By Eric Heinz
Officials of Saddleback Memorial Medical Center in San Clemente, the city’s only inpatient emergency services provider and Dana Point’s nearest hospital, maintain their stance that the emergency facilities are not financially feasible to maintain.
The hospital has made an effort to change the legislative requirements for freestanding emergency rooms within the city of San Clemente, but two bills that would have done so were shut down in respective California Senate and Assembly committees.
Freestanding emergency rooms, in theory, would be able to provide emergency services with a limited number of inpatient beds and not as many services as typical inpatient facilities.
“We had been focusing our efforts for the past 18 months on the new vision for an ambulatory campus of the future and getting the Satellite Emergency Department legislation passed,” Tony Struthers, Saddleback Memorial Medical Center administrator said in an email. “Now that the city has severely limited our ability to continue to operate the facility in a manner that reasonably addresses changes in the market and direction of healthcare, we must consider all possible options.
“When we acquired the campus in 2005, we were concerned with the impact of the trend in healthcare away from inpatient hospitalization and substantially moving towards outpatient services—and the fact that multiple previous owners had major challenges in operating the facility, and had downsized the property and services,” Struthers added.
Struthers and Saddleback Memorial Medical Center staff met with the San Clemente Times last week to discuss some of the issues that have surrounded the hospital’s emergency room.
“Things are evolving, and it’s not just beds but also the eight essential services we have to provide,” Struthers said. These services include an adequate blood bank, nursing services, a lab and others. “The same thing that hurts us with the freestanding hospitals hurts us with the (smaller) hospitals; you still have to have all those services.”
Because of the advances in the medical care facilities that are independent of large hospitals, more outpatient services have driven the inpatient services down, which, Struthers said, “is a good thing,” but because people aren’t paying the price of admission to a hospital bed, it drives the revenue down and makes it less or not sustainable.
San Clemente Hospital officials said they provide an average of one inpatient or outpatient surgery a day, and sometimes their inpatient census is as low as six people.
“The more surgeries you do, the more proficient you become, and that’s why we have regional centers of excellence for cardiac (issues) or strokes,” Struthers said.
For many health care organizations, Struthers said, the rate for this is accelerating.
“At some level you have to generate enough to keep the facility updated,” Struthers said. “But it’s not specifically a money issue.”
The hospital is licensed to have 76 inpatient beds but at one point hosted as many as 104.
“With such few outpatient services and a small inpatient census, we would say it’s economically not viable,” Brennan James, the hospital network’s vice president of administration, said.
Struthers said the Orange County Emergency Medical Services programs have designated systems because demonstration of competency is essential in order to be designated by the EMS providers.
“We never have provided the level of service to be a cardiac receiving center or a stroke receiving center,” Struthers said.
San Clemente Hospital officials said there are very few services that can provide all three.
Struthers said the money the hospital brings in is one aspect, but not being able to provide the required services is the other half.
At its bare minimum, San Clemente Hospital officials said they have already reduced their staff to as few staff members as possible.
“We have shrunk the overhead at this facility a lot,” Struthers said. “We’re required to staff a certain number and we can’t go below those standards. That overhead was taken away a long time ago.”
Brennan James, vice president of Saddleback Memorial Medical Center administration strategy, said there has not been a lawsuit filed against the city of San Clemente at this time.
“It is our intent to pursue our rights as property owners,” Struthers said. “I don’t know what that may end up being, but we feel very strongly that we need to pursue our rights.”
James said the administration works for both the Laguna Hills and the San Clemente facilities, but the number of nurses, doctors and surgeons must be staffed at a mandated minimum.
Officials also said this will have a direct effect on the property value of the hospital.
Although the hospital is zoned now to provide emergency services, that doesn’t mean the hospital or its emergency room will stay open, as Saddleback is a private nonprofit.
When asked when a decision will come regarding Saddleback Memorial Medical Center’s future intentions, officials said a decision will come “soon.”
Effects of the Closure
It would take about 10 to 15 minutes on average for an ambulance to get to Mission Hospital or Saddleback Memorial Laguna Hills, the nearest emergency facilities, from any point in San Clemente, and that’s if the traffic is not jammed on Interstate 5.
Additionally, the statistics that have been mentioned at many past City Council meetings and community forums insist the mortality rate of an area that loses an emergency room rises 5 to 15 percent.
The final decision on the hospital depends on many factors, but the idea of losing a facility that has served San Clemente for decades does not sit well with many locals.
A study had been proposed by legislators during the committee meetings, but because the bills didn’t pass, there may not even be enough time before Saddleback makes a decision on when to shutter its emergency services.
“There is that option to us in the next couple years, but we would have to wait until 2017 to have another bill introduced,” Struthers said.
At one point, the hospital was entertaining the possibility of opening a $40 million refurbishing of its location and turning it into a large urgent care facility, but Struthers said even that would not be economically feasible.
This proposed option was an outpatient facility instead of an inpatient facility. The price tag also could have changed during the initial phases.
“Because it is a wing of Saddleback Memorial’s large regional facility in Laguna Hills and operated under a consolidated license, we do not create separate financial statements for the San Clemente campus,” Struthers said in the email. “Among the significant benefits of this consolidated approach, we have been able to reduce some of the costs of operating the facility. However, we have been analyzing the economic viability of the San Clemente operations, and this analysis suggests that the San Clemente campus operates at an estimated annual loss of $2 million to $3 million.”
[box] More Information
More information can be found at www.memorialcare.org/saddleback-memorial-san-clemente. Although the hospital foundation, Saddleback Memorial Foundation, does not separate the finances between its two entities in San Clemente and Laguna Hills on its tax forms, the nonprofit forms for the foundation can be found at www.chartiynavigator.org under the IRS 990 forms.[/box]