By C. Jayden Smith
Whether a hospital would return to San Clemente has been a longstanding question. This past weekend, however, the two councilmembers who have been tasked with addressing that very query affirmed that such an endeavor was currently not an option.
“Financially, it’s just not possible at this point,” Mayor Pro Tem Chris Duncan said on Saturday, April 9, when the city hosted the first of two community roundtables concerning the future of health care in San Clemente.
“I don’t know if I can say that more clearly,” he continued. “The city would have to bear essentially all of the financial outlay—actually the residents (would), through a bond, and the residents would have to pay for the operation of the hospital.”
Mayor Gene James, Duncan’s fellow hospital subcommittee member, agreed.
With a low baseline of a $200 million bond to construct the hospital, plus the costs of zoning, securing property, and other hassles, let alone trying to operate in an outdated form of inpatient care, James said the prospects are not viable and felt it “would be a burden for our taxpayers.”
He added that he feared many would not be willing to give up their medical provider, and doctors with whom they have developed close ties, to switch to a new system at a new San Clemente hospital.
James and Duncan said they are hoping for legislation that would allow for emergency rooms to exist separate from a hospital, and want to be prepared to take advantage should such a measure become a reality.
During Saturday’s roundtable, conducted over Zoom, the two city officials were joined by leaders across several health-related industries in Southern California including Tammi McConnell, division manager of Orange County’s Emergency Medical Service system and Randy Black, assistant chief of Orange County Fire Authority’s Emergency Medical Services.
Also in the roundtable were Rob Capobianco, division chief of OCFA Operations Division 3, which serves San Clemente among other South County cities; Paul Young, senior vice president of Public Policy and Reimbursement at the Hospital Association of Southern California; and Tatyana Popkova, chief strategy officer of UC Irvine Health.
Included in the roundtable was a video presentation from the city that chronicled San Clemente’s recent history of health care, including the city’s interactions with MemorialCare, the former operator of the hospital at 654 Camino de Los Mares, and efforts to bring a hospital back.
It told of councilmembers meeting with health care providers and hospital systems that all believed their system couldn’t create a financially viable operational model. It also recalled the request for proposals (RFP) the city released in January 2020 to seek a contractor to partner with redeveloping the hospital site—an effort that didn’t receive any offers.
The video further discussed the results of the survey FM3 conducted in December 2021, which indicated that a majority of respondents favored creating a hospital and using taxpayer funds to build it.
MemorialCare had closed the San Clemente hospital in 2016 amid litigation with the city that stemmed from a dispute over whether to have an urgent care facility or one that provided an emergency room and other hospital functions.
The city and MemorialCare reached a settlement in June 2019. Since then, the hospital subcommittee has mended the previously adversarial relationship and engaged in two-way communication with the provider, according to James and Duncan.
The mayor pro tem said the subcommittee has moved on to try to set policy that responds to residents’ needs.
Multiple urgent care facilities have opened since the hospital’s closure in 2016, James said, and another is on the way, to be built at the Outlets at San Clemente with provider Providence.
“They’ve already received the grading permit and they’re moving forward with (what) I believe is a 7,500-square foot health care facility, to include urgent care,” the mayor said.
There are no plans for future emergency services, however.
Last month, MemorialCare filed an application with the city that proposes to turn the site of the shuttered hospital into a senior residential and health care community.
PARAMEDIC OPERATIONS
Along with responding to fires, OCFA is the city’s advance life support (ALS) and EMS-contracted provider, which has its challenges in getting services down to the southernmost town in the county, division chief Rob Capobianco noted.
With those difficulties intact, the agency always works to be proactive and the recent additions of paramedic staff in San Clemente have helped maintain the quality of service as well.
“Our emergency command center up in Irvine is constantly evaluating the coverage and we’re moving resources down to the city so that we can continue to run those back-to-back calls,” Capobianco said. “I can tell you from my years of watching the calls in San Clemente, it is not unheard of for San Clemente to have two, three, or even four calls going at the same time.”
In addition to OCFA functioning properly, it needs complementary hospital systems that are present and ready to receive patients, Tammi McConnell added. The spacing of specialty centers across the county and hospitals’ investment in staff training ensures they meet the “appropriate standards of care” McConnell’s team requires.
While patients are taken to both Providence Mission Hospital Laguna Beach and Mission Viejo, the Mission Viejo campus receives the majority of the 3,000 annual transports the county EMS provides. Another 25% go to Laguna Beach, while others are taken to various hospitals around the county.
Despite the impact of the hospital’s closure and the COVID-19 pandemic, Capobianco said response times have remained mostly the same over time because of OCFA’s efforts to maintain proper staffing levels and the addition of paramedic units.
The average time from when calls are entered by dispatchers to when the first vehicle arrives to a scene is six minutes and 55 seconds.
“(Staffing) does have a financial impact to it, but it also has an impact on our people, which we think is so important,” Capobianco said. “Our force hiring during COVID was extreme but that’s the only way we can hold those response times.”
Going forward, there will not be such a significant emphasis on response times, according to McConnell.
It is hard to get out of the mindset that each transport needs to be treated with the utmost urgency as a member of the public and especially as a parent, but that is how the industry is progressing.
“What we find in the actual clinical data (is) there are very few medical emergencies that actually require, you know, a very quick lights and sirens response and transport to the hospital,” McConnell said.
Patients are receiving care within half an hour of calling for ambulance to transport them, which is up to par with paramedic standards, and EMS services don’t want to risk harming others when rushing to arrive to a case.
Popkova added that with technology, in which patients have wearable devices that can be detected, medical data or with the adoption of digital care methods such as telehealth, resources will be better utilized.
FUTURE OF HEALTH CARE
Referring to James’ opinion about the decline of the inpatient model of care, Young concurred and cited a drop in San Clemente residents utilizing inpatient services from 2016 to 2019.
He added that federal and state entities such as the influential Center for Medicare and Medicaid Services are pushing towards an outpatient environment, as it is cheaper for governments to pay for outpatient surgery at a “third to a quarter of the cost” of inpatient stays.
Hospitals spend the majority of their budgets on salary, basic services and compliance costs in operating a 24/7 facility with an emergency room.
“It’s a tough run,” Young said. “I would say 40% of our hospitals, unfortunately, are in the red (in) any given year. Hospitals are not profitable across the board.”
Adding onto Young’s sentiment, Popkova said hospital systems are trying to determine how to deliver digital care, handing off patients with other facilities, and collaborate with public and private organizations because of the expense of inpatient environments.
Though the Affordable Care Act created the CMS Innovation Center, which came up with new ideas such as the Acute Hospital Care at Home program born out of the pandemic, the federal authorities’ regulation of the industry only allows for spurts of creativity.
Around the time of the ACA’s passage, health care providers believed the answer to any community’s health care needs was building a hospital regardless of its size or amount of beds, according to Popkova.
Now, they ask questions concerning how to best deliver care and how modern technology can cater to communities.
Areas across the country require different models of care, as there are fewer beds per capita in the West region than in the South, and even in California, not all of the beds present in hospitals are currently being occupied. This forces entities to be creative in a rapidly changing industry.
“I’d like to think that California is very, very innovative in the sense of trying to figure out (solutions) because we have things like the UC system, right?” Young added. “We’re looking at trying to develop more outpatient-based care. You look at the fact that health care already consumes almost 20% of our national GDP, I don’t think we want to consume more.”
Beyond San Clemente, there is an increasingly smaller need for general acute care hospitals, and systems are recognizing the need for acute psychiatric hospitals and behavioral health care.
Throughout the industry, more are focusing on what the right kind of health care delivery is necessary, and San Clemente appears to be one of numerous communities trying to find the best path.
The next opportunity for residents to take part in health care discussions will occur on April 23 at 10 a.m. The city will hold an in-person Community Roundtable at the San Clemente Community Center, where the public can speak with local leaders on what steps to take next.
Visit san-clemente.org for more details.
C. Jayden Smith graduated from Dana Hills High in 2018 before pursuing a Bachelor’s degree in digital and broadcast journalism from the University of North Texas. After graduating in December 2020, he reported for the Salina Journal in Salina, Kansas. Jayden loves college football and bothering his black lab named Shadow.
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