“Time is brain.”
Neurologist Camilo Gomez coined the phrase in 1993, and for the following 28 years it’s guided this understanding in the medical world:
The longer it takes to get someone suffering a serious stroke into an emergency room, that person has a greater chance of death or permanent brain damage.
Since San Clemente’s one standard hospital closed in 2016, the closest emergency rooms are up to half an hour away from residents – a majority of whom surveyed last year enjoyed their quality of life in the south county coastal enclave, but not the distance from critical healthcare.
One City Council member, Kathy Ward, said her town needs at least one emergency room, echoing the concerns of residents surveyed.
“We are too many minutes from the nearest hospital,” Ward said in a Tuesday phone interview.
She said having one ER department would shore up what she considers a “No Man’s Land – a Bermuda Triangle here for emergency medical services.”
But city officials are scratching their heads on how to best address San Clemente’s lack of an emergency room amidst the seeming fiscal infeasibility of building a new hospital to host it. Some say the city’s current and upcoming urgent care facilities could help with the issue.
Meanwhile, experts at an April 9 community roundtable pointed to data showing that medical transports out of San Clemente are more often for non-acute, general medical problems and that emergency patients went to further hospitals anyway because they had more services than the old hospital.
Still, some wonder what happens to those who aren’t breathing, those who need to stabilize – those who need a closer ER.
More than half of the nearly 1,000 residents surveyed by a city-contracted study group, FM3 Research, consider their health care quality and access to be sufficient.
And many want a closer hospital.
Yet building one – and operating it – is costly, city officials say.
So are the accompanying legal issues.
A few years ago, San Clemente fought in court with the operator of its old hospital, MemorialCare Health Services, which shuttered the facility on Camino de Los Mares – but also wanted to redevelop it, while the city moved to maintain hospital services in the area through rezoning.
The two parties settled and seemingly resolved their disputes in 2019.
Since then, MemorialCare filed a new application with the city last month to turn the site into a mixed-use, senior housing complex with a health center, urgent care, and doctors’ offices.
But no emergency room.
Meanwhile, council members like Chris Duncan and Mayor Gene James have signaled their waning interest in the idea of building a new hospital, citing a lack of interest by hospital operators they sought proposals from and the construction and operating costs that could come down on taxpayers.
“I don’t think inpatient care (staying overnight at a hospital) in San Clemente is going to be financially viable,” James said at an April 9 community health roundtable on the issue, which he and Councilmember Chris Duncan hosted.
It would cost around $200 million to build such a facility, say city officials.
James, at the discussion which was broadcast on Zoom, wondered aloud whether healthcare has “moved away from the old inpatient care model, especially with insurance companies who try to push patients out of hospitals as quickly as they can.”
“You see where people are getting knee transplants or hip transplants, which is outpatient surgery,” James said. “Your primary care physician is a very personal relationship you have, and is usually attached to some healthcare system, and will you give up that primary care physician to use a hospital in San Clemente?”
The challenge lies in the urban topography.
San Clemente residents sit amidst a 40-mile stretch that’s void of emergency rooms, between a hospital in Oceanside and hospitals in Mission Viejo and Laguna Beach.
“If there’s at least some type of hospital here, where there’s an ER, that’s all we need to stabilize,” Ward said.
On the cost, Ward pointed to the idea of a hospital district to fund its construction, but it’s an idea that could manifest a property tax increase for residents.
In a Tuesday phone interview, council member Laura Ferguson said the city heard interest from at least one group, Palomar Health, which is a hospital district operating several healthcare facilities in San Diego County. And while she’s fine putting the idea before voters, she said she’d personally vote “No.”
“I don’t think it will prove to be what it appears,” she said in a Tuesday phone interview.
Just half of the nearly 1,000 residents surveyed last December supported building a hospital with public funds.
But what about cheaper ways?
One idea was a freestanding ER, one not connected to a standard hospital, but that’s illegal in California.
Four years after the MemorialCare hospital on Camino de los Mares closed, the city officially sought an operator to develop the site into an acute care facility.
Yet, by city officials’ own account, they received a few letters of interest and not a single proposal.
During other consultations with what the city said were “numerous nationally recognized health care systems,” the city said none believed they could stake a fiscally viable model on the site.
“We have actively sought hospitals to come into San Clem and partner with us to move forward with a hospital – full-service hospital, with emergency room services,” said Duncan at the April 9 roundtable.
“No one has stepped forward and been willing to partner with us on that. It’s not for a lack of effort,” Duncan said. “We have really tried to solicit that interest and have not gotten it.”
Residents want a hospital – “we knew that before the poll came out,” Duncan said, adding “we’ve been chasing this down for years now and it’s very apparent in the hospital community we’re looking for a hospital to come and haven’t got anyone to dance, essentially.”
Since 2016, several urgent care facilities have been set up in town.
But paramedics don’t usually bring patients to urgent care, Ward noted over the phone.
Though a project by Providence Health & Services, a nonprofit Catholic health care system, is going through a city permitting process to build a 7,500 square-foot health care facility in the San Clemente outlets, with urgent care, said Mayor Gene James at the same panel discussion.
Ferguson, who said she recently spoke with people from Providence about the project, likened it to an “ER alternative.”
“Staffed with ER doctors seven days a week and able to handle about 80% percent of hospital room cases, which will be placed upon permitting at the outlet mall there,” Ferguson said. “I think that will be very beneficial for us.”
Still, there are no current plans for emergency services “in the sense of an emergency room at this point,” Duncan said, “but there are other projects … that provide other kinds of health services.”
More than 70% of survey respondents thought it “important to improve preparedness for public health emergencies and to have a local ER for traffic and beach accidents,” according to the survey.
While chiefly a firefighting resource, the Orange County Fire Authority also provides paramedic services to residents in town.
Back in 2017, in response to the closure, the Fire Authority and the city set up a third paramedic unit. Previously there were two.
But with paramedic services, one also needs a “complimentary hospital system to receive those patients,” said Tammy McConnell, the emergency medical services director for the county Health Care Agency’s Emergency Medical Services system, at the roundtable.
Since the 2016 hospital closure, McConnel said San Clemente residents are being transported to the Laguna Beach and Mission Viejo hospitals, with “pretty much 70% of all calls in San Clemente” going to Mission Viejo.
Ward questioned whether that meant the absence of an ER in San Clemente was “inundating” the other nearby hospitals and dragging out wall times.
“If a person was not breathing and the paramedics couldn’t revive them, they would take them to the hospital in San Clemente first, and stabilize them. We have had people in San Clemente who have passed because it was too many minutes,” Ward said in the Tuesday phone interview.
On an average year, San Clemente residents “incur roughly 11,000 ER visits dispersed throughout the county, predominantly at Mission Viejo or Laguna Beach,” said another April 9 roundtable panelist, Paul Young, of the Hospital Association of Southern California.
But Young said inpatient admission among San Clemente residents has “declined over the years” – in 2016, the number was closer to 6,000. In 2019, Young said, that number was 5,000, pre-pandemic.
“We’re already on a downward trend in utilization,” he said.
A majority of average transports from San Clemente are “non-acute,” McConnell added, “meaning they’re not having a heart attack, haven’t choked, a finger isn’t cut off, they’re not having trouble breathing.”
The majority of medical calls in San Clemente “are really generic medical problems that do require medical assessment” but don’t necessarily “require transport to a specialty care center,” McConnell said.
There are roughly 3,000 yearly ambulance rides out of San Clemente annually, since the MemorialCare hospital closure, she said.
“What we see out of the 3,000 annual transports out of San Clemente is only about 4% or 100 patients are in that cardiac, chest pain category and would go to Mission Viejo – and strokes account for less,” McConnell added.
Pre-hospital closure, McConnell said patients with urgent medical needs like heart attacks were already going to specialty centers at Mission Viejo and Laguna Beach anyway.
“It’s fine to go all the way over there,” Ward said over the phone Tuesday.
“If you’re breathing.”
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