SAN PABLO -- The latest plan to stave off the closure of Doctors Medical Center would create the only free-standing emergency room in the state, saving key services for West Contra Costa County but risking a continuation of the financial bleeding that has imperiled the local health care network.
Nurses unions and doctors at DMC are decidedly against the plan, which surfaced at a public forum last week as health officials rescinded a closure notice for the facility. The medical personnel hope some combination of new funding and wage cuts can keep the hospital open in its current form, and say residents would be poorly served by any plan that significantly reduces DMC's level of care.
"The medical staff and I think it's a dreadful idea," said Dr. Sharon Drager, a vascular surgeon at the hospital and a member of its governing board. "It's telling people they have care when they only sort of have care."
But local health care officials say the free-standing model could be the only hope of preserving some services at the 60-year-old hospital in the wake of a failed parcel tax measure last month to keep it solvent.
A free-standing emergency room isn't the only scenario officials are exploring. A task force created earlier this month is also analyzing whether the hospital could survive with fewer beds and reduced services. Both scenarios would depend largely on the amount of funding that could be secured, both through private and public means.
"The goal is to avoid complete closure of the hospital, particularly saving the emergency department," said Dr. William Walker, director of Contra Costa Health Services.
The idea behind a free-standing emergency room would be to quickly treat area residents in need of urgent care. Patients with more serious conditions who require admission to a hospital would be stabilized at DMC before being transferred to another facility.
Local officials say it is unclear whether a free-standing ER would provide specialized care for heart attack and stroke victims as is currently the case, though doctors and nurses predicted last week those services would be lost.
Free-standing ERs are unheard of in California and typically found only in rural areas of the country. Drager estimated that fewer than 200 employees would be retained in a free-standing emergency room scenario, from a current workforce of 900, and that West County taxpayers would still shoulder millions in parcel taxes they passed in previous years to keep the hospital open.
"This new plan serves the needs of the other hospitals because they won't be inundated by West County patients and the political officials who can say, 'Look, we saved the ER,' but it is really just an urgent care center on steroids," Drager said.
Currently, 25 of the 40 emergency room beds in West Contra Costa are located at DMC; the rest are at Kaiser Permanente in Richmond.
Health care officials have said in recent days that they expect other area hospitals to pony up money to fund a free-standing emergency department to absorb the 40,000 annual patient visits that would otherwise inundate their emergency rooms.
"Kaiser Richmond, Sutter Health and John Muir are focused and committed now to helping us to establish a new model," said West County Healthcare District Director Eric Zell. "They weren't willing to commit any more dollars to our existing model."
County Supervisor John Gioia said assistance from other hospitals is desirable but that "(existing) parcel taxes will be the primary funding source."
Dylan Roby, an assistant professor at the UCLA Center for Health Policy Research, believes a free-standing emergency room model poses significant challenges. "It's difficult to sustain that model if you're reliant on reimbursement, but a stand-alone ER could work if it is funded by the area hospitals if they are willing to make that investment," he said. "If you have a stand-alone ER, you are also inviting avoidable ER visits by patients whose care will not be fully reimbursed, so it's a loss magnet."
The scenario was revealed Monday at a town-hall meeting in San Pablo. It includes asking county supervisors to approve a $6 million loan against future property tax revenues to the health care district to sustain the hospital for about four months while health care district officials continue to appeal to other area hospitals and private foundations for funding.
Officials say an assessment will be done within 30 days by the Hospital Council of Northern California to study two scenarios for a "sustainable delivery model" for the hospital.
One plan calls for a reduction in the hospital's 189 beds to a "minimal number," eliminating other unspecified services and maintaining the emergency department but at a reduced volume.
The other option calls for a free-standing emergency department and eliminating all other services -- including ICU beds -- while hammering out agreements with other hospitals to accept DMC patients that need additional care.
Walker disputed the assertion that a stand-alone ER would be a magnet for costly, unreimbursed care.
"Absolutely, a scaled-down DMC would save money," Walker said. "But without some source of care here for older people and people with sicknesses, they will have to migrate much farther. We are trying to maintain services in the community and determine what is viable."
Claude Watts, interim senior vice president and area manager of Kaiser Permanente East Bay, stopped short of saying Kaiser would provide funding in a statement released Thursday.
"Whether the decision is to end operations or pursue another model of care, other local hospitals and health systems, including Kaiser Permanente, will work with the county and Doctors Medical Center to ensure an orderly transition for the residents of West Contra Costa County," he said.
Ben Drew, a spokesman for John Muir Health, wrote in an email Thursday that "considering any additional assistance or support would be contingent on the development of a sustainable health care-delivery system for West Contra Costa County."
The reduced-services plan is not the only proposal on the table. At the same time, county supervisors have commissioned a poll gauging voter support for a countywide sales tax hike to fund public safety and emergency health services, part of which could save the hospital, which runs an annual operating deficit of about $18 million because of low reimbursement rates from its patients.
The various proposals would require state regulatory or legislative tweaks to allow the unconventional plans to move forward.
"From a legal perspective, there are a number of obstacles that need to be cleared" to approve a free-standing emergency room, said Felicia Sze of Hooper, Lundy & Bookman, PC, a Los Angeles-based firm that represents health care providers. "There would also have to be coordination with local emergency medical systems. It will be challenging, certainly."
Contact Robert Rogers at 510-262-2726. Follow him at Twitter.com/sfbaynewsrogers.
What: Contra Costa County Board of Supervisors hearing
Where: County Administration Building, 651 Pine St., Martinez
When: 9 a.m. Tuesday