Tenet Healthcare Corp. said last week it will end acute-care services at a small hospital on the east side of the San Francisco Bay and consolidate those services at a nearby hospital it leases in San Pablo, Calif.
The decision concludes a self-imposed two-year moratorium on closing 137-bed Doctors Medical Center-Pinole (Calif.). The announced termination of acute-care services-and closure of the emergency room-in 1997 so greatly upset the local citizenry that the Contra Costa County Board of Supervisors asked Tenet not to proceed with the plan.
The county also sponsored a bill in the California Legislature to give counties authority to veto hospital closures if they endangered public safety, but the bill failed.
"The reasons that I was concerned about it two years ago haven't changed any," Supervisor Donna Gerber said last week.
Gerber said she's worried that the availability of intensive-care services in the area is falling below safe levels and that emergency patients won't get to the San Pablo hospital in time because of traffic congestion. Local activists have announced they will oppose Tenet's plans.
Tenet said the realignment of services is necessary to respond to patient preferences, a low census and changing patterns of hospital usage.
The Pinole hospital building will be converted for use for long-term care, outpatient surgery, transitional care and substance abuse treatment. Acute-care services will move five miles to Doctors Medical Center-San Pablo, which Tenet has leased since 1996. The emergency room at the Pinole facility will be converted to urgent care.
Tenet spokesman Brandon Edwards stressed that "three-quarters of the visits to that emergency room are urgent care only. We're able to serve the vast majority of patients who need care there, without an emergency room."
After the conversion in March 2000, those patients will be directed to the San Pablo emergency room.
The seven-story San Pablo hospital opened in 1954 and does not meet new seismic codes. It has 312 licensed beds and runs an average daily census of 80 to 90 patients, Edwards said. The Pinole hospital, built in 1967, has a census of around 20.
"When you have two hospitals nearby, neither heavily utilized, and you have a heavy demand for outpatient services, you have to make a decision to rationalize this," Edwards said.
But local activists and public officials say the county's main problem is not overcapacity but undercapacity, especially of emergency- and critical- care resources.
In 1997 and 1998 a series of deaths in emergency rooms in the area was attributed to insufficient intensive-care-unit capacity and slow emergency response. County authorities worried that cost-conscious hospital owners were eliminating too much ICU capacity and making emergency care inaccessible to local residents (July 20, 1998, p. 36).
As a result of that crisis, county officials asked the hospitals to voluntarily submit daily summaries of their available bed capacity. Data show very few medical-surgical beds available on most days, and even fewer ICU beds available.
For most of the week of Aug. 27 through Sept. 1, for example, the Pinole hospital reported having zero ICU beds available, Gerber said.
Tenet has applied to add 14 new ICU beds to the San Pablo facility.