SAN PABLO -- While various stakeholders scramble for a "Hail Mary" to dig up the cash needed to save Doctors Medical Center, county health officials are trying to figure out how to patch the gaping hole that would be created by the closure of a hospital that receives over 40,000 visits to its emergency room every year.
But a stark reality faces West Contra Costa residents who suffer life-threatening emergencies if the hospital closes: Some may die.
More than 70 heart attack victims are rushed by ambulance to DMC each year, more than one-quarter of all victims countywide, and another 30 are brought by friends and relatives. The hospital also receives a handful of gunshot and other trauma victims who need stabilizing quickly before transfer to a designated trauma center.
"It's with those types of patients that we have the potential to lose lives every year," said Dr. Joseph Barger, medical director of Contra Costa Emergency Medical Services.
Earlier this month, DMC leaders announced plans to close the 60-year-old hospital this summer after voters rejected a parcel tax measure needed to keep it solvent. The public hospital has been bleeding red ink for years, a result of a patient mix tilted heavily toward those on government-sponsored health coverage such as Medicare and Medi-Cal that carry low reimbursement rates.
The hospital is the lone provider of advanced cardiac care for heart attack victims in West County, and its closure would leave the area with only 15 of the county's 242 emergency room beds. In situations where every minute counts, heart attack victims in West County would be taken to Alta Bates Summit in Oakland, Kaiser Permanente in Vallejo, Marin General in Greenbrae or John Muir in Concord.
It would be a far cry from the situation 15 years ago, when Doctors Medical operated two emergency rooms in West County; its Pinole campus received about 9,000 emergency visits a year before closing in April 2000.
The San Pablo hospital handled the influx of new patients relatively well after the Pinole closure, and many residents had to go only an additional few miles to get care. But a new reality confronts West County residents today, particularly those at risk of heart attacks and strokes.
DMC is the only public hospital in West County and the site of 25 of the area's 40 emergency room beds. Kaiser operates the only other ER in West County at its medical center in Richmond, but it is not equipped to treat heart attack victims.
"The major impact of the closure of DMC is less about where patients get elective surgery or primary care; it's about the lack of emergency room beds we have in West County," said Contra Costa Supervisor John Gioia, of Richmond, who also sits on DMC's governing board.
Dr. William Walker, the director of Contra Costa Health Services, said talks are ongoing with emergency responders and other county health officials to develop a plan to deal with DMC's closure.
Changes in how ambulances are deployed and routed is the most immediate issue, Walker said. DMC receives an average of 22 emergency ambulance visits per day. For those suffering strokes, Kaiser Richmond, Alta Bates Summit in Berkeley or Muir Concord will be the options, Walker said.
On the day of closure, which could come as early as late July, the county plans to declare a public health emergency to mobilize public and private hospitals to operate at full capacity to deal with the impact. Walker said the county will urge Kaiser to increase its same-day appointment capacity for non-Kaiser patients. Response times for 911 calls likely will be delayed as well, as more ambulances traveling farther distances will have to triage their responses, prioritizing calls by apparent severity and wait times at other hospitals. All the extra transport could cost millions, some of which will be borne by the county.
The secondary planning will focus on walk-in, nonemergency patients, which average about 100 per day to DMC, most of whom use the hospital as a primary care destination rather than emergency room.
Average wait times for walk-in patients at Kaiser's ER would soar as high as 12 hours, according to one study. While emergency departments are required to treat all patients who come through the door, the perception that Kaiser's hospital is only available to its members and long wait times would likely deter uninsured and Medi-Cal patients from going there.
Given the distance to other hospitals, many of the county's older and uninsured would likely defer care until their symptoms become severe, according to the 2011 study commissioned by the county.
That reality was on display at DMC last week.
Emergency Department physician Humayan Tufail, who monitored a computer screen displaying information on about 15 patients, bolted from his chair toward one of the emergency beds.
In bed lay Manuel Garcia-Cruz, 59, hooked up to crimson IV tubes and complaining of severe stomach pain.
Garcia-Cruz, a San Pablo resident who lost his job at a Richmond warehouse last month, had been brought in by his adult daughter after days of passing blood.
Without DMC, he said he had no idea where he would have gone.
"I guess I would probably have just called 911," he said.
Dr. Tufail ordered blood transfusions and a stay in ICU for additional tests to determine what caused the stomach bleeding. He said ICU care will cost at least $5,000 per day, and the hospital would almost surely take a total loss on those costs.
"In some ways, (Garcia-Cruz) is the perfect example of the shortcomings in our health care system and how catastrophic it would be if we closed," Tufail said. "He has no insurance, and he hasn't seen a doctor in years, and now he's very sick, and it's going to be very costly to the system."
Walker said efficiently diverting this flow will require a "community wide effort" to educate people about alternatives, including urgent care centers and a county-run nurse advice line that will be opened up to all residents of West County if the hospital closes.
"We are all going to ask everyone to step up to the plate," Walker said. "But it will not be the level of service that the patients of West County received before, and there will be some bad outcomes as result of long transports."
Walker said he also holds out hope that an urgent care wing of DMC may remain open after the hospital closes. Contra Costa supervisors also plan on June 3 to consider conducting a poll to gauge voter support for a countywide sales tax hike on the November ballot to save the hospital, or reopen it if it closes. The quarter-cent sales tax would raise $40 million annually
Dr. Tufail mentioned a gunshot victim, age 17, who was rushed to DMC with a stomach wound last month after being shot in Richmond. The boy was stabilized with water and blood transfusions at DMC before being airlifted to the trauma center at John Muir in Walnut Creek.
"He was losing a lot of blood, and that had raised his heart rate to more than 160 beats per minute, and his blood pressure was falling rapidly," Tufail said. "And it was rush hour, so there was little doubt that he wouldn't have made it for a longer trip."
Contact Robert Rogers at 510-262-2726. Follow him at Twitter.com/sfbaynewsrogers.