Deal Struck to Rescue and Reopen San Pablo, CA ER

RICHMOND -- The emergency room at Doctors Medical Center could go back to full service again as early as Wednesday -- and with flu season approaching, officials say it's none too soon.

Since Sept. 11, the San Pablo hospital has diverted 9-1-1-call ambulances to other East Bay hospitals, primarily to Kaiser Medical Center Richmond. Doctors averaged more than 20 9-1-1-call ambulances per day before the diversion.

"Kaiser Richmond has stepped up to the plate," Art Lathrop, Contra Costa County's director of emergency services, said earlier this month. "They've added staffing, and they've been able to handle the increased ambulance load so far."

But Kaiser will not be able to keep up with the increased load indefinitely, officials warn.

A 2004 study of West Contra Costa emergency services predicted that a downsizing or closure of emergency department operations at Doctors would have dire consequences for all area hospitals, especially Kaiser Richmond.

"Waiting times at Kaiser Medical Center Richmond will likely reach 10-12 hours for walk-in patients," said the study, available online at.

As the Contra Costa County Board of Supervisors prepares to vote on a joint management agreement today, part of a rescue package that includes a complicated set of money transfers among several agencies, Doctors is looking to emerge from its recent tailspin that saw it file for bankruptcy protection Oct. 1.

"This affiliation ... has renewed the life expectancy of the hospital," said Dr. John Rampulla, director of the emergency department and the current hospital chief of staff, anticipating a yes vote by the supervisors today and by the California Medical Assistance Commission today. The West Contra Costa Healthcare District, which owns the hospital, approved the arrangement last week.

While on diversion, the emergency room at Doctors has remained open to walk-in patients.

The 11-member emergency physicians group served a

30-day termination notice in late September, about six months after the hospital stopped paying them their contractually specified stipend. The stipend is supposed to defray some of the losses the doctors incur when uninsured or underinsured patients cannot pay their bills.

The overdue stipend, Rampulla said, is simply gone.

"It's part of the bankruptcy," he said. "We're in line with the rest of the creditors."

But because services rendered after the bankruptcy filing will be paid 100 percent, the group has rescinded its termination notice, Rampulla said.

His group of doctors remains virtually intact.

"We lost one, and we're hoping to keep one who was ready to leave," he said.

With the flu season approaching, emergency rooms at Kaiser Richmond and other hospitals faced the prospect of gridlock if Doctors' ER remained on diversion or closed.

"We dodged that bullet," Rampulla said.

Edith Stradtner, a Kaiser Richmond HMO subscriber, got a foretaste of what emergency care in West Contra Costa might look like if Doctors San Pablo and its emergency room should close.

Stradtner, 83, an El Sobrante resident, felt extreme abdominal pain one afternoon earlier this month, so her husband brought her to Kaiser Richmond's emergency room.

"It looked like Grand Central Station," Stradtner said. "The place was jam-packed. The nurses, they were running back and forth."

After seeing "the lady up front," Stradtner underwent some tests. Then she got put in a room. Then, "they put me out again."

"A guy came in with two cops," Stradtner said. "So they put me out in the hallway."

The bright light bothered her, so someone gave her a towel to cover her eyes. After that, Stradtner said she lay there unattended for a long time.

"It took me hours to get a goddamn bed pan," Stradtner said. "I should have peed in the bed."

Although Kaiser is among the major players in West Contra Costa's emergency services network, its officials repeatedly sidestepped requests for comment this month. Regional public relations officers delegated questions to local subordinates who promised to have an expert call, but no one ever did.

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