In a still from 'The Desert,' locals observe as Doctors Medical Center in San Pablo is torn down following its closure in 2015, leaving the nearest public hospital 15 miles away. (Courtesy Bo Kovitz)
“The Desert”, a documentary film recently released as part of KQED’s Truly CA series, looks at the ripple effects in a community after a hospital closes. Doctors Medical Center operated for 60 years, serving western Contra Costa County from its location in San Pablo, north of Richmond in the East Bay.
When it closed in 2015, after failing to bridge a stubborn $18-20 million annual deficit, it left nearly 250,000 mostly low-income residents more than a half-hour drive away from the closest hospital.
The film was produced and directed by Bo Kovitz, who spoke with The California Report Magazine. Interview excerpts have been edited for length and clarity.
On what inspired her to make the film
I had gone to a public forum about the planned closure of Alta Bates Summit Medical Center in South Berkeley. And there was a lot of discussion at the time about how we would lose another emergency room on a critical corridor of the Bay Area. There was reference to a hospital that had already closed in Richmond. It was sort of glossed over. It really piqued my interest.
We really take for granted this idea that we all have a hospital in our neighborhood. I thought, what does it look like to live in a community where there isn't a hospital? I approached this wanting to hear from the doctors, the frontline workers, the patients, about what the tragedy was. They were never quite heard. And I wanted them to drive this story. I wanted them to be the storytellers.
I felt that the reporting and the knowledge around the closure of Doctors Medical Center was never really in the hands of the people who were living and breathing the impacts of what happened.
On following patients who must plan a whole day around a hospital visit
I think there's been a lot of focus about the loss of (Doctors Medical Center) through the prism of emergency services and not having an emergency room in West Contra Costa County. But there's another enormous deficit, which is specialty care.
There was a cancer center at Doctors Medical Center. Epigmenio Mayo and Angelica Lopez are a couple, both battling cancer. At the time the film was shot, they regularly made a trip where they would take three different buses to get to the county hospital in Martinez, where both of them were receiving cancer treatment. For them, this trip is an absolute necessity, but it's something that they have to plan their entire day around. They are winded by the time they even show up to their appointments.
By the end of the film, the sun is already set. It's a full day trip. They've talked a lot about how there's no other option. As they say in the film, they prepare their minds and bodies for the trip because they know they have to take it. This is how they survive.
On the urgent care clinic now across the street from the former Doctors Medical Center site
They're serving the same population with just a quarter of the staff.
People like Millie Callen worked at Doctors Medical Center for more than a decade. She was one of the coordinators in the E.R., which is one of the most important roles. She's making sure that everything's moving smoothly, bringing people in, bouncing them to their doctors, making sure their insurance is covered.
Even before the hospital closed, Millie was caring for her own loved ones and understood the before and after of what it's like to lose a hospital. Her mother has a heart condition. The urgent care where Millie now works is much busier with the spike of COVID-19 cases.
For a while, they were one of the few locations that were doing COVID-19 testing. Not only are they answering a lot of patients needing primary care, but they are also dealing with an additional load of patients who were experiencing or showing symptoms of COVID-19. And then there's that added stress of how do we sequester that person away from the rest of our patients? They had set up a tent in the back parking lot and they were running back and forth.
On the firefighters and paramedics she follows in the film
There isn't a Richmond paramedic company. There's no West Contra Costa County paramedic company. So the firefighters take on the role of being the first to arrive on scene. Firefighters can get on scene, but they're limited in what they can do because in certain advanced or complicated cases, the ambulance and the paramedics are the ones who need to show up and then transport the person and have specialty training.
There are times of the day where highways are really, really congested. Wait times for the paramedics to show up can be up to 30 minutes depending on the day. And then those paramedics are often forced to transport patients outside the city or county for care.
One of the paramedics that I had the opportunity to film with is Aimee Skaggs, and she has been in the community for years. She was around when Doctors Medical Center was there and brought a lot of patients there.
Aimee describes something that I think is unique to low income communities where 911 calls are really treated as primary care. Emergency responders are the ones who essentially are doing triage on the spot. They are having to navigate so many different layers of what it means to make the best decision for a patient.
It's more than just 'what's the closest hospital?' It's 'what makes the most financial sense? Where is going to be the closest place that the family can come without it being a hassle?' And in cases where the issue is something really time-sensitive, paramedics like Aimee have to bring in another dimension to the decision making: how to get them somewhere fast when highways are clogged.
Some hospitals may not take them. Where do they go that is not going to also leave the patient riddled with hospital bills in the aftermath?
On how hospital closures are playing out throughout the state
There are more hospital closures that are happening in California. They're mostly in rural communities.
I think the closure of Doctors Medical Center represents an accelerating trend in urban communities. Regions that are concentrated areas for Medi-Cal, Medicare or uninsured patients are losing hospitals because hospitals and ERs are trying to consolidate in urban centers where there are more privately insured patients.
On the burden of shouldering COVID-19 patients now that the hospital has closed
Right now, Bay Area hospitals haven't been overwhelmed so far with COVID-19 cases — which is lucky. But if things were to get really over the top, I think people will wish Doctors Medical Center was there. There's definitely concern about capacity. There's also a concern that many people — especially those with chronic illnesses like diabetes, hypertension or asthma — may not be getting seen for illnesses that need to be managed right now.
We may never know how many people are in West Contra Costa County who may have died, who did not seek emergency care or did not seek health care, because they were afraid of being exposed to COVID-19.
When Doctors Medical Center closed, a lot of trust was lost among the community. A community that has historically been marginalized from the health care system now feels further marginalized because they lost a resource. They lost an institution that represented a lot of trust in the system.
I spoke about this with the ambulatory director at the county hospital in Martinez, Dr. Gabriela Sullivan. She says that health care is often left with the job of trying to plug all these holes that are in the social fabric of our country. And that if we are trying to leave social issues on the doorstep of health care, that's a recipe for failure. A lot of people in the years leading up to the hospital closure said it will take a public health crisis of extreme proportions to reveal how essential Doctors Medical Center and other safety net hospitals are.
I think with this pandemic, it's not just that Black and brown communities are dying and are more impacted. There's also going to be a downstream increase of morbidity and mortality for years to come. There is a real worry that they're holding back the dams right now in terms of acute care. The realities of the disparity are going to last far beyond this pandemic.