Monday, May 09, 2005 | I am deeply concerned about the proposal by the University of California, San Diego to close its Hillcrest hospital in order to expand hospital services in La Jolla at the East Campus, also known as UCSD Thornton Hospital. UCSD has characterized its plan as a “New Vision for Healthcare,” but the plan does not address the needs of those who live, work and care about the future of the communities south of Interstate 8.

San Diego County’s current health care system is extremely fragile. As we’ve seen in recent years, the loss of even small hospitals such as Mission Bay have had ripple effects on the remaining health care providers with longer emergency room wait times, emergency rooms often in diversion, and hospital beds full across the county.

Make no mistake; UCSD is announcing the closure of a hospital, the largest hospital closure planned in our community. And it is a closure in an area of the county already underserved by full service hospitals. The downstream effects will be many and they will be dramatic.

UCSD has prepared carefully for this announcement, but has not considered several important factors:

UCSD officials have said that health care is moving more and more to outpatient services and there is no longer as much demand for in-patient hospital beds. If that were true, then why build new in-patient beds at Thornton? The fact is, there are not enough in-patient beds in Central and South San Diego today to meet current needs and we expect the population of those areas to continue to grow as downtown neighborhoods, Eastlake and Mission Valley continue to add new housing. The loss of nearly 400 hospital beds will exacerbate an already serious problem of access to care for the communities south of Interstate 8.

The University also claims that it wants to continue to serve the communities south of Interstate 8 and that patients currently using UCSD Hillcrest will not mind traveling 12 additional miles for hospital care at Thornton. As physicians who currently treat this population can tell you, it is unrealistic and illogical to expect patients, particularly the poor who often have transportation challenges, to travel to La Jolla for hospital care. These patients will undoubtedly choose other hospitals, closer to their homes and families, which do not have the capacity to handle them. If UCSD were truly committed to the underserved it would not move out of a community centrally located to serve that population for an affluent community 12 miles away with limited public transportation options. How will the homeless, AIDS patients and those who rely on public transportation access Thornton? They won’t.

Part of the university’s plan calls for a stand-alone emergency room, something currently not permitted under state law but for which plans are being considered as a stop-gap measure in Los Angeles County. Although UCSD officials have touted the existence of other such facilities in other parts of the country, San Diegans should bear in mind that these types of emergency rooms are considered when there are no other options for health care services. In Los Angeles, after several hospital closures in poverty-stricken communities, a stand-alone ER may be the only option to keep some services in these communities. In other areas, it’s a means of providing an ER to a rural community. It’s a desperation measure. This is not the situation in Hillcrest and we believe that this standard of healthcare is unacceptable to those living in the city of San Diego.

As one of two Level 1 trauma centers in the county, this plan includes the relocation of that center to La Jolla – a relocation that can only be authorized by the San Diego County Board of Supervisors. San Diego County’s trauma system is an international model and has worked well for 20 years. Moving a county-designated trauma center raises many questions that must be answered, but one thing is certain: It would leave Scripps Mercy as the only trauma center south of Interstate 8 – an area that accounts for 40 percent of the county’s trauma patients.

UCSD’s proposal is made all the more distressing when one considers that its hospitals are government-supported and benefit tremendously from tax dollars. The land it plans to develop was purchased with tax dollars. The subsidies received from the county to care for the poor for the past two decades were community tax dollars. The passage last November of Proposition 61, while billed as the Children’s Health initiative, will actually give UCSD $20 million.

Although UCSD claims their plans are 15 to 20 years away, a plan like this must start now in order to be completed by then. In the meantime, the remaining hospitals in South Bay and Central San Diego will struggle to determine whether they can expand to serve the patients UCSD is abandoning. That will be difficult. All three South Bay hospitals – Paradise Valley, Scripps Mercy Chula Vista and Sharp Chula Vista – are losing money.

Before this plan is allowed to go forward, we hope the community will demand close scrutiny of each element of UCSD’s proposal; that our county supervisors will not approve the relocation of the trauma center or a redrawing of the trauma service map without extensive study and public input; that our local state assembly and senate representatives will find a way to prevent a stand-alone ER from coming to San Diego County; and that all concerned about the future of health care in San Diego will speak up.

Midge Costanza is president of the Midge Costanza Institute for the Study of Politics and Public Policy.

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