November 5, 2004

San Jose Med Center closure on schedule; reports coming

By Carol Rosen
Staff Writer

While San Jose and Santa Clara County prepare to meet what could be a huge health care crisis, the cause of the crisis—closure of San Jose Medical Center (SJMC)—continues to meet the closing schedule outlined by owner HCA Healthcare. Meanwhile, November looks to be a busy month for anyone involved in the closure process.

On Nov. 1, the San Jose Planning Commission paved the way for HCA to move its trauma unit from SJMC to Regional Medical Center, another HCA property. The commission voted unanimously to approve land use and zoning changes to Regional’s 34-acre site in East San Jose at Jackson Avenue and McKee Road.

At the same time, HCA submitted a 100-page application to move its trauma unit from the downtown medical center about four miles to Regional Medical Center, formerly Alexian Brothers Hospital. The County Board of Supervisors received and reviewed the application and forwarded it to the state. The supervisors also forwarded an Impact Evaluation Report to the State Department of Health Services and Emergency Medical Services Authority on Nov. 2.

“We don’t know the timing of the process,” said an employee of the county’s emergency medical services’ authority.

“After they’ve turned in the application, depending on how complete it is, we have to secure an outside consultant and experts to review the application and the facility. The process can take three months to a year.”

In an effort to alleviate trauma and emergency problems, the city and county are working to beef up the staff at Valley Medical Center to ensure that as many patients as possible can be treated, said District 3 City Councilmember Cindy Chavez.

Impact report
The report, which is required by the state, reviews and discusses the impacts the closure will have on the county’s inhabitants. The report follows a public hearing held Oct. 19. At the meeting, about 15 people spoke including a couple of doctors, HCA employees and people from the community.

“The overwhelming sentiment is that people are sorry to see it close,” said a County Health System employee who asked not to be named. “Most everyone there was upset with the closing and the short—90-day—notice. Even HCA employees expressed frustration,” she said.

A summary of the report indicates that the closure “will create severe impacts. Extreme pressure will be placed on the 11 remaining emergency departments in the County to handle the 30,000-plus visits [that are typically] seen [annually] at SJMC. Regional Medical Center, located just over two miles from SJMC, will handle many of those ED visits. Santa Clara Valley medical Center and O’Connor [Hospital], located 4.9- and 5.7 miles away from SJMC respectively, will also see a dramatic increase in [patient] volume,” according to the report’s synopsis.

Ripple Affect
“The closure will have a big ripple affect on the other 11 emergency departments in Santa Clara County,” said Supervisor Jim Beall. He added that each hospital has a certain amount of capacity. Once that capacity has been reached, “the EMT staff is diverted to other hospitals. This could prove a problem in peak periods. We’re also concerned that with the flu season coming and the vaccine shortage, that the remaining emergency rooms could be easily overwhelmed—placing a strain on medical staffs,” Beall said.

In other words, the downtown hospital’s closing is likely to intensify emergency department overcrowding, which in turn may increase ambulance diversion that can provide temporary relief to an emergency room. This could result in increased workload at secondary locations and will definitely increase transport time and limit patients’ ability to choose a hospital.

However, it is very rare that a trauma center will go on diversionary status, said a county EMS employee. “It’s happened, but it’s really rare. Just like with an emergency room, if the hospital is on diversion, it can be forced back open if the situation requires.”

City and county officials and EMS employees are hoping to push the trauma move to Regional through as swiftly as possible, although most expect the process to take at least six months. Statutes indicate that the move can occur within a three to twelve month period.

“The city and the county are working together to find private sector partners that can assist us in looking out for the health care of the citizens in San Jose and Santa Clara County,” Chavez added. “My primary interest is to maintain and improve the quality of health care in our community.”

SJMC closing timetable
The timetable for SJMC’s closure already has begun. Starting Nov. 12, the only medical center located in downtown San Jose will stop doing elective procedures. Nov. 19 is the last day for outpatient laboratory and X-ray diagnostics. By late November, either Nov. 22 or Nov. 30, the center will be off of ambulance rotation and emergency medical services.

HCA is “making arrangements for appropriate transfer of [current] patients based on their individual medical needs,” said Leslie Kelsay, assistant administrator for SJMC. “The emergency department and all services supporting it—X-ray, cardiac catherterization, for examples—will remain open until 5 p.m. on Dec. 9,” she added.

“In the meantime, we are making an investment to keep doctors, specially trained nurses and ancillary services here at Regional. We have to have the capacity [and the ability to perform trauma services] before Regional can be declared a trauma center. We hope to be up and operating before we receive the designation. Once SJMC is no longer in the ambulance rotation, doctors, nurses and the balance of personnel will transfer to Regional on Dec. 10,” said Kelsay.

HCA is making plans for Regional to be able to handle emergency room cases. Geographically, people from the downtown area are near Regional, Kelsay said. In addition, HCA will open an urgent care center with an initial capacity of 1,000 to 1,500 patients per month and increase that if necessary. Urgent care will be open 12 hours per day, from 11 a.m. to 11 p.m.

That will free the emergency department’s capacity to be able to care for patients whose symptoms are more severe or life threatening, Kelsay said. In addition, the set up will change to a “rapid medical exam.” Doctors will see patients quickly and prescribe medication or tests streamlining the process and getting patients in and out quickly.

MediCal
At the same time, HCA’s MediCal contract with the state expired Nov. 1. The contract determines what the state pays the for-profit HCA for patient care. Kelsay told the Times that HCA has been negotiating with the state for more than a year. “We’ve been to Sacramento several times to discuss this. Regional’s CEO went to appeal to the director of the commission that oversees MediCal, but we haven’t heard from them since.

“The state decided it’s not important enough to keep Regional in the network and to continue negotiations,” Kelsay said.

“California ranks dead last in the nation on spending for patient coverage. The United States averages $5200 per covered person. The state of New York pays $8800 per person and California only pays $2700,” Kelsay added claiming that a number of hospitals had dropped MediCal since September including Community Hospital of Los Gatos. “There’s others too, but they’ve done it very quietly.”

Actually, that makes a lot of sense, Supervisor Beall noted. “There aren’t a lot of patients near Los Gatos that use MediCal,” he pointed out. However, “you take away MediCal from Regional and you’re turning your back on the people in that area, such as the working poor and others,” who rely on MediCal to help with health care bills.

Letters
Although it doesn’t appear that anything will come of it, area elected officials are contacting state officers and people associated with HCA to try to forestall SJMC’s closure. Nearly a month ago Mayor Ron Gonzales sent a letter to Attorney General Bill Lockyer explaining HCA previously had indicated the center would close in 2007, but announced Sept. 8 it would close SJMC in 90 days.

At the same time, Representatives Zoe Lofgren and Mike Honda wrote a letter to Tennessee Senator Bill Frist, a medical doctor with ties to HCA, asking him to look into the situation.

No answers from anyone were forthcoming, however, press assistants for Lofgren, Honda and Frist noted that little probably would be done until after the election.