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Trying the legislative route to create a free-standing or satellite emergency room in San Clemente was unsuccessful for local advocates.
Hoping to get a bill past the first legs of the legislative hurdle, Assemblyman Bill Brough, San Clemente Mayor Bob Baker and Saddleback Memorial Medical Center administrator Tony Struthers spoke in favor to the Assembly’s Health Committee hearing Tuesday of a bill that would allow for a free-standing emergency room in San Clemente. Committee members voted down the bill 6-10.
On Wednesday, Senate Bill 787, Sen. Patricia Bate’s similar bill, was heard be that branch’s Health Committee. Similar arguments were repeated in the debate, and the committee did not reach a majority to pass the bill to the Senate floor—two aye votes, no nay votes, but seven abstained votes put an end to it.
Bates and Brough released a statement on Wednesday following the Senate Health Committee hearing.
“This says a lot more about a flawed process than anything else, and in no way reflects upon the City of San Clemente, Saddleback Memorial, or our residents, who made a compelling case for the need to take action now,” the release stated. “Fundamentally, we are deeply troubled by Sacramento’s failure to recognize the scope of the problem and support these enduring community health care needs. With the implementation of the Affordable Care Act and the rapidly changing health care industry, California must develop a comprehensive plan of response. If not, more hospitals will close and more Californians will go unserved. Our efforts will always be for our residents regardless of special interests and industry trends and we will continue to make this case. Our work has not ended with the committees’ votes on our bills.”
Opposing the bill were the California Nurses Association, Service Employees International Union-United Healthcare Workers West and the California Labor Federation.
The main concerns about the bill, specific to San Clemente’s needs, were that the freestanding emergency room would not offer adequate cardiac or stroke emergency services or on-site surgery and that there was not wording in the bill to protect patients from paying emergency room fees as opposed to urgent care fees. The opponents were also not satisfied with Saddleback’s response to questions regarding a sufficient blood bank on site.
“This affects the residents of San Clemente and carries over to San Juan Capistrano and Dana Point. That’s why this is so important,” Baker said. “The number that stood out to me is the increase in mortality. Those numbers are a 5 to 15 percent increase in mortality.”
Opponents said the Saddleback location would operate more as an urgent care facility.
Patients with certain medical issues currently administered to Saddleback are stabilized but then sent north to Mission Hospital or another facility better equipped to handle those kinds of needs, Struthers said.
CNA members also asserted that Saddleback’s claim that it cannot operate within its profit margins is false, citing the hospital has operated with a 9 percent positive revenue stream whereas many hospitals operate within a 2.6 percent positive revenue stream.
“Arguments of serving the underserved are overblown at best,” SEIU representative Michelle Cabrera said. “This is a nonprofit with profit margins that most hospitals would be envious of. The question we came up with is why is this needed? Why do the people of San Clemente feel they have no other choice but to do a stand-alone ER?”
Struthers said the hospital has an inpatient population in the teens and sometimes less than 10 at a time, making it not feasible for the hospital to operate efficiently.
Health Committee Chairman Rob Bonta of Oakland visited the site in September but said he could not support the bill as it stands.
“I sympathize and understand the potential loss,” Bonta said. “I had the same issue in the East Bay, and we kept it open under a much different circumstance. Maybe there’s another solution here. This is an issue throughout the state and is likely not going away.”
Committee Member Assemblyman Freddie Rodriguez said the Committee members want to continue to work with Brough and the rest of California to come up with a solution to the issues.
During the Senate hearing, points were made between committee members about the unique situation San Clemente finds itself, but it wasn’t enough to support the bill’s continuance at this time.
It’s possible that a pilot program could come to the area to explore the possibility of a free-standing hospital specific to San Clemente’s needs, but unless the law is tailored to allow it, Saddleback may end up closing the emergency room or altering it to an urgent care facility.