CONTRA COSTA CO.: LONGER AMBULANCE TRANSPORT, ER WAITING TIMES AFTER DOCTORS MEDICAL CENTER CLOSURE
When Rachelle Bertumen started working at the Contra Costa Regional Medical Center in Martinez as an emergency room nurse in the fall of 2013, the department saw one- to two-dozen patients a day.
“Leisurely” was how she described her pace at work.
With today marking the one-year anniversary since Doctors Medical Center in San Pablo stopped taking ambulance transports, and just over three months since its full closure, Bertumen says the emergency room at CCRMC has never been busier.
“It was a huge difference” when Doctors stopped taking ambulance transports, she said.
“We used to see patients who were not really that sick,” Bertumen said. “Then, we started getting more ambulances and the nurses, they’re not used to it, they get stressed.”
When Doctors shut its doors for good on April 21, the situation only got worse, she said.
“When Doctors finally closed down, the patients we see in the ER actually doubled or tripled,” she said. “We have patients coming here with congestive heart failure or with a history of bypass and they have chest pain and shortness of breath and they have to wait two hours because we don’t have any room to see them.”
The county’s regional medical center is not alone. At Alta Bates Summit Medical Center in Berkeley, the emergency room has seen a 25 percent increase in walk-in traffic since August of last year, according to spokeswoman Carolyn Kemp. And the number of patients coming from West County is up by roughly one-third, she said.
The numbers for Kaiser Permanente Medical Center in Richmond were harder to come by. In a statement, Odette Bolano, senior vice president and area manager for Kaiser Richmond, said the emergency room is “frequently at or above capacity.”
At a board meeting of the West Contra Costa Healthcare District, board chairman Eric Zell said Kaiser Richmond reported to the district that their average daily patients had increased from 110 patients to 208 since Doctors closed its doors, but representatives from Kaiser declined to verify
An increase of 98 patients per day is roughly 18 percent higher than what was predicted by Contra Costa Emergency Medical Services, which published a report in June 2014 warning what would happen if Doctors stopped taking ambulance traffic. The authors of the report estimated that Kaiser Richmond would see an increase of 83 walk-in patients per day.
“We do know we have an ongoing issue of too many walk-in patients using Kaiser’s (emergency department),” Contra Costa Health Services Director Dr. William Walker said at the July 29 WCCHD board meeting. “When Kaiser Richmond’s emergency department is full, we do attempt to move patients around and they have also been getting better at handling the load.”
The county established an advice nurse line for residents who don’t have insurance to call before walking into an emergency room, Walker said. It’s one of the strategies the health services department hopes will help divert people away from using the emergency room, he said.
The county also helped establish an urgent care clinic across the street from Doctors in San Pablo, run by LifeLong Medical Care. When patients come to the emergency room at Kaiser Richmond but don’t need emergency care, Bolano said staff encourages those patients to visit either a primary care provider or an urgent care center, including LifeLong’s clinic in San Pablo.
The pressure on emergency departments means residents have to travel further to get care.
According to statistics provided by Contra Costa Health Services, travel times for residents in West County have increased an average of 4 minutes since last year and an average of 5 minutes and 38 seconds since 2013.
Residents in San Pablo have been hit the hardest. Transport times increased an average of 6 minutes and 26 seconds since last year and 9 minutes and 17 seconds since 2013, according to transport time data.
The longer transport times is not only hard on patients, it’s hard on the entire emergency medical system, American Medical Response spokesman Jason Sorrick said.
The number of patients being transported to a hospital outside of Contra Costa County has increased from 8 percent last year to between 28 percent and 31 percent today, according to data provided by Contra Costa Health Services.
“That’s a longer time that (patients) are suffering from whatever pain or illness they have,” Sorrick said. “You’re pulling ambulances out of the system and in order for us to maintain our response time, we have to accommodate for those losses in units.”
That means more ambulances on the street, which Sorrick said amounts to roughly 500 hours of additional staff time each week.
“On top of that, if a hospital is impacted, if it physically doesn’t have the capacity, that means you’re waiting with your crew and some crews are waiting hours with a patient because the hospital doesn’t have the ability to take those patients,” he said.
Compounding the problem is the same issue that forced the closure of Doctors in the first place: reductions in reimbursement rates for Medi-Cal and other patients since the passage of the Affordable Care Act, Kemp said.
“It’s important to note that all hospitals in the area are seeing an increase in emergency room visits and inpatient care — Kaiser, John Muir, Eden, Delta — with the exception of Highland in Oakland,” Kemp said. “With more members of the community receiving care under the Affordable Care Act, the results are visible within the hospitals.”
Sorrick echoed Kemp’s concern.
“It all boils down to lack of reimbursement, which really impacts the sustainability of the system,” he said. “The county has done everything it can to address that situation, but the reality is they’re not the ones who chose the levels of reimbursement for treating those patients.”
Alta Bates has partnered with the LifeLong urgent care clinic in San Pablo to take some of the burden off of its emergency room and Kemp said the hospital is also working with LifeLong to open an urgent care clinic in Berkeley, which is expected to happen in less than two months.
Patricia Frost, director of emergency medical services for Contra Costa Health Services, said the department worked with surrounding counties for a year before Doctors stopped taking ambulance patients and those partnerships continue today.
“This has been an example of a community coming together to deal with a crisis in access to care,” Walker said. “We all know that everything we’re doing cannot replace a full-service hospital. We’re trying to do the best we can with regard to access to urgent care and trying to use the (emergency medical services) system appropriately.”