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Emergency room legislation cited as reason for choice
By Jim Shilander
The board of MemorialCare announced Thursday that it is continuing the feasibility study about the future of its San Clemente campus to wait for legislation to progress in both houses of the state legislature that could allow the hospital to move forward with its plans while maintaining emergency services.
MemorialCare announced a feasibility study in August for a proposal to transform the current hospital facility, Saddleback Memorial Medical Center San Clemente Campus, into an outpatient medical pavilion that would result in the razing of the current facility with the current emergency room transformed into an urgent care facility as a new pavilion is being built. However, community groups and the San Clemente City Council voiced opposition to the proposal, as did councils in Dana Point, San Juan Capistrano and other neighboring cities.
San Juan’s city council passed a resolution opposing the hospital closure on Jan. 20; Dana Point’s council passed a similar resolution on March 3.
“When we began the feasibility study to transform the San Clemente campus, a freestanding emergency department was not a possibility. Since then, State Senator Patricia Bates and State Assemblyman William Brough have introduced legislation to allow for a freestanding emergency department in San Clemente,” a letter sent to hospital staff stated. “As a result, the Saddleback Memorial Board of Directors has agreed to continue the feasibility study to determine whether we can maintain emergency services as part of our proposal to transform the campus. We will continue to pursue and support legislative and regulatory opportunities that would allow us to maintain emergency services on the San Clemente campus. We will offer more information as it becomes available in the coming months.”
The letter acknowledges the difficulties the hospital says it faces moving forward.
“There is a growing demand for high quality, convenient and affordable outpatient centers, and less of a need for inpatient hospital beds. We face significant challenges operating our small hospital in San Clemente because of very low patient volumes, and these volumes continue to shrink. We also understand that the emergency services we offer are used and valued by the community.”
Hospital administrator Tony Struthers said there is currently no timeline for the end of the study.
Tuesday, Struthers, who is scheduled to make a presentation to the San Clemente City Council regarding the current status of the hospital on Tuesday, April 7, said the focus for the hospital is now on the legislative path.
“The board felt strongly that there were still too many unanswered questions,” Struthers said. “Especially as it related to the emergency department legislation. There’s not really any more information to make a final decision, so we’re going to continue the process that we’ve had ongoing since September. I think this is just part of the process. Nothing’s really changed.”
Struthers said the hospital is now looking to coordinate efforts at improving whatever chances the Bates/Brough legislation has to be successful. This could include partnering with other groups on lobbying efforts, or with the city itself.
“The people I’ve talked to in the community really feel strongly about that, maintaining emergency services,” Struthers said.
Struthers said any disruption to current services offered at the hospital would be “ill-advised” given the legislative push.
“We truly are looking at all options, and truthfully, this is an option that wasn’t available to us until February when this legislation was introduced. Now we want to support them where we can,” he said.
Brough said the bill has been referred to the Assembly’s Health Committee. In consultation with colleagues, Brough said he had been given the impression that it would be better to pursue a singular waiver for the San Clemente hospital as opposed to pursuing statewide legislation to allow for “stand-alone” emergency rooms, though such legislation is being proposed. Under current state law, an emergency room must be attached to an in-patient facility to operate.
Dr. Gus Gialamas, one of the leaders of the Save San Clemente Hospital nonprofit that led the opposition to the proposal, said he was pleased.
“We welcome the delay,” Gialamas said. “I applaud Steve Geidt (Saddleback’s chief executive officer) to have the wisdom to move his board toward exploring other options.”
Gialamas suggested one such proposal could be a smaller-footprint hospital facility proposed by his group. A cost analysis of the group’s proposal will be released soon, he said.
“This is the first step in the right direction,” Gialamas said.
Dr. Steve Cullen said he was pleased to have anything that helps to keep the hospital open moving forward, but said he still has concerns about the future of the facility.
“It seems pretty clear that MemorialCare is open to saving the emergency room but has given up on the (in-patient) hospital completely,” Cullen said. “The emergency room has always been our first priority and if we had to choose one or the other, we’d rather have the emergency room.”
Cullen said he is interested in putting together a committee of MemorialCare staff to determine ways of increasing the patient census of the in-patient hospital. MemorialCare has cited a declining census at the hospital as one of the reasons for the proposal to transform the hospital.
San Clemente’s city leaders said they welcome the additional time.
“It sounds like good news,” City Manager James Makshanoff said. “We’ll continue to work with them.”
Makshanoff said any potential lobbying efforts in Sacramento, which could be undertaken in partnership with other south county cities that expressed opposition to the hospital’s closure, would need to be brought before San Clemente’s City Council. Councilman Tim Brown, who has previously discussed potential partnerships, said he’d been asked about pursuing such an effort by residents.
The city has also explored potentially rezoning approximately 10 acres, currently zoned for open space along Avenida La Pata, to allow for a hospital. At a meeting last month, City Attorney Scott Smith said he did not believe the council would have to ask voters for approval of such a move, though councilmembers expressed confidence it would pass if it did go before voters.
Mayor Pro Tem Bob Baker said he welcomed the emphasis on continuing emergency services.
“I’m encouraged by this,” Baker said.
Mayor Chris Hamm said he has mixed feelings. He joined Baker in expressing pleasure with the company’s emphasis on emergency services, but said the board should have rejected the proposal outright, given the community’s negative reaction to it.