(Bay City News) A federal judge in San Francisco today heard arguments Wednesday for -- and against -- court intervention that would force financially embattled Doctors Medical Center in San Pablo to restore recently cut emergency services.
The U.S. District Court hearing came amid an ongoing fight to keep the hospital open. Officials have reduced services and shed more than 80 staff members there after multiple failed attempts to cover the hospital's $18 million deficit.
Earlier this month, the hospital stopped accepting emergency ambulances, closed its heart attack intervention unit and reduced its number of inpatient beds to 50. Emergency ambulances that would normally go to DMC are now re-routed to other area hospitals.
A group of doctors, nurses and community advocates filed a lawsuit in federal court on Aug. 12 against Contra Costa County, each member of the Board of Supervisors and West Contra Costa County Healthcare District and district board chairman Eric Zell.
Judge William Orrick rejected a motion earlier this month to grant a temporary restraining order that would stop the diversion of ambulance services from the hospital but today heard additional arguments from Price and attorneys representing the county and healthcare district.
"The county is a full participant in the decision to close this hospital," said Price, who has argued that county officials could provide the funding DMC needs. The county also made the decision to divert emergency ambulance service from the hospital earlier this month, she noted.
County officials have maintained that the county isn't in a financial position to keep the hospital afloat, and has already given more than $30 million over the years to bail the hospital out.
But Price today argued that by not using its authority to keep the hospital open, the county is failing to comply with federal law, which states that counties must ensure prompt services and equal access to care for Medicaid patients, called Medi-Cal in California. Medi-Cal patients make up about 80 percent of the patient population at DMC.
"To say that the quality of care in Contra Costa County right now is the standard is a fallacy," she told the court.
"The standard of care is not for people to die," she said, citing a Richmond man who died last Wednesday of an apparent heart attack after an ambulance brought him to Alta Bates Medical Center in Berkeley instead of to nearby DMC.
Price also alleged that healthcare district officials are accelerating the hospital's closure by "dismembering" it unit by unit. She noted that a medical-surgical unit at the hospital closed on Tuesday night, ahead of its previously scheduled closure on Sept. 5.
DMC spokesman Doug Finnie said today that the unit was consolidated from two floors to one floor due to a dwindling patient population and a lack of need.
The decision is also meant to save money and ultimately to keep the hospital open longer, he said.
Doug Straus, an attorney for the healthcare district, countered that death is not an uncommon outcome for patients and cannot be attributed to the diversion of ambulance service from DMC.
"The evidence doesn't support the conclusion that people are dying at any greater rate than before," he said.
He also argued that the healthcare district has fought for years to keep the hospital open and continues to, despite its deepening financial deficit.
Straus said the decision to divert ambulance service and reduce other services was made in the interest of patient safety and at the recommendation of emergency medical staff at the hospital.
Monika Cooper, an attorney representing the county, said county officials have worked for years to keep the hospital open and are continuing to work to find a solution to keep DMC functional.
That solution, according to Supervisor John Gioia, may be to convert DMC into a satellite hospital with an emergency room. As the Contra Costa Times reports:
If the emergency department is absorbed as a satellite facility in the county system, patients would still have to be taken to other hospitals in the area if they need specialized care, as in the case of trauma and heart attacks. But a satellite emergency department has advantages over a freestanding unit because it could include better reimbursement rates under the county license and county subsidies. A satellite facility could also benefit from better integration with the resources of the county medical system.
"A satellite and a freestanding (emergency department) are pretty similar in some ways operationally," said Dr. Joseph Barger, director of Contra Costa Emergency Medical Services. "While there could be an advantage of having an associated medical staff of another entity, there would still be the challenge of making sure that patients who need additional care can be promptly and efficiently transported elsewhere."
County officials are also encouraged by a bill introduced last week by state Assemblywoman Nancy Skinner that would place the hospital in California's public health system, making it eligible for higher reimbursement rates from the state.
For now, the plaintiffs in the lawsuit, which call themselves the DMC Closure Aversion Committee, are hoping Orrick will rule in their favor.
In court today were dozens of hospital workers and West Contra Costa County residents, many of whom voiced concerns about what will happen to them and their families if the hospital closes for good.
One attendee, El Sobrante resident Alberto Ramon, 72, said he survived a heart attack 10 years ago thanks to the prompt care he received at DMC.
"If I had to go to another hospital I'm not sure I'd be here," he said.