Recent meetings of the governing board of Doctors Medical Center San Pablo have felt like a waiting room for an intensive care unit. Well-wishers wearing solemn expressions assemble in hushed silence awaiting a prognosis on the chances for survival.
Funding woes have plagued the hospital for as long as anyone can remember, but there was always a flicker of hope in the past -- an infusion of cash from Kaiser Permanente and John Muir Health; $35 million in loans from Contra Costa County; a $3 million gift from the state; a promise of $15 million from Richmond.
Thanks to an assortment of saviors, DMC has stared down death more often than James Bond. But all the harrowing escapes seemed a distant memory Wednesday afternoon, when directors of the West County Healthcare District signaled that the time is near to prepare for the end.
They announced their intention to sell three parcels of hospital property to San Pablo for $7.5 million, most of which is expected to be used for paying off outstanding expenses in preparation for closure.
"We're no longer kicking the can down the road," board President Eric Zell said. "We're dealing with the reality of our financial situation."
The coffin has not been nailed shut. The hospital will remain open in a limited capacity for now, clinging to the faint hope that survey results will reflect an appetite for a new district parcel tax. But inasmuch as the last effort, just 10 months ago, came up 15 percent short at the polls -- 52 percent in favor of a measure needing two-thirds support -- this escape would rival anything Houdini ever attempted.
Zell pegged decision time at 30 days. "We have to decide when we're going to stop burning money on operations and start using it for closure," he said.
There's never been a shortage of a need for DMC. It typically averages 40,000 emergency room patients a year, including more than 500 requiring cardiac care. The problem is that funding for services has not kept pace. About 80 percent of patients are on Medicare or Medi-Cal; about 10 percent are uninsured.
"This hospital cannot continue on a stand-alone basis as long as Medicare and Medi-Cal rates are as low as they are," Zell said. "If we got the full cost of care, we wouldn't be having these conversations."
He couldn't help but note the irony of recent nationwide health care reform: "Under the Affordable Care Act, we're providing greater access to health care but not providing more money to serve the people who are getting access."
No one can fault the hospital's supporters for the long-dreaded arrival of D-Day. Directors knocked on doors and lit up phone lines in search of funding answers. Members of a dwindling staff took extra shifts and agreed to benefit concessions. Their collective sense of loss was in the air at the most recent meeting.
This end was likely inevitable. The question that follows: What's next?
Zell holds out hope that LifeLong Medical Care, which operates a health care clinic in one of the nearby facilities San Pablo bought, will find the resources to convert to an urgent care center. He hopes the West County Health Center on San Pablo Avenue can pick up some of the slack when Doctors closes its doors.
Even in recent weeks, as service has been scaled back, the hospital has treated nearly 100 patients a day. The unanswered question is where those folks will find help when the plug is pulled on DMC.