Hard times beset hospital in San Pablo

Doctors Medical Center in San Pablo is among the most troubled hospitals in California.

By 2006, it was so strapped financially that it turned to San Quentin prison for patients — knowing that the state, at least, would pay its bill. That backfired when a sex offender serving 100-plus years managed to undo his manacles and briefly escape through a fire door, causing a top police official to accuse administrators of skimping on safety for easy money.

In 2008, the state hit the hospital three times with its highest possible penalties for lapses in patient care, including a death after a catheter was incorrectly inserted into a patient’s vein.

The same year, the federal government threatened to cut off the hospital’s Medicare money after inspectors observed a staff member changing dressings on a wound with soiled hands and discovered “grimy and dirty� equipment.

The threats did not materialize, but earlier this year, even the hospital’s nurses joined the chorus, picketing out front to “warn the public that care … is inadequate and unsafe,� according to their press release.

As if this weren’t enough, someone recently stole the ATM from the entrance.

Afflicted though it is, Doctors serves a wide swath of Contra Costa County, and poor residents of Richmond and San Pablo depend on it. Doctors’ emergency room, which has 24 beds, treats about 40,000 patients a year.

Along with more and more other hospitals in California and nationwide that serve poor communities, Doctors is going broke. It loses money on many of the patients who walk — or are wheeled — through the door. Often such facilities — with the notable exception of teaching hospitals — can’t afford to offer the most competitive salaries, shiniest equipment, best security or most cutting-edge programs.

But in an emergency, they offer patients a key advantage: proximity.

In the last decade, 10% of emergency rooms in California have closed; many were in poor areas, according to researchers at UC San Francisco and Rand Corp., the Santa Monica-based research institution.

Doctors, which this year has an $18-million deficit, may soon be one of the casualties. Administrators say that if voters in western Contra Costa County don’t approve a parcel tax this November to raise $5.1 million, it probably will close next year.

The nearest other public hospital in the county, Contra Costa Regional Medical Center, is 30 miles away in Martinez.

“Doesn’t anyone care about healthcare for the poor?� asked Dr. Desmond Carson, who grew up in Richmond and now works in the ER even though, he said, he could make more money elsewhere.

“A kid came in here days ago blue. If we were not here … that baby would be in the morgue today.�

Doctors has problems besides money. Inspectors have cited it for quality issues, including a repeated failure to report errors. But money may be the hospital’s biggest problem.

Just 10% of patients at Doctors have private insurance, and government insurance programs often don’t cover costs, hospital officials say. They say they are making improvements despite a tight budget and deny there are safety or security problems.

Doctors’ plight may be extreme but it is not unique. In Southern California, 11 hospitals have closed in the last decade because of financial pressures, and half a dozen more are “on the cusp� of doing so, said Jim Lott, executive vice president for the Hospital Assn. of Southern California.

The national healthcare reform law, if it survives legal challenges, may improve things because it will require patients to have some kind of health coverage. But some hospitals, he said, may not be able to stay open until 2014, when the law is to take effect.

Compounding Doctors’ troubles is its status as a stand-alone hospital operated by a public health district, one of about 80 in California.

Unique to California, district hospitals are public entities but can’t rely fully on county funding and are run by elected boards whose members may lack healthcare expertise. Although they can levy property taxes with voter approval, such taxes often yield far too little. Many district hospitals across California, including some in Contra Costa and Riverside counties, have shut their doors or changed management in the last few decades.

Doctors’ troubles represent a steep fall from the day in 1954 when it opened, with a green lawn leading up to a white structure that was — and still is — the tallest building in town. Back then, Richmond and San Pablo were home to thousands of workers in the nearby shipyards and factories, who earned union wages.

But by the 1990s, many of those jobs were gone, and the population had become increasingly poor.

Money troubles, said Steven Valentine, president of the Camden Group, a healthcare consulting firm, can limit “the wages [hospitals] pay and the doctors and nurses they can attract.� Struggling hospitals, he said, also sometimes cut back on training and may not have optimum staffing levels.

State officials raised that issue during an inspection at Doctors earlier this year after a patient did not receive proper pain medication, saying there was the potential the hospital may not have had enough staff “to meet patient care needs.�

Hospital officials dispute that, saying they had proper staffing ratios in place. But they said they plan to ensure in the future that no nurse has too many acute-care patients at one time.

Dawn Gideon, the hospital’s new interim chief executive, said she prides herself on the quality of care the hospital is able to provide given its limited resources, and she denies that it has safety or security problems.

Just last month, she said, the hospital received certification to begin treating stroke patients, after easily passing an inspection. Even so, she is still prepared for the possibility of a shutdown if the parcel tax fails.

That prospect has many in the community feeling sad and angry.

“If not for this hospital, [my husband] would probably be dead,� said Philomena Escobar, 71, who lives across the street and said her 89-year-old husband, Antonio, had a heart attack in February. “If they close it down, what’s going to happen to us?�

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