volume of 40,473 makes the ED the busiest in the West County area, and it is the second highest volume ambulance destination site countywide with 8,186 EMS arrivals during 2009. The hospital is the destination for approximately 71 percent of all ambulance transports for the West County area.