The potential loss of Doctors Medical Center has West County residents on edge. Community hospitals are like family, particularly ones like Doctors that support low-income neighborhoods. Everyone in West County, it seems, has a personal story about how the nurses and physicians at Doctors literally saved the day -- for their stricken spouse, for their injured child, for themselves.

Like any long-term relationship, it's difficult to fathom this one ending for good. Doctors is a medical safe haven in West County, and its problems are not of its own making. A free-standing, full-service hospital is simply at a disadvantage in today's health-care environment, particularly one like Doctors, which is dependent on below-cost government payments to finance a majority of its patients.

Doctors Medical Center as currently configured cannot be maintained. The good news, though, is that for the first time there is a real opportunity to permanently reshape the health-care system in West County so that essential medical services are not continually at risk. A stakeholder group made up of the region's top hospital executives -- representing Kaiser Permanente, John Muir Health and Sutter Health -- plus the county health services, physicians, clinics and Doctors Medical Center itself, has committed to finding a viable alternative.

The stakeholder group is unique. Funded by the members of the Hospital Council of Northern and Central California and led by the county, it includes experts in the field of health-care finance, medical law and reimbursement. The goal is to find an option that provides the maximum level of affordable care, meets government standards and is self-sustaining.


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Despite regulatory obstacles, group members are confident a creative alternative can be found. A number of options and variations are being considered, ranging from a scaled-down hospital that retains essential services such as emergency care to a free-standing emergency department -- something that has never been done in California but has been used successfully in other states.

Somewhat surprisingly, in a recent guest commentary in this newspaper, members of the senior medical staff at Doctors refused to consider anything short of a full-service hospital and accused the Hospital Council of "recommending" a free-standing emergency department. That's not correct -- nothing has been recommended and no alternatives have been eliminated by the technical team, which is just now starting its analysis.

It turns out the commentary was filled with other inaccuracies and false assumptions. The four unions representing 90 percent of the hospital staff have not agreed to a salary cut, as the doctors suggest. And an alliance with Touro University for a moneymaking residency program is a nonstarter, as Touro cannot create residency programs unilaterally.

The commentary accuses the county of having never come to Doctors' aid, ignoring that four times since 2007 -- most recently June 17 -- the supervisors have loaned the hospital tax money to support operations. In total, county advances have amounted to $35 million. And twice in the past 10 years, county voters have approved parcel taxes and bonds to keep Doctors afloat.

That assistance is on top of the $19 million provided Doctors by the Kaiser Permanente and John Muir health systems over a four-year period. While no further direct contributions are being considered at this point, the neighboring hospitals have agreed to fund the task force analysis and will work with the county and Doctors on managing any transition in care.

Emotions are running high, but it's important that everyone keep an open mind when considering the alternatives. No one wants Doctors to close, but it can't survive in its current state. A new model, short of a full-service hospital but including emergency, urgent and primary services, would be no less caring and supportive. Working together, we can remove Doctors from life support and keep the doors open to long-term quality health care in West County.

Art Sponseller is president and CEO of the Hospital Council of Northern and Central California.