Contra Costa Times: Doctors Medical Center closure to ambulance traffic packs other East Bay hospitals

SAN PABLO -- Diversion of ambulances from cash-strapped Doctors Medical Center has packed other local hospitals with new patient traffic and lengthened wait times for those who need emergency medical care, according to data released by Contra Costa County Emergency Medical Services.

The data, which compare August to December 2013 with the same period a year earlier, bears out county projections about how diversion of ambulance traffic from DMC would affect patients. DMC's administration and governing board decided to stop accepting ambulance traffic in early August when the hospital's finances worsened and dozens of employees quit.

The result is dramatic increases in the number of patients going to Kaiser Richmond, which has a 15-bed emergency department and is the closest to Doctors, as well as Contra Costa Regional Medical Center in Martinez and Alta Bates in Oakland, along with a few patients going to other area hospitals. No one has died as a result of the change, said Pat Frost, Contra Costa County's emergency medical services director.

Transport times from pickup of emergency patients to their arrival at the hospitals have also increased substantially. San Pablo residents endure the biggest increase in ride time -- an average of 18 minutes, 39 seconds to reach a medical facility, up from 11 minutes, 24 seconds before Doctors suspended ambulance traffic. Residents in Richmond and Pinole also have longer transport times than they did last year.

"The increases were predictable," Frost said. "You have taken a facility away, and Kaiser has such a small emergency department. But even though transport times have extended, what we have put in place is more ambulance hours in West County."

Kaiser Richmond has taken the brunt of the new traffic, with 1,622 ambulance visits from Richmond 911 callers from August to December, about 50 percent higher than the same period in 2013. Kaiser Richmond also took 454 patients from San Pablo, more than double what it took a year earlier. 

The new reality was clear at Kaiser Richmond's emergency room Tuesday evening, as the waiting room overflowed with dozens of walk-in patients and ambulances dropped off others.

"The wait is worse now, for sure," said Richmond resident Antwon Cloird, who was there to support a friend whose mother was in the ER. "I know a lot of people who didn't know they could still go to DMC."

At Doctors that same day, the emergency room waiting area was sparse, with only five people seated in a room that holds more than 50. Patients there said they walked in to get care and didn't know that ambulances no longer take patients to the hospital.

Kaiser Permanente spokesman Jessie Mangaliman declined to comment on the surge of traffic to Kaiser Richmond but reiterated earlier statements that Kaiser "shares a mutual concern about access to care for underserved residents of Richmond and West Contra Costa County" and has provided financial support to DMC in the past.

Frost said county officials stay in constant contact with Kaiser Richmond to triage patients to other hospitals when the facility gets overwhelmed, using color codes that indicate the level of inundation.

About half of the time, Kaiser is able to accept ambulances without difficulty, Frost said. About 20 percent of the time, called red status, Kaiser is "severely impacted" and ambulance staff advises patients they can go to another hospital to be more quickly treated. About 1.5 percent of the time, ambulance personnel do not give patients a choice and instead take them to other hospitals because Kaiser cannot accept them, Frost said. Since August, 115 patients have had no choice but to go elsewhere.

Frost said longer transport times have not cost any lives, although relatives of a man who died in August after being taken by ambulance from Hercules to Alta Bates Summit Medical Center in Berkeley claimed he may have survived had DMC, which is much closer, been open. Frost could not say whether any patients' health had worsened because of longer transports.

"We are unable to determine that information with any accuracy right now," Frost said.

Frost said the situation will grow more dire if DMC, which still accepts emergency patients who self-transport or are brought by others, closes its 25-bed emergency room completely. Hospital officials are trying to piece together a multifaceted plan to keep DMC open as a full-service facility before it runs out of money in coming weeks.

The beleaguered hospital runs deficits because it serves mostly patients of MediCal and Medicare, which provide low reimbursement rates.

Contra Costa County supervisors last month forgave $12 million in debt owed by DMC on previous cash advances. The Richmond City Council also voted to earmark $15 million for DMC from a Chevron community benefits package tied to a refinery modernization, but that money won't become available until the refinery receives final permission to begin the project.

American Medical Response, which has a contract through the end of this year to transport emergency patients in the county, has borne much of the cost for the longer travel times, said spokesman Jason Sorrick.

"If this situation remains in 2016, it's unclear who will pay more (for transports)," Sorrick said. "We are hopeful that DMC will be reopened to ambulance traffic."

Reposted from Contra Costa Times.

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