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The incredible pace of hospital emergency room closures quickened in California with the sixth announced shut down in a year of a hospital or its emergency room in California, underscoring the need for passage of Proposition 67—The Emergency Medical Services Initiative.

San Jose Medical Center in San Jose serves more than 96,000 patients in its ER annually and is one of three trauma centers in Santa Clara County. The closure of the hospital means increased waits in emergency rooms, slowed care and diversion of ambulance patients to other hospitals in the area.

The latest closure also underscores the increasing financial pressure on hospitals caused by unpaid care delivered in emergency rooms. The San Fernando Valley lost more than $1.7 million a year in ER operations in 2001-02.

Former San Jose Medical Center patients will be diverted to other hospitals, including the other two trauma centers—Santa Clara Valley Medical Center and Stanford Hospital. Diversion of patients often means delay of care. When this occurs during the critical “golden hour” after an accident or health care emergency—such as a stroke or heart attack—it can mean the difference between full recovery, and death or significant impairment, said Dr. Jack Lewin, CEO of the California Medical Association.

The closure was expected, perhaps in 2007, but the abrupt announcement caught some by surprise. Some pointed to a flood of losses at emergency rooms statewide. The red ink is expected to top $600 million this year.

“I don’t blame the hospital,” said Dr. James Hinsdale, M.D., hospital chief of staff. “The red ink was mounting and you can’t keep a hospital open without money.”

CMA officials predicted the losses would shift to the other hospitals in the county as ER patients looked for care elsewhere. The hospital lost more than $18 on every ER visit in 2001-2002, the most recent year for which state data is available.

“The disease that closed San Jose Medical Center is not cured, it will simply spread to other hospitals and endanger them,” said Dr. Jack Lewin, CEO of the California Medical Assn.

CMA is backing Proposition 67, The Emergency Medical Care Initiative, which would raise $600 million annually to fund lifesaving emergency medical care, trauma and emergency rooms, and community clinics in California.
The measure has the support of most healthcare groups in California. It is backed by a broad coalition of medical and emergency care providers, including the Santa Clara County Medical Assn., community clinics, emergency nurses, firefighters and medical staffs at hospitals.

“This initiative will provide critical funds to our beleaguered trauma care system, so that emergency rooms remain open to provide the lifesaving services all Californians need and expect,” said Dr. Lewin. “Lives could be lost if something isn’t done, plain and simple.”

More than 65 emergency rooms have closed statewide about a decade and more than two dozen in the last five years. In addition to funding for emergency rooms, trauma centers, and emergency doctors and specialists, the ballot measure would provide money for community clinics to pay for urgent and primary care services that reduce the flow of patients to overcrowded hospital emergency rooms. It would also provide support for the 911 emergency dispatch system.

The initiative would increase the 911 surcharge on phone bills from 0.72% to 3.72% on calls made within California. The surcharge would be capped at 50 cents per month for residential telephone customers. Senior citizens and others who are on basic lifeline rates would be exempt. The average cell phone bill of $35 would increase about $1. The Constitutional amendment would also provide for strict auditing and oversight of the funds.

The campaign for the measure is being supported the Coalition to Preserve Emergency Care (CPEC), comprised of the Emergency Nurses Association of California, California Professional Firefighters, California Chapter of the American College of Emergency Physicians (CalACEP), California Primary Care Association, and the California Medical Association.