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HomeMy WebLinkAboutMINUTES - 01112000 - D2 TO: BOARD OF SUPERVISORS • FROM: William B.Walker,M.D.,Health Services Director i Contra Costa DATE: January 11,2000 County SUBJECT: Impact Evaluation of the Realignmentof Hospital Emergency Services at Doctors Medical Center,Pinole Campus SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: 1. Approve the Impact Evaluation Policy as revised to include recommendations made by the Board on December 7, 1999. 2: Accept the Preliminary Impact Evaluation Report by the Emergency Medical Services Agency in response to the proposed closure of emergency services by Doctors Medical Center Pinole. FISCAL IMPACT: This recommendation has no fiscal impact. BACKGROUND: On December 7, 1999, your Board approved, with revisions, the Impact Evaluation Policy prepared by the Emergency Medical Services Agency pursuant to California Health and Safety Code Section 1300,and designated the EMS Agency to conduct an Impact Evaluation on the proposed closure of emergency services at Doctors Hospital Medical Center Pinole. The EMS Agency has conducted the required notifications and consultations and has conducted two public hearings held December lb, 1999, and January 5, 2000, respectively. The Preliminary Impact Evaluation Report has beeri prepared by EMS staff based upon information routinely collected by EMS and information provided for this report by Doctors Medical Center, the City of Pinole, American Medical Response,County Counsel, other agencies and organizations,and public comment. Copies of the Preliminary Impact Evaluation Report were distributed to the public at the January 5fl'public hearing. In compliance with Health and Welfare Code Section 1300,a final Impact Evaluation Report will be completed by the EMS Agency by January 15t` and sent to the State Department of Health Services for action on the Doctors Medical Center request to close emergency services at its Pinole campus. CONTINUED ON ATTACHMENT: NO SIGNATURE RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON January 11, 2000 — _ APPROVED A'SREGO MENDED SEE ADDENDt7M FOR BOARD ACTION VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT„4Lgf tic”- ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERV ORS ON THE DATE SHOWN. Contact:Emergency Medical Services 646-4690 CC: County Administrator ATTESTED Ze�__61elanz County Counsel FW SATCHELOR, K O THE BOARD OF Auditor-Controller PERVISORS AN COUNTY ADMINISTRATOR Emergency Medical Services BY 10� y- �7EPUTY �l ADDENDUM D.2 January 11, 2000 On this date,the Board of Supervisors considered the revised Hospital Closure Impact Evaluation Policy and the Preliminary Impact Evaluation Report on the closure of emergency services by Doctors Medical Center, Pinole Campus. The Chair invited the public to comment. The following persons presented testimony: Peter Murray, 2100 Whippoorwill Court, Pinole, Maria Alegria, City of Pinole Councilmember; Betty Boyle, 2534 Doidge Avenue, Pinole; Kay McVay, California Nurses Association, 3644 Ranchford Court, Concord; John Dalrymple, Labor Council, 1333 Pine Street, Martinez; William F. Butte, 1419 Brett Court; Julie Reisetter, Contra Costa County Emergency Medical Care Committee, 161 Ygnacio Valley Road; Wanda Huss,Bay Park Retirement, 2621 Appian Way, Pinole; Nancy McCoy,232 Dryden,Vallejo; Ann Snyder, 280 Calais Drive, Contra Costa Interfaith Sponsorign Committee,Pinole; Michele Villegas, 1080 Bayview Farm Road, Pinole; Shirley McNair, 1236 Marionola Way, Pinole; Lorene Scalora, 406 Live Oak Lane,Pinole. Following further discussion,the Board took the following actions: I. APPROVED the Impact Evaluation Policy as revised on December 7, 1999; 2. ACCEPTED the Preliminary Impact Evaluation report by the Emergency Medical Services (EMS)Agency in response to the proposed closure of emergency services by Doctors Medical Center Pinole; 3. AUTHORIZED the Chair of the Board to sign a cover letter to accompany the submission of the Impact Evaluation Policy and the Impact Evaluation Report to the California Department of Health Services (DHS), recommending denial of a closure permit for a proposed closure of emergency services at Doctors Medical Center,Pinole campus, and indicating that should closure occur, DHS should require the mitigations in the report and incorporate as an addendum the comments on issues raised by the Board today. (AYES: I,II, III, V and V; NOES: None; ABSENT: None; ABSTAIN: None) Contra Costa Health Services Emergency Medical Services Agency Preliminary Impact Evaluation Report on the Doctors Medical Center, Pinole Campus Proposed Emergency Department Closure January 5s 2000 Table of Contents I. Purpose of Impact Evaluation.............................:..................................................................1 II. Scope of Impact Evaluation...................................................................................................1 III. Impact Evaluation Process.....................................................................................................2 IV. Summary of Findings.............................................................................................................2 V. Recommendations..................................................................................................................6 VI. Background Information........................................................................................................9 A. Doctors Medical Center..................................................................................................9 B. The Community ............................................................................................................10 C. Hospitals and Hospital Emergency Services.................................................................10 D. Impact of Closure on Hospital Emergency Services.....................................................I 1 E. Specialty Services .........................................................................................................12 F. Trauma Services,....................................................................................... ...................13 C. Base Hospital Services..................................................................................................13 H. Disaster and Seismic Issues ..........................................................................................14 I. Prehospital Emergency Medical Services.....................................................................14 J. Ambulance Transport Times.........................................................................................15 K. Notification to the Public..............................................................................................16 L. Legal Liability Resulting from Closure........................................................................16 Appendices A. Doctors Medical Center -Notice of Intent to Close - Request to Submit Information to County - Response to Request B. EMS Notices i �1 C. Location of Hospital Emergency Services D. Report from City of Pinole E. EMS Data F. Comments from impacted Agencies C. Comments from the Public H. Contra Costa Impact Evaluation Policy ii Impact Evaluation Deport on the Doctors Medical Center, Pinole Campus Proposed Emergency Department Closure I. Purpose of Impact Evaluation On November 16, 1999, the Contra Costa Emergency Medical Services Agency received notification from Doctors Medical Center of a realignment of hospital services between the Pinole and San Pablo Campuses effective March 2000. (See Appendix A.) This proposed realignment is to include the closure of acute medical care and intensive care units at the Pinole Campus and replacement of the Pinole Emergency Department with an Urgent Care Center. The Pinole Campus is to retain outpatient surgery services, transitional care, long term care, substance abuse, sleep lab, and cardiac rehabilitation. The purpose of this report is to assess the impact of the Emergency Department closure upon the community, including the impact on access to emergency care and the impact on emergency services provided by other entities such as ambulance, police, fire, and other area hospitals. The impact evaluation report will be submitted to State Department of Health Services in accordance with provisions of Health and Safety Code Section 1300. Authority to approve the suspension or cancellation of a special permit for emergency services rests with the State Department of Health Services. II. Scope of Impact Evaluation The scope of the impact evaluation is set forth in the County's impact evaluation policy, a copy of which is contained in Appendix B. The impact evaluation will consider: (1) Impact of the closure on current and projected population of Doctors Medical Center Pinole service area, including access to emergency services and related specialty services. (2) Impact of the closure on prehospital emergency service agencies (ambulance, fire), hospitals, and other health care providers. (3) Impact of the closure on community disaster resources. (4) Steps taken by Doctors Medical Center to notify the public, prehospital emergency service agencies, health plans and health plan members and steps taken by Doctors to accommodate members of the public potentially affected by the closure. (5) Potential liability resulting from the closure. (5) Public comment. 111. Impact Evaluation Process The impact evaluation process is set forth in Section 1300 of the California Health and Safety Code and in the County's Impact Evaluation Policy adopted pursuant to the Health and Safety Code. The impact evaluation provisions were added to the Health and Safety Code by the passage of AB 2103 (Gallegos) which signed into law in September 1998. The Gallegos bill sets requirements for notification by the hospital and for the conduct of an impact evaluation study. Notification requirements include notification to the State Department of Health Services, to the local government agency in charge of health services, to health plans under contract with the hospital, and to the public as soon as possible, but not later than 90 days prior to the planned elimination or reduction of services. Public notice must be provided in a manner likely to reach a significant number of the residents of the community services by the hospital whose emergency services are being closed or downgraded. The bill requires that the county conduct an impact evaluation in accordance with a county-adopted impact evaluation policy to determine the impact of the closure or reduction of emergency services upon the community, including access to emergency care and the affect on emergency services provided by other entities. The impact evaluation report must include at least one public hearing and must be completed within 60 days of notification. The county impact evaluation report must be submitted to the State Department of Health Services for consideration before it approves a closure or reduction in emergency services for that facility. The impact evaluation process for the Doctors Medical Center Pinole closure is being conducted by the Contra Costa Health Services Emergency Medical Services Agency. Based upon the November 16, 1999 notification by Doctors Medical Center, the report must be completed by January 15, 2000 and submitted within three days to the State Department of Health Services. In accordance with Contra Costa's impact evaluation policy, the evaluation includes two public hearings held December 16, 1999 and January 5, 2000, both from 7:00 to 9:00 p.m. at the Pinole City Hall. Notification of closure and an invitation to submit information was sent to all Contra Costa cities, emergency service agencies and hospitals, to the Alameda- Contra Costa Medical Association, to the Hospital Council of Central and Northern California, Pinole area health care facilities, and to other interested organizations and individuals. All these organizations were invited to participate in the public hearings and/or to submit written information relevant to the proposed closure of Doctors Medical Center emergency services. Data for use in the impact evaluation was also obtained from Doctors Medical Center, from other affected agencies, and from Contra Costa EMS records. This Preliminary Impact Evaluation Report was prepared by EMS staff for review at the January 5th public hearing and for submission to the Contra Costa Board of Supervisors on January 11, 2000. A final Impact Evaluation Report will be prepared fallowing the public hearing and Board of Supervisors review and transmitted to the State Department of Health Services to meet the January 15`h deadline. IV. Summary of Findings 1. Doctors Medical Center, in a realignment of services between it San Pablo and Pinole campuses, has announced plans to close its Pinole emergency department and to discontinue acute and intensive care services at its Pinole campus effective March 1, 2000. 2 2. Doctors Medical Center Pinole is one of three hospitals (Doctors Pinole, Doctors San Pablo, and Kaiser Richmond) serving the communities of western Contra Costa County. Western Contra Costa County is an area of over a quarter million residents living in the cities of El Cerrito, Hercules, Pinole, Richmond, and San Pablo and in the unincorporated communities of El Sobrante, Crockett, Kensington, North Richmond, Port Costa, and Rodeo. Doctors Pinole lies in the northern portion of this area, Doctors San Pablo is located a little over four miles to the south, and Kaiser Richmond is about three miles further south. The area is geographically isolated from the rest of Contra Costa County by a range of low lying mountains and from other Bay area communities to the west and north by the northern extension of the San Francisco Bay and by the Sacramento River. The principle traffic corridor through western Contra Costa County is the heavily congested Interstate-80 connecting to the San Francisco Bay Bridge. 3. Doctors Medical Center Pinole is currently the principal hospital emergency medical resource serving the communities of Pinole, Hercules, El Sobrante, Rodeo, Crockett, Port Costa in the northwestern region of Contra Costa County. The next nearest hospital emergency services are located at Doctors Medical Center San Pablo (located 4.2 miles from the Pinole campus to the south), at Sutter Medical Center in Solano County (located 12.9 miles to the north), or at Contra Costa Regional Medical Center (12.8 miles to the east). Kaiser Foundation Medical Center Richmond (7.0 miles to the south) currently provides "standby emergency services," but plans to upgrade to full "basic emergency services" in March 2000. 4. The discontinuation of emergency services at Doctors Medical Center Pinole will have impacts on the residents of Pinole, Hercules, and Rodeo and, to a lesser extent upon the residents of El Sobrante, Crockett, and Port Costa. These impacts will include. a. Longer travel times to reach hospital emergency services. b. Possible delays in obtaining prehospital emergency medical services as a result of longer out-of-service times for prehospital EMS personnel engaged in patient transports to more distant hospitals. c. Potential increased demands for emergency services resulting from migration of "private transports" to "9-1-1 transports" where patients are unfamiliar with routes to more distant hospitals or are uncomfortable with the longer transport times by private automobile. d. Increased overtime costs for fire personnel (or decreased fire protection) when fire personnel accompany critical patients transported by ambulance to more distant hospitals. e. Risk of patients in need of emergency medical care being transported in error to Doctors Medical Center Pinole after closure of emergency services. This may occur due to patient's/family's failure to know that emergency services have been discontinued or failure to distinguish between medical conditions requiring "urgent care" services and those requiring "emergency care" services. f. Loss of immediately available emergency services for long term care patients continuing to be treated at Doctors Medical Center Pinole. 3 3 1,5 g. Loss of nearby hospital emergency services at convalescent and assisted living facilities located near Doctors Medical Center Pinole. h. Potential direct and indirect economic impact to the communities' including loss of economic base and loss of an important amenity attracting residential and business development. i. Loss of community resource for disaster response. 5. The total number of emergency treatment stations in the west county region has increased from 34 in 1997 to 43 in 1999. The increase resulted from the addition of 13 emergency stations at Doctors San Pablo. The closure of Doctors Pinole would bring this number back down to 35 emergency treatment stations. 6. Hospital emergency visits to the region's three hospitals currently run about 72,000 visits per year. These visits are accommodated with 43 emergency treatment stations — 8 at Doctors Pinole, 24 at Doctors San Pablo, and 15 at Kaiser Richmond. To meet the American College of Emergency Physicians (ACED) standard of one treatment station per 2,000 annual visits 36 treatment stations are required. This standard is currently exceeded by seven treatment stations, but the number of treatment stations would fall one short of the standard if Doctors Pinole were closed and all emergency visits were absorbed by the two remaining west county hospitals. Should as many as 70 percent (9,825 patient visits annually) of the patient volume at Doctors Pinole be accommodated at the new urgent care center as forecast by Doctors or be accommodated at other hospitals outside west county, the number of emergency treatment stations required to meet ACED standards would drop to 31, leaving the region exceeding the ACED standard by four emergency treatment stations. 7. Doctors Medical Center San Pablo is the hospital whose emergency services are likely to be most impacted by the closure of the Pinole emergency services. Recent expansion of the emergency department at San Pablo should provide it with sufficient physical capacity to handle the added patient volume from Pinole. Added ambulance traffic, however, will tax the capacity of the existing ambulance docking area and may result in delays in ambulance "turn around time." 8. Although requested data on patient waiting time at the Pinole and San Pablo emergency departments was not made available by Doctors Medical Center, it is likely that patients with non-life-threatening illness will experience longer waiting time at the San Pablo campus than at Pinole. 9. Other hospital emergency departments which may have some impact include Sutter Solano in Vallejo and Contra Costa Regional in Martinez. Sutter Solano would become the closest emergency services to the community of Crockett and Contra Costa Regional would become the closest to Port Costa. These communities account for 3.6 percent (76) and 0.4 percent (9), respectively, of patients transported by emergency ambulance (Code 2 and Code 3)to Doctors Pinole. 10. The recently completed East.Bay Flospital Capacity Study prepared by the Lewin Group for the Hospital Council of Northern and Central California projects an excess supply of emergency treatment stations for Contra Costa County through 2003. 4 t b. Open an additional 14 intensive care beds by 2001 at the San Pablo campus raising the intensive care capacity of that facility to 44 beds. c. Maintain the 14 intensive care beds currently licensed at the Pinole campus in suspense and in a state of readiness with respect to equipment and drugs to be reopened on one to four weeks' notice in the event of need. This capacity would be maintained for one year or until the opening of the additional 14 intensive care beds at the San Pablo campus. d. Commit to conducting a comprehensive communication program to the community and affected health care providers. V. Recommendations The following recommendations are made to mitigate of the impacts which might otherwise result from the closure of emergency services at Doctors Medical Center Pinole, A. Doctors Medical Center 1. A firm commitment should be made by Tenet Healthcare Corporation to maintain hospital emergency services in west county and to undertake those structural improvements to the San Pablo facility which will be required to meet the state's seismic requirements for 2008. 2. An extensive public information campaign to inform the community of the closure of emergency services must be undertaken to avert the inappropriate transport to Doctors Pinole of patients in need of emergency services. In additions to informing the public of the closure of emergency services, this campaign should inform the public in the appropriate use of urgent care services, when emergency services should be obtained, where the nearest emergency services are located, and how to access emergency services through the 9-1-1 system. Special efforts should be made to bring this message to non-English speaking residents of the area. 3. In addition to the general public information campaign, a special outreach program should be directed at residents of assisted living facilities in the Pinole area who relic on Doctors Pinole for their emergency care. 4. Closure of the Pinole emergency services should be conditioned on Doctors Medical Center committing to operating an urgent care center on a 7-day/week basis at the Pinole campus as proposed. 5. Doctors Medical Center should agree to maintain indefinitely the capability of reopening the emergency services at Pinole in the event of a disaster and should explore the possibility of establishing an approved helipad or emergency helicopter landing area at the Pinole facility. 6 11. Major construction projects planned by California Department of Transportation (CalTrans) for the next five years include two projects for west Contra Costa County. These are construction of a new Carquinez Bridge for northbound I-80 and addition of a high occupancy vehicle lane for northbound 1-80 from the Highway 4 area to the Carquinez Bridge. These projects are planned to take place with no reduction in the number of traffic lanes during peak hours. 12. Population projections recently released by the Association of Bay Area Governments show that the west county population is expected to grow by some 15,000 (6.9 percent) over the next 10 years. While the largest numerical increase is projected for Richmond (8,400), the community with the fast rate of projected growth is Hercules (21.1 percent). 13. West Contra Costa County is traversed by the northern extension of the Hayward fault, reportedly one of the most dangerous earthquake faults in California. Currently, only the recently constructed Kaiser Permanente Medical Center in Richmond meets seismic code requirements for 2008. Both the Doctors Pinole and San Pablo facilities have been evaluated by architectural and engineering firms retained by Doctors Medical Center and both facilities have been determined to be capable of upgrading to meet the 2008 standard. Plans for correction are not required to be filed by the facilities until 2001. Doctors Medical Center has committed to the EMS Agency that it intends to file the required correction plan by 2001 and complete the required upgrades by 2008. 14. A major concern of the community is not just the loss of emergency services at Doctors Medical Center Pinole, but the potential loss of emergency services at both Doctors Pinole and Doctors San Pablo. Doctors San Pablo is operated by Tenet Healthcare under a 30-year lease with the West Contra Costa Hospital District. That lease provides an escape clause for Tenet Healthcare if Doctors San Pablo cannot be operated at a profit. Should factors such as the required seismic upgrade render the continued operation of Sutter San Pablo unprofitable, closure of this facility would leave western Contra Costa County with a single hospital emergency service at Kaiser Richmond. 15. Since Contra Costa County's contract with American Medical Response (AMR) to provide emergency ambulance service requires a 10 minute response, overall emergency ambulance response times and the cost to the County will not be affected under the term of the current contract. However, longer "times-on-task" for ambulances responding to the northwest county area will increase to cost of providing ambulance services. While these increased costs may be absorbed by AMR. in the short run, they will eventually be passed on to the consumer in the form of increased cost or decreased service. 16. In an effort to mitigate the effects of closure of emergency, acute, and intensive care services at its Pinole campus, Doctors Medical Center has stated its intention to undertake the following: a. Establish a permanent urgent care center at the Pinole campus operating on a 60-hour /week basis. The emergency competency level of physician and nurse staffing at the urgent care center will be on a par with the Doctors San Pablo emergency department, and personnel will rotate between the two facilities to assure maintenance of emergency service proficiency. 5 t 6. Doctors Medical Center should provide a written plan for handling various types of emergency patients inappropriately brought to the Pinole campus either when the urgent care center is opened or closed. The plan should address: a. Emergency facilities and equipment to be maintained at the Pinole campus; b Qualification of physician and nursing staff at the urgent care center; c. Stationing of an ambulance at the Pinole facility for the initial 30-days following closure; and d. Procedures for treating and/or transferring patients requiring emergency care, including plans for sending hospital staff with patient when appropriate. 7. Doctors Medical Center should reopen intensive care beds closed as a result of the December 27`h fire in the San Pablo burn unit prior to closure of emergency or acute care services at Pinole. 8. Doctors Medical Center should commit to maintaining the ICU beds placed in suspense at the Pinole facility is a state of readiness for rapid reopening if needed until the additional ICU beds planned for the San Pablo campus are available in 2001. 9. Doctors Medical Center should work with American Medical Response and other emergency agencies to assure that an adequate flow pattern is maintained for ambulance traffic arriving and leaving the San Pablo facility. If necessary, the existing ambulance dock should be expanded. 10. Doctors Medical Center should take whatever steps are necessary to assure that ambulance crews can be rapidly returned to service. B. American Medical Response 1. American Medical Response should develop an ambulance deployment plan that will assure continued coverage of the Pinole/Hercules/Rodeo/Crockett area at the existing response levels. 2. American Medical Response should monitor crew turnaround times at Doctors San Pablo and be prepared to bring any problems immediately to the attention of Doctors Medical Center. 3. American Medical Response should monitor west county response times on a community by community level, and react quickly to correct any deterioration of times. C. Fire Services 1. Fire services should consider upgrading their EMS services to provide paramedic level first response. 2. Fire services should work together and with AMR and Doctors Medical Center to explore procedures to assure prompt return of firefighters to their units. 7 D. Emergency Medical Services 1. EMS should monitor ambulance response times in west county communities. 2. EMS should monitor hospital status in west county for emergency department diversions and census alert levels. E. California Department of Health Services 1. DHS should determine that Doctors Medical Center is in compliance with the recommendations or this report prior to authorizing the closure of emergency services at Doctors Pinole. 2. DHS should determine that all signage referring to availability of emergency has been removed by Doctors Medical Center and by CalTrans prior to authorizing closure of emergency services. 8 VI. Background Information A. Doctors Medical Center 1. Pinole Campus. Doctors Medical Center Pinole is a 136-bed acute care hospital located at 2151 Appian Way in the City of Pinole. Originally founded in 1967, the Doctors Hospital of Pinole was leased by National Medical Enterprises in 1978. National Medical Enterprises became Tenet Healthcare Corporation in 1995. The name of the hospital was changed to Doctors Medical Center, Pinole Campus in 1997 when Tenet entered into a 30-year agreement with the West Centra Costa Healthcare District to lease and manage the 233-bed former Brookside Hospital located in San Pablo. Brookside Hospital became Doctors Medical Center, San Pablo Campus. Both hospitals are permitted by the State Department of Health Services to provide "Basic Emergency Services," the standard designation in California for hospital emergency services which include 24-hours physician coverage. I The emergency department at Doctors Pinole includes 8 treatment stations and is normally staffed by one physician, an emergency department charge nurse, and one or two staff emergency nurses. Flexible staffing provides some overlap of nursing shifts to make more nurses available during peak periods. Physician services are provided by California Emergency Physicians (CEP) under contract to Doctors Medical Center. Emergency services at both the Pinole and San Pablo campuses are managed by a single Vice President for Patient Services (nursing director) who reports to the Doctors Medical Center Chief Operating Officer. Most of the emergency physicians and several of the emergency nurses work shifts at both campuses. Visits to the Doctors Pinole emergency department average about 14,000 per year. Of these, about 3,000 arrive by ambulance, including some 180 unstable patients transported Code 3 (red lights and siren). On its busiest shift of the week — Sunday evenings — Doctors Pinole averages 19 patient visits. 2. Doctors Medical Center San Pablo. Doctors Medical Center San Pablo is a 233-bed acute care hospital located at 2000 Vale Road in San Pablo. Doctors San Pablo, also operated by Tenet Healthcare Corporation, is located 4.2 miles from Doctors Pinole and provides the next closest hospital emergency services to most areas currently served by Doctors Pinole. The emergency department at San Pablo has been upgraded to include 24 patient treatment stations, an increase from the 11 treatment stations available in 1997. Staffing includes one charge nurse, and four to five staff nurses per shift. Flexible staffing provides some overlap of nursing shifts so that six, staff nurses are actually available during peak periods. Physician overlap also provides two physicians during busy periods. Additional staffing includes a physician's assistant and an emergency technician during certain periods. Doctors San Pablo sees about 28,600 patients per year, including some 7,200 transported by ambulance. ' Hospital emergency services are regulated through the issuance of special permit by the California Department of Health services. Three levels of permits are available. The most common is for Basic Emergency services which requires that the hospital have a physician on duty in the emergency department 24-hours per day. A permit for Standby Emergency Services requires only that a physician be on-call 24-hours a day. A permit for Comprehensive Emergency Services requires the availability of certain specialty services only found in certain teaching hospitals. 9 B. The Community Doctors Medical Center Pinole is located in the City of Pinole in western Contra Costa County. West county accounts for some 231,600 (24.6 percent) of the county's 941,980 population. The Pinole/Hercules/Rodeo/Crockett area of northwest Contra Costa has a population of about 60,000. The area is expected to add another 6,100 residents by the year 2010. Population Projections 2000 2010 Area Percent Growth Number Percent Number Contra Costa County,total 941,980 100.0 1,076,800 14.3 West county,total 231,600 24.6 247,600 6.9 Pinole/Hercules/Rodeo/ Crockett 60,000 6.4 66,100 10.2 Source: Association of Bay Area Governments,Projections 2000,December 1999. In its response to the EMS Agency's request for information, Doctors Medical Center describes the service area for inpatient services at its Pinole campus. (Appendix A.) Based upon patient origin by zip code, the primary service area of Doctors Pinole includes a 1998 population of 110,992 which is expected to grow to 117,964 (6.3 percent) by 2003. The population is ethnically diverse with Caucasians accounting for 37.1 percent of the residents, Asians for 24.2 percent, and African Americans and Hispanics for 19.0 percent each. Median household income in 1998 was $61,587. Some 55.9 percent of the population 25 years or older have completed at least some college. The 1998 population of the primary service area include 25,705 (23.2 percent) persons 14 years or younger and 11,052 (10.0 percent) persons 65 years or older. C. Hospitals and Hospital Emergency Services Contra Costa County is served by nine acute care hospitals providing emergency services. These hospitals, along with the number of licensed beds, number of licensed intensive care beds, number of emergency treatment stations, and number of emergency patient visits in 1998 are shown below. These hospitals had a total of 270,460 emergency patient visits in 1998. These patient visits were accommodated in 157 emergency treatment stations for an average of 1,723 patients visits per year per treatment station. This is within the American College of Emergency Physicians' standard of one treatment station per 2,000 annual visits. Z The primary service area is defined as the closest area (by zip code) from which 70 percent of the facility's inpatients originate. 10 Contra Costa County Hospitals with Emergency Services Licensed Emergency ENIS 1498 Hospital Licensed Intensive Emergency Treatment Visits/Station Transports, Beds' Care Beds Visits, Stations 1998 Doctors Medical Center, Pinole 136 14 13,733 8 1,717 2,112 Doctors Medical Center, San Pablo 233 30 27,452 24 1,144 7,728 Kaiser Permanente Medical Center,Richmond(standby emergency services) 50 8 29,154 15 1,944 0 Contra Costa Regional Medical Center,Martinez 164 8 32,349 19 1,703 4,699 Mt.Diablo Medical Center, Concord 250 25 42,626 22 1,938 7,677 Sutter Delta Medical Center,Antioch 111 12 35,245 22 1,602 5,670 Kaiser Permanente Medical Center,Walnut Creek 229 24 43,730 23 1,901 3,237 John Muir Medical Center, Walnut Creek 321 35 301,991 15 2,066 4,451 San Ramon Medical Center,San Ramon 123 12 15,180 9 1,687 840 Total 1,617 1,356 270,460 157 1,723 36,414 Total,west county 419 52 70,339 47 1,497 9,840 Note: Kaiser Richmond was not a receiving hospital for ambulance during 1998,but,with the reopening of critical care services in 1999, is currently authorized to receive most categories of ambulance patients. Kaiser plans to upgrade from"standby"to"basic"emergency services in March 2000,at which time the facility will be authorized to receive all categories of emergency ambulance patients Source: Contra Costa Emergency Medical Services and California Office of statewide Health Planning and Development. D. Impact of Closure on Hospital Emergency Services Doctors Pinole accounts for 5.1 percent of all emergency visits and 5.8 percent of EMS transports to Contra Costa hospitals. Within west county, :Doctors Pinole accounts for 19.5 percent of all emergency visits and 21.5 percent of EMS transports. The impact of the closure of emergency services at Doctors Pinole will depend upon what options patients who would have sought treatment at Pinole's emergency department choose. About 85 percent of all emergency department patients are transported to the hospital by private automobile or other non-EMS means. These patients have a choice of hospitals or non-hospital medical facilities. Patients transported by the EMS system (about 15 percent of emergency department patients) generally have a choice of hospital emergency departments, but cannot be transported to a facility without an emergency department. Unstable patients transported by the EMS system (fewer than 10 percent of EMS transports)are usually transported to the nearest hospital emergency department. Distribution of the Doctors Pinole projected emergency department volume under various scenarios is given below. The greatest impact under any scenario would be on Doctors Medical Center San Pablo which stands to gain an additional 4,152 to 13,837 patients. 11 Under the scenario anticipated by Doctors, the San Pablo facility would gain only the smaller number of patients with the most of the remainder choosing the urgent care services to be opened at Pinole. Sutter Solano would be the next most impacted hospital receiving from 165 to 3,604 additional emergency patients under the scenarios shown. Contra Costa Regional would be minimally impacted, as would other hospitals not shown. The ratio of patient visits to treatment stations at Doctors San Pablo would remain within the 2,000 visits per station American College of Emergency Physicians standard under any of the scenarios. Sutter Solano, with 15 emergency treatment stations and 21,465 emergency visits in 1998, would be able to absorb an increase in emergency patients without exceeding the ACED standard. Distribution of Emergency Patients from Doctors Pinole Contra Scenario Total Doctors Sutter Costa Urgent San Pablo Solano Regional Care Doctors Pinole, 1998 13,733 Doctors Pinole,2000 projected 14,416 Scenario#I —All patients to nearest hospital emergency department(ED) 14,416 13,837 551 28 0 Scenario#2—70%to urgent care,30%to nearest ED 14,416 4,152 165 8 10,091 Scenario#3—50%to urgent care,50%to nearest ED 14,416 6,918 275 15 7,208 Scenario#4—30%to urgent care,70%to nearest ED 14,416 9,685 385 21 4,325 Scenario#5—50%to urgent care,25%to Sutter Solano,25% to Doctors San Pablo 14,416 3,604 3,604 0 7,208 Emergency department diversion occurs when EMS transports are temporarily diverted by EMS policy away from an overloaded hospital emergency department. Diversion has not been an issue with respect to Doctors San Pablo. Since expansion of treatment stations from 11 in 1997 to 24 in 1999, the incidents of diversion have dropped from 34 (77.8 hours) in 1997 to 6 (6.1 hours) in 1998 and to 1 (2.4 hours) during the first 11 months of 1999. Information on emergency department waiting times was requested for both the Pinole and San Pablo facilities. Doctors Medical Center did not provide waiting time information, but states that "All emergency and life threatening conditions are immediately triaged and treated upon arrival to the Emergency Department." E. ,Specialty Services Doctors Pinole does not provide special permit, specialty, supplemental, critical ancillary, or physician specialty services not available at Doctors San Pablo. The following services 12 annually reported to EMS by all hospitals are available at San Pablo, but not at the Pinole facility: Special permit services Cardiovascular surgery Burn center FAA and CalTrans approved helipad Supplemental services Prenatal unit Hospital specialty services Radiation medical team available 24/hours Burn service Surgical services Backup on-call surgical team available within one hour Critical ancillary services Angiography,coronary artery and other types Physician specialty and subspecialty availability Cardiac surgery Neurologic surgery(not available at Pinole,occasionally available at San Pablo) OB/Gyn surgery(occasionally available at Pinole, normally available at San Pablo) Pediatric services Psychiatry Urologic surgery(occasionally available at Pinole,normally available at San Pablo) Hand surgery(occasionally available at Pinole,normally available at San Pablo) Infectious diseases (occasionally available at Pinole,normally available at San Pablo) Nephrology(occasionally available at Pinole,normally available at San Pablo) Neonatology Additional special services Labor and delivery unit within hospital Newborn nursery Cesarean section suite F. Trauma Services Closure of Doctors Pinole will have little impact on trauma services as major trauma patients are transported in most cases to the John Muir Trauma Center in Walnut Creek., or, in the case of pediatric trauma, to the Children's Hospital Trauma Center in Oakland. Critical trauma from west county is routinely transported by helicopter. G. Base Hospital Services Doctors Hospital Pinole is not a paramedic base hospital and, therefore, closure would have no impact on base hospital services. tCl 13 H. Disaster and Seismic Issues Because of its geographic isolation, its location on one of the most dangerous earthquake faults in the state, and the presence of two oil refineries and related petrochemical industries, western Contra Costa County is particularly vulnerable to disaster. Closure of Doctors Pinole would leave the area with only two hospital emergency departments — Doctors San Pablo and Kaiser Richmond. Because of it location and construction, Doctors San Pablo is at significant risk for loss of function in the event of a major earthquake on the northern Hayward fault. Doctors Medical Center has stated that "All buildings at both hospital sites are capable of being structurally upgraded. It is the hospital's intent to file its plan of correction by 2001 to complete the remedial work required and meet seismic code requirements by 2008 as required by law." Doctors San Pablo has special facilities for disaster response including a approved helicopter landing pad and a separate decontamination area with buffer zone, control points, shower and sink and a decontamination table with drainage system. Doctors San Pablo has exhibited a high level of preparedness to receive mass numbers of patients as might be received from a hazardous material exposure incident. 1. Prehospital Emergency Medical Services Prehospital emergency medical services are provided by the fire services which are first responders to medical emergencies and by American Medical Response under County contract to provide emergency ambulance service in response to 9-1-1 requests. Fire response is provided in the areas served by Doctors Pinole by the Pinole Fire Department (municipal service), the Rodeo-Hercules Fire Protection District (independent district), Contra Costa County Fire Protection District (county district), and the Crockett-Carquinez Fire Protection District (county district). All firefighters are trained to at least the public safety first aid level and most are trained as Emergency Medical Technicians 1. All firefighters are trained and equipped to provide cardiac defibrillation using automatic defibrillators. Ambulances assigned to respond to emergency calls are staffed with a crew of two paramedics. The standard for fire response time is five minutes. The standard for ambulance response time, monitored by the EMS Agency, is ten minutes or less to 95 percent of emergency calls as measured during the course of a month within west county. EMS responses and average emergency ambulance response times within the communities served by Doctors Pinole are shown below. ELVIS Responses, 1998 Number of ENIS Average Emergency Community Responses Ambulance Response Time Pinole 1,234 6.22 Hercules 595 7.83 El Sobrante 585 7.96 Rodeo 273 8.00 Crockett 118 10.77 Part Costa 6 17.80 Source; Contra Costa Emergency Medical Services Agency. 14 ::::..... _..r.. :r..::. . While most fire response times should not be adversely affected by the closure of Doctors Pinole, there will be certain periods when fire response is adversely affected by the longer out- of-service times for fire units. Normally, firefighters are released from the scene following arrival of the ambulance and transfer of patient care to the ambulance crew. However, for certain critical patients, a firefighter may be required to accompany the ambulance crew to assist in patient care en route to the hospital. In this situation, the fire unit remains out-of-service until the firefighter is returned to the unit or until a replacement firefighter is obtained. Pinole Fire estimates that it provides a firefighter to accompany the ambulance on about 25 call per year and that the additional out-of-service time for its single on-duty engine company as a result of the Doctors Pinole closure would be about 35 to 45 minutes. During this period the community would be at risk for longer fire response times. A similar impact would be anticipated for Rodeo-Hercules Fire and Crockett-Carquinez Fire. Contra Costa Fire, serving the El Sobrante area closer to Doctors San Pablo would not be significantly impacted. American Medical Response ambulance crews will experience longer times-on-task for all transports going to Doctors San Pablo or other more distant hospitals as a result of the Doctors Pinole closure. While this will certainly have an impact on American Medical Response, the impact on ambulance response times in the Pinole-area communities will be dependent on AMR. ambulance deployment decisions. Contractually, AMR is required to maintain the 10-minute response standard throughout west county and is required to maintain reasonable response times within each community. Maintaining the existing response level while committing resources to longer transports will prove a difficult task at best. In addition to possible delays in fire and ambulance response resulting from increased time on task, the City of Pinole has raised a concern that there may be an increase in emergency calls as a result of persons choosing to call 9-1-1 rather than drive to a more distant and less familiar hospital emergency department. J. Ambulance Transport Times Existing average emergency ambulance transport times from communities for which Doctors Pinole is the closest hospital are as follows. Ambulance Transport Times, 1999 Community Code 3 Transport Time (minutes) El Sobrante 6.6 Pinole 7.0 Hercules 8.5 Rodeo 9.1 Crockett 11.9 Based upon the difference in driving times between the city center to Doctors Pinole and to the next nearest hospital emergency department reported by MapQuest.com, Inc., the following are the estimated emergency ambulance transport times if Doctors Pinole closes its emergency services. Increases in average ambulance transport times using this approach range 15 from two added minutes for transports from Crockett to Sutter Solano to eight added minutes for transports from Hercules to Doctors San Pablo. These differences in transport times, however, do not consider peak traffic periods. Estimated Ambulance Transport Times Following Closure Community Code 3 Transport Time Hospital Emergency (minutes) Department El Sobrante 14.6 Doctors San Pablo Pinole 12.4 Doctors San Pablo Hercules 13.9 Doctors San Pablo Rodeo 14.1 Doctors San Pablo Crockett 16.5 Sutter Solano K. Notification to the Public Doctors Medical Center has committed to an education and information campaign to the public beginning in January and lasting through May 2000. This campaign would include direct mail, newspaper, bus shelter advertizing, television, and community presentations. Notification to health plans was sent on November 15, 1999 and a follow-up notification is planned for after January 1, 2000. L. Legal Liability Resulting from Closure It is difficult to predict with any accuracy the potential legal liability that could result from the closure of emergency services at Doctors Medical Center Pinole. Obviously, the greatest risk of liability arises from people who make mistakes of one kind or another. That said, all efforts should be made to notify the community, the patients, the ambulance providers, the local fire departments, the surrounding cities, and everyone who is involved in the emergency response process, so that patients will not go, or be taken, to Doctor's Pinole for emergency services after March 2000. The failure to provide adequate notice could result in liability to the Medical Center and possibly to the County if a court determined that to be a responsibility of Emergency Medical Services, should a patient thereafter arrive at Doctors Medical Center Pinole with a medical emergency and be unable to receive care, to the patient's detriment and injury. The need for wide dissemination of the information that the emergency department is closed, assuming closure is ultimately approved by the State, is obvious and should be taken seriously by all parties, including EMS and Doctors Medical Center. Liability could also arise from the failure of an ambulance driver to know that the emergency department has been closed and the driver's attempt to bring a patient to the emergency department, delaying or ultimately denying medical treatment to a patient which results in further injury to the patient. The potential defendants in such a situation would depend on the specific facts in the particular case, but they range from Doctors Medical Center to the ambulance driver and the ambulance company or fire district, depending on what agency operated the ambulance in question. Given the publicity surrounding this proposed closure and the public hearings scheduled for December 16, 1999 and January 5, 2000, notice of the closure will hopefully reach most member of the public and the affected emergency response agencies. It is in the best interests of all concerned to widely 16 2:21 disseminate the news should the State approve the closure of the Doctors Medical Center Pinole emergency services. 17 ' ? Appendix A Doctors Medical Center ► Notice of Intent to Close ► Request to Submit Information to County > Response to Request Nov-20-99, 12x49 From-ADMINISTRATION +5109705T20 T-349 P�02/03 F-237 Doctors Medical Center Tenex meolrhSysrem San?abio Comp,. 2000 voit 6taod Son Poblo,CA 9a800 Tel 510 970 5000 Set¢J/. —Mn+rh.aUh com November 15, 1999 Art Lathrop EMS Director Conga Costa County Health Services Department 50 Glacier Drive Martine, Ca 94553 Dear Mr. Lathrop: Today,Doctors Medical Center of San.Pablo and Pinole has announced the realignment of hospital services effective March 2000. 1 am writing to inform you about our decision and help you and your staff answer any questions you may receive from your constituents. For your information,I have attached a press release that is being distributed today. It is our intent to relocare intensive care,acute medical services and emergency care to San Pablo. The Pinole campus will retain Outpatient Surgery services, Transitional Care, Long Terra Gaze, Substance Abuse,Sleep Lab and Cardiac Rehabilitation. Emergency care services at Pinole will be converted to an urgent care center,and all ambulance traffic will be directed to San Pablo in March. The Governing Board, Medical Staff leadership and hospital management made this decision after an evaluation of the needs of the community and the ability of the hospital to meet those needs. During this transition,we will maintain all medical services required for our patients'zuedical care. This realignment effort will consolidate expertise at the two respective campuses to improve.patient care outcomes and achieve operational efficiency. Like many hospitals in the region,Doctors Medical Center is seeking to respond to reimbursement reductions by federal programs and insurance companies. In addition,both hospitals are faced with lower bed usage as a result of Kaiser redirecting patients to facilities outside of San Pablo and Pinole. This realignment of services will focus complex tertiary level services at DMC San Pablo and enable unproved outpatient surgical services and inpatient long-terns care services at DMC Pinole. Since 70%of the patients treated its Piuole's emergency room require only urgent care services,establishing an urgent care center at Pinole will respond to the community's needs while accomplishing the goals of the realignment. In addition,the hospital has expanded emergency services in San Pablo from 1 I to 24 emergency bays,increased monitored care capacity and upgraded facility and equipment to accommodate the consolidation of acute care services. r CC Nov-29-99 12.49 From-ADMIM STRATTON +5109705728 T-349 P.03/03 . F-237 . Page 2 of 2 DMC Service Realignment November 15, 1999 Long term plans have been initiated to build an additional 14-bed intensive care wait(TCU)at DMC San Pablo to meet the expected needs for beds after the realignment. While the process of gaining approval from the California Office of Statewide Health Planning and Development (OSHPD)can take as long as 24 months, the hospital will be working with the agency to expedite the process in this case. In the meantime,Pinole's ICU beds will be available in the event of a surge in demand for acute services. Our main priorities are to continue to meet the immediate medical needs of our patients. During this transition,we will maintain all medical services required far our patients' medical care and conduct a community education campaign to raise awareness of the realigned services within our community. The hospital has sought to minimize the disruption of this service realignment plan on our employees. We anticipate that this service realignment will result in the elimination of fewer than 20 positions out of a total of 465 Pinole employees. Every effort will be made to assist our personnel in acquiring alternative employment opportunities within the facility, at other Tenet hospitals in Northern California or other area hospitals. Change is never easy.However, we are committed to responding to challenging environmental changes to secure health care in West Contra Costa County.Please call me directly at(5 10)970- 5102 if you have any questions. Sincerely, Gary Sloan Chief Executive Officer Wtct2A,A 8. Wa'LKER. M. D. CONTR- COST1 HEALTH StRVIC$5 DIRECTOR EM E RCr E Ptit CY EMs Diit cTaR -•wrr"" �, ■ r"'M'"wl�""""� MEDICAL ,SERVICES MEIIIGAL DIRECTOR CONTRA COSTA 50 Glacier Drive HEALTH E RT�f f I C Martinez, California 9x553-553-1531 Ph(925)545-4590 Fax(925)646-4379 Dece-mber 10. 1999 Gary Sloan Doctors Medical Center 21-;1 Appian Way Pinole, CA 94806 Dear Mr. Sloan: Enclosed is a list of data and other hospital information we are requesting for use in the Impact Evaluation study on the proposed closure of emergency services at the Doctors Medical Center Pinole Campus. As you know, we will be preparing a preliminary report for distribution at the January w. ?000 public hearing. To meet this timetable, we will need to have your responses by December 24. 1999 for inclusion in the preliminary report. The preliminary report will be presented to the Board of Supervisors for consideration at its January I I" meeting. The anal report must be completed by January 13'h. Please let me know if you have any questions regarding the information requested. Sincerely, E � Art L a p I ENIS Dire-.'r Enclosure cc: William B. Walker. M.D. 21 Contra Z:sn Z..Irn ;ullq;u4Stance Abuse itr ices • 'ontra I� sta Enercenct x ec;ca ._J5ta Eriimnrnen aj rs@ith ' ::Cfltfd C.;sia"?Bltr,?ran + + �Jrttra .CStd"aZatC9aS t.tdt@r!ais''r~,C]'afns _. trd%:Sta iiet",`31 Heaif" ,.. ...._ .,,, ^9s.: ' Z-' CS' ? n� mcn • . 'i.'a 1. is ey.Cnai'1_„,,._I� =^i»! :ntta wSid Hpoltn �ntan CONTRA COSTA HEALTH SER.-VICES Emergency Medical Services Agency December 10, 1999 Impact Evaluation Study Closure of Emergency Services at Doctors Medical Center Pinole Campus Hospital Data and Information from Doctors Medical Center Pinole and San Pablo Campuses 1. Emergency department primary service area (Pinole Campus only) a. Describe primary service area(map) b. Total population (1) age (2) sex (3) income (4) population with special needs C. Population projection— 10 years '. Emergency department patient visits. 1998 and 1999 year-to-date (Pinole and San Pablo) a. Number of visits by month b. Arrival mode by year (1) ambulance (2) other C. Emergency department patients by triage category by year d. Emergency department disposition by year V (1) admitted to acute care (2) admitted to intensive care (3) treated and released (4) transferred to other acute care facility (5) died (6) other e. Patient characteristics (1) age (under 18, 18-054, 65 and older) (2) sex f. Patient paver mix (1) MediCal (2) Medicare (3) Kaiser (4) Other third party payer (5) Private pay 3. Existing emergency department capacity and loading (Pinole and San Pablo) a. Number of treatment spaces b. Average number of patients treated per shift(day, evening, night) C. Average number of patients treated on busiest shift of week (specify shift) ::..vuun:vw:..:.•:.:::. .:±:nan r:,:: .... .::•. .:ice•:-........... -•:::::-. .... ...:.....:: .:::. •r:v.-. -.u: _... ....._.. I Average emergency department wait time (arrival to ED discharge) e. Average emergency department wait time on busiest shift of week f. Normal emergency department staffing (physician, nurse) during busiest shift of week g. Emergency department diversion time by month, 1998 and 1999 4. Emergency department patient transfers, 1998 and 1999 (Pinole and San Pablo) a. number b. reason for transfer C. hospital transferred to 5. Communicable disease (Pinole and San Pablo) a. Number of emergency patients presenting with reportable communicable diseases by disease category b. Number of negative flow isolation rooms available (describe) 6. Hospital services (Pinole and San Pablo) a. Number of beds licensed and available for use by hospital policy (1) acute care beds (2) intensive care beds (3) other, describe b. Average daily census. 1998 and 1999 year-to-date (1) acute care (2) intensive care (3) other C. List of specialty services available 7. Seismic factors (Pinole and San Pablo) a. Seismic status of existing hospital facilities (critical, ancillary facilities) 8. Emergency and urgent care plans (Pinole Campus only) a. Plans for notification to public, health plans, health plan members b. Plans for coordination with impacted health care facilities and emergency providers b. Plans for continuation of emergency and/or urgent care services at existing or alternate facilities C. Contingency plans for handling emergency patients for whom services will no longer be provided d. Assessment of capacity of other facilities to absorb impact of closure Doctors Medical Center Tenet HealthSystern San Pablo Campus 2000 Vale Road Son Pablo,CA 94806 Tel 510.970.55000 http://www.tenethealth.com December 22,1999 Art Lathrop, Director Centra Costa Emergency Medical Services 50 Glacier Drive Martinez, California 94553 Dear Mr. Lathrop: :Doctors Medical Center will be consolidating emergency room services from the Pinole campus to the San Pablo campus on March 1, 2000. San Pablo is located 4.5 miles from Pinole. This emergency room consolidation is one element of a larger re-alignment service project. By consolidating complex inpatient and emergency services at San Pablo and focusing specialty and outpatient services at Pinole, the hospital will be better able to respond to declining reimbursement, adapt to the erosion of patient volume and enhance service levels to the community by providing more efficient operations. In 1997, Tenet HealthSystem acquired Doctors Medical Center-San Pablo and preserved critical emergency services to the region. While no other organization was able to offer to preserve these critical services to the community three years ago, Tenet was able to determine that through realignment and consolidation of services, we could operate both Pinole and San Pablo facilities to the benefit of West Contra Costa. In 1997, the medical center engaged the services of California Emergency Physicians (CEP) to better coordinate the emergency services offered at both facilities. Today, over seventy percent (70%) of the patients seen at the Pinole Emergency department are urgent care patients. Those patients requiring urgent care services will be able to continue to access these services in Pinole. CEP will retain an emergency physician at Pinole and the hospital will retain emergency trained nurses at the urgent care facility. Since all ambulances will be re-directed to San Pablo, Pinole's urgent care patients will be seen in a more efficient manner, given the lack of priority emergency patient interruptions. Moreover, outpatient surgical services in Pinole will also operate in a more efficient manner given the absence of emergency surgeries. As Pinole converts to an urgent care center, emergency physician services at San Pablo can also be re-aligned to better service peak demand periods. Since 1997, Doctors Medical Center has invested over $20 million to accommodate the additional emergency and inpatient volume anticipated in this re-alignment of services project. San Pablo has increased emergency bays from 11 to 24, added emergency room monitors, increased the available ICU beds from 23 to 30 licensed available intensive care beds and added 33% more telemetry monitored beds in the hospital. The hospital also plans to add 14 ICU beds at San Pablo within two years. DR Page 2 of 2 EMS Impact Data December 22, 1999 Based on the American College of Emergency Physicians planning guidelines, an emergency room can accommodate six (6) patients per station per day resulting in a capacity of 52,560 visits per year at the San Pablo emergency room (6 patients x 24 stations x 365 days). The Advisory Board Company performed a study in November 1995 suggesting an average range of 10-11 visits per station per day. Indeed, it is apparent that there is sufficient emergency room capacity at the San Pablo campus even if all emergency and urgent care patients currently served at Pinole were treated at San Pablo, (There were 39,842 annual visits between the two campuses in 1998). In summary, Doctors Medical Center is responding to economic, environmental and operational forces in a responsive and responsible way. The hospital has addressed issues associated with the consolidation of services between our two campuses. • Added Emergency room capacity at San Pablo over the past three years. + Added Telemetry capacity. • Increased existing available ICU beds and planned the increase of ICU bed capacity at San Pablo. • Substantively improved ED diversion times through improved procedures. • Improved Emergency Department physician coordination. Planned to retain urgent care services at Pinole to accommodate 70% of the patients currently served in that immediate vicinity. • Invested $20 million in capital improvements to the hospital plant over three years. • Continue to staff emergency physicians and nurses at the Pinole urgent care center. • Maintain ambulance stationed at Pinole urgent care for initial phase of closure. Committed to a comprehensive communication program to our community and affected health care providers. While I recognize that change is a difficult process for any community, this re-alignment of services between these hospital campuses will enhance the delivery of health care in our community. The hospital has sought to mitigate potential negative impact to the community and is confident that these two hospitals, working synergistically, will continue to serve the public well. Sincerely, tGoan Chief Executive Officer CONTRA COSTA HEALTH SERVICES Emergency Medical Services Agency Impact Evaluation Study Closure of Emergency Services at Doctors Medical Center - Pinole Hospital Data Request The following data is provided pursuant to your request. (1999* reflects YTD through November) 1. Emergency department primary service area (Pinole Campus only) a) Primary Service Area map (Exhibit 1) The primary service area(PSA) consists of the top 70% of inpatients by origin Zip code. The secondary service area (SSA) consists of the next 15% of inpatients by origin Zip codes. Doctors Medical Center relies upon Inforum Products who uses the last three years of available HCFA Hospital Market Service Area File data(HIYLU). b) Total Primary Service Area Population: In 1990, the total population for Pinole's primary service area was 101,562. By 1998 this population grew to 110,992 and is projected to grow to 117,964 by 2003 (6.3% growth rate between 1998-2003. (Exhibit 2) 1) Age: Ten percent (10%) of the population is over the age of 65, 23.2% of the population is under age 15 and 56.8% of the population between 15-64 years of age. The distribution of age groups between 1998 to 2003 is not expected to substantively change. 2) Sex: 51.3% of the population is female and 48.7% male 3) Income: 27.1% of the population has a household income under $30,000 while 51.7% of the population maintains a household income between $30,000 —$50,000. 11.2% of the population has an income over $100,000 per annum. 4) Population with special needs: None known. c) Population projection — 10 years (Exhibit 3): Based upon data obtained from the Contra Costa Planning Department, the attached exhibit illustrates population growth projections by area. Page 2 Doctors Medical Center- Pinole ED Impact Evaluation Data December 22, 1999 2. Emergency department patient visits, 1998 and 1999 year-to-date (Pinole and San Pablo) a) Number of visits by month: Emergency visits have declined at both Pinole and San Pablo campuses since 1997. This is a reflection of general population use trends and the re-distribution of emergency visits to Kaiser Richmond during the past three-year period. A study conducted by the Lewin group in 1999 revealed a decline in historical and projected emergency use rates for Contra Costa County. This county experience is also reflected among these two local hospitals as shown in Exhibit 4 and annual visits shown below: Annual ED Visits 1998 1999* Pinole 13667 12867 San Pablo 26175 26251 b) Arrival mode by Year Transport Mode Pinole 1998 1999* Ambulance 3257 2737 Other i4410 igm Total 13667 12'L'57 San Pablo 1998 1999* Ambulance 7718 6589 Other 18457 19662 Total 26175 26251 Page 3 Doctors Medical Center- Pinole ED Impact Evaluation Data December 22, 1999 C) Emergency deoartment disposition by triage category by year Pinole 1998 1999* Level 1 255 284 Level 2 4488 4316 Level3 8056 7348 Level 4 868 919 Total 13667 12867 San Pablo 1998 1999* Levell 3182 6745** Level2 7850 7158 Level3 8732 7481 Level 4 6411 4967 Total 26175 26251 **Chevron toxic cloud emergency d) Emergency department disposition by year Pinole 1998 % 1999* % Acute Admit 1324 9.7010 1229 9.6% ICU Admit 523 3.80,10 405 3.1% Treated & released 11084 81.2% 10564 82.1% Transferred 251 1.8010 224 1.7% Died 44 0.3% 26 0.2% Other 441 3.2% 419 3.3% San Pablo 1998 % 1999* Acute Admit 3690 14.1010 2800 10.7010 ICU Admit 1117 4.3% 910 3.5% Treated & released 19011 72.4% 20684 78.7% Transferred 709 2.9% 500 1.9% Died 133 0.5% 109 0.4% Other 1515 5.8% 1248 4.8% Page 4 Doctors .Medical Center-Pinole ED Impact Evaluation Data December 22, 1999 e) Emergency Department Patient Characteristics Pinole 1998 1999* Age 0-18 2685 2456 18-64 8113 7840 65+ 2869 2571 Sex Male 6169 5781 Female 7498 7086 San Pablo 1998 1999* Ave 0-18 5066 4915 18-64 15873 16952 65+ 5236 4384 Sex Male 11866 11583 Female 14309 14668 f) Patient paver mix Pinole 1998 % 1999* % MediCal 996 7.2% 945 7.3% Medicare 1968 14.4% 1889 14.7% Kaiser 834 6.1% 567 4A% Other Insurance 8251 60.4% 7776 60.4% Private Pay 1618 11.8% 1690 13.1°'o San Pablo 1998 % 1999* % MediCal 4295 16.4% 3675 14.0% Medicare 2707 10.3% 2679 10.2% Kaiser 1275 4.9% 761 2.9% Other Insurance 12549 47.9% 12600 48.0% Private Pay 5349 20.4% 6536 24.10% may. -..:;}:+:45:4:ii•}, :x .xay.•W?v:•:J+'-.-::.v:..xe•..w.v.•.v.:.v. ..:.-.v:::.rv-:::.1tv:�..z Page 5 Doctors Medical Center-Pinole ED Impact Evaluation Data December 22, 1999 3. Existing emergency department capacity (Pinole and San Pablo) a) Number of treatment spaces 1997 1998 1999 Pin SP Tot Pin SP Tot Pin SP Tot ED Beds 8 11 19 8 20 28 8 24 32 b) Average number of patients treated per shift (day, evening, night) Ave. ED Visits per Shift Pinole San Pablo Days 14 31 Evenings 16 35 Nights 5 12 C) Average number of patients treated on busiest shift of week (specify shift) Pinole Sunday evening 19 patients San Pablo Friday evening 42 patients d) Patient wait times: All emergency and life threatening conditions are immediately triaged and treated upon arrival to the Emergency Department. e) Current emergency department staffing (Physician, nurse) during busiest shift of the week) MD RN PSA Pinole 1 3 0 Overlap TLN San Pablo 1 6 1 Overlap NM The San Pablo department also is supported with emergency room technicians(10a-6p and 6p-2:30a) Page 6 Doctors Medical Center- Pinole ED Impact Evaluation Data December 22, 1999 f) Emergency department diversion time, 1998 and 1999 1998 1999* #ED Total Hours #ED Total Hours Diversion on diversion Diversion on diversion Pinole 2 3.2 1 2.7 San Pablo 6 666 1 224 Total 8 9.8 2 5.1 % of Total ED Operating Hrs 0.1% .06% 4. Emergency department patient transfers, 1998 and 1999 (Pinole and San Pablo) Pinole 1998 1999* a) Number of Transfers 251 224 b) Reason for transfer Pediatric 40 46 Psychiatric 67 42 Higher Level 32 34 Mgd Care 96 91 Pt. request 8 6 Other 8 5 C) Hospital transferred to Childrens Hospital Oakland 40 45 Contra Costa Regional 67 42 John Muir 2 2 Alta Bates 6 6 Kaiser 81 79 DMC -San Pablo 29 30 Other 26 20 Page 7 Doctors Medical Center- Pinole ED Impact Evaluation Data December 22, 1999 San Pablo 1998 1999* a) Number of Transfers 709 500 b) Reason for transfer Pediatric 189 185 Psychiatric 353 216 Higher bevel 38 35 Mgd Care 92 36 Pt. request 23 24 Other 12 7 C) Hospital transferred to Childrens Hospital Oakland 184 183 Contra Costa Regional 352 209 John Muir 13 20 Alta Bates 26 8 Kaiser 79 61 Other 55 19 5. Communicable disease (Pinole and San Pablo) ,a) Number of emergency patients with reportable communicable disease. 1998 1999* Pinole 20 20 San Pablo 41 44 b) Number of negative flaw isolation rooms available Pinole San Pablo Negative Pressure Rooms 4 2 Hepa Filter Room 2 4 Isolation Rooms * 4 (*Negative Pressure Rooms at Pinole act as isolation rooms as well) SIB Page 8 Doctors Medical Venter- Pinole ED Impact Evaluation Data December 22, 1999 6. Hospital services (Pinole and San Pablo) a) Number of beds licensed and available for use by hospital policy San Pablo #of beds Acute care Intensive Care 14 Coronary Care 9 Burn 7 Perinatal 18 Neonatal 2 Med/Surg 171 Geropsych 12 Total 233 Pinole Acute care Intensive Care 7 Coronary Care 7 Chemical Dependency 12 Med/Sorg 44 Cather Skilled Nursing 66 Total 136 b) Average daily census, 1998 and 1999 year to date Pinole 1998 1999 Acute care 27.0 24.4 ICL 5.2 6.3 Chem. Dependency 10.1 9.7 SNF 25.8 19.7 Sub-acute 27.7 27.6 Total 95.8 87.7 Page 9 Doctors Medical Center- Pinole BD Impact Evaluation Data December 22, 1999 Averase daily census. 1998 and 1999 vear to date(cont} San Pablo 1998 1999 Acute care 80.4 54.0 ICU beds 12.5 13.3 Burn 5.6 5.1 Geropsych 0.0 4.0 Perinatal 1.1 2.0 Level II Nursery LO 005 Total 100.6 78.9 7. Seismic factors (Pinole and San Pablo) a) Seismic status of existing hospital facilities A seismic evaluation has been performed at both San Pablo and Pinole campuses by the architectural firm of Lee, Burkhart and Liu and J,A. Martin and Associates, structural engineers. All buildings at both hospital sites are capable of being structurally upgraded. It is the hospital's intent to file its plan of correction by 2001 to complete the remedial work required and meets seismic code requirements by 2008 as required by law. 8. Emergency and urgent care plans (Pinole Campus only) a) Notification Public: An extensive education and information campaign has been planned that targets affected markets from January through May. This plan includes the use of Direct mail -Television Newspaper - Community Presentations Bus Shelters Health PIans and Health Plan members: Letters informing health plans were sent on 11/15/99. Secondary notification of health plans will occur after 1/l/00. Meetings with key health plans and medical groups will also occur prior to March 2000. Direct mail efforts by the hospital and its broad communication plan will assist the Health Plans in notifying members. C7 Page 10 Doctors Medical Center- Pinole ED Impact Evaluation Data December 22, 1999 b) Plans for coordination with impacted health care facilities and emergency providers: Key providers in the area have been notified of our intention to re-design services at Pinole and convert the emergency room to an urgent care facility. We will continue to schedule meetings throughout January and February with EMS, local hospitals, fire and ambulance providers. Discussions with local medical facilities and other health providers will occur prior to March to assure appropriate notification and coordination. C) Plans for continuation of emergency and/or urgent care services at existing or alternative facilities: DMC will establish urgent care services at the Pinole campus with extended evening and weekend hours. In addition, we will work with EMS and local fire departments to direct ambulances to the San Pablo campus. The hospital will initially maintain an ambulance at the urgent care center until the hospital is satisfied that communication and use of the urgent care facility is appropriate. d) Assessment of capacity of other facilities to absorb impact of closure. There will be minimal impact of the closure of emergency services on other facilities. There is adequate capacity at the San Pablo facility to accommodate the average daily acute census of 30 patients relocated from Pinole. There is more than sufficient emergency room capacity at San Pablo to treat patients previously treated at Pinole who require emergency services. Over seventy percent of the patients currently seen at Pinole will be able to continue to receive urgent care services at that facility. EXHIBIT I Combined Service Area Doctors Hospital of Pinole Primary Service Area 1 Secondary Service Area Interstates Hospitals ' County Boundary 00 Zip Boundary 3 and 8 Mile Radii P� i Northbay Medical Center !� ---Sutter Soiano Medical Center ..._��� Kaiser Found Hosp-Vallejo California Specialty Hospital STATE 4VVY d jDoctors Hospital of Pinole Doctors Medical Center '' _ yX — ✓`� Kaiser Found Hospital 1 0 3 6 Miles pit lnfarum informabo SOvic es Group � � �� Copyrigk�t 199$ ai vitas Inc Li o a CUA \ �,. MMM A q *�! CTi td9 CCI C Kt RC `d CCS M CS C V CD Cp C9 r CA r iCf C:! C4 OCD N tC1 M N CS 191 r- f'- C"SwrNN O I- °r`• NMN O e+ e- U O o CZ M YCr�S�S N L r Cw m 'T CD COv CO CV 4 ER 9 M N N M t++ �- N r i w r y N _ C4 CL G � C6! td70 �0-) fit^» rte+ Ct rC7C7 Nt�SC? m r- t[9 tt? N LLS h M 0) coN 0 e- N G e a. e- CD UC7 r- M CV td'1 M N CSy e- G7 CS OD CPS CSS /y ►. tti Cp 00 (0 C � t!C3 C7b `�i N N N rW CCS o 0 e- J O L U. N C s3 C p U CS = 5. 0 G -6 42 0 d? V 0 i M 9t CL CL qi O i C? to CL 9s 5. (D Lu S C } N cu 0 C4 c co J Co a) CO F- S W tmn \n w td7a r x CO C,7 � co co Ln CO Cfi NCI Nu M C39 b Ct7 CS CAN CL 0 O O CL CM - t`- Gf Q OOtOCACAGCVF+ N a a a a v r UA V CCS CD h- v S a a aoCSp. a`+ _ R F CI oNNODrn � Ct � h -gr co N U) co WC4H+ M0N1- C C4 -,i MODCD 'i N N M r CS Z �N�pprnt � 000NUN"Sot''Cs 6i) CA0) Q f� � 4th• C�CA z Ua CS! CfJ� CX) e- C? U) 0 M 0 O O M Q° Z CrQ i 3 U73 75 75 C CL C4 C6 co 0 '0 c U Y Cry a C Q o YYYo �- O ea = set� 0 S 0 ' t�siuM 17 Ct. et r`, T + a OCaC7Oo � w W oarno 0 `r uiusuyu� o Q Mme- - F4cnu) > C> to to F- U) v AF* 44 ur ell 0 h- 0 sv Leo 19 a , 88 $ W3 C4 � r as h � 43 s. w wl 44 HC14 110N C14 as 00 N tn N cr > Itr 00 0 Z N d d N N 00 00 G ts. cr v`y ao �Ca 00r- Tcr Tr9-4 rry tCNh CCe r N r-+ C 0 00 _ cc ,- N 4.t CN C C14 C""4 x. G1 cit v� E— N C 0C � Cj •—+ Ch urs co cc N tn en � h �+ cq r hJ on rrr 00 a ..w 'vy u5 w CZ O cC Cil ccs Appendix B EMS Notices ILLIA'M B. WALKER. M. D. L..L,.l1NTRA COSTA HEALTH SERVICES DIRECTOR Air I.arr�t Ro r E tel E FLC��`�!CY MEDICAL JE EMS DIRECTOR RV(CS JOSEPH 1 R, mo.D. MEDICAL DIRECTOR CONTRA COSTA 50 Glacier Drive Martinez, California ! HEAL H SERVICES 94553.1631 Ph(925)646.4690 Fax(925)646-4379 December 8, 1999 TO: All Contra Costa County Hospital Administrators All Contra Costa County Emergency Department Directors All Contra Costa County City Managers All Contra Costa County Planning & Zoning Authorities All Contra Costa County Fire & Police Chiefs All Contra Costa Countv Ambulance Services All Pinole Area.Health Care Facilities Pinole, Hercules, and El Sobrante Chambers of Commerce Contra Costa Emergency Medical Care Committee Alameda-Contra Costa Medical Association Hospital Council of Central and Northern California Other Interested Organizations and Individuals FROM: Art LaLop, Con�CostaEmergencv .)vfedical Services Director SL;BJ: Notice of Planned Closure of Hospital Emergency Services Pursuant to California Health and Safety Code Section 1300 and direction from the Contra Costa Board of Supervisors. the Contra Costa Emergency :Medical Services Agency is undertaking an Impact Evaluation of the closure of the Doctors .Vledicai Center Pinole Campus Emergency Department planned for March 2000. We are providing you with this notice in compliance with the .Health and Safety Code requirement that all hospital and prehospital health care providers are consulted with and that local emergency service and planning and zoning authorities are notified with respect to the planned closure. Additionally, it is the Board of Supervisors' desire that broad community input be solicited in preparing the Impact Evaluation report. A copy of the County Impact Evaluation Policy approved by the Beard of Supervisors is enclosed. The Impact Evaluation will include two public hearings conducted by the Contra Costa Emergency Medical Services Agency to be held on December 16, 1999 and on .January 6, 2000, both from 7:00 —9:00 p.m. at the Pinole City Council chambers, 21311 Pear Street, Pinole. All organizations and individuals with information relevant to the impact of the proposed closure of emergency services are invited to attend these hearings and/or to submit written information to the Contra Costa Emergency Medical Services Agency. Written information should be submitted as soon as possible, but not later than January 6, 2000. The Impact Evaluation is planned for completion by January 15, 2000 as required t • CoRICd CtstB CJ!"fR1Uf1;2'J SUdStdRC2 Abuse.ENiL9S • CCRttd Costa v'TIEtGetiCJ medlLBi:wC':EQ:$ ' �tSR{Cd{.0528 cRViCORmetit8i Health • woC3ftd%'7st8 Hedith P18R ' • Contra Costa Hazardous.Materials°,,ocrrarns 'COR?rd Costa!`.Qet't31 Heairh ' -oR?ra�.s2a Contra rosta Regional Medical C_e^ter • _aVva Costa Heatth Cemex . by statute. Results of the Impact Evaluation will be provided to the California Department of Health Services. enclosure cc. Board of Supervisors County Administrator County Health Services Director County Counsel California Emergency Medical Services Authority California Department of Health Services M...... ». .. ..... .....:. ...... ,rn..y!+ ...::Vis •;{{rx..,..s:.: Contra Costa Emergency Medical Services Agency announces: Two PUBLIC HEARINGS on the CLOSURE of DOCTORS MEDICAL CENTER. PINOLE CAMPUS EMERGENCY SERVICES Thursday,Dec. 16, 1999 7:00 -- 9:00 p.m. and Wednesday,Jan. 5, 2000* 7:00 -- 9:00 p.m. To be held at: Pinole City Council Chambers City Hall, 2131 Pear Street, Pinole Pursuant to Section 1300 of the California Health and Safety Cade and by order of the Contra Costa County Board of Supervisors, the Contra Costa Emergency Medical Services Agency will conduct two public hearings on the proposed closure in March 2000 of emergency services at the Doctors Medical Center, Pinole Campus. These public hearings are being held in connection with an Impact Evaluation Report being prepared by the Contra Costa Emergency Medical Services Agency on the proposed Doctors Medical Center closure of emergency services. The Impact Evaluation Report will be submitted to the California Department of Health Services. Written comments may be submitted to: Contra Costa, Emergency Medical Services Agency 50 Glacier Drive, Martinez CA 94553 Tel: (925) 646-4690 Fax: (925) 646-4379 email: pinoleimpact@hotmail.com hotmail.com Copies of the preliminary findings of the Impact .Evaluation will be available at the January 5t' hearing. *Note: Hearing originally announced for Jan. 6, 2000 has been changed to Wednesday,Jan. 5,2000. ��� Contra Costa Health Services Emergency Medical Services Agency PUBLIC HEARING on the CLOSURE of DOCTORS MEDICAL CEN'S'ER PINOLE CAMPUS EMERGENCY SERVICES Pinole City Council Chambers City Hall,2131 Pear Street,Pinole December 16, 1999 7:00—9:00 p.m. Agenda 1. Scope of Impact Evaluation and Public Hearings —.Art Lathrop, Contra Costa EMS Director 2. Comments from the Contra Costa Health Services Director —William B. Walker, MD 3. Plans related to the closure of Doctors Medical Center Pinole Campus emergency services —'Gary Sloan, CEO. Doctors Medical Center —John Rampulla. MD. Chief of Emergency Doctors Medical Center 4. Comments from the public officials 5. Comments from the public (please limit comments to 3 minutes) 6. Comments from Doctors Medical Center 7. Closing comments by Contra Costa Emergency Medical Services There will be a second Public Hearin; on Wednesday, January 5, 2000 7:00—9:00 p.m. Pinole City Hall Contra Costa Health Services Emergency Medical Services Agency PUBLIC FEARING on the CLOSURE of DOCTORS MEDICAL CENTER. PINOLE CAMPUS EMERGENCY SERVICES Pinole City Council Chambers City Hall,2131 Pear Street,Pinole Wednesday, January 5,2000 7:00—9;00 p.m. Agenda 1. Opening Comments -Art Lathrop, Contra Costa EMS Director 2. Presentation of Preliminary Impact Evaluation Art Lathrop, Contra Costa EMS Director 3. Comments from the Contra Costa Health Services Director -William B. Walker, MD 4. Comments from Doctors Medical Center, Pinole Campus 5. Comments from the public officials 6. Comments from the public (please limit comments to 3 minutes) 7. Closing Comments Public Comments will be accepted by telephone during this Public bearing Appendix C Location of Hospital Emergency Services HOSPITAL EMERGENCY SERVICES West Contra Costa County Hospitals Doctors Hospital-Pinole, 2151 Appian Way, Pinole, CA 94564 Doctors Hospital-San Pablo, 2000 Vale Avenue, San Pablo, CA 94806 Raiser-Richmond(Standby), 901 Nevin Avenue, Richmond, CA 94801 Other Contra Costa County Hospitals Contra Costa Regional Medical Center, 2500 Alhambra Avenue, Martinez, CA 94553 John Muir Medical Center(Trauma Center), 1601 Ygnacio Valley Road, Walnut Creek, CA 94598 Raiser-Walnut Creek, 1425 South Main Street, Walnut Creek, CA 94596 Mt. Diablo Medical Center, 2540 East Street, Concord, CA 94524 Sutter-Delta Medical Center, 3901 Lone Tree Way, Antioch, CA 94509 San Ramon Regional Medical Center, 6001 Norris Canyon Road, San Ramon, CA 94583 Out of County Hospitals Kaiser-Vallejo, 975 Sereno Drive, Vallejo, CA Sutter-Solano Medical Center, 300 Hospital Drive, Vallejo, CA Kaiser-Oakland, 280 West MacArthur Boulevard, Oakland, CA Alta Bates Medical Center, 2450 Ashby Avenue,Berkeley, CA Childrens Hospital (Trauma Center), 747 52nd Avenue, Oakland, CA Summit Medical Cemter, 350 Hawthorne Avenue, Oakland, CA Highland Hospital (Trauma Center), 1411 East 31" Street, Oakland, CA Eden Medical Center, 20103 Lake Chabot Road, Castro Valley, CA Kaiser-San Rafael, 99 Monticello Road, San Rafael, CA Marin General Hospital,250 Bon Air Road, Greenbrae, CA M ct Ln co P- Lo W r-_ N M V LO CEJ 1 - *— N M Cf .o 11H 1NVSV31d xN Ki YJ r • P i F r + p; 3� uj �r E U WaN rE ca o CLi s, L r� Lo / N L ti' ON Y In � I � VI a off � t A 1 s 311VA 1 ", ► s F 3 Pt Ij > 4-4 d in yL i �+ b 0Nil n yf ' ! 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I a.x W d•���E «�K �� �'� 9 ` Appendix D Report from City of Pinole P is n o e L,7it C; 2131 Pear Strut Tel : (510) 724-9000 Pinole, CA 94554 Fax : (510) 724-9826 O Date: December 23, 1999 To: Art Lathrop, EMS Director CC: Mayor and City Council From: Marc Grisham, City Manager Subject: Potential Elimination of Emergency Services - Doctors Medical Center, Pinole Thank you for providing the City of Pinole with the opportunity to comment on the potential elimination of emergency medical services at Doctors Medical Center in Pinole. As I am sure you are aware, following the county's first public hearing in our Council Chambers on this matter, all of the community is concerned about this closure and its negative effect on primary care needs in the region. These comments will not be as complete as we might wish, but the notification of the potential closure comes at a difficult time of the year to secure the fullest level of community input. Let me first start by saying that the method of notifying the community as required under Health and Safety code 1255.2: Reasonable Effort for Public Notice was not satisfactory and demonstrated a disregard by Tenet HealthSystem, Inc. for informing our citizens and these citizens in surrounding communities of the potential elimination of emergency services. I will very quickly recapitulate those efforts relating to communicating with the community: • Letter dated November 15, 1999 from Tenet with press release regarding closure of emergency service at Doctor's Pinole Campus. This letter was read to the city council as part of the Mayor's Report at the November 16 Council Meeting. The Mayor was directed by the council to invite the hospital administrator, Crary Sloan, to make a presentation at our December 7 Council Meeting regarding the elimination of services. • Letter dated December 6 to Mayor Peter Murray from Mr. Sloan declining invitation to attend the December 7 meeting. This declining of the invitation to speak was made after the previous Mayor, Maria Alegria, and myself had confirmed the invitation with Mr. Sloan's staff. It was certainly apparent during my conversations with Tenet that they wanted to minimize the public input process and only participate in the minimal amount of required public hearings. \\CTVTC\,YS\A17MTNOFC\C`.iry Nitanaoeer`Mcaotonz Ho-,nital\RertnrmgP 12-21doc i i i • To date, the Pinole City Council has not received any fiurther written communication from Mr. Sloan or Tenet HealthSystem, Inc. regarding their Pinole emergency services elimination proposal. • Tenet Health System, Inc. did not notify us of the county's rote in preparing an Impact Evaluation Report. Our City Council only learned of the proposed impact evaluation policy guidelines a few days before the December 7 Board of Supervisors' meeting. • The Pinole Community as well as our neighboring communities of Hercules, Rodeo, Crockett and El Sobrante have not been informed regarding this radical change in emergency medical services. We have concluded that this decision to notice the Health Services Department of Contra Costa County on November 15 is not coincidental. It comes on the heels of our traditional holiday season including Thanksgiving, Hanukkah, Christman and New Years. This is a time when may businesses, schools, cities, and their respective employees are rearranging their schedules for the holidays. Therefore, this becomes a time when it is difficult to secure community input and engage in thoughtful dialogue. • Cour City Council will not be meeting again until January 4, 2000, a day before the preliminary report is due from the County's EMS Agency. All of these factors seem to indicate an undue haste to close a service that is vital to the well being of West Contra Costa County. One would hope that the county could prevail on Tenet HealthSystem, Inc. to take more time in this process and serious consider the disruptions that are going to be caused in the affected communities. I wanted to now talk about direct impact on emergency services. I have attached a memo from the Fire Chief of Pinole regarding the negative impact on our emergency service providers. I would expect that the .Fire Chief of the Rodeo/Hercules Fire Protection District, the Chief of Contra Costa County Fire, and the Chief for Crockett's volunteer fire service would echo his comments. We have a system that is already operating at an overburdened le el and Tenet's actions will only increase response times to critical emergencies. The key points on this are as follows: • Closure of the emergency room will result in the AIMR ambulance unit being out of service area for an average additional 30 minutes based on round trip travel time. • Pinole fire personnel, when required to ride with the ambulance, will be out of area thus negatively impacting on the service availability of our engine company. • With the increased distance to the emergency room and the awareness of residents that the travel corridors can be significantly impacted., we will expect an increase in calls for service where a resident feels that emergency vehicles will have a better chance of getting to the emergency room. This will add to the burdens of one of the busiest emergency response areas in the Bay Region. I\CTVTCVSY41ADM1NnR7\City Mananer\ oo.tor¢ Hrssnital\Re,;nnn�e 12-23.cioe 2 S • In an area that already is under served by medical service providers, this closure of the emergency room and the intensive care unit, will seriously decrease the disaster response capabilities of West County. The City is also concerned about the impact of consolidation at Doctors .Hospital Campus at San Pablo. We would expect that prior to the closure of any services in Pinole, that Tenet would be able to clearly demonstrate to all parties that their remaining facility can adequately handle the needs of our area. Some of the issues that we are aware of are as follows: • What are Tenet's plans for the seismic retrofit of the existing medical building and how can the community be assured that the retrofit will occur in a timely manner? Have funds been set aside for this work? Shouldn't we wait on placing all emergency medical services at a single location until the seismic work is completed? We would expect that a seismic retrofit plan must be required by the Department of Health Services as part of the OSHPD's permit approval process regarding the elimination of emergency services in the Pinole/Hercules area. • Who will monitor the adequacy and training of the remaining emergency medical staff in our area? If only one emergency room is available in an area where major refineries, railroad lines hauling hazardous materials, and a heavily used Interstate 30 are present; how can we be sure that there are adequate human resources to handle an emergency? By reducing emergency medical services by 50% in our area, the remaining facility will have a much higher burden and should be held to the highest standards by the county and state. It should be noted that many development decisions in the area relating to senior housing were made based on an assumption that emergency medical services would be available in the community. I have attached a letter from the Pinole Senior Village in regards to the new Assisted Living, Alzheimer, and Adult Day Care Center that they are constructingin Pinole. This letter identifies many of the concerns that they have in regards to this anticipated closure. I would expect that the Bay Parr Assisted Living Center and the two non-profit Bridge Senior Citizen housing complexes in Pinole and Hercules would express the same concerns. Tenets assurances that we will receive the same high level of emergency medical services when the services are 15 minutes farther away are no assurance to our senior community. We are aware that Tenet's argument for this closure is purely one of economics. We could appreciate this health care argument if it was focused on elective medical services. However, Tenet is cutting to the heart of basic medical service provision when they reduce our emergency medical services by 50%. The lives of our residents should not be reduced to an earnings statement or the price of their stock and people don't elect to go to the emergency room. Tenet has told us that of the 1000 emergency roam visits only 300' or 300 need the emergency room and the others can be seen by Tenet's urgent care facilities. What this really means is that there are 300 people per month that desperately need these services and will be now sent on extended trips to San Pablo. The argument is \\C.TVT(7\SY,9\ADMTNf` F(-71C1ty ManacrerMoctnr-, Hr,-nitaRRasnonce 12-2.'�Aoc 3 r, made that the full array of intensive care services will be at San Pablo, but those services were once available in Pinole. Additionally, there is no guarantee that Tenet will even keep the urgent care services open in the future. Based on Tenet's potential actions, the public sector will be forced to step in and deal with their abandonment of a basic core service. Increased service calls, emergency units being out of area for longer periods of time, and the need to train and provide more first in responders with emergency medical skills will all be the legacy that Tenet's leaves Contra Costa County, the City of Hercules, the City of Pinole, and their emergency service providers. This legacy will result in increased costs to the woefully under funded communities. This translates,into public sector costs to maximize private sector financial returns. Obviously, we would hope that Contra Costa County's final report recognizes the devastating impact that Tenet's corporate actions will have on West County and recommends against the closure. The city looks forward to seeing the county's report as soon as possible and hopes that it will have the widest possible circulation. We are prepared to participate in any public discussion and look forward to the public hearing on January 5. \\C'TVTC%SY,S\ADMTNnF(,\City mi anaaer\i octnrs WngnitaRRe.,qnnnse ,,,., Pinole Fire Department Memorandum Date: 12/22199 To: Marc Grisham, City Manager From: Tun Parrott, Fire Chief Subject: Preliminary Assessment of Doctor's Hospital Emergency Room Closure Some of the direct and indirect ramifications of the closure of Doctor's Hospital emegency room will likely encompass some or all of the following areas: 1) In cases of cardiac or respiratory arrest, fire personnel often accompany ANM paramedics in the ambulance. In the case of Station 73, it is estimated that personnel perform in this role perhaps 25 times in a year. When this does occur, our single on-duty engine company is placed out of service until the personnel are returned and all equipment is restored to ready condition. On these occasions,we activate recall and attempt to back-fill our station responsibilities with reserve and off-duty firefighters. The extra travel time to Doctor's Hospital, San Pablo, (versus the Pinole campus), is approximately 15 minutes additional driving time each way, "code 3" (lights and siren). Once there with the ambulance, the fire personnel would have to await the arrival of our fire engine or (a driver in a staff vehicle if that could be arranged). Travel time back to our district would be at least 15 additional minutes. Therefore, it can be assumed that our engine company will be out of service an:' additional 35 to 45 minutes, compared to current circumstances, for each call where ANIR is assisted by our personnel. 2) The availability of ambulances will be affected to an unknown degree. As mentioned previously, there is at least an additional 30 minute travel time(round-trip)to the Doctor's San Pablo campus. Without adding additional ambulances to the fray, the availability of ambulances will diminish. Currently, it is not uncommon for the ambulance to make a quick transport to Doctor's Pinole and quickly clear to handle the next emergency call. As mentioned at last week's public hearing, the AMR unit stationed in Pinole is among the busiest emergency ambulances in Contra Costa County. 3) Emergency medical calls may increase. It is clear that a number of victims of illness and injury privately transport themselves to the nearby Pinole hospital. It is a given that some of these patients will elect to utilize the 911 system in the future rather than take chances driving to a more distant hospital. 4) In the event of major regional emergencies, each hospital is an available resource. Persons not accessing the 911 system tend to gravitate toward the nearest hospital to seek medical aid or quell anxiety. These people will likely continue to behave this way in future situations, regardless of the level of medical expertise that is available at the hospital (ie: urgent care clinic). It is unkown whether this type of public need will also default onto the 911 services where it might have been handled, albeit slowly, at a full hospital previosly. 5) From a fire emergency standpoint, the our department would be concerned about the staff to patient ratio. Any type of emergency within the Doctor's Pinole building requires assistance by fire and/or police services. At this time, we don't have figures on the availability of trained staff to help mitigate internal emergencies in the proposed configuration. we are referring to the availability of nurses and or engineering staff to perform patient evacuation and monitor vital building Functions. Pinole Assisted Living Community 1564-A Fitzgerald Drive PMB 404 Pinole, California 94564-2229 December 21, 1999 Mr. Peter Murray Mayer City of Pinole 2131 Pear Street Pinole, CA 94564 Dear Mayor Murray: Pinole Senior Village is the new Assisted Diving, Alzheimer, and Adult Day Care Center under construction in Pinole which is owned by the Pinole Assisted Living Community, a non- profit corporation. The community will have 39 live-in residents, 49 in assisted living and 40 in the special care Alzheimer's wing. In addition it will also have up to 25 adult day care residents Monday through Friday. The average age of our live-in residents is expected to be 82. Our emphasis in the assisted living portion of the community is on serving the fra:.1 elderly, i.e., those with 2 or more limitations in Activities of Daily Diving. Even though we will be licensed as a Residential Care Facility for the elderly we will not be a medical facility or be licensed to provide medical care. Because of the age, frailty, and level of care we can provide we are very concerned about the well being of our future residents if Pinole does not have an emergency room as currently operated. There are several events that are common for the residents we will be providing care for that require stat emergency analysis and care. These events include TIA strokes, stokes, heart attacks, diabetic reactions and fractures (Lsually hip fractures from falls). It is crucial that these events and others that elderly residents of Pinole may experience be analyzed and treated as soon as possible. As an example, TIA strokes need to be quickly identified and the patient properly medicated within a short time period in order to provide proper treatment. Emergency room care in Pinole is important for Pinole. It is crucial for the elderly of Pinole, which will include our residents. Very trSz yours, John M46 n Presides Appendix E EMS Data Existing Hospital Intensive and Acute Care Bed Capacities Licensed Acute Licensed intensive Monitored Acute Care Beds Care Beds Care Beds Hospital 1998 1999 1998 1999 1998 1999 West County hospitals Doctors Pinole 136 136 14 14 12 12 %of"West County 36.9% 32.5% 31.8% 26.9% 27.3% 23.1% %of County 8.8% 8.4% 8.8% 8.3% 9.4% 8.7% Doctors San Pablo 233 233 30 30 32 32 Kaiser Richmond n/a* 50 n/a* 8 n/a* 8 West County Total 369 419 44 52 44 52 Other Contra Costa Hospitals Contra Costa Regional 164 164 8 8 10 10 John Muir 321 321 35 35 24 35 Kaiser Walnut Creek 213 229 24 24 20 20 Mt. Diablo 250 250 25 25 60 60 San Ramon Regional 123 123 12 12 5 5 Sutter Delta 109 111 12 12 8 8 County total 1549 1617 160 168 127 138 *although licensed for 50 beds,no inpatient services available in 1998 at Kaiser Richmond Source: Contra Costa EMS Agency based on information provided by hospitals. Existing Hospital Emergency Department Capacity and Patient Visits Hospital Emergency Department Emergency Department Patient Visits Treatment Stations 1998 1998 1999 Nest County Hospitals Doctors Pinole 13,733 8 8 %of West County 19.5% 18.6% 17.0% %of County 5.0% 5.5% 5.1% Doctors San Pablo 27,452 20 24 Kaiser Richmond 29,1.54 15 15 West County Total 70,339 43 47 Other Contra Costa Hospitals Contra Costa Regional 32,349 19 19 John Muir 30,991 1 S 15 Kaiser Walnut Creek 46,144 23 23 Mt, Diablo 42,626 22 22 San Ramon Regional 15,180 9 9 Sutter Delta 35,245 I5 22 County total 272,874 146 157 a N 00 (D r- Itr 00 cl� C'i C-i CC as ON rfl to ty Cli C14 52 C> cq m Q t-: 06 C� vi S2 tip as W) N00 0 Ix 't Lei m pi A4 -low 0o tits o a, IRE 0 C in co Before Closure Average Ambulance Emergency Travel Time to Closest Hospital by Community Community Closest Hospital Average Time (minutes) San Ramon San Ramon 5.4 San Pablo Doctors-SP 5.6 Martinez Contra Costa 6.7 Alamo Kaiser-WC 6.9 El Sobrante Doctors-Pinole 7.0 North Richmond Doctors-SP 7.2 Pinole Doctors-Pinole 7.2 Concord Mt Diablo 8.3 Richmond Doctors-SP 8.6 Antioch Sutter Delta 8.7 Rodeo Doctors-Pinole 9.3 Pacheco Mt Diablo 9.3 El Cerrito Doctors-SP 10.2 Crockett Doctors-Pinole 11.4 Pittsburg Sutter Delta 11.4 Moraga Kaiser-WC 11.8 Bay Point Mt Diablo 11.9 Orinda Kaiser-WC 12.1 Pleasant Hill John Muir 12.3 Kensington Doctors-SP 13.5 Oakley Sutter Delta 14.2 Brentwood Sutter Delta 14.6 Clayton John Muir 14.7 Knightsen Sutter Delta 19.3 Byron Sutter Delta 20.8 Bethel Island Sutter Delta 24.5 Discovery Bay I Sutter Delta 24.5 Source: Centra Costa EMS Agency,Ambulance Dispatch Data,January 1998—July 1999. After Closure Average Ambulance Emergency Travel Time to Closest Hospital by Community Community Closest Hospital Average Time (minutes) San Ramon San Ramon 5.4 San Pablo Doctors-SP 5.6 Martinez Contra Costa 6.7 Alamo Kaiser-WC 6.9 North Richmond Doctors-SP 7.2 Concord Mt Diablo 8.3 Richmond Doctors-SP 8.6 Antioch Sutter Delta 8.7 Pacheco Mt Diablo 1 9.3 El Sobrante Doctors-SP 10.0* El Cerrito Doctors-SP 10.2 Pittsburg Sutter Delta 11.4 Moraga Kaiser-WC 11.8 Bay Point Mt Diablo 11.9 Orinda Kaiser-WC 12.1 Pinole Doctors-SP 12.2* Pleasant Hill John Muir 12.3 Kensington Doctors-SP 13.5 Oakley Sutter Delta 14.2 Rodeo Doctors-SP 14.3* Brentwood Sutter Delta 14.6 Clayton John Muir 14.7 Crockett Doctors-SP 16.4* Knightsen Sutter Delta 19.3 Byron Sutter Delta 20.8 Bethel Island Sutter Delta 24.5 Discovery Bay Sutter Delta 24.5 Source: Contra Costa EMS Agency,Ambulance Dispatch Data,January 1998—July 1999 * Estimated. Hospital Bed Projections All Licensed Beds 1998 1199 *April 2000 # %, # % change # % change from 1998 from 1998 County Totals 1549 100% 1617 4.2% 1481 -4.6% Nest County Totals 369 100%J 419 11.9% 283 -30.4% * After proposed closure of Doctors Pinole Intensive Care Unit Beds 1998 1999 *April 2000 # % # % change # % change from 1998 from 1998 County Totals 160 100°fro 168 4.8% 154 -3.9% West County Totals 44 100% 52 15.4% 38 -15.8% * After proposed closure of Doctors Pinole Emergency Treatment Spaces 1998 1999 *April 2000 # % # % change # % change from 1998 from 1998 County Totals 146 100% 157 7.0'!0 149 2.0% West County Totals 43 100% 47 8.5% 39 -10.3% *After proposed closure of Doctors Pinole Source: Contra Costa EMS Agency based on information provided by hospitals. Emergency Department Diversion Report 1997 1998 1999* County-wide Incident Totals 88 21 18 Hours/minutes 181.4 hrs 35.1 hrs 30.4 hrs West County Incident Totals 37 6 2 Hours/minutes 83.2 hrs 6.1 hrs 5 hrs Doctors Pinole Incident Totals 3 0 1 Hours/minutes 5.4 hrs 0 hrs 2.6 hrs Doctors San Pablo Incident Totals 34 6 1 Hours/minutes 77.8 hrs 6.1 hrs 2.4 hrs ,r ,rWrc Kaiser Richmond 0 Hours/minutes / 0 hrs 'Through 11/99 Source: Contra Costa EMS Agency as reported by hospitals. Interfacility Emergency Department Patient Transfers Reported by Sending Hospitals Countywide 1998 Contra Doctors Doctors Kaiser Kaiser Mt. San Sutter Costa Pinole San Pablo John Muir Rihmond Walnut Diablo Ramon Regional cCreek Regional Delta 1/98 2 17 68 11 135 72 14 2 61 2198 2 23 64 11 153 89 3 5 53 3/98 6 19 49 18 169 74 2 10 29 4/98 4 17 54 16 149 41 6 4 51 5/98 3 27 64 20 154 40 17 6 53 6/98 4 20 56 17 160 50 26 1 53 7/98 2 27 65 12 175 40 17 2 65 8198 4 28 72 18 138 60 14 7 34 9/98 2 N/R 53 11 N/R 54 22 7 56 10/98 5 N/R 44 13 141 48 26 1 41 11/98 5 N/R 48 3 124 28 16 4 73 12/98 2 15 49 3 1 20 27 3 53 Total 41 193 686 153 =1,499 616 190 52 622 N/R=Not Reported. 01/01/99 through 11/30/99 Contra Doctors Doctors Jahn Muir Kaiser Kaiser Nit. San Sutter Costa Pinole San Pablo Richmond Walnut Diablo Ramon Delta Regional Creek Regional 1/99 3 24 41 10 157 30 17 4 70 2/99 9 20 65 12 98 30 15 5 65 3/99 5 N/R 45 13 96 37 21 5 7 4199 4 N/R 42 17 60 22 29 3 87 5/99 2 12 59 13 40 17 18 11 77 6/99 2 N/R 26 13 N/R N/R 25 4 85 7/99 7 N/R 45 8 N/R 17 22 5 61 8199 2 N/R 73 N/R 84 23 32 1 77 9/99 5 N/R 106 N/R 76 15 26 6 83 10/99 1 16 43 NIR 92 29 16 5 71 11/99 2 10 81 N/R 89 19 13 4 30 Total 42 82 626 86 792 239 234 53 713 N/R=Not Reported. Source: Contra Costa EMS Agency as reported by sending hospitals. > �}, t� n•:.:evvh,v:++x4'F.:w::KOhA+CM r.v...yx.±n!. ... n.,:..: .r...r.. y:::. s...:;. ........ :•,v:• ..... ... ............. ?{•:!.w.v.•.w.vw,t� itr�: .vrxxuvw !r::• .. Sending Hospital Rationale for Emergency Department Patients Transferred To Doctors Pinole and Doctors San Pablo 01101198 through 11/30/99 Doctors Pinole Doctors San Pablo Transfer Rationale Total transfers received 31 100.0% 520 100.0% Higher level of care 21 67.7% 504 96.9% Not marked 2 6.5% 0 0.0% Patient Request 2 6.5% 5 1.0% No bed at sending facility 1 3.2% 4 0.8% Insurance 0 0.0% 1 0.2% Other 5 16.1% 6 1.2% Source: Contra Costa EMS Agency as reported by sending hospitals. Receiving Hospital for Emergency Department Patients Transferred From Doctors Pinole and Doctors San Pablo 01/01/98 through 11/30/99 Transfers to: Doctors Pinole Doctors San Pablo Totals transferred to other facilities 275 100.0% 1,312 100.0% Contra Costa Regional 74 26.9% 574 43.7% Kaiser Oakland 47 17.1% 103 8.2% Children's Oakland 45 16.4% 369 28.1% Doctors San Pablo 31 11.3% Doctors Pinole 11 0.8% John Muir 0 0.0% 39 3.0% Kaiser Vallejo 18 6.5% 10 0.8% Kaiser Walnut Creek 14 5.1% 17 1.2% Alta Bates 8 2.9% 31 2.3% Kaiser Richmond 6 2.2% 29 2.1% Other 32 11.6% 129 9.8% Source: Contra Costa EMS Agency as reported by sending hospitals. Categories of Emergency Department Patients Transferred From Doctor's Pinole & Doctors San Pablo 01/01/98 through 11/30/99 Doctors Pinole Doctors San Pablo Category Total reported transfers 275 100.0% 1,312 100.0% General Medical 78 28.4% 181 13.8% Psychiatric 74 26.9% 585 44.6% Pediatric 49 17.8% 353 26.9% Respiratory 19 6.9% 27 2.1% Trauma 18 6.5% 34 16% Cardiac 13 4.7% 24 1.8% OB/Gyn 8 2.9% 9 0.7% Neurosurgery 7 2.5% 50 3.8% General Surgery 6 2.2% 42 3.2% Other/not marked 3 1.2% 7 0.5% Source: Contra Costa EMS Agency as reported by sending hospitals. Rationale Given for Transferring Emergency Department Patients From Doctors Pinole & Doctors San Pablo 01/01/98 through 11/30/99 Doctors Pinole Doctors San Pablo Transfer Rationale Total reported transfers 275 100.0% 1312 100.0% Higher level of care 83 30.3% 199 15.1% Insurance 80 29.1% 99 7.5% 5150(psychiatric hold) 73 26.5% 580 44.2% Patient request 19 6.9% 55 4.2% Other/not marked 13 4.7% 89 6.8% No bed 7 2.6% 290 22.2010 Source: Contra Costa EMS Agency as reported by sending hospitals Triage and Hospitalization of Non-Critical Trauma patients Countywide/West County/Doctor's Hospitals 1998 1994 (1/1!98-1 1131199) Non-Critical Trauma Transports # % # % County-wide Trauma patients triaged as"Non-critical" 1,739 100.0% 1,733 100.0% Non-critical trauma patients requiring hospital admit. 237 13.6% 153 8.8% West County Trauma patients triaged as"Non-critical" 414 100.0% 404 100.0% Non-critical trauma patients requiring local hospital 80 19.3% 42 10.4% admission. Pinole Campus Trauma patients triaged as"Non-critical" 111 100.0% 87 100.0% Non-critical trauma patients requiring local 20 18.0% 9 10.3% hospital admission. San Pablo Campus Trauma patients triaged as"Non-critical' 296 100.0% 306 100.0% Non-critical trauma patients requiring local 60 20.3 32 10.5 hospital admission. Source: Contra Costa EMS Agency based on trauma triage information provided by John Muir Trauma Center and follow-up data provided by receiving hospitals for January 1948 through November 1999. !a�- Number of Dispatches, Response Code and Response Level Pinole Zone* 1998 1999 Total Dispatches 2,823 100.0% 2,731 100.0% Code 3 Dispatches 2433 86.2 2340 85.7 Code 2 Dispatches 390 13.8 391 14.3 Total Code 3 Dispatches 2,433 100.0% 2,340 100.0% ALS Response 2402 98.7 2301 98.3 BLS Response 31 1.3 39 1.7 Total Code 2 Dispatches 390 100.0% 391 100.0% ALS Response 251 64.4 255 65.2 BLS Response 139 35.6 136 34.8 *Pinole Zone includes Pinole,Rodeo,Hercules,Crockett,Port Costa and El Sobrante. Source: Contra Costa EMS Agency based on ambulance dispatch data. West Contra Costa County 1998 1999 Total Dispatches 16,539 100.0% 15,761 100.0% Code 3 Dispatches 14,176 85.7 13,488 85.6 Code 2 Dispatches 2,363 14.3 2,273 14.4 Total Code 3 Dispatches 14,176 100.0% 13,488 100.0% ALS Response 13,990 98.7 13,142 97.4 BLS Response 186 1.3 346 2.6 Total Code 2 Dispatches 2,363 100.0% 2,273 100.0% ALS Response 1,181 50.0 1,05 44.2 BLS Response 1,182 50.0 1,268 55.8 Source: Contra Costa EMS Agency based on ambulance dispatch data. lam' Emergency (Dispatch and Ambulance Data Number of Dispatches, Response Code, and Response Level by Ambulance Provider 1998 American Medical San Ramon Valley All Providers Response Fire MoragalOrenda Fere Total Dispatches 53,490 100.0% 50,007 100.0% 2,368 100.0% 1,115 100.0% Code 3 Dispatches 42,199 78.9 38,847 77.7 2,276 96.1 1,076 96.5 Cade 2 Dispatches 11,291 21.1 11,160 22.3 92 3.9 39 3.5 ToWCode3Dispatdres 42,199 100.0% 38,847 100.0% 2,276 100.0% 1,076 100.0% ALS Response 41,697 98.8 38,345 98.7 2,276 100.0 1,076 100.0 BLS Response 502 1.2 502 1.3 0 0.0 0 0.0 Total Code2Dispatches 11,291 100.0% 11,160 100.0% 92 100.0% 39 100.0% ALS Response 6,369 56.4 6,238 55.9 92 100.0 39 100.0 BLS Response 4,922 43.6 4,922 44.1 0 0.0 0 0.0 Source: Contra Costa EMS Agency based on ambulance dispatch data. 1999 All Providers American Medical San Ramon Valley Moraga/Orinda Fire Response Fire Total Dispatches 51,945 100.0% 47,248 100.0 3,243 100.0 1,454 100.0% Code 3 Dispatches 40,410 77.8 35,879 75.9 3,079 94.9 1,452 99.9 Cade 2 Dispatches 11,535 22.2 11,369 24.1 164 5.1 2 0.1 TotalCode3Dispatches 40,410 100.0% 35,879 100.0% 3,079 100.0% 1,452 100.0% ALS Response 39,608 98.0 35,077 97.8 3,079 100.0 1,452 100.0 BLS Response 802 2.0 802 2.2 0 0.0 0 0.0 Total Code 2 Dispatches 11,9W 100.0% 11,369 100.0% 164 100.0% 2 100.0% ALS Response 5,802 50.3 5,636 49.6 164 100.0 2 100.0 BLS Response 5,733 49.7 5,733 50.4 0 0.0 0 U Source: Contra Costa EMS Agency based on ambulance dispatch data. V Patient Transport by Ambulance Provider Pinole Zone* American Medical Response 1998 1999 Total Dispatches 2,823 100.0% 2,731 100.0% Transported 1,999 70.8 1,900 69.6 Canceled 824 29.2 831 30.4 Total Patient Transports 1,999 100.0% 1,900 100.0% Transported Code 3 176 8.8 492 25.9 Transported Code 2 1,805 90.3 1,392 73.3 Helicopter Transport 18 0.9 16 0.8 Total Canceled 824 100.0% 831 100.0% Enroute 204 24.8 177 21.3 On Scene 620 75.2 654 78.7 Includes Pinole,Rodeo,Hercules,Crockett,Port Costa and El Sobrante Source: Contra Costa EMS Agency based on ambulance dispatch data. West Contra Costa County American Medical Response 1998 1999 Total Dispatches 16,539 100.0% 15,761 100.0% Transported 11,827 71.5 11,717 74.3 Canceled 4,712 28.5 4,044 25.7 Total Patient Transports 11,827 100.0% 11,717 100.0% Transported Cade 3 948 8.0 2,912 214.9 Transported Code 2 10,824 91.5 8,710 74.3 Helicopter Transport 55 0.5 95 0.8 Total Canceled 4,712 100.0% 4,044 100.0% Enroute 1,043 22.1 869 21.5 On Scene 3,669 77.9 3,175 78.5 Source: Contra Costa EMS Agency based on ambulance dispatch data. Patient Transports by Ambulance Provider 1998 All Providers American Medical San Ramon Valley Moraga/Qrinda Fire Response// Fire Total Dispatches 53,490 100.0% 50,007 100.0% 2,368 100.0% 1,115 100.0% Transported 38,510 72.0 36,047 72.1 1,773 749 690 61.9 Canceled 14,980 28.0 13,960 27.9 595 25.1 425 38.1 Total Patient Transport 38,510 99.7% 36,047 99.7% 1,773 100.0% 690 100.0% Transported Code 3 3,272 8.5 3,132 8.7 117 6.6 23 3.3 Transported Code 2 35,129 91.2 32,806 91.0 1,656 93.4 667 96.7 Helicopter Transport 109 0.3 109 0.3 0 0.0 0 0.0 Total Canceled 14,980 100.0% 13,960 100.0% 595 100.0% 425 100.0% Enroute 3,140 21.0 3,011 21.6 60 10.1 69 16.2 tan Scene 11,840 79.0 10,949 78.4 535 89.9 356 83.8 Source: Contra Costa EMS Agency based on emergency ambulance dispatch data. 1999 (through November 30) All Providers American Medical San Ramon Valley Moraga/Orinda Fire Response Fire Total Dispatches 51,945 100.0% 47,248 100.0% 3,243 100.0°l 1,454 100.0% Transported 36,462 70.2 35,104 74.3 539 16.6 819 56.3 Canceled 15,483 29.8 12,144 25.7 2,704 83.4 635 43.7 TotalPatimtTransports 36,46 99.310 35,104 99.3% 539 100.0°l 819 100.0% Transported Code 3 9,273 25.4 9,186 26.2 43 8.0 44 5.4 Transported Code 2 26,944 73.9 25,673 73.1 496 92.0 775 94.6 Helicopter Transport 245 0.7 24 0.7 0 0.0 0 0.0 Total Canceled 15,483 100.0% 12,144 100.0% 2,704 100.0°! 635 100.0% Enroute 3,448 22.3 2,538 20.9 815 30.2 94 14.8 On Scene 12,035 77.7 9,606 79.1 1,888 69.8 541 85.2 Source: Contra Costa EMS Agency based on emergency ambulance dispatch data, Responses by Community, Response Code, Average Code 3 Response Time and RLS Response Code 3 Pinole Zone* 1998 All Responses Code Two Code Three Community # % # °10 # % Awe BLSUnitont,v Time** on Repe Totals 2,823 100.0% 390 13.8 2,433 86.2% 7.29 31 0.2% El Sobrante 585 20.7 61 10.4 524 89.6 7.96 9 1.7 Pinole 1,239 43.9 145 11.7 1,094 88.3 6.23 12 1.1 Hercules 596 21.1 101 16.9 495 811 7.83 3 0.6 Rodeo 273 9.7 56 20.5 217 79.5 8.00 3 1.4 Crocker 124 4.4 26 21.0 98 79.0 10.80 4 4.1 Port Costa 6 1 0.2 1 1 16.7 5 83.3 17.80 0 0.0 *Pinole Zone includes Pinole,Rodeo,Hercules,Crockett,Port Costa and El Sobrante. **Average response times are in minutes and do not include calls canceled enroute or Paramedic First Responder calls. Source. Contra Costa EMS Agency based on ambulance dispatch data. West Contra Cosh County 1998 All Responses Code Two Code Three Community # % # % # % AmwVRqxm BLSUt*o* Tune* on PZVOM Totals 16,539 100,0% 2,363 14.3% 14,176 85.7% 6.88 186 1.3% Richmond 9,031 54.6 1,180 13.1 7,851 86.9 6.75 104 1.3 San Pablo 2,773 16.8 542 19.5 2,231 80.5 6.24 27 1.2 El Cerrito 1,476 8.9 212 14.4 1,264 85.6 7.55 22 1.7 El Sobrante 585 3.5 61 10.4 524 89.6 7.96 9 1.7 North Richmond 272 1.6 20 7.4 252 92.6 � 7.02 0 0.0 Kensington 164 1.0 19 11.6 _ 145 88.4 11.34 2 1.4 Pinole 1,239 7.5 145 11.7 1,094 88.3 6.23 12 1.1 Hercules 596 3.6 101 16.9 495 83.1 7.83 3 0.6 Rodeo 273 1.7 56 20.5 217 79.5 8.00 3 1.4 Crocker 124 0.7 26 21.0 98 79.0 10.80 4 4.1 Port Costa 1 6 0.0 1 16.7 5 83.3 17.80 0 0.0 Source: Contra Costa EMS Agency based on ambulance dispatch data. Responses by Community, Response Cade, Average Code 3 Response Time and BLS Response Code 3 1998 All Responses Code Two Code Three Community tt .t,t tt % % # % AVMVRe)om B1..SUnito* Time* onRegxxm Totals 53,490 100.0% 11,291 21.1%, 42,199 789% 7.22 499 1.2% Richmond 9,030 16.9 1,180 13.1 7,850 86.9 6.75 104 1.3 San Pablo 2,772 5.2 5421 19.6 2,230 80.4 6.24 27 1.2 El Cerrito 1,476 2.8 212 14.4 1,264 85.6 7.55 22 1.7 El Sobrante _ 585 1.1 61 10.4 524 89.6 7.96 -9 1.7 North Richmond 272 0.5 20 7.4 252 92.6 7.02 0 0.0 Kensington 164 0.3 19 11.6 145 88.4 11.34 2 1.4 Pinole 1,234 2.3 144 11.7 1,090 88.3 6.22 12 1.1 Hercules 595 1.1 101 17.0 494 83.0 7.83 3 0.6 Rodeo 273 0.5 56 20.5 217 79.5 8.00 3 1.4 Crocket 118 0.2 24 20.3 94 79.7 10.77 4 4.3 Port Costa 6 0.0 1 16.7 5 83.3 17.80 0 0.0 Concord 8,280 15.5 2,324 28.1 5,956 71.9 7.02 71 1.2 Martinez 2,608 4.9 773 29.6 1,835 70.4 7.85 67 3.7 easant Hill 2,010 3.8 508 25.3 1,502 74.7 7.61 19 Pl1.3 Pacheco 266 0.5 82 30.8 184 69.2 8.67 3 1.6 Clayton* 349 0.7 87 24.9 262 75.1 12.54 3 1.1 Clyde 19 _ 0.0 4 21.1 15 78.9 8.75 0 0.0 Walnut Creek 5,307 9.9 1,196 22.5 4,111 77.5 7.23 38 0.9 Lafayette 1,061 �2.0 292 27.5 769 72.5 9.17 7 .9 Orinda 520 1.0 39 7.5 481 92.5 7.75 0 0.0 Moraga 541 1.0 33 6.1 508 93.9 6.32 0 0.0 Alamo 303 0.6 13 4.3 290 95.7 5.80 0 0.0 Danville 952 1.8 51 5.4 901 94.6 5.59 0 0.0 San Ramon 1,099 2.1 41 3.7 1,058 96.3 5.21 0 0.0 Antioch 4,861 9.1 1,279 26.3 3,582 73.7 6,99 40 1.1 Pittsburg 4,630 8.7 1,247 26.9 3,383 73.1 7.29 37 1.1 Bay Point 1,231 2.3 246 20,0 985 80.0 7.38 1.3 1.3 Oakley 687 1.3 176 25.6 511 74.4 8,89 2 0.4 Bethel Island 351 0.7 105 29.9 246 70.1 13.96 3 1.2 Knightsen 113 0.2 39 52.7 74 100.0 8.93_ 0 0.0 Brentwood* 922 1.7 241 26.1 681 73.9 8.75 5 0.7 Discovery Bay* 205 0.4 60 29.3 145 70.7 16.49 0 0.0 Byron* 1 0.2 26 25.2 77 74.8 13.25 0 0.0 Out of County 46 0.1 18 39.1 1 28 60.9 8.44 1 3.6 Other/Unknown 501 0.9 51 10.2 450 89.8 16.65 4 0.9 *Average response times do not include calls canceled enroute or Unit 75 calls Average Code 3 Response Time and BLS Response Code 3 Pinole Zone* 1999(through November 30}x') All Responses Code Two Code Three Community A W SUnit on # % # % # % P&pmTm*** Cb&3Raq=w Totals 2,731 100.0%n 391 14.3% 2,340 85.7% 7.57 39 0.3% El Sobrante 453 16.6 63 13.9 39 86.1 7.75 8 2,1 Pinole 1,0151 38.5 113 10.8 938 89.2 6.29 17 1.8 Hercules 636 23.3 100 15.7 536 84.3 7.79 8 1.5 Rodeo 355 13.0 78 22.0 277 78.0 8.42 2 0.7 Crocket 229 8.3 36 15.7 193 84.3 11.84 4 2.1 Port Costa 7 0.3 1 14.3 85.7 12.25 0 0.0 *Pinole Zone includes Pinole,Rodeo,Hercules,Crockett,Port Costa and El Sobrante. **Average response times are in minutes and do not include calls canceled enroute or Paramedic First Responder calls. Source: Contra Costa EMS Agency based on ambulance dispatch data. Nest Contra Costa County 1999(through November 301') All Responses Code Two Code Three Community Av a B1SUnito*on # # % # % PA"=Thne Cb&3 Totals 15,761 100.0% 2,273 14.4% 13,488 85.6% 7.05 346 2.6% Richmond 8,961 56.9 1,159 12.9 7,802 87.1 6.98 210 2.7 San Pablo 2,508 28.0 509 20.3 1,999 79.7 � 6.08 55 2.8 El Cerrito 19350 8.6 192 14.2 1,158 85.8 7.60 37 3.2 El Sobrante 453 2.9 63 13.9 390 86.1 7.75 8 2.1 North 19 0.1 1 5.3 18 94.7 6.71 0 0.0 Richmond Kensington 192 1.2 21 10.9 171 89.1 11.60 5 2.9 Pinole 1,051 6.7 113 10.8 938 89.2 6.29 17 1.8 Hercules 636 4.0 100 15.7 536 84.3f7.79 8 1.5 Rodeo 355 22.6 78 22.0 277 78.02 2 0.7 Crocket 229 1.5 36 15.7 193 84.34 4 2.1 Port Costa 7 0.0 1 14.3 6 85.7 12.25 J. 0 0.0 Source: Contra Costa EMS Agency based on ambulance dispatch data. Responses by Community, Response Code, Average Code 3 Response Time and BLS Response Code 3 1999 (through November 30th) All Responses Code Two Code Three Community o Atierv#ReWom USUnitonly /o # # /o # /a Time'' onPeWom Totals 51,945 97.111,535 22.2 40,410 77.8 7.16 802 2.0 Richmond 8,961 16.81' 509 1,159 12.9 7,802 87.1 6.98 210 2.7 San Pablo 2,508 4.7 20.3 1,999 79.7 6.08 55 2.8 El Cerrito 1,350 2.5 192 14.2 1,158 85.8 7.60 37 3.2 El Sobrante 453 0.8 63 139 390 86.1 7.75 8 2.1 North Richmond 19 0.0 1 5.3 18 94.7 6.71 0 0.0 Kensington 192 0.4 21 109 171 89.1 11.60 5 2.9 Pinole 1,051 2.0 113 10.8 938 89.2 6.29 17 1.8 Hercules 636 1.2 100 15.7 536 84.3 7.79 8 1.5 Rodeo 355 0.7 78 22.0 277 78.0 8.42 2 0.7 Crocket 229 0.4 36 15.7 193 84.3 11.84 4 2.1 Port Costa 7 0.0 1 14.3 6 85.7 12.25 0 0.0 Concord 7,909 14.8 2,469 31.2 5,440 68.8 6.79 114 2.1 Martinez 2,511 4.7 810 32.3 1,701 67.7 79368 4.0 Pleasant Hill 1,871 3.5 531 28.4 1,340 71.6 6.50 21 1.6 Pacheco 160 0.3 30 18.8 130 81.3 7.16 4 3.1 Clayton* 371 0.7 93 25.1 278 74.9 10.60 6 2.2 Clyde 8 0.0 1 12.5 7 87.5 9.57 0 0.0 Walnut Creek 4,840 9.0 1,285 26.5 3,555 73.5 7.37 48 1.4 Lafayette 876 1.6 252 28.8 624 71.2 8.95 6 1.0 Orinda 803 1.5 18 2.2 785 97.8 8.29 2 0.3 Moraga 602 1.1 7 1.2 595 98.8 7.70 0 0.0 Alamo 312 0.6 23 7.4 289 92.6 5.19 0 0.0 Danville 1,213 2.3 66 5.4 1,147 94.6 4.74 0 0.0 San Ramon 1,067 2.0 55 5.2 1,012 94.8 4.23 0 OA Antioch 4,800 9.0 1,394 29.0 3,406 71.0 6.67 64 1.9 Pittsburg 4,494 8.4 1,291 28.7 3,203 71.3 7.27 74 2.3 Bay Point 1,091 2.0 249 22.8 842 77.2 7.51 14 1.7 Oakley 859 1.6 210 24.4 649 75.6 9.05 11 1.7 Bethel lsland 249 0.5 68 27.3 181 72.7 14.4$ 4 2.2 Knightsen 12 0.0 - 0.0 12 100.0 13.20 1 8.3 Brentwood* 1,006 1.9 257 25.5 749 74.5 8.98 14 1.9 Discovery Bay* 192 0.4 64 33.3 128 66.7 17.11 3 23 Byron* 127 0.2 40 31.5 $7 68.5 15.60 2 2.3 Other/Unknown 811 1.5 49 6.01--7 6 .0 5.30 0 0.0 *Average response times do not include calls canceled enroute or Unit 75 calls. Number of Ambulance Transports by Hospital Destination and Transport Cade Pinole Zone 1998 All Transports Code Three Code Two Transport Code Hospital Transports Transports Unknown Totals 1,999 100.0°! 189 9.5% 1,810 90.5% 0 0.0 Contra Costa Reg. 145 7.3 7 4.8 138 95.2 0 0.0 .Doctors,Pinole 1,386 69.3 127 9.2 1,259 90.8 0 OA Doctors, San Pablo 248 12.4 11 4.4 237 95.6 0 0.0 John Muir 23 1.2 16 69.6 7 30.4 0 0.0 Kaiser,Richmond 0 0.0 0 0.0 00 0.0 0 0.0 Kaiser, Walnut Crk 3 0.2 1 33.3 2 66.7 0 0.0 M .Diablo 5 0.3 0 0.0 5 100.0 0 0.0 San Ramon Reg 0 0.0 0 0.0 0 0.0 0 0.0 Sutter/Delta 0 0.0 0 0.0 0 0.0 0 0.0 ValleyCare 0 0.0 0 0.0 0 0.0 0 0.0 Alta Bates 8 0.4 0 0.0 8 100.0 0 0.0 Children's 8 0.4 2 25.0 6 75.0 0 0.0 Eden 0 0.0 0 0.0 0 0.0 0 0.0 Highland 0 0.0 0 0.0 0 0.0 0 0.0 Kaiser,Vallejo 105 5.3 1 1.0 104 99.0 0 0.0 Kaiser,Oakland 9 0.5 0 0.0 9 100.0 0 0.0 Summit 0 0.0 0 0.0 0 0.0 0 0.0 Kaiser, an Rafael 0 0.0 0 0.0 0 0.0 0 0.0 Sutter Solano 3 0.2 0 0.0 3 100.0 0 0.0 llekopterTmnspott 18 0.9 13 72.2 5 27.8 0 0.0 0ther/Unknown 38 19 11 28.9 27 71.1 0 0.0 Source: Contra Costa EMS Agency based on ambulance dispatch data. f Number of Ambulance Transports by hospital Destination and Transport Code West Contra Costa County 1998 All Transports Code Three Code Two Transport Code Hospital Transports Transports Unknown Totals 11,827 100.0% 985 8.3% 10,839 91.6% 3 <0.1% Contra Costa Reg. 832 7.0 44 5.3 788 94.7 0 0.0 Doctors, Pinole 2,072 17.5 179 8.6 1,893 91.4 0 0.0 Doctors, San Pablo 7,652 64.8 582 7.6 7,080 92.4 0 0.0 John Muir 74 0.6 51 5$9 23 31.1 fl 0.0 Kaiser, Richmond 1 OA ..0 0.0 1 100.fl 0 0.0 Kaiser, Walnut Crk 8 0.1 1 12.5 7 87.5 0 0.0 Mt. Diablo 14 0.1 4 28.6 10 71 A 0 0.0 San Ramon Reg 0 0.0 0 0.0 0 0.0 0 0.0 Sutter/Delta 0 0.0 0 0.0 0 0.0 0 0.0 Va1leyCare fl 0.0 fl 0.0 0 OA 0 0.0 Alta Bates 423 3.6 15 3.5 408 96.5 4 0.0 Children's 81 0.7 14 17.3 67 82.7 0 0.0 Eden 1 0.0 0 0.0 1 100.0 0 0.0 Highland 10 0.1 3 30.0 7 70.0 0 0.0 Kaiser,Vallejo 135 1.1 1 0.7 134 99.3 0 OA Kaiser,Oakland 185 1.6 4 2.2 181 97.8 0 0.0 Summit 0 0.0 0 0.0 0 0.0 0 0.0 Kaiser, San Rafael 3 0.0 0 0.0 3 100.0 0 0.0 Sutter Solano 3 0.0 0 OA 3 100.0 0 0.0 Helir fh;r 55 0.5 37 67.3 15 27.3 3 5.5 Other/Unknown 268 2.3 50 18.7 218 81.3 0 O.fl Source: Contra Costa EMS Agency based on ambulance dispatch data. Number of Ambulance Transports by Hospital Destination and Transport Code 1998 All Transports Code Three Code Two 'Transport Cotte Hospital Transports Transports Unknown # % # % # % # % Totals 38,510 100.0°l 3,332 8.7% 35,154 91.3°/ 24 <0.1% Contra Costa Reg. 4,744 12.3 281 5.9 4,463 94.1 0 0.0 Doctors,Pinole 2,112 5.5 181 8.6 1,931 91.4 0 0.0 Doctors, San Pablo 7,728 20.1 588 7.6 7,140 92.4 0 0.0 John Muir 4,458 11.6 601 13.5 3,857 86.5 0 0.0 Kaiser,Richmond 3 0.0 0 0.0 3 100.0 _ 0 0.0 Kaiser, Walnut Crk 3,239 8.4 246 7.6 2,993 92.4 0 0.0 Kaiser,Martinez 3 0.0 0 0.0 3 100.0 0 0.0 Mt, Diablo 7,677 19.9 675 8.8 7,002 91.2 0 0.0 San Raman Reg 850 2.2 61 7.2 789 92.8 0 0.0 Sutter/Delta 5,658 14.7 484 8.6 5,174 91.4 0 0.0 Valley Care 23 0.1 0 0.0 23 100.0 0 0.0 Alta Bates 644 1.7 25 3.9 619 96.1 0 0.0 Children's 137 0.4 �29 21.2 108 78.8 0 0.0 Eden 15 0.0 3 20.0 12 80.0 0 0.0 Highland 11 0.0 3 27.3 8 72.7 0 0.0 Kaiser,Vallejo 155 0.4 1 0.6 154 99.4 0 0.0 Kaiser, Oakland 145 0.4 4 2.8 141 97.2 0 0.0 Summit 23 0.1 0 0.0 23 100.0 0 0.0 1-leliaopterTranspott 109 �0.3 60 55.0 25 22.9 24 22.0 Kaiser, San Rafael 3 0.0 0 0.0 3 100.0 0 0.0 Sutter Solano 27 0.1 1 3.7 26 96.3 0 0.0 Other/Unknown 1 746 1.9 89 11.9 657 88.1 0 0.0 Source: Contra Costa EMS Agency based on ambulance dispatch data. t Number of Emergency .Ambulance Transports by Hospital Destination and Transport Code Pinole Zone 1999 (through November 30) All Transports Code Three Code Two Transport Cade Hospital y{ yy Transports+/ Transports Unknown Totals 1,900 100.0% 498 26.2% 1,393 73.3% 9 0.5% Contra Costa Reg. 174 9.2 80 46.0 94 54.0 0 0.0 Doctors,Pinole 1,243 714.4 295 23.7 948 76.3 0 0.0 Doctors, San Pablo 147 11.8 38 25.9 109 74.1 0 0.0 John Muir 16 10.9 13 81.3 3 18.8 0 0.0 Kaiser, Richmond 116 725.0 25 21.6 91 78.4 0 0.0 Kaiser, Walnut Crk 5 4.3 0 0.0 5 100.0 0 0.0 Mt. Diablo 2 40.0 1 50.0 1 50.0 0 0.0 San Ramon Reg 0 0.0 0 0.0 0 0.0 0 0.0 Sutter/belta 0 0.0 0 0.0 0 0.0 0 0.0 ValleyCare ^ 0 0.0 0 0.0 0 0.0 0 0.0 Alta Bates 11 0.0 2 18.2 9 81.8 0 0.0 Children's 13 118.2 7 53.8 6 46.2 _ 0 0.0 Eden 0 0.0 0 0.0 0 0.0 0 0.0 Highland 0 0.0 0 0.0 0 0.0 �0 0.0 Kaiser,Vallejo 141 0.0 26 18.4 115 81.6 0 0.0 Kaiser,Oakland 4 2.8 0 0.0 4 100.0 0 0.0 Summit 0 0.0 0 0.0 0 0.0 0 0.0 Kaiser, San Rafael 0.0 0 0.0 0 0.0 0 0.0 Sutter Solana 1 0.0 0 0.0 1 100.0 0 0.0 s HelioTransport 16 1600.0 6 37.5 1 6.3 9 56.3 Other/Unknown 11 68.8 5 45.5 6 54.5 0 0.0 Source: Contra Costa EMS Agency based on ambulance dispatch data. A Number of Emergency Ambulance Transports by Hospital Destination and Transport Code West Contra Costa County 1999(through November 30) All Transports Code Three Cade Two Transport Code Hospital Transports Transports Unknown # % # % ## % # % Totals 11,717 100.0% 2,962 25.3% 8,716 74.4% 39 <0.1% Contra Costa Reg. 997 8.5 458 45.9 539 54.1 0 0.0 Doctors, Pinole 1,811 15.5 409 22.6 1,402 77.4 0 0.0 Doctors, San Pablo 6,483 55.3 1,433 22.1 5,050 77.9 0 0.0 John Muir 75 0.6 64 85.3 11 14.7 0 0.0 Kaiser,Richmond 1,241 10.6 342 27.6 899 72.4 0 0.0 Kaiser, Walnut Crk 100.1 0 0.0 10 100.0 0 0.0 Mt.Diablo 6 0.1 1 16.7 5 83.3 0 0.0 San Raman Reg 0 0.0 0 0.0 0 0.0 0 0.0 Sutterlllelta 0 0.0 0 0.0 0 0.0 0 0.0 ValleyCare 0 0.0 0 0.0 0 0.0 0 0.0 Alta Bates 414 3.5 76 18.4 338 81.6 0 0.0 Children's 113 1.0 47 41.6 66 58.4 0 0.0 Eden 0 0.0 0 0.0 0 0.0 -0 0.0 Highland 5 0.0 3 60.0 2 40.0 0 0.0 Kaiser,Vallejo 178 1.5 34 19.1 144 80.9 0 0.0 Kaiser,Oakland 146 1.2 -14 9.6 132 90.4 0 0.0 Summit 0 0.0 0 0.0 0 0.0 0 0.0 Kaiser, San Rafael 12 0.1 4 33.3 8 66.7 0 0.0 Sutter Solano 1 0.0 0.0 1 100.0 0 0.0 HelirTianspart 95 0.8 50 52.6 7 7.4 38 40.0 Other[Unknown 130 1.1 27 20.8 102 78.5 1 0.8 Source: Centra Costa EMS Agency based on ambulance dispatch data. 0 CI Dumber of Ambulance Transports by Hospital Destination and Transport Code 1999 (through November 30) All Transports Cade Three Cade Two Transport Code Hospital Transports Transports Unknown # % # % # % # % Totals 36,462 100.0% 9,387 25.7% 26,963 73.9% 112 0.3% Contra Costa Reg. 4,856 13.3 1,917 39.5 2,939 60.5 0 0.0 Doctors, Pinole 1,821 5.0 410 22.5 1,411 77.5 E10 0.0 Doctors, San Pablo 6,490 17.8 1,436 22.1 5,054 77.9 0.0 John Muir 4,165 11.4 1,143 27.4 3,022 72.6 0.0 Kaiser, Richmond 1,248 3.4 344 27.6 904 72.4 0.0 Kaiser, Walnut Crk 3,107 8.5 659 21.2 2,448 78.8 0 0.0 Kaiser, Martinez Mt. Diablo 6,972 19.1 1,722 24.7 5,250 75.3 0 0.0 San Ramon Reg 297 0.8 26 8.8 271 91.2 0 0.0 Sutter/Delta 5,601 15.4 1,314 23.5 4,287 76.5 0 0.0 Valley Care 13 0.0 1 7.7 12 92.3 0 0.0 Alta Bates 628 1.7 96 15.3 532 84.7 0 0.0 Children's 183 0.5 75 41.0 108 59.0 0 0.0 Eden 3 0.0 2 66.7 1 33.3 0 0.0 Highland 5 0.0 3 60.0 2 40.0 0 0.0 Kaiser, Vallejo 211 0.6 35 16.6 176 83.4 0 0.0 Kaiser, Oakland 159 0.4 14 8.8 145 91.2 0 0.0 Summit 15 0.0 - 0.0 15 100.0 0 0.0 Helicol t Tmnspart 12 0.0 4 33.3 8 66.7 0 0.0 Kaiser, San Rafael 17 0.0 2 11.8 15 88.2 0 0.0 Sutter Solano 245 0.7 114 46.5 20 8.2 111 45.3 Other/Unknown 414 1.1 70 16.9 343 82.9 1 0.2 Source: Contra Costa EMS Agency based on ambulance dispatch data. t California Department of Transportation Anticipated West Contra Costa Projects Southbound Interstate 80: - No major projects planned. Northbound Interstate 80: Construction of new Carquinez Bridge. The existing bridge will remain open during the construction period. Addition of a high occupancy vehicle lane (HOV) from HWY 80 in the Hwy 4 area to the Carquinez Bridge within 3- - 5 years. During construction Caltrans plans to keep all lanes open during peak hours(ham— l0am; Spm—7pm) and 2 lanes open during off-peak hours. Source: California Department of Transportation, Ace Worsen, Office Chief of Design C� 15 ,01-7 Appendix F Comments from Impacted Agencies Hospital Council #1940 December 16, 1999 Art Lathrop Director, EMA Agency Contra Costa County 50 Glacier Drive Martinez, CA 94553 Dear Art: On behalf of the Hospital Council members, I am submitting the following as input for the local impact evaluation of the realignment of the Doctors Medical Center emergency department services to the San Pablo campus. A central purpose of AB 2103 was to increase the notice period of a change in emergency department services so that the local community can take steps to collaboratively plan as appropriate. The notification by Doctors Medical Center of the closure of the Pinole campus emergency department has provided an opportunity for health care providers, including hospitals, the EMS Agency, and other stakeholders to undertake this planning process. In compliance with AB 21103, the scope of the process is to be focused on the impact of the closure of the emergency medical services. Hospitals recognize that there are other issues that arise relatinato a downgrade or closure of services: however, pursuant to AB Z� - 2103 this process is focused solely on the impact on emergency medical services. The impact evaluation should consider the factors that will mitigate the impact of the downgrade or closure on emereency medical services. The closure should not be considered "in a vacuum," but should be viewed in the context of the impact on the overall EMS system and any steps taken by the hospital or other health care providers to meet the emergency health care needs of the community. The analysis of the impact of an emergency department downgrade or closure must consider the net impact and account for any mitigating steps taken by community providers. The analysis by the EMS Agency for the impact evaluation should be very specific to the local situation under consideration. For example, it is well known that many patients who seek treatment in an emergency department do not in fact need emergency health services and could be more appropriately and effectively served in a primary care or urgent care setting. In 1997 38% of all emergency department visits were for non- emergency conditions. The specific need of patients in the local situation of the emergency department downgrade or closure should be considered in the impact evaluation analysis. AB 2 103 directs a local EMS Agency to do an impact evaluation and does not direct that specific recommendations be made as to whether the hospital can or should proceed with the down-rade or closure. If recommendations will be made, the Hospital Council 0 D:\HCNCC\EBHC,1999\1999 letters&mernosALathrop re A82103 12-16-99.doc Hospital Council of Northern and Central California - Bav Area Division 28.50 Tele-raphAvenue,6th Floor - Bt-rkeiey,California�)4705 - Fax -j W-705-8992 Phone i10-705-391)o supports recommendations that relate to the overall effectiveness and accessibility of the EMS system. We expect to continue to participate in the development and implementation of recommendations that would enhance the effectiveness of the EMS system. For vour information and use Z have attached two charts form our recently released East Bay Hospital Capacity Study. The supply data include the decrease in emergency department beds at Doctors Medical Center, Pinole campus. You will note that in Contra Costa as a whole as well as in the North subrecrion, there are more emergency department beds than even the most conservative, peals demand projections will require in the future. The Hospital Council appreciates the efforts of the EMS Agency to consider the input of stakeholders and to implement a process that is fair and focused on the specific issues of the impact of the emergency department closure. .Sincerely, Lynn H. Baskett Regional Vice President Cc: Contra Costa Chief Executive Officers i?.\HCNCC%EBHCi1999\1999 letters&memos\ALathrop re AB2103 12-16-99.ddc Cl4 - er (� .sco i W CA � ~ c. , , ++' c\ Iso + ;, _ c ' ttA o CA / i spy r- t� .. b. a0 pay 6t�d"'t+Du tl Ln C n14�ti3��at8Pus� ; 1 �c � 04 t "4 �, T � Y �' ca cn — � c5 �'�rr►' YLS;IA vt P I rt� ch cn I I 1 Sq SIA ui pantidt3 putiwsa put Atddng!tnuuy I ti cn 71 CL W .o ■il�ll � I � II"� I .r". i ■der NO r > tll=IA ui p/ttuCrp putwtp put Alddnglonuur 43 CIO cc a LM .. K �• CDCL 4CL cnI 1011A ui ptttUdr3 put mop put AlddoSitnuuv 1'2/23/99 THU 00:19 FA.l 510 885 8804 A)IR WEST Q003 AIVIERWAN i , I I 1 ` I i a 4 t MEDICALRESPONSE t i i r December 22, 1999 1 t c i Art Lathrop, Director Contra Costa County Emergency Medical Services 50 Glacier Drive Martinez, CA 94553 Dear Mr. Lathrop; This letter is in response to the impact Evaluation being conducted by your office in response to the proposed closure of the Doctor's Medical Center-Pinole Emergency Department. As the primary Emergency 9-1-1 Paramedic and non- emergency ambulance provider, we have assessed the following key impacts to our current operations. ➢ Increased transports times to the closest ED facility in and around the Pinole area. A Increased 9-1-1 responses to the DMC-Pinole old ED/Urgent care clinic due to confusion by the public regarding level of service requirements. > Patients in the area often request DMC-Pinole, therefore, there will be a learning curve to the community as the 9-1-1 system ambulances can only transport to ED facilities. Increase volume and ambulance traffic at the DMC-San Pablo ED causing delays and patient overload issues during busy times. ➢ Increase time transferring patient care to the DMC-San Pablo ED staff, hence ' delaying ambulances from getting back into service and available for another ' response. Minimal ambulance parking at the DMC-San Pablo facility. ➢ New Deployment plan for ambulance resources and posting locations will be required due to increased travel time and overall time on task. ➢ Challenges with technological communications due to poor reception (gagers, radios, cellular telephones) as DMC-San Pablo is a"dead zone"for current communication resources hence, difficulty getting a gold of personnel within i the ED. A From the city of Crockett, Sutter Solana will frequently be the closest facility, therefore, having ambulances transporting out of county. Responses Into Crockett reflect 2% of the west county rail volume. � I i I Contra Costa County Division 2350 Whitman Road,Suite F,Concord,CA 94518 Phone(925)602-1300« Fax(925)883.8804 i .{1 Contra Costa County �;`°'� .Fire Protection District f Fire Chief KEITH RICHTER December 21, 1999 Art Lathrop, Administrator Contra Costa County EMS Agency 50 Glacier Drive Martinez, CA 94553 Dear Mr. Lathrop, This letter is in response to the Impact Evaluation being conducted by your office in response to the proposed closure of the Doctors Medical Center-Pinole Campus Emergency Department. The Contra Costa County Fire Protection District provides 1 st responder services to the El Sobrante and San Pablo areas. It is our understanding that Doctors Medical Center intends to enhance its E.D. capabilities at their San Pablo Campus as part of this closure. Regarding any impact to the Fire District, we are concerned about any potential decrease in available ambulances to respond into the El Sobrante area as a result of longer transport times to the San Pablo Campus. The resultant impact may commit our resources to the scene for an extended period of time. Additionally, there may be a negative impact to the El Sobrante Community in cases where immediately life threatening illnesses or injuries have to be transported a further distance, taking our Engine company out of service for a longer period of time. This impact is speculative and would require further study. If ambulance availability remains unchanged, in either the El Sobrante or San Pablo area, then we would not expect to be impacted as a result of the Emergency Department closure at the Pinole Campus. Sincerely, Stephen J. Maiero Chief, Fire Emergency Medical Services cc: Leslie Mueller, AMR ❑ 2010 GEARY ROAD - PLEASANT HILL. CALIFORNIA 94523-3594 1 TELEP4ONE 1925) 930-5500 - FAX 930-5592.' J fit. ❑ 4527 DEERFIELb DRIVE - ANTIOCH, CALIFORNIA 94509 • TELEPHONE (925) 757-1303 • FAX 754-$952 ` a WEST COUNTY AREA • TELEPHONF (510) 374-7070 ._.,,...,,..,...,..h,.,.....n,:...«ww�r�r..,>:...v...,.w.u..xr, �..:..,..,,.,v., ,,::,,...,«<.,,.......,.,.,t...r.,,,t..,.::............,:.,..v::::,::r,.. ::.,.,..�..... .....,... •::.,.. :.....,............. ..........-....:... __ _ ......... ....... ...... ..... .::.... K..«pax ............. L)3,199 THL 380 AAR wEs,r AMEWICAN MEDICAL RESPONSE Decimber 22, 1999 Art Lathrop, Director Contra Costa County Emergency Medical Services 50 Glacier Drive Martinez, CA 94553 Dear Mr. Lathrop; This letter is in response to the impact Evaluation being conducted by your office in response to the proposed closure of the Doctor's Medical Center-Pinole Emergency Department. As the primary Emergency 9-1-1 Paramedic and non- emergency ambulance provider, we have assessed the following key impacts to our current operations: > Increased transports times to the closest ED facility in and around the Pinole area, > Increased 9-1-1 responses to the DMC-Pinole old ED/Urgent care clinic due to confusion by the public regarding level of service requirements. > Patients in the area often request DMC-Pinole, therefore, there will be a learning curve to the community as the 9-1-1 system ambulances can only transport to ED facilities. > Increase volume and ambulance traffic at the DMC-San Pablo ED causing delays and patient overload issues during busy times. > Increase time transferring patent care to the OMC-San Pablo ED staff, hence delaying ambulances from getting back into service and available for another response. > Minimal ambulance parking at the DMC-San Pablo facility. > New Deployment plan for ambulance resources and posting locations will be required due to increased travel time and overall time on task > Challenges %Mth technological communications due to poor reception (pagers, radios, cellular telephones} as DMC-San Pablo is a "dead zone" for current communication resources hence, difficulty getting a hold of personnel within the ED. > From the city of Crockett, Sutter Solano will frequently be the closest facility, therefore, having ambulances transporting out of county. Responses into Crockett reflect 2% of the west county call volume. Contra Costa County Division 2350 Whitman Road,Suite F.Concord,CA 94518 Phone(925)602-1300 0 Fax(925)68!-8804 12/23/91V IbU Okii`zu M.1 51U 685 8804 Alu1P�I' _ _ l@U04 i i 'i > Increase in ALS responses and trans the DMC-Pinole campus. ports to the skilled nursing facility within a r I believe each of these system concerns coordination of keycanand be worked through with the receiving hospitals; and addresscn91 bora cal ion of a Plan Overload consolidation of services. challenges anticipat darts hethi Sincerely, Leslie K. Mueller Director of Operations Contra Costa County Division American Medical Response Cc: Chief Maiero, CCCI=D Dmcimpaadoc i i i t i it i r i r i x l � z 2500 Charles Avenin • Pinole, CA 94564 • (510) 724-9800 • Fax (510) 724-9809 SENV����� December 27, 1999 Contra Costa Emergency Medical Services 50 Glacier Dr. Martinez, Ca. 94553 Attention: Mr. Lathrop The Pinole Area Senior Foundation has been advised that Tenent is planning to close the emergency room at the Doctors Medical Center in Pinole. This news is very disturbing to our organization. This Foundation operates a Respite Care program at the Pinole Senior Center. Our participants may have Alzheimer disease, dementia or possibly be a strobe victim. Because of space constraints,we only operate two days per week. We presently have approximately 20 participants and a waiting list. Pinole is in the process of building an assisted living facility,the Pinole Assisted Living Community (PALC) Our Foundation has contracted with them to move our Respite Care program to their location and expand our services to five days per week. One of the factors that PALC considered in locating in Pinole was the proximity of emergency room services. By the very nature of the assisted living occupants and the Respite Care participants,it is vital that we have an emergency room available in the least possible response time. Please take this into consideration when evaluating the closure of the emergency room at Doctors Medical Center,Pinole. Thank you. Sincerely, Margie E. Doty W Treasurer to 4, NG;'-�rc;it _ecj .— =6B-02'7*,W MEMORANDUM CONTRA COSTA CONTRA COSTA REGIONAL HEALTH SERVICES MEDICAL CENTER CONTRA COSTA HEALTH CEIW"I ERS 2500 Alhambra Avenue Iv=iam CA 94553 Phone(925)370-5 100 TO: Art Lathrop,Director DATE: December 23, 1999 Fax (925)370-5138 Emergency Medical Services FROM: Frank.J. Pli ` � SUBJECT: CLOSING OF DOCTORS Executive D eo HOSPITAL PNOLE Contra Cost `o, al Medical Center Contra Cosh ealth Centers This is in response to your request as to the impact on Contra Costa Regional Medical Center (CCRNIC) of the proposed closing of the Doctors Hospital Pinole Emergency Department. In my opinion. CCRMC will not be impacted by the closing of the Emergency Department at Doctors Hospital Pinole. The number of admissions/transfers from Doctors Hospital Pinole has been declining over the years. In fiscal year 95 --96, we had 27 admissions/transfers, In fiscal year 98 --99, it was 17. If additional information is needed, please do not hesitate to contact me. FTP:amw cc: William Walker, M.D., Director, Health Services Department Fred Beek, M.D., Chief, Department of Emergency Medicine Alan Spain, M.D., Department of Emergency Medicine Michelle Shanks, R.N., Nurse Program Manager, Emergency Department �w Cam Costa Subsume Abuse Scryim Comm Costs Erna=CY 90(kcal alth Plan Cotrrra Costa Hazardous Materials Program+Contra Costa Meatal Health+ Contra Gita PubGe Health+Contra Costa Revonal Medical Center+Ca=Costa Health C4ncrrs Appendix G Comments from the Public Vilest Contra Costa Conservation League 1015 Leneve Place, EI Cerrito, CA 54530 Jean Sim, President Barbara Vincent, Vice President Kelly Falconer, Secretary J J 1C, / 4 -ct-' .it /t..,+=.J G''Lr•..2..-*.:�:�io• ..J/.1.—'tY" i .,...-.�.._ ,J "1.''t! �/�.-Z+C_',-�- ,'aJ`l"'C^•+°�'.L-2-`s-`.t... (`-^"�'��,.,.2.,�,�.,6p r",7 ftIle,, �'2,.�� GG•Tt,;,s:. '..�..ry ••i.�:�..-C.r!' zV dJ Y . -+''1 t ,,, � -�+''�-.•t.E_it G%/ .�..--G-c�.-7�!3 -67 �„y L;, b. f.'.G" � �f/�-..-t_E:.ti.cy� '-G'"'Z`_-^"rhe."'�,• , � �c— �--� .,•� :� �'� '� �` Via.�:_ ,Gd ,�e d n I OLA Hotmail Read http://lw2fd.hotmaii.msn.com/cgi-b...sg=MSG945205661:6&start=O&Ien=2004 What's the big deal H(,rma l pinoleimpacta@hotmail.com Home KESearch Shopping Money People & Chat' sn�'ourttw' . a � • tLir� • e • ~+ e A i • u . Folder: Read From: Donna Candido<candido(,,a�home.com> Save Address Block Sender To: pinoleimpact@hotmail.com Save Address Subject: EMERGENCY MEDICAL SERVICES Date: Tue, 14 Dec 1999 13:08:47-0800 The closure of the emergency room at Doctor's Medical Center, Pinole Campus, affects not only the population of Pinole. It also affects those of us who live in Rodeo and Crockett and Port Costa. As it is, we are far enough from Pinole to endanger anyone who has a serious medical emergency. If the emergency room is closed WE will have that much farther to travel on a crowded freeway! ! ! My husband has had two heart by-pass surgeries and God forbid he should have an emergency and have to travel all the way to San Pablo to receive treatment, especially if it should happen in a commute hour! ! ! I am diabetic with other risk factors that make me eligible for stroke --- the first three hours of initial symptoms are critical. Deduct the time to call for an ambulance, wait for it's arrival and travel time to San Pablo, and the wait time to be triaged and diagnosed before treatment can be started. That sure narrows down the window of critical time, doesn't it??? We are totally against the closure, we knew this sort of thing would happen when Tenet took over the two hospitals. Cost cutting at the expense of patients. . . . Donna and Daniel Candido Move To (Move to Selected Folder) .� ... ......... 'i Get notified when you have new Hotmail or when your friends are on-line. Send instant messages. Click here to get your FREE download of MSN Messenger Service! To meet new friends at the new MSN Chat, click here. Buy Books ( Buy Music ( Apartment Finder( Clothes ( download Music ( En�clopedia Free Games ( Free Home Pages ( PC Downloads (Travel Agent i Yellow Pages ( More... Search Search the web: Lel 1999 Microsoft Corporation. All rights reserved. Terms of Service Privacy Statement 1 of I 1tj 12/16/1999 1:57 PM Hotmail Rt ad http://lw2fd.hotmail.msn.com/cgi-b...MSG945284925.4&start=2002&len-1366 MSN Worldwide ofMail pinoleimpacte@hotmail.com Home x Search IShOPPIngi mone iPeople & Chan $$PO 3 + ♦ x x x t x s � � x ui x Folder: Read From: Modrichl@aol.com Save Address Block Sender To: pinoleimpact@hotmail.com Save Address Subject: Closure of Hospital Acute care services at Plnole. Date: Wed, 15 Dec 1999 14:08:20 EST Sirs: I'm not in favor of the closure of the acute care services at the Pinole Campus. This potential closure will impact the West County area negatively. Geographically, the closest hospital to serve the Crockett, Hercules, Rodeo and Pinole area then will be the San Pablo Campus. This will be life threating to some of the residents of West county. The extra time to transport the patient, to San Pablo may be the difference between life and death. I believe, the overall effect of this closure will be waiting times will increase, service decrease at San Pablo, due to the volume and residents of West County will be underserved. Sincerely, Michael A. Modrich, RN `" � " • - - - r ` • Move To {Move to Selected Falder} ,l .......... .....:. _ _ r_.LL_: Get notified when you have new Hotmail or when your friends are on-line. Send instant messages. Click here to get your FREE download of MSN Messenger IServicel To meet new friends at the new MSN Chat, click here. Buy Books l Buy Music {Apartment Finder l Clothes l Download Music l Encyclopedia Free Games l Free Home Pages l PC Downloads l Travel Agent l Yellow Pages l More... __-__ Search Search the web U 1999 Microsoft Corporation. All rights reserved. Terms of Service Privacy Statement 1 of 1 12/29/99 5:36 PM Hotmail head http;//lw2fd.hotmail.msn,com/egi-b...MSG945407173.6&start=3368&len=3003 w MSN Worldwide rau�occt;- +C�r/�' ail pinoleimpact@hotmail.com Home Search Sho vingl Money Jpeople & Chat'l Folder: Bead From. "Robert De Le Campa"<RobDLC@home.com> Save Address Block Sender To; <pinoleimpact@hotmail.com>Save Address Subject: Closing Pinole's emergency room [late: Thu, 16 Dec 1999 20:59:01 -0800 Closing this E.R. would be a huge mistake and directly effect the quality of life in Pinole, as well as Hercules, Tara Hills, Rodeo and Crockett. In all of Tenent's public relations campaign for (Brookside) 2000 Vale Road, they say they are adding beds. Well, I have not heard once that they are adding more Medical Doctors. Adding more beds does nothing but make more room for people to wait to see the M.D. Are they adding more Doctors? If they don't, the waits will be unbearable. If they are adding more Doctors, where is the financial savings? They may as well just keep paying the ones at the Pinole facility. People do not realize how many people live in these communities. The people setting up this closure just see how many fewer uninsured victims of violence go to Pinole's hospital. The numbers of sick people is not less. And based on the population of the West Contra Costa County area, it is ludicrous t think that one E.R. Doctor can handle all of the medical emergencies at once. Besides, Brookside is in a very unsafe neighborhood. Anyone who tells you otherwise is lying or naive. It is bordered by a Casino, run down neighborhoods, and trailer parks. San Pablo is per capita one of the most dangerous towns in Northern California. I live about a half mile from Doctors in Pinole and I refuse to go to such an unsafe neighborhood for treatment. I also refuse to wait for hours with the other 100,000 plus people that live in the West County. If my family has an emergency, they'll get seen quicker if we drive out to John. Muir in Walnut Creek. Which we will be doing. Pinole needs to stand up to the Downsizers out there. Today I read that now they want to close our Animal Shelter. What is going to be next? We already get tons of school kids from Richmond which has no Middle School of its own, now more and more of our services are taken away while we educate the bigger city's children. If this trend continues, I'll be selling my Pinole home and moving away. Robert De La Campa t� I of2 12/29/99 6:36 Pk1 Hotmail Read http://lw2fd.hotmail.msn.cam/cgi-b...MSG945462951.1&start=6371&len=2232 wa ere can fou rneeA some. lntareslinS perple Hoirmailpinoleimpact@hotmail.com Home Search Shoppingl Money !People & Chat' ,"`sPO + SII !`older: Read From: Bruuka@aol.com Save Address Block Sender To: pinoleimpact@hotmail.com Save Address Subject: pinole closure Date: Fri, 17 Dec 1999 15:32:56 EST � r Dear Mr Lathrop and Dr. Ward, I am a registered nurse and am currently working in the emergency department at Doctors Medical Center in Pinole. I am concerned regarding this closure. I recently worked a pm shift at pinole this past tuesday and within an hour we received 4 ambulances with very sick patients. Our emergency room was full unitl about 8 p.m. We can never tell what comes into our emergency room, but we do know that we do get patients that need immediate care and sometimes walk right in with a heart attack. I am also concerned in regards to moving us down to San Pablo. They already have a 4-6 hour wait to be seen. With us combining, the wait will be doulbed to 8 hours. If a patient is sick, and all beds are full, where will we put them? Tenet has not even built their additional 18 beds in the ICU. Flow can they accomadate the additional patients, moving them to the medical surgical floor where patients are not closely monitored? I have lived in thij community for over 20 years and Doctor's Hospital is used by my friends and family. I have heard time and time again by many others, that if we close, they will NOT go to Doctor's San Pablo for care. The City of Hercules is estimated to increase it's population by 10,000 next year. Where will all these people go for medical emergencies? Yes, San Pablo maybe 4.5 miles away, but no one has ever taken into consideration the traffic that Hwy 80 constantly has. This is all politics, not about patient care. We need to keep Doctor's Medical Emergency Department in Pinole for our �community. Move To (IVlcve to Selected folder} '. ENIMM Get notified when you have new Hotmail or when your friends are on-line. Send instant messages. Click here to get your FREE download of MSN Messenger 'Servicel To meet new friends at the new MSN Chat, click here. l of 2 12/29/99 5:36 PM William John &Joan L. Fewins 2714 Sheldon Drive Richmond, CA 94803 December 17, 1999 Contra Costa Emergency iWedical Services Agency 50 Glacier Drive Martine, CA 945j3 Ladies and Gentlemen: Please record our very strong disapproval of the proposed closure of Emergency Services at.Doctors!Medical Center, Pinole Campus. We feed the people living in the immediate area of the Pinole facility wauuld really suffer from limited and effective emergency medical care. This does not effect only Pinole,Hercules, but the residents of the El Sobrante.,Richmond area. The configuration of the surrounding area makes it almost impossible to transport patients in dire need of emergency medical care to the.Brookside Emergency Room. Just listen to the traffic reports to realize the horrendous congestion on Highway �80 to prove aur concern. You can't get therefrom here and this doesn't take into consideration a major explosion, earthcpiake or poison chemical release-all of which have occurred in the recent past. Please make�ure all of the residents of this area are given access to immediate emergency medical care. Very truly yours, I111r. &Mrs. Ism. John Fewins j,k4 pro Hotmail Read http:,I/lw2fd.hotmail.msn.com/egi-b...G945744777.22&start=8b(f3&len=43696 .. ,4 Hotmail pinoleimpact@hotmail.com Home + Search Sho P's$�SO ,�, ping Mol ney �Reocle & Chat; sE�,V, Folder: Read From: "Nancy McCoy„ anmccoy@napanet.net> Save Address Block Sender To: "EMS 1" <pinoleimpact@hotmail.com>, "ems 2" <cccems@hotmail.com> Save Address CC: "Donna Gerber" <Donna@dgerber.org>, "Uikema" <gayle&@bos.co.contra-costa.ca.us> Save Address Subject: Pinole Closure Date: Mon, 20 Dec 1999 18:37:54 -0800 • .VIS" ' I� - • ��- _ - �'= - .�. � - I have two email address for the CCEMS agency so will send this to both. Thank you for your attention to this important matter. Attachment: emsclosureletter.doc (42k) -- Download without Scan -- Scan with McAfee Move To (Move to Selected Folder) r4 .:::..:. .._ .....::.: .. .....:....:... .. :.... Get notified when you have new Hotmail or when your friends are on-line. Send l instant messages. Click here to get your FREE download of MSN Messenger Service! To meet new friends at the new MSN Chat, click here. Buy Books j Buy Music j Apartment Finder j Clothes j Download Music j Encyclopedia Free Games j Free Home Pages j PC Downloads j Travel Agent j Yellow Pages j More... _..____.._ . .... _. ._ _ ... . _.._j arch Search the web: Se_.._... 0 1999 Microsoft Corporation. All rights reserved. Terms of Service Privacy Statement 1 of 1 12/29/99 5:37 PM To: Contra Costa Emergency Medical Services Agency From: Nancy McCoy RN, CORN, BSN, BS, Staff nurse in the intensive/cardiac care unit at Doctors Medical Center Pinole Re: Proposed closure of acute care services at Doctors Medical Center Pinole It is my understanding that Tenet proposes the following actions: a) Move the Critical Care and Medical Surgical units to San Pablo b) Convert the emergency room to an urgent care center, which will not be open 24 hours per day. c) Divert ambulance traffic from Pinole's ER to San Pablo. d) If an unstable patient comes to the urgent care facility, 911 will be called. e) If a same day surgery patient gets into trouble requiring ICU level of care, 911 will be called. f) If any inpatient requires ICU level of care, 911 will be called. I have some strong concerns about the impact of the proposed closure of the Critical Care Unit and downgrading of the Emergency Room. These include the following: I. Re: Diversion of ambulances to San Pablo: What percent of CCU/ICU admissions come by private transportation and thus would need a 911 call to transfer them to San Pablo? Studies by the staff done in 96 and 97 show a range between 39 and 57%. Despite years of community teaching people with heart attacks often do not call 911, but access the medical system via private transportation. 2. Tenet keeps talking about the need to consolidate services in San Pablo to improve quality of care. The example they keep using is for cardiac patients,but they neglect to mention what percentage of our patients is not cardiac. From a quick check of our records the other day I would estimate that less than half of our patients are cardiac. 3. We have a large population of Sub-acute patients on ventilators in Pinole. Frequently they get into trouble and are transferred to our ICU. These patients were admitted with the family's knowledge there was an on- premise ICU if there were problems. How many of them will survive a 911 call to get to San Pablo? 4. What studies can they produce to show that not only the ER, but also the rest of SP can handle the increased load? It's not just ER beds, but x-ray, lab, respiratory therapy etc. What is the average wait now in SP a)to be seen in ER, and b)to get transferred to a bed if admitted. Testimony at the recent hearing indicated that there is a faster turn around time in Pinole than in San Pablo. Thus between a longer drive to get to an ER, plus a slower turn around time,the county's ambulances will be tied up for longer periods of time. 5. Earthquake safety:. What would the community do if an earthquake damaged the San Pablo facility? (An especially appropriate question considering that it sits between 2 earthquake faults.) Mr. Sloan stated last week that San Pablo is structurally more sound than Pinole. I'd like to see documentation to that effect. My discussions with engineers indicates that a cement building like San Pablo is far more likely to fail than the wood construction of Pinole. 6. Maintenance of the 14 Critical Care beds in Pinole. We have been told both that the license will be maintained for the beds in case of"a catastrophic event"and that"Pinole's ICU beds will remain available in the even of surge in demand for acute services"(quotes from WCT times article and Gary Sloan's letter to the employees respectively.): How are they going to suddenly open an ICU? Where will we get the supplies that are specific to an ICU?(There would be no reason to keep them in the building since no other unit uses many of them.) Who will keep the supplies current(as the one who does this now, I can tell you many supplies and drugs have expiration dates.) Who will check the temporary pacemaker batteries to be sure they are ready if we should use it? If they convert the ER, where will we get the physician to respond to a cardiac and/or respiratory arrest? (It is my understanding that the urgent care center will not be open 24 hours a day.) Who will be on the code team? (Currently specially trained staff make up the code tpam). Will there be adequate equipment available to suddenly handle acute patients(IV pumps,feeding'pumps, hypothermia blankets etc.)? 7. Why are they overstaffing the hospital on New Years Weekend?(They told us they didn't think SF would have enough bed space.) 1'2- 8. How do they plan to communicate to the community about the change in the ER status—especially since there are those who speak different languages,are illiterate,and/or who don't read the paper? What will happen when someone arrives in trouble after the clinic is closed? 9. How many ambulances can the ER bay at SP hold? What do they do with the overflow? If it is full and a Code 3 comes in, what will they do? 10. Why not build the new ICU first and then reevaluate the closure?If they are serious about building a new ICU, why didn't they do it in 1998 like they said they were going to when they first proposed the consolidation of services. At a meeting in August of 1999 we were told that Tenet hadn't even authorized the money to build it. My guess is they are going to try to weasel out of building it at all —thus leaving the community with fewer ICU beds as the population increases. If they are allowed to close the Pinole beds before replacing them, who will make them build it? In 1997 in a letter from Gary Sloan to local officials he said, "It is our intent to keep our basic emergency room services and critical care beds available at Doctors Hospital during the next year while construction proceeds to add 14 to 16 new ICU beds at Brookside." As I testified last week, they have previously made commitments to the community,which they haven't kept. (I would be happy to provide you with a copy of those commitments if you would like.) 11. What will West County do if the freeway is closed between Pinole and SP? What about the fact that it can take up to 20 minutes to travel the distance between the hospitals if you hit the lights wrong—much more if the freeway is clogged? What commitment do they have to the Pinole/Crockett etc. community that has supported them for so many years? How many times a day is the freeway impassable? The bottom line is that ambulances will be less available to the county's citizens if Tenet is using them for transfers between campuses and for longer runs. 12. What will the impact be on the county's EMS system? Are there enough paramedic units to handle the CCU/ICU caliber patients who will arrive at the Pinole urgent care needing a 911 transfer? (Remember what happened to the Kaiser patients who went to urgent care centers.) What about the regular ambulances—the impact on their availability to the community if they are used for transfers between Tenet facilities? Who pays for these transfers—many insurance companies will not cover ambulances. 13. Mr. Sloan stated last week that for a short period of time Tenet will have an ambulance in Pinole for transfers. He, however, did not state what level of ambulance and whether it would be staffed, nor for how long they would keep it. It is my understanding that Kaiser Richmond also had an ambulance when they downgraded their ER, but that it wasn't staffed. It would not surprise me in the least if Tenet did the same thing. 14. Come and go surgeries: What will happen if they have to be admitted?Where will they stay? If they have to go to SP, how will they get there and who will pay for the ambulance? 15. What about the fire departments? My understanding is that in case of a cardiac arrest a fireman rides in the ambulance(the fire department is usually the first responder). After arrival at the ER,the city has to send staff to the ER to pick up their fireman. This leaves the involved city with less fire protection while the truck is out of service—which could be quite a while depending on traffic. In 1997 Pinole only had one staffed fire truck. 16. In Gary Sloan's July 2, 1997 letter to you he stated that there would be a"Board Certified Emergency Room physician on-call to transport critically ill patients between Doctors Hospital and Brookside Hospital. This is the highest level of transport safety." He also stated"... will provide two 24-hour per day emergency physicians at the Brookside Emergency Room ..." What has happened to these commitments? 17. On the weekend of Nov. 27-28,the San Pablo campus transferred at least one patient to Pinole for surgery because the back-up generator had failed. What would they do if they couldn't use Pinole for back-up? 18. How many ICU beds in the Bay Area have been taken out of service in the last 5 years? What is the population increase in that same time frame? 19. Yesterday's paper had articles about the unexpected closure of 2 floors at Vallejo Kaiser and the threat of closing the whole hospital, as well as a lack of CCU bed space in Southern Calif. bec. of a surge in demand. How can the community handle the loss of almost 1/3 of the critical care bed space for a long period of time? Clearly in the last 2 years we have needed every ICU bed in the county. Just because we don't utilize all the beds all the time,doesn't mean we don't need them. We must have the leeway to handle disasters or flu epidemics. 20. Tenet may claim that we don't need our ICU beds. What they won't tell you is that since in Pinole we house our"step-down"patients in our ICU that they are often downgraded to step-down status earlier than if the step-down unit were elsewhere in the hospital. These patients frequently get returned to ICU status within 24 hours because they weren't really ready to move. The physicians know that our step-down patients are cared for by ICU nurses and often get ICU level of monitoring and that we will catch problems early. 21. Every time there is a problem with the local refineries,both campuses go into disaster mode. If they close the acute care services in Pinole, all will be sent to San Pablo. Can they handle that kind of a load? What if the structure or staff were put out of service by a disaster? I sincerely hope that your agency's findings are that closure of Pinole's ER would have a negative impact on the county. I would be more than happy to discuss this with you. I can be reached at 707 552-8877. Sincerely, Nancy McCoy 232 Dryden Dr. Vallejo, CA 94591 P.S. For future hearings--if you cut off public comment while there are still people waiting to speak(which is my understanding of last weeks hearing),please indicate so. Since I was the only staff person who was allowed to speak last week, it appears that I was the only one who wanted to. On Friday I was told I was the only staff person who spoke, which was true, but not the whole picture. It is a sign of how concerned we are that the staff is willing to speak out openly against our employers. Thank you. TO: Congressman George Miller Governor Gray Mavis Assemblyman Tom Torlakson -.Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, ' ' � r Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name , 72 Address rAl „�'� •�'yr�'" � .�'' ''� Phone/Fax/Emai %fV 1 jGt t,U{F'7dt t ' Tom- i.'tc L t Lcr r4 6 (��1�.'�t�� , .� �r�...�1-�'GL.1-- {�IJLt r"t,�"'. �.r ,tom., l.''+c'-'�.�-• 2�6�- dC'"'rt.* �'✓ t�'"tr1 �� yk."Z.. 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J• 1 � re `vt D-1� �v �,�1 •fc f t� ;}�GZs�'"'�.nu�-..� tom-*" j Lu�¢- , '„L�' vti, �'►rt '%'yt,Lt� r� .�"/ (r/t .Q�G�•trL,r'ay��1 4L-"� ccs r`E?. cr✓f''v'£'.-� /�1 � (a�'L c^7�� �, t7G r. �j'(GcV /h C. , /' ,�i� G!•�'-+� i'°G,��J%',t,�_.�,;,1 �-�''��C c�rlrl'!/' e"-r' �?�ii.L-r��7-- ,�'" �G.S��J; � J ..� ,,�I .- Hotmail Read http://lw2fd.hotmail.msn.com/cgi-b...G946032009.13&start=52299& 1en=3565 dr,71 nl . :"ard to keep track of those little yellow notes? tAiGfdflO`^ Hormailpinoleimpact@hotmaii.com Home Search Shoppingf Money !People & Chad ` g_,'E3PO Z, Felder: Read From: NurseNan@aol.com Save Address Bloch Sender To: pinoleimpact@hotmail.com Save Address Subject: closure of Doctors' Med Center Pinole Date: Fri, 24 Dec 1999 05:33:02 EST 12/23/99 Art Lathrop Director of Contra Costa County EMS Dear Mr. Lathrop, As Charge Nurse on the night shift at Sutter Solano Medical Center's ER, you can imagine my surprise and fear at the proposed closure of Doctor's Medical Center Pinole. Our ER has 2 RNs and 1 MD at night, and for the most part, we have a busy ER during the hours of 2300-0700. We were lucky to convince the hospital of the need for assistance until 0300, and there is an extra RN that works from 1900-0300. We see anywhere from 1600-1900 patients per month, and for the past 4-5 years, the acuity has been very high. It's not uncommon to have at least 3-4 medical admissions and 2 ICU admissions on our shift. Sutter Solano Medical Center is a small facility, and has a high census in the winter months. The combined ICU/CCU has 12 beds, and this unit usually has a census of 8-12 patients. During 3 months last year, our CCU was full 53 times, requiring some type of diversion status. I also worked as a staff RN for 4 years at Brookside Hospital 's ER on all of the different shifts. Doctors' Hospital San Pablo has a very busy ER, with a high volume of admissions into their hospital. They are staffed with more RNs and LVNs than we are at Sutter Solano Medical Center, but even with the amount of staff, it is a very busy ER, with high acuity patients. It was common for BLS ambulances to arrive "code 3" with CPR in progress because the ALS rigs were tied up with other high acuity patients. Doctors' Medical Center Pinole is located about half-way between Doctors' Medical Center San Pablo and Sutter Solano Medical Center. Because of the geography of Contra Costa County, and the Interstate 80 corridor, if Doctors' Medical Center Pinole closes, I car. imagine that ambulances east of Pinole would be tempted to go to Sutter Solano Medical Center, and ambulances west of Pinole would continue to transport to Doctors' Medical Center San Pablo. I shudder to think of the impact of all of these extra ER patients arriving to Sutter Solano Medical Center. Also, at this moment in time, Kaiser Vallejo is experiencing major structural problems with their facility, requiring the closure of 2 of their floors due to fire safety issues, and the impact has yet to be felt by our facility, but I am sure that we will accept some of their patients if our bed capacity can handle it. Because of Kaiser's problems, the upcoming flu season, and the expected high patient-volume months ahead, . I am begging your County to reassess the need for the closure of Doctors' Medical Center Pinole. Sutter Solano's small ER cannot handle a drastic increase in patients without some sort of MAJOR pre-planning. 1 of 2 12/29/99 5:38 PM Hotmail Read http://lw2fd.hotmail.msn.com/c-i-b...G946032009.l3&start=52299&len=3565 Thank you for listening to my concerns. They are shared by my co-workers. Sincerely, Nancy Hiteshew RN, CEN, CCRN, MICN Charge Nurse, Night Shift Sutter Solana Medical Center Vallejo, CA MOM Move To (Move to Selected Folder) 11111111111111n, Addresses Get notified when you have new Hotmail or when your friends are on-line. Send r instant messages. Click here to get your FREE download of MSN Messenger Service! To meet new friends at the new MSN Chat, click here. Buy Books Buy Music I Apartment Finder I Clothes I Download Music I Encyclopedia Free Games ( Free Home Pages PC Downloads I Travel Agent' Yellow Pages I More... __...._.... Sem Search the web .._.I O 1999 Microsoft Corporation. All rights reserved. Terms of Service Privacy Statement 1 t� 2 of 2 12/29/93 5:38 PM Hotmail Read http://lw2fd.hotmaii.msn.com/cci-b...SG946065440.4&start=55864&len=9962 , �. Make your Hotmail" a Messenger Service HA__ pinoleimpact@hotmail.com Home Search 'Shopping; Money OPeople &. Chat P7S4p� r • •• • • X#Nlv • is �! r • a r Felder: Read From: "Kim Waldron"<kwaldron@calnurses.org> Save Address Block Sender To: <pinoleimpact@hotmail.com> Save Address Subject: Pinole acute care service closure Date:. Fri, ��■24�Dec 1999 12:37:44-0600 12/24/99 To Art Lathrop From California Nurses Association Re Closure of Acute Care Services at Doctors Medical Center (DMC) in Pinole Information is needed to effectively evaluate the impact of the closure of these services. Who uses the services now? This needs to be defined by location (zip code) , as well as age, race, gender, and ability to access other health resources. How do the patients pay, or do they pay? What are the nature of the traumas (DRC) treated now? What now is the outcome history of the treatment of these cases? What is the average length of stay and what relationship does it have to survival rates? We have been unable to collect the above data in order to comment by the recommended December 24 deadline. we do believe the following issues need to be addressed in an impact report. Patients throughout Pincle and the surrounding area (particularly Hercules, Rodeo and Crocket) use the Emergency Department. In a disaster, they depend on it. What is the impact of the closure on County disaster planning? Does the March closure date allow the County sufficient time to revise disaster planning? This information should be included in the preliminary report to be issued January 5 for evaluation and response by affected parties before the final report. If the State approves the closure of the DMC Emergency Department, will the State assume any liability to Contra Costa County or individual residents for losses experienced in a disaster due to inadequate emergency resources? Will Tenet assume any obligation to the County Emergency Services Department or County residents? We note the Lewin report cited by Tenet at the January 16 hearing does not address disaster planning. Does Tenet have any data that will help the County evaluate the impact of this closure on disaster planning? DMC plans to hold 14 critical care beds in suspense in Pinole until a new critical care unit is built at San Pablo. This directly affects Emergency Department treatment availability. Frequently beds or treatment areas cannot become available in the Emergency Department until patients are transferred from Emergency to ICU. How long will it take DMC to convert suspended ICU beds to beds available to receive patients if needed? Supplies have usage dates. Non-acute facilities do not maintain night laboratories. What if emergency l of4 12/29/99 5:38 PM Hotmail Read http://lw2fd.hotmail.msn.corn/c-i-b...SG946065440.4&start=55$64&len=9962 surgical services are needed? There is a nursing shortage that will inhibit recruiting nursing staff. If the cost of maintaining critical care readiness or re-opening critical care beds, is prohibitive, or if the time involved in re-opening is excessive, DMC should delay the closure until the new ICU beds are staffed and available in San Pablo. Kaiser Vallejo's, including the Emergency Department, is reducing services due to problems with meeting fire safety standards. How does this impact emergency services in the County? This is of particular concern since this is an area that has experienced several toxic/chemical leaks from oil refineries. San Pablo's facility is old. Before retrofitting, can we count on the critical care services, including the Emergency Department, in case of earthquake or other disaster. Are generators fully operational? How are fire services affected in surrounding communities by the loss of a Pinole Emergency Department? In the case of a cardiac arrest situation, a firefighter assists the paramedic with the patient in the ambulance during transport to the hospital. With one firefighter unavailable, the engine company goes out of service until the firefighter is rF.turned to his/her engine. In 1997 the Pinole Fire Chief provided informar_ion that, with the Pinole Emergency Department, the out-of-service time was kept to 15 minutes. He also noted that an engine cannot leave the district to pick up and return the firefighter and other arrangements to do this expand the out of service time to over one hour. Such medical emergencies occurred on an average of twice a month at the time of that report. Increasing traffic on the 1--80 corridor has increased ambulance response need. what is the impact on the next-nearest Emergency Departments that will absorb the patients now seen by DMC in Pinole? What are waiting times now? An increase in waiting time impact outcomes of treatment to patients. What available treatment area/bed changes and staffing changes are anticipated in the next-nearest hospitals? what treatment capacity was planned in the construction of these Emergency Departments? Critical care beds? Hoer close are they to capacity? Tenet says they are within the guidelines provided by the American College of Emergency Physicians. For national averages? For the population growth anticipated in West County? For the aging population in the immediate area? For the uninsured population in the area? For an earthquake area down the road from oil refineries? What is the plan for ambulance service in the event of construction on I-80 and I-4? At the December 16, 1999 hearing 'Tenet cited a study that showed emergency outcomes are more impacted by the time it takes to ambulance to reach a patient than by the time it takes to transport a patient to an Emergency Department. What study is this? Doesn't the nature of the trauma dictate which is more important? What about bleeding that requires emergency surgery? Doesn't the nature of the medical emergency in the ambulance influence the importance of how long it takes to reach a hospital? What if intubation is needed? Defibrillation? If the Emergency Department Closes, patients with injuries and illness of an emergency nature will continue to present themselves to the new DMC Pinole urgent-care clinic. IZ!rr 2 of 4 12/29/99 5:38 PM Hotmailltad http://lw2fd.hotmail.msn.corn/cgi-b...SG946065440.4&start=55864&len=9962 How will patients with emergency needs be transported to other Emergency Departments? Who pays for this transport? Will this impact Emergency resources in the County? What is the anticipated number of patients that will need transport to San Pablo, Sutter Solano or other facilities? Do the existing transport guidelines accommodate this? What training is planned for the urgent-care clinic staff who will deal with emergency patients? On-going training? What communication about the closure is planned for the community? For the residents of senior and assisted living centers? For the uninsured? Non-English speaking uninsured? What happens to Pinole Same Day Surgery patients that have emergency complications? Tenet reports that a significant percentage of Emergency Department visits are urgent-care, non-emergency visits. Is this because patients are frail elderly and/or the uninsured who are most likely to use an Emergency Department for basic health care? By law, an Emergency Department must see that a patient who asks for services is stabilized. An urgent-care clinic can decline treatment of an uninsured patient. Untreated non-emergency health problems become emergencies with time. What impact will the loss of basic health services to this community mean for increased emergency service demand? Because the uninsured use emergency services as the primary access to care, the losing of such facilities tends to discriminate statistically against the uninsured, single mothers and dependent children and restricted income elderly. It amounts to redlining of the most vulnerable. What is the impact on Medicaid funds? Will this impact emergency resources? The decision to close the Emergency Department is based on Tenet' s financial concerns, not planning for residents' health needs or area population growth. Will the closure negatively impact San Pablo or other affected hospitals financially, setting off a domino effect that will further jeopardize resources in the future? Doctors Medical Center San Pablo and Kaiser Richmond will be the only full service hospitals along the densely populated, heavily congested 1-80 corridor between Berkeley and Vallejo. Kaiser Vallejo is now at risk. if San Pablo closes in the next two years, what will be the impact on County emergency services? What commitments for services will Tenet make to the area? Will they commit to work with the community to What is the average length of stay of patients that enter the hospital through the Emergency Department? Is that related to survival rates? Is it related to type of payment? The closure negatively impacts disaster and other emergency health service availability. What actions can the County recommend to the state to take to protect services? If the uninsured are disproportionately affected, estimates should be formulated for the numbers of increased deaths, lost incomes of the affected groups. Legal action (TRO, Title VII suit based on a specified protected class) can then be pursued. An effort to secure sufficient Medicare/Medicaid or other funding can be pursued in exchange for a moratorium on closing of services for a specified period. 3 of4 12/29/99 5:38 PM Cl 2.t4: t t`a C:- a_b ; (, -(L;NV;zE `S`►-a� rs.N;��:.�,.�;��C_i� C.•t...�'��<:.•� C,"� A c..,}�-E c��ft�. =�rc.szr.1� �.`'�,� f�`T c_-r Ca\2' t r1 C).\c.i`+��-.. C_ t`S i` 2 "S"1 t�C:��. V 15, YLP+t-r N I r.,L� ►r3 �Jc -Z c v t� `7" 'e st -r r k.A s R. JTN rb2-c t NTc"Z. P+r.:Ltj 1c A 1S J "fir- c x rr o rs C> ( T kt, o,� 'x,Qrz: I Z :s c -r'C:N `P 2- v;W--r iEi _`�..� ��r---c� i sv :...cam c•�� C:� �— tr.,��.,rc� C. e.�� �-c, "zcy �c��2.� T ry 1 r.,.%t-4 ...0 r�tJN�p C.�r`-r -r.o. � �►cl "?ri.Qv� \S �.::.�= '��-2, :v t:�. Lory�...�„•'�;t�r,,� , "'�`4,. �N�,., 'C..L..0•�a\ta'�� `�\4v C:a�..,"`�... v:a�t...� 'E=vt'....c.`k.. �'A`T-\�tV`T� i �J CY`+\�,�.�.c�.i �►L.� q`c`,�.t`5"5` , l� `-�u t`� t\ N r.:� s.c..y`,v ts��,-t. "f"�'�� t z:`�` '�-t2�<r, '��... �c�+3n.l1.av ate„ l�..cv,� mss't e�r��..�:�. v..�1�-c.._ C.r•b tics '.`�3(Y„a 'cam A,�.-4......... . Q—K-- i�1�`�p ,'C`-�.L..a �1'�1 M1\i.l\��.�3•'��'.. CSJ v�V`..S 1 \,(�`�}�s�.\�L:. '�""J�- "'��t 1� torry�� 1 $`+ �S' M `.S '1 �cs"[-'�. tt•�Cs- t^hr�t`c_4� '_''C`t=t 4s,`'r1 Nl'�t�'e�•�NS.� . �W� 'r"w"��s`5�®fit... `�ti ct,..�c°-`rpt'... C�� "C'E-1�. t*�`�t�sZti►'C• c..,.,f \N "�,�W��„� �"rP+-txc� �T ---r r"`t t`c f P fit CJ `�-JN�UtN - `17.<t:c_ rs-3- 7�P mP viii -rbc t fa.f� 1N"c2rJa �.,s —V= ra "r a eJ Q-4 f�, t6 P C fi1L lac ` "r-A'c� -}�+� 1' h'e V NG tt '► v�.a2 rte '7 i tv ,+vj --re,, `:t�Q w . tv tN ki L���. +� r��+��-r `t�l-��.i`t`°,. �C-t-t- ate`-�.�'`� t� f� `�Amt�►�w... � 25' .........�..N.w.., h....:.,. A.,::, Appendix H Contra Costa Impact Evaluation Policy .............................. ................................................................................................................................... Contra Costa Health Services Emergency Medical Services Agency December 7, 1999 (revised) Impact Evaluation Policy L Purpose To establish the process and criteria to be used to evaluate the impact of the closure or downgrading of hospital emergency services. II. Authority California Ijealth and Safety Code Section 1340. III. Policy A. Fallowing receipt of written notification from a licensed acute care hospital located within Contra Costa County that it intends to close or downgrade its emergency service, the Contra Costa EMS Agency will: 1. Carnplete an evaluation report, including at least two public hearings, on the proposed closure or downgrade within sixty (60) days. 2. Unsure that hospitals and prehospital emergency care providers in the geographic area impacted by the service change are consulted with and that local emergency service agelncies and planning or zoning authorities are notified prior to completing the impact evaluation. 3. Submit the impact evaluation report to the Contra Costa County Emergency Medical Cate Committee, Contrra Costa County Board of Supervisors,the hospital proposing closure or reduction of emergency services, and the State Emergency Medical Services Auihority. 4. Notify the State of the results of the impact evaluation within three (3) days of co#ipletion of the evaluation report. 5. Copies of the completed impact evaluation report shall be made available to the public for review upon request. B. The following criteria will be used to evaluate the impact of the proposed closure or downgrade of hospital emergency services: I. Geography (facility isolation; service area population density, age and socio-economic characteristics, populations projections 10 years forward; distance to next nearest facility and travel times, including peak commute hour travel times and consideration of major construction projects affecting traffic flow; number and type of other available emergency services; average emergency department census and patients treated per shift for hospitals in affected area;payer mix (uninsured, Medi-Cal, Medicare,private); availability of prehospital care resources, including ambulance and fire first responder service; impact on other hospital emergency services, including number of emergency patient visits (ambulance and walk-in), capability of other hospitals to absorb increased numbers of emergency patients, and steps taken to accommodate proposed emergency service closure or reduction in services; number of emergency physicians on duty. 2. Base hospital designation(number of calls by type, impact on patient, prehospital personnel, and other base hospitals). 3. Trauma care (number of trauma patients; impact on other hospitals, trauma centers, and trauma patients). 4. Specialty services provided (neurosurgery, obstetrics, burn center, pediatric critical care etc., and their next nearest availability); communicable disease treatment capacities of hospitals in the affected area(availability of negative flow isolation rooms, volume of patients with communicable diseases presenting in the emergency department). 5. Patient volume (number of patients annually, including 9-1-1 transports and other patients seeking emergency services). 6. Notification by hospital to the public (public hearing, advertising, etc.) 7. Communication from hospital to health plans and health plan members. 8. Steps taken by hospital and community providers to accommodate members of the public who may be affected by the proposed closure or downsizing. 9. Impact on community disaster resources, including seismic and hazardous materials incident considerations. 10. Potential liability resulting from emergency department closure or downsizing, including identification of potential defendant(s). 11. Ambulance diversion(number, frequency, duration) for hospitals in affected area. 12. Average emergency department waiting times(arrival to emergency department discharge) by shift for hospitals in affected area. 13. Standards for hospital emergency services for county and impacted area(e.g., American College of Emergency Physicians standard of one emergency treatment station per 2,000 annual emergency department visits) " K C. The Impact Evaluation data collection shall include the most recent full calendar year plus the current year to date. D. Data for the Impact Evaluation shall be provided by the hospital closing or reducing emergency services, other impacted hospitals, and prehospital emergency services as requested by the EMS agency pursuant to this policy. FROM' : doctors MO Pinole ER PHONE NO. 15107246640 Dec. 04 1999 10:05PM F-BECEIVED-, JAN 112000 REGARDING THE CLOSURE OF DOCTORS MEDICAL CENTER IN F THE,RECENT DECISION TO LIMIT SERVICES IN THE EMERGENCY ROOM AT PINOLE IS A DEATH KNELL FOR ALL HEALTH SERVICES IN WEST CONTRA COSTA COUNTY, AND WILL HAVE DIRE AND EXTRAORDINARY CONSEQUENCES TO THE CITIZENS OF TIIE AREA OVER THE NEXT FEW YEARS. THE PROMISE OF MR. SLOAN TD KEEP THE PRESENT EMERGENCY ROOM OPEN AS AN URGENT CARE FACILITY IS NOTHING MORE THAN A BONE TOSSED CYNICALLY TO THE AREA RESIDENTS. AN URGENT CARE FACILITY IN A:HOSPITAL SETTING IS A GUARANTEED MONEY LOSER, AND SOON RESIDENT'S WILL BE TOLD THAT THE URGENT CARE FACILITY IS SCHEDULED FOR.CLOSURE FOR-OF COURSE--FINANCIAL REASONS. THIS PLAN TO CLOSE THE PINOLE FACILITY IS BASED ON A FAULTY, MAJOR PREMISE. THAT THOSE PATIENTS WHO HAVE TRADITIONALLY USED THE PINOLE FACILTY WILL SIMPLY CONVERT THEIR PAT'T'ERN OF USAGE TO TIDE SAN PABLO FACILITY. ALL OTHER.DECISIONS SEEM TO ARISE FROM THIS WRONG-HEADED BELIEF. THOSE OF U'S WHO HAVE PRACTICED IN THE WEST COUNTY COMMUNITY FOR MANY YEARS KNOW THAT MANY PATIENTS HAVE ALREADY DEVELOPED ALLEGIANCES EL5EW'HERE. THOSE PATIENTS WHO ARE MOBILE, WHO ARE SOMEWHAT AFFLUENT, WHO ARE INSURED,HAVE BEEN LEAVING THE COMMUNITY EVER.SINCE MR. SLOAN LET IT BE KNOWN THAT CLOSURE OF PINOLE. WAS GOING TO OCCUR.AT SOME INDEFINITE DATE. THOSE WHO ARE LEFT, WHO ARE NOT MOBILE, WHO ARE NOT INDEPENDENT.ARE THE FRAIL. ELDERLY, THE POOR, THE CHRONICALLY DISENFRANCHISED, THE DRUG AND ALCOHOL DEPENDENT, THE HOMELESS. THESE PATIENTS WILL CERTAINLY USE THE SAN PABLO FACILITY,BECAUSE THEY WILL HAVE NO CHOICE IN MOST CASES. THE PRESENT CONSTRUCT OF THE COUNTY EMS SYSTEM DEMANDS THAT CRITICALLY ILL PATIENTS BE TAKEN TO THE NEAREST SUITABLE HOSPITAL- THE NEAREST SUITABLE HOSPITAL TO THE RESIDENTS OF CROCKETT,RODEO AND HERCULES IS SUTTER, SOLA.I O, ONCE PINOLE IS CLOSED. MR.. SLOAN AND HIS ALLIES DREAM T14AT ROUTING AMBULANCE TRAFFICE AWAY FROM PINOLE WILL SOMEHOW MAGICALLY ENHANCE THE`*PATIENT MIX" AT SAN PABLO. AT AN AVERAGE OF 5-6 AMBULANCE CASES A DAY, IT MIGHT INFLUENCE THE MIS,BUT IS NOT GOING TO MAKE A SUBSTANTIAL DIFFERENCE . THEY ALSO IMAGINE THAT WE AMONG THE MEDICAL STAFF CAN INFLUENCE OUR PATIENTS TO ACCEPT SERVICES AT SAN PABLO. THERE IS ALREADY AN ANt QLE PROOF OF HOW THIS WILL NOT WORD. CONSIDER THE NUMBER OF INSURED, WORKING CLASS PATIENTS W,HO HAVE FOR YEARS BYPASSED SAN PABLO TO ,HAVE MATERNITY SERVICES AT ALTA BATES, AT SOMETDVTS CONSIDERABLE FROM : Doctors MC Pinole ER PHONE NO. 15107246640 Dec. 04 1999 10:06PM P3 INCONVEN ENCF, ALL THE WHILE THAT QUALIFIED MA'iERNITY SERVICES HAVE BEEN AVAILABLE IN SAN PABLO, IF A PREGNANT WOMAN IN LABOR.IS WILLING TO TAKE HER CHANCES IN TRAFFIC ON I-80 TO AVOID CONFINEMENT AT SAN PABLO, IS YT REASONABLE TO ASSUME THAT SHE, OR HER FAMILY,WILL BE.DRAWN TO THAT FACILITY FOR OTHER HEALTH SERVICES? THOSE PATIENTS WHU WILL, OUT OF NECESSITY, BE LEFT WITH NO OTHER CHOICE THAN TO GO TO SAN PABLO ARE THE MOST COSTLY OF PATIENTS FOR WHOM CARE IS PROVIDED, THE"MARGINS" OF HEALTH,CARE PROFIT, WHICH ARE SCANT ENOUGH, ARE THE WORST FOR THE FRAIL ELDERLY, THE CHRONICALLY ILL, AND OF COURSE, FOR.THE MEDICALLY INDIGENT AND NEGLECTED, HUGE DOLLAR LOSSES OCCUR CLOSING PINOLE WILL 'WORSEN,NOT IMPROVE THE FINANCIAL PICTURE AT SAN PABLO. IF ANYONE BELIEVES THAT TENET WILL END[l'RE CONTINUED AND INCREASING LOSSES FOR VERY LONG, T14EY HAVE NOT BEEN PAYING Al'TENTION TO THE CORPORATE PHILOSOPHY. TENET WILL PULL THE PLUG ON SAN PABLO;TENET IS NOT A PHILANTHROPIC AGENCY NOR DOES IT HAVE THE ABILITY TO TURN TO PUBLIC AGENCIES FOR. RELIEF. WHEN THE DOORS CLOSE AT SAIN PABLO, WHERE THEN WILL PATIENTS TURN FOR CARE? TO KAISER.? TO ALTA BATES? TO VALLEJO? CONTRA COSTA COUNTY, THE SECOND OR THIRD WEALTHIEST COUNTY IN CALIFORNIA,HAS CONTINUALLY TURNED ITS BACK.ON niE HEALTH CARE NEEDS OF ITS POOREST RESIDENTS. LOS MEDANOS HOSPITAL STANDS CLOSED,A MONUMENT TO THE HEALTH CARL INEQUITIES IN OUR SOCIETY. IT WILL SOON BE JOINED BY THF FORMER.BROOKSlDE DISTRICT HOSPITAL 'WHICH WILL BE DOONIED BY PATIENT DEMOGRAPHICS AND ITS LOCATION IN ONE OF CALIFORNIA'S POOREST DISTRICTS, SURROUNDED BY CONTRA COSTA'S INCREDIBLE AFFLUENCE. THOSE WHO CAN TRAVEL. WHO HAVE SUFFICIENT SUPPORT AND MOBILITY, 'W'ILL FIND CARE ELSEWHERE. THOSE WHO CANNOT WILL FIND THEMSELVES BEREFT OF SERVICES AND WILL IMPACT THE HEALTH CARE SYSTEM BY PRESENTING THEMSELVES FOR CARE WHEN IN CRISIS. I THINK THAT MR. SLOAN AND ITS ALLIES, AND MOST CERTAINLY THOSE TO WHOM HE ANSWERS AT TENET,HAVE LONG SINCE MADE THEIR. DECISION ABOUT THE CLOSURE OF PINOL.E. IF THEY HAVE THOUGHT THIS THROUGH TO ITS LOGICAL CONCLUSION, TION THEY ARE TREATING THE CITIZENS OF'WEST CONTRA COSTA COUNTY WITH A GREATER DEGREE OF CYNICISM THAN MOST OF US WOULD THINK POSSIBLE. IF TAY HAVE NOT THOUGHT THIS THROUGH TO ITS MOST LOGICAL CONCLUSION, THEN THEY ARE SIMPLY ENGAGING IN CORPORATE STUPIDITY. REGARDLESS, THE OUTCOME FOR HEALTH CARE IN THE AREA. IS GOING TO BE SEALED FROM : .Doctors MC Pinole ER PHONE NO. : 15107245640 Dec. 04 1999 10:07PM P AND WILL EE BITTIrR.. WDEED, FOR THE ELDERLY,THE POOR AND THE ALREADY UNDERSERVED, SIGNED. FORREST BEATY",M.D. FORMER.MEDICAL DIRECTOR., EMERGENCY ROOM FORMER.MEDICAL STAFF CHIEF DOCTOR'S HOSPITAL OF PINOLE I7ESDAY j�' -.`:`T ,.JAN VARY }"1, her K`,_, EBF Fj�{ iJOHN,AAitmM T�Ro� tar sit Via President !«TaweAN 1s4NO8 ngErytat ' THE TIMIES IRAN HATF1ELt3, d Page hduor CL A Knight Ridder Ncwspaper t iq Ec tatuzl SCOlt Starters' % OMM1NGHAM NEWS- Emq `en room issue 1 AN ANYTHING BE DONE to stop the looming doaure v, of the emergency room at Doctors Medical Center in , r,Pinoie?The answer is complex and,ln.a larger sense, beyond local control. " That could,become clear today when the county Hoard,of 5u {+ } pervLwra takes up a' Impact evaluation of the doaure i ei.• s , planned for March`1,The'iepott will be accompanied by strong" opposition to dosing-tire facility by the county's top health offi- •- dal,Dr William`Walker,director of the Health Services Depart went Sadly sad trtkn uthere is lfttk`the cinmtytrtcan do to stop the a, ' closure under o4 prevent Iioalttt ossa s�8dER1�•s -` { «, �' "' �I}jhy\1 j County officials cask and:w!!t forward a final report to, state' ' } Health Services Department by Safurday-Wilt the state step in ► and stop the cls?„That”:quattionable,in Use view of Gil mar- regional director af`tlieent :,"We could`evaluate`the reiwrt'and mike comments on It,*hMarW tinez told",Times, month "Poaiibly we could inform a hoe p1tal aCout bur reservattuma As to,preventing x closure;I don't + know�3 c�=sa > •xi.,r w?,� e ,,w. x...,� > ,'!-* - !' _The stats oesn"t know bemuse it is reluctant to throw.its weight,against a logiti trit"'profit-making In,the Amen :. can free enterprise"am 71 met Healthcare Itie,owner of� Pinote'and•San Pablo hbspitais,is one of the natien s largest for ,` pront hospital-'cia ,'It had Mvemr"for the ending Aug 31 of$2.8 billion.xx the'Isaalth services dlrectorcan The au tvSso and. - pF. strong appeals to keep the,emorgency room open They can cite; � �• }.' •= a~ _ compelling i9gtrt es abouC Incase ad travel time to bbctors Medical : Center tri San Pablo.They can poinf to the number of,doctom nur�ses`who,attended a'recent"pubh�bearing to protest the clo-,i a sure.-They cu}emphaslze.the,genuine faar.of the*ntr,of- mole, Hercules,Rodeo and other WeatCounty,.&mnt"as that; in time of need emergency care will have been sacrificed to bottom line of a corporate balance sheet If all of this doeadt prevail in Sacramento,however,itdoe s n't• mean the vigorous public concern of residents,health pmfasaion• ars and county offidala have been in vain 'A serious issue about hedth.and public'aafety has been robed. • The contxrrn can stlmutate thought and action about what can be;tqfodWokk done tb avoid.uchdist}tsletio$developmcnta in the � mcs Assemblywoman Dion Aroner,D•Harkel�ey,is spin Pushing a ' hsbb� bili that would essentially give Bounties a`veto over a b"asl t i t TiiNDSIGH7'JANE Swift must „ ; ways sty no to the raise, company's decision to toric an emergency room ., ti, lank back an her ppraxnancy at `Nevertheless,when all the e The taessute p_ 'an appeal bybspitadrt tr>too state's sac ,: the good bid dam VVlnetrrwt shr h era laid and lana;there 3a mo retary of health end h5hian servicea.'A similar blll narrowly�;,� :wout to the llitiB.isue f or liauunitnf tNa#tap"than one:lieutenant g governor motherof to occupy this tseco dirst { - `I'm not asking to Interfere lm'every oorperate detain that r " hospitals-tnake,`.Aron�iw'_"Hut wbett.0 retries dtsv }to them j faitowed ha t i en dkron- hatrter!t is fa again jthe gap bef, dosing a facility community that would t)e telt barei,2 think-- iclad her'morning'ricknees atld ELIEN'GO{3I)MAN T '' wank and fam#ly�ee days.Th« l the have a tight to step in at.that poimt" t?- yW t3 h M coiutirfd the osrbork t of dtncolate milk" Syndiated bolatnnist tante,the hours;the expectatic And hospitails do chsuige than"minds Kaiser permai►e�Pnte Ln {` Her press secretory had toexpleen " ;the job only grow wider the n, that the In cup was deed. yo to,the top. Richmond did,Last,Mai�ti;'aifire sf,tbo-Chevron•►efinery sant ;at t vni ttinry woman to run zsir.chsfandud her�lf,ln�daHng thp., . �dday,'twti`worktng parents x hiundreds of residents irito,the emergency fsc ft that,I4aistsr fwd the staffers wens voluuaeen a tarp,. to n gat a short time before Lt because of b• foestatewide office,in`s:maternity. uystem"who heipsd her hold treterrrs the norm But the new e- agteed tie j r t Pu tsars;she was taken to task by the ,' a demands mora and more t right of hoc owe Republican x t together the best l t er, Sita da ,In the upper eGhalans of the r, Y scribed herself man average work-,, Concerned 1Vesk County resident are Wagidlg a good fight fbr t one'p�y Irate citizen .,�pint with above-average do atonal would our fathers'ave, keeping the eine nc!'service they feel with good t�iaaan,they . said that It she wasrrt Beteg to stay ;mxnds:'TI a ars tortes wheat 1 to n't *`�$+ ,, now as-mar. need.Toney have caught:the ear of equally eoncertned local sift home with the baby she ought to,; sick,when I can t jwt net be ' ' dais and health`. tesaionala have a cat Instead. _ s available."r' Not fang ago*,CEO downs; 3f prq ,> * ,, t> . , Ybt that war the P Soma who rltsresi the hie company was asked bov, If their expressions of awdety over the impending Into of the ` Today,the holes in the Swiss of working parenthood sympathized would decide who got the pinks emergency room in Pinole spread to the capital In Sacramento,-; drama of this working mother's child, with Swift while resented bar -What he'd like to do,he answe even to Washington,for some sort of restructuring of health care,. care have larded on�s aria.Fiat, privilege.The reaction to the per. was stand by the door and see good could coca of it come the news that taWt sneaks . tonal use of staffers split between left work st 6 p.m., r hellcapter to,her home!n North ,those who said"mets have done this in private,life,bosses rotchc Adams when,among other things,- forvrvert"and those who answered the demands.But in public tiro ' her 14-month old daughter had exacriyl`., voting bases expect 14/7 even I pnemmonia Skating ahead of the ice politicians who preach family va• "n „rsRtn# Phan came reports that rhe often of now motherhood,Swift to in. it's no wonder that the too, Jtuadits Mf l9 We nit0 dre',ahb ttyk. used statehouse staffers At her"vii+. sited that the staff enjoyed caringthe top is filled by meat in trsiditi a c {titirk o►a fRvlsr Ti as 1 Some baby-sat for Elizabeth for Elizabeth because"she'e sdorable, marriages and women without u¢titlt '. linehti'ipinloq saotiAn when all else failed.others ran er• and engaging and she's teamed to dren.it's no wonder that,on e rands for Jane.' . , blow kisses."Somehow it was easy ;age,American women enter pol The 34-year-old lieutenant goner• to forget that"volunteers"can't U- a decade behind men,Or thn, Dave Snell REGFIXFO From: Counci12 Sent: Wednesday, January 05, 2000 7:25 PM JAN 112000 To: Councill; ©ave Snell Subject: ncol CL RK ARDWTRA FSU 0. s I've lieved in SI Sobrante for 37 years-Doctors Hospital have always been there for me and my family-all the residents of EI Sobrante are going to have to go to SP. I am very against closing Doctors Pinole. Janet Bailey, EI Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:19 PM To: Councill; Dave Snell Subject: ncol I'm against the closure-I feel that we need that emer room b/c the one in SP is already pretty busy-it's not very good when you go and need help and have to wait I've lived in El Sobrante for 40 years. Its a disservice to close the Doctors Pinole. ALice Mulkey, El Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 6:57 PM To: Councill; Dave Snell Subject: ncol Surprised it's coming up again - lived here for 38 years in EI Sobrante/Pinole, Doctors Medical SP clearly busy, can't imagine them taking on more. Very emotional subject-hard to believe it can happen. Family members have used Doctors Pinole before and liked care there. Very fearful of the results. Very difficult to imagine. Kelly Gooding, EI Sobrante Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 6:41 PM To: Councill; Dave Snell Subject: ncol 1. Helicopter pad in Hercules would make for faster transport time-avoid commute backup Ken, Hercules 10 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:39 PM To: Council1; Dave Snell Subject: ncol At the ER you have to wait long enough now. I can't imagine having to wait twice as long. It's too far and inconvenient to get to Brookside. Cheryl Lewis, EI Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:33 PM To: Council1; Dave Snell Subject: ncol 1 really think it would be a big mistake to close Doctors emergency room. I've used it many many times-one time when I had to go to the ER, if I'd had to go to Brookside I wouldn't have made it. I oppose closing our local ER. Sue Cochran, El Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:31 PM To: Council1; Dave Snell Subject: ncol Brookside has too many patients going in already. We need Doctors Pinole. Mr. Bryan, EI Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:30 PM To: Council1; Dave Snell Subject: ncol 1'd like to oppose closing Doctors Pinole. I've lived here 50 years. More waiting is serious-can overload emergency room at Brookside. 1 am against closing Doctors Pinole emergency services. Mrs Bryant, EI Sobrante 9 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8.22 PM To: Councill; Dave Snell Subject: ncol Helen Sanders, unincorporated county area I don't have a car so I rely on public transportation. It's three bus rides to get to Brookside, and only one to get to Doctors Pinole. What about people like me who don't have cars? Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:18 PM To: Councill; Clave Snell Subject: ncol I specifically moved to Pinole, right down the street from Doctors, because my mother who needs medical care lives with me. 1 know lots of other people who did the same thing. My mother had cardiac crest, and the only reason she survived was because we were so close to Doctors. We have a growing, and aging, community, and I hate to think how many people won't survive similar episodes because of longer travel. Even if one life could be saved .. it's worth it. Tenet doesn't care about the community. Karen Costa Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:55 PM To: Councill; Dave Snell Subject: Icol PUBLIC OFFICIAL- BETTY GRIMES CITY CLERK ON HOLD Dave Snell - From: Counci12 Sent: Wednesday, January 05, 2000 7:46 PM To: Councill; Dave Snell Subject: ncol I feel that it's important to keep Doctors Pinole ER open because there are only 2 hospitals around here as it is- Doctors Pinole is closer to Pinole-EI Sobrante residents and much easier to get to. Sandy, EI Sobrante s Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:38 PM To: Councill; Dave Snell Subject: ncol Will speaking time be extended past 9 PM? Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:29 PM To: Councill; Dave Snell Subject: ncol Keep Doctors Pinole open - SP is just inadequate. It's hard to get into it as it is. There's a need for it in Pinole, Brookside's area would be too vast and one ER can't cover everything. Neil Mulkey, El Sobrante Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:24 PM To: Councill; Dave Snell Subject: ncol I live near Brookside, but service is slow as it is and I hate to think what will happen when another ER closes. Richmond resident Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:22 PM To: Councill; Dave Snell Subject: comment Got a call from someone complaining that people in the audience weren't getting to speak. Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:47 PM To: Councill; Dave Snell Subject: ncol I work in CCC health services and I know that people in that area need access to emergency health services. People need that care. Rita Barouch, Martinez Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:45 PM To: Councill; Dave Snell Subject: ncol I feel like Brookside hospital saved my husband's life during his recent heart attack. Travel time is one thing, but there is no problem with the level of care at San Pablo. Kelly Hammer, Tara Hills Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:45 PM To: Councill; Dave Snell Subject: ncol Brookside is very understaffed and nurses are overworked - I am concerned about the aging population in our city. I echo most of the othe comments. Connie Gozzano, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:42 PM Cla To: Councill; ve Snell Subject: ncol A point that should be made is the 3 major refineries in the area - I am more concerned about how the hospitals will handle that - what sort of contingency plan exists for refinery and earthquake disasters? Susan Cole, Pinole _ZX Dave Snell From: Council2 Sant: Wednesday, January 05, 2000 8:53 PM To: Councill; Dave Snell Subject: ncol I was a cardiac patient at Brookside recently - the service was very poor and especially at night. Obviously understaffed - at Doctors wasn't much better. A doctor told me the wrong thing and I could have died. Tenet just cares about money, they don't care about people. Michael Wilkie, Pinole resident for over 40 years Dave Snell From: Council2 Sant: Wednesday, January 05, 2000 8:48 PM To: Councill Cc: Dave Snell Subject: RE: ncol nobody has wanted to talk live so far --Original Message— From: Councill Sent: Wednesday,January 05,2000 8:45 PM To: Council2 Subject: RE: ncol we could start taking a few calls —Original Message— From: Council2 Sent: Wednesda ,January 05,2000 8:42 PM To: Councill;Dave Snell Subject: ncol A point that should be made is the 3 major refineries in the area - I am more concerned about how the hospitals will handle that - what sort of contingency plan exists for refinery and earthquake disasters? Susan Cale, Pinole - Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:47 PM To: Councill; Dave Snell Subject: ncol I am a 30 yr Pinole resident - used Pinole ER lots for both parents lately. It's a lot easier having a hospital closer when you have to go there multiple times a day. We need our local ER for the community. Pat Davis, Pinole s Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:06 PM To: Councils; Dave Snell Subject: ncol (paraphrase] Problem with care at Brookside -felt like care was bad, and understaffed, and felt unsafe Mary Temple, San Pablo Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:06 PM To: Councils; Dave Snell Subject: ncol I work in Richmond, and live in Pinole. 3 weeks ago when the diesel truck crashed on 1-80, it took me an hour and a half to get home. THey keep talking about "normal' commute times but you can always count on something like that happening, and what happens to emergency transport then?. Harold Davis, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:03 PM To: Council1; Dave Snell Subject: LCOL- Michelle, Pinole personal story Dave Snell From: Council2 - sent: Wednesday, January 05, 2000 9:00 PM To: Councils; Dave Snell Subject: ncol I spoke with Gary Sloan personally 2 years ago and explained to him that I had a situation that I would have died if I'd had to be taken to Brookside. doctors Pinole saved my life. At that time, Gary Sloan promised it would not close. Patty Vitamer, Pinole 4 l r/�iJG1 Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:22 PM To: Councill; Dave Snell Subject: LCOL-Rob from Pinole Effect on youth sports Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:19 PM To: Councill; Dave Snell Subject: ncol My wife was in Doctors Pinole 8 or 9 years ago for a long time (48 days in the ICU) and taken very well care of- I feel like they saved her life. The care there is the reason why she's still here. Recently I've been to Brookside and seen that it is so understaffed - lights are on outside the rooms and nobody is answer them. THere isn't enough staff there to care for the patients. [have Steel, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:08 PM To: Councill; Dave Snell Subject: ncol (paraphrase] We very much need the doctors hospital ER - it's important for the community that we have that emergency service locally available. Raul Lopez, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:07 PM To: Councill; Dave Snell Subject: ncol I've used the er at doctors a number of times - in fact, I moved here to be close to it (I live right below it). What if the county hospital closes because of budget cuts? Will it overburden Brookside? Mr Tillman, Pinole 3 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:31 PM To: Councill; Clave Snell Subject: LCOL-Marie Augustin from Pinole general comments Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:29 PM To: Councill; Dave Snell Subject: ncol Everyone has a personal story to tell. It has nothing to do with minorities. THe community (HErcules) is growing, Doctors is growing, and we will need it more than ever. Joanne, Hercules Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:26 PM To: Councill; Dave Snell Subject: ncol Debbie Clark, lifelong area resident My mother just moved into Say PArk, one of the main reasons being that Doctors Hospital is so close. 1 was there a few weeks ago when someone fell. An ambulance and the fire dept were there in 2 minutes and 15 seconds. It's unacceptable to close Doctors Hospital. Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:24 PM To: Councill; Dave Snell Subject: LCOL-William Butte from Pinole MEAD ME NOWII already spoke from audience - follow up on fire inspection do you want to take him??? z Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:43 PM To: Councill; Dave Snell Subject: ncol I think they should close the Doctors ER if they can't get better staff and provide better care. I lost both my parents there. One doctor yelled at my family when my mother died, and the same thing from another doctor when my father died. I pray to God that no one in my family ever has to go there again. Hercules resident Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:38 PM To: Councill; Dave Snell Subject: LCOL-Scott from Pinole general comments Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:32 PIN To: Councill Cc: Dave Snell Subject: NCOL-William Butte from Pinole He spoke live and called in to add this comment: After the fire inspector completes his report, OSHPOD has to came in and inspect the hospital before occupancy by any patient. (This should be done before the ER closure is approved.) ­—Original Message-- From: Counclll Sent: Wednesday,January 05,2000 9:25 PM To: Counci12 Subject: RE: LCOL-William Butte from Pinole READ ME NOWP let's hear from those who havent soijen yet furst ---Original Message---- From: Counci12 Sent: Wednesday,January 05,2000 9.24 PM To: Councill;Dave Snell Subject: LCOL-William Butte from Pinole READ ME NOWT! already spoke from audience - follow up on fire inspection do you want to take him??? i 8. Dave Snell From: Counc112 Sent: Wednesday, Janua05,2000 7.25 PM To: Councill; Dave Snell Subject: ncol I've lieved in SI Sobrante for 37 years-Doctors Hospital have always been there for me and my family-all the residents of El Sobrante are going to have to go to SP. I am very against closing Doctors Pinole. Janet Bailey, El Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:19 PM To: Councill; Dave Snell Subject: ncol I'm against the closure-I feel that we need that emer room b/c the one in SP is already pretty busy-it's not verygood when you go and need help and have to wait I've lived in El Sobrante for 40 years. It's a disservice to close the Doctors Pinole. Alice Mulkey, EI Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 6:57 PM To: Councill; Dave Snell Subject: ncol Surprised it's coming up again-lived here for 38 years in El Sobrante/Pinole, Doctors Medical SP clearly busy, can't imagine them taking on more. Very emotional subject-hard to believe it can happen. Family members have used Doctors Pinole before and liked care there. Very fearful of the results. Very difficult to imagine. Kelly Gooding, El Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 6:41 PM To: Councill; Dave Snell Subject: ncol 1. Helicopter pad in Hercules would make for faster transport time-avoid commute backup Ken, Hercules 10 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:39 PM To: Councill; Dave Snell Subject: ncol At the ER you have to wait long enough now. I can't imagine having to wait twice as long. It's too far and inconvenient to get to Brookside. Cheryl Lewis, EI Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:33 PM To: Councill; Dave Snell Subject: ncol I really think it would be a big mistake to close Doctors emergency room. I've used it many many times-one time when I had to go to the ER, if I'd had to go to Brookside I wouldn't have made it. 1 oppose closing our local ER. Sue Cochran, El Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7:31 PM To: Councill; Dave Snell Subject: ncol Brookside has too many patients going in already. We need Doctors Pinole. Mr. Bryan, El Sobrante Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 7;30 PM To: Councill; Dave Snell Subject: ncol I'd like to oppose closing Doctors Pinole. I've lived here 50 years. More waiting is serious-can overload emergency room at Brookside. I am against closing Doctors Pinole emergency services. Mrs Bryant, EI Sobrante 9 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:22 PM To: Councill; ©ave Snell Subject: ncol Helen Sanders, unincorporated county area I don't have a car so 1 rely on public transportation. It's three bus rides to get to Brookside, and only one to get to Doctors Pinole. What about people like me who don't have cars? Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:18 PM To: Councill; Dave Snell Subject: ncol I specifically moved to Pinole, right down the street from Doctors, because my mother who needs medical care lives with me. I know lots of other people who did the same thing. My mother had cardiac arest, and the only reason she survived was because we were so close to Doctors. We have a growing, and aging, community, and I hate to think how many people won't survive similar episodes because of longer travel. Even if one life could be saved .. it's worth it. Tenet doesn't care about the community. Karen Costa Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 7:55 PM To: Councill; Dave Snell Subject: lcol PUBLIC OFFICIAL- BETTY GRIMES CITY CLERK ON HOLD Dave Snell - From: Counci12 Sent: Wednesday, January 05, 2000 7:45 PM To: Councill; Dave Snell Subject: ncol I feel that it's important to keep Doctors Pinole ER open because there are only 2 hospitals around here as it is-Doctors Pinole is closer to Pinole-EI Sobrante residents and much easier to get to. Sandy, El Sobrante a Dave Snell From: Councii2 Sent: Wednesday, January 05, 2000 8:38 PM To: Councill; Dave Snell Subject: ncol Will speaking time be extended past 9 PM? Dave Snell From: Councill Sent: Wednesday, January 05, 2000 8:29 PM To: Councill; Dave Snell Subject: ncol Keep Doctors Pinole open - SP is just inadequate. It's hard to get into it as it is. There's a need for it in Pinole, Brookside's area would be too vast and one ER can't cover everything. Neil Mulkey, El Sobrante Dave Snell From: Councill Sent: Wednesday, January 05, 2000 8:24 PM To: Councill; Dave Snell Subject: ncol I live near Brookside, but service is slow as it is and I hate to think what will happen when another ER closes. Richmond resident Dave Snell From: Councill Sent: Wednesday, January 05, 2000 8:22 PM To: Councill; [have Snell Subject: comment Cot a call from someone complaining that people in the audience weren't getting to speak. 7 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:47 PM To: Councill; Dave Snell Subject: ncol I work in CCC health services and 1 knew that people in that area need access to emergency health services. People need that care. Rlta Barouch, Martinez Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:45 PM To: Councill; Dave Snell Subject: ncol I feel like Brookside hospital saved my husband's life during his recent heart attack. Travel time is one thing, but there is no problem with the level of care at San Pablo. Felly Hammer, Tara Hills Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:45 PM To: Councill; Dave Snell Subject: ncol Brookside is very understaffed and nurses are overworked - I am concerned about the aging population in our city. I echo most of the othe comments. Connie Gozzano, Pinole Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:42 PM To: Councill; Dave Snell Subject: ncol A point that should be made is the 3 major refineries in the area - I am more concerned about how the hospitals will handle that - what sort of contingency plan exists for refinery and earthquake disasters? Susan Cole, Pinole 6 Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 8:53 PM To: Councill; Dave Snell Subject: ncol I was a cardiac patient at Brookside recently - the service was very poor and especially at night. Obviously understaffed - at Doctors wasn't much better. A doctor told me the wrong thing and I could have died. Tenet just cares about money, they don't care about people. Michael VVilkie, Pinole resident for over 40 years Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:48 PM To: Councill Cc: Dave Snell Subject: RF: ncol nobody has wanted to talk live so far —Original Message From: Councill Sant: Wednesday,January 05,2000 8:45 PM To: Council2 Subject: RE:ncol we could start taking a few calls --Original Message-- From: Counci12 Sent: Wednesday,January 05,2000 8:42 PM To: Councill;Clave Snell Subject: ncol A point that should be made is the 3 major refineries in the area - I am more concerned about how the hospitals will handle that - what sort of contingency plan exists for refinery and earthquake disasters? Susan Cole, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 8:47 PM To: Councill; Dave Snell Subject: ncol I am a 30 yr Pinole resident - used Pinole ER lots for both parents lately. It's a lot easier having a hospital closer when you have to go there multiple times a day. We need our local ER for the community. Pat Davis, Pinole s Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:06 PM To: Councill; Dave Snell Subject: ncol [paraphrase] Problem with care at Brookside - felt like care was bad, and understaffed, and felt unsafe Mary Temple, San Pablo Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:06 PM To: Council1; Dave Snell Subject: ncol I work in Richmond, and live in Pinole. 3 weeks ago when the diesel truck crashed on 1-80, it took me an hour and a half to get home. THey keep talking about "normal" commute times but you can always count on something like that happening, and what happens to emergency transport then?. Harold Davis, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:03 PM To: Council1; Dave Snell Subject: LCOL- Michelle, Pinole personal story Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:00 PM To: Council1; Dave Snell Subject: ncol I spoke with Gary Sloan personally 2 years ago and explained to him that I had a situation that 1 would have died if I'd had to be taken to Brookside. Doctors Pinole saved my life. At that time, Gary Sloan promised it would not close. Patty Warner, Pinole 4 Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:22 PM To: Councill; Dave Snell Subject: LCOL-Rob from Pinole Effect on youth sports Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:19 PM To: Councill; Dave Snell Subject: ncol My wife was in Doctors Pinole 8 or 9 years ago for a long time (48 days in the ICU) and taken very well care of- I feel like they saved her life. The care there is the reason why she's still here. Recently I've been to Brookside and seen that it is so understaffed - lights are on outside the rooms and nobody is answer them. THere isn't enough staff there to care for the patients. Gave Steel, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:08 PM To: Councill; Dave Snell Subject: ncol [paraphrase] We very much need the doctors hospital ER - it's important for the community that we have that emergency service locally available. Raul Lopez, Pinole Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:07 PM To: Councill; Dave Snell Subject: ncol I've used the er at doctors a number of times - in fact, I moved here to be close to it (I live right below it). What if the county hospital closes because of budget cuts? Wlll it overburden Brookside? Mr Tillman, Pinole Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:31 PM To: Councill; Dave Snell Subject: LCOL- Marie Augustin from Pinole general comments Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:29 PM To: Councill; [have Snell Subject: ncol Everyone has a personal story to tell. It has nothing to do with minorities. THe community (HErcules) is growing, Doctors is growing, and we will need it more than ever. Joanne, Hercules Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:26 PM To: Councill; Dave Snell Subject: ncol Debbie Clark, lifelong area resident My mother just moved into Bay PArk, one of the main reasons being that Doctors Hospital is so close. I was there a few weeks ago when someone fell. An ambulance and the fire dept were there in 2 minutes and 15 seconds. It's unacceptable to close Doctors Hospital. Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:24 PM To: Councill; Dave Snell Subject: LCOL-William Butte from Pinole READ ME NOWII already spoke from audience - follow up on fire inspection do you want to take him??? Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9.43 PM To: Councill; Dave Snell Subject: ncol I think they should close the Doctors ER if they can't get better staff and provide better care. I lost both my parents there. One doctor yelled at my family when my mother died, and the same thing from another doctor when my father died. I pray to God that no one in my family ever has to go there again. Hercules resident Dave Snell From: Counci12 Sent: Wednesday, January 05, 2000 9:38 PM To: Councill; Dave Snell Subject: LCOL-Scott from Pinole general comments Dave Snell From: Council2 Sent: Wednesday, January 05, 2000 9:32 PM To: Councill Cc: Dave Snell Subject: NCOL-William Butte from Pinole He spoke live and called in to add this comment. After the fire inspector completes his report, OSHPOD has to come in and inspect the hospital before occupancy by any patient. (This should be done before the ER closure is approved.) ---Original Message-- From: Council_, Sent: Wednesday,January 05,2000 9:25 PM To: Council2 Subject: RE:LCOL-William Butte from Pinole READ ME NOWI! let's hear from those who havent soijen yet furst --Original Message--- From: Counci12 Sent: Wednesday,January 05,2000 9:24 PM To: Councill;Dave Snell Subject: LCOL-William Butte from Pinole READ ME NOW!! already spoke from audience - follow up on fire inspection do you want to take him??? i TO: Congressman-George-Miller_.. Governor Gray Davis Assemblyman Torn-T dakson Contra Costa County Supervisors Mayors of Pinole;Crockett,. Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District- Art Lath p, Cont.ra._Costa.County_Emerg. Med. Services Gil Martinez, California Dept. of Health Services ]erry Barbakow, CEI , Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I. am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Historically, wherever Tenet Health Care Corporation has entered a community, via a hospital purchase, corporate assurances were given to the community relative to the continuance of excellent health care and facilitates. However, when the purchases were consumated, the hospitals were either"downsized"or closed, causing extreme degredation of available emergency health care to the community. In the case of the Pinole campus of Doctor's Medical Center, the same thing is happening, once-again.- Tenet plans to change the Pinole campus into an"urgent care"facility, thereby eliminating emergency room faciaities. This, in tum,will increase profit margin for Tenet, but will decrease the quality of health care for the local community. -in some cases, local emergency room facilities will cease to exist. As stated in the.firstsentence,_above,theseactions_am-part.of a pattern that Tenet has established, not only in the united States, but internationally, as well. Some countries have been successful in curbing Tenets lack of corporate.ethics. We urge you to help us accomplish the same by reigning in Tenet's disregard for community welfare. Please let rue-.know-what you will do to-make.acute-care health care services available to our West Contra Costa County communities. Sincerely, Signaturre Printed name..,KAREN C. HARRINGTON Address 1750 Chandon Way,Oakley,Califbmia 94561=3060 Rhone/Fax/Email (925)6264659 I 1 4 2 - f , t�s. 4 Y7 w 1 TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Toriakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds In Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, 7` C,o.w�w e�,;v r� + ti's 7" /Ie.. 4 A)6 7"�e Liss o3 '. Pl12�a�S d �r + re,,�:S ld /&Jce L 7'1� �22�a;�.2 � "1 � -1 Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name A LZ r Address .�S .'�' o4SWW00 2 Phone/Fax/EmaOas�.26�9ySOe ) ola9-S-Oe l SGAK:O A oL•Cv4� TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Toriakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEG, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature n ant+�t Printed name !► , A D Address y Phone/Fax/Email I t TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercuies, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services .ferry Barbakow, CEO, Tenet Corporation Subject. Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, J. "�''`'�-�,�.,,,k,.� Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed namei//'V Address AL(e j�: Phone/Fax/Email / / ='e / TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of gyne Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, P 10 � .s---rte--- Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature el kill Printed name � 0 krl s em. fn 1 � Address Aoll d- Phone/Fax/Ercall -'rl a 1 I ' TO. Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Plnole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, , / Signaturef '� -U Printed name Y FT`t7g� Address Phone) axJEmail�`f�.-�a_�••61 s,�` / 1 TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett., Hercules,. Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop,, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name Address CIA I A 1,110"/1 'V/.'rNJ" F' Phone/Fax/Emall �kY, 03'J-3 TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors- Mayors upervisorsMayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name C) Is Address Phone/Fax/Email '` 1 25 1 3 1 TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Plnole, Crockett, Hercules, Rodeo and El Cerrito. West Contra Costa Healthcare district Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CECT, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, r l / -. Signature Printed name Address , L' -. -- Phone/Fax/Small TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CED, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name h-=ig j c_ CZi LIZ Address ;Z 6 i / P Pr+► Phone/Fax/Email 2- 7 ,s 71 TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature &,,� Printed name /f G Address zp q ��7 Phone/Fax/Emali J I TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. f In particular,-'tk" cc. �,,.tz�..�1,,i�,t..-. •/� ,-�...� �+-Z?,-t..-- 'j� �rt,,,rte.,._ ::j -;c.-,'v.a..-� �-�`.#. Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, r � Signature 1 Printed name T k e kn, Address n I an W'1'-4 L ri NJ V) C9 e. Phone/Fax/Emall / �j �` �/ d TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare district Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name Address 0,6p 0' �� } 1,�'' TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, r. Signature n,2,,,Q ®t , Printed name. �� Address W Pr� 109 Phone/Fax/Emall TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, LCi L l. •�lL J�_y/ �/ GCr•i y.yL1t ✓-L 'L 'L G ✓! L' �'LYI r Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name-- Address ame_Address Phone/Fax/Email ;z.?. • TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of U ie Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, ,�'C� '" uL.t.-Y""' �,.:'.-�. .��` J ' .eat.-i�--t�'- � �*_`Ate• -�....: 9 ,,.�� .��.�`-- ,..�L r� �-�_•L-G .,•��fes-- ..��-�--�1' 1z / J 1.Jr Ya+ •,•t -rv' Please let me know what you will do to make acute care health care services available to our Vilest Contra Costa County communities. Sincerely, Signature Printedname Addresst,'L.Z Ir- �j Phone/Fax/Email I SAMPLE STATEMENTS Sample statements to elected officials: Can you stop Tenet from closing emergency room services and critical care services at Doctors Medical Center in Pinole? We can't live without them. --------------------------- We do not have enough emergency rooms and intensive care beds in the ,County now, and we are still growing. We're counting on you to act to protect our services. --------------------------- If Tenet closes the emergency roam and acute care beds at Pinole Doctors Hospital, what Is next? What services will Tenet guarantee to Pinole? (or Hercules or Crockett or Rodeo?) --------------------------- I count on the Emergency Department at Pinole for - �"' {my heart conditlon, my child's astl4ma, etc. . Don"t let these services leave the area. Sample statements for Tenet Corporation: If the County Impact statement shows that closing acute care services at [doctors Pinole is bad for residents, will you honer that recommendation and keep services open? --------------------- What services will Tenet guarantee residents of the area? Do you promise to keep San Pablo"s Emergency Department and critical care units open? TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: toss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, •1- ,42 . L ec ✓`.t_. Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature f r . Printed name ' ° �'- Address Jar A: C Phone/Fax/Email TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med, Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, If 1er., a- r Please let me know hat you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature } Printed name a CLn A4 C 5 6-e-ry Address I --Pr cz Phone/F ictal TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Toriakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular., r � , K .� r .. �`it''1 1~�`��X � \,�'`YL"�d �J' � 7 �� Gam" �..`(' ✓ C .. .'t / r i y Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name ► ' ✓ t ",- Address A C Phone/Fax/Small 1 1 TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name 'i lir LG' Ir - Address 2 l 2/ 4P e l t rs WA Phone/Fax/Email I I TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Toriakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, v 7 �. _ }{ �, „ r, 1.0 . i � •-t,i # t . y,e /rt.' � ti .�1. iii.. .. Y.. t� /'': ; , rt- �' y / '1 !•_ ft T �, 1. '1, t,•.i' � )t t�._� �I � � �_ t:.�, I. . —; C Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature r Printed name Address_ - -^- �� Phone/Fax/Email ("/gip .-. / TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CECT, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. Inarticular, p r J • �� Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature ►��- Printed name M M{ K Address ' Phone/Fac/Emall S / TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, ti �.44.J 4 ,; V Please let me know what you will do to make acute Icre health care services available to our West Contra Costa County communities. Sincerely, Signature ' Printed name . a 0 1 Address ` i- 5-1 o` Phone/Fax/Email TO. Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, . . rtz T 7 Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature -- Printed name. , Address - t &ra �� � -lam I Phone/Fax/Small Seo-' 2-!4_a tp&/__ / TO: Congressman George Miller Govemor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Plnole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Meda Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CECT, Tenet Corporation Subject: Loss of Emergency Department and intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, - y4' v ' s Y 4 6 r Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature - - -� Printed name ''" Address yrs.-•,.. GGt. e jr,�trc� a� Phone/Fax/Email TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, 17 Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, , r Signature ' Printed name Address cI Phone/Fac/Emall TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, -. CX or Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name - 4 P 7 Address_ Phone/Fac/Email !�j ' / ', ` 1. TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, - �y..� {;� zi �. �_ DO a+. Y J S L'j+ L•� k__._- G� �--.��.. ,,�.-t �r�-���..�,�..--�.. ..wry��.�:�•t�� � Pleasetlet me k-� w what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature �``-- Printed name Address Phone/Fax/Emali , rJ fL2 J) Ze 6 1 Z2il-A'S i , (!X)S , C- TO. Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. } r In particular, - {c. {k.:..�.� v :� + �f ,�'.. •<L t;le- ec t��...f'l=°� L/'�1�-��.. �:./�-C` c: I / �t'i „��t 7'\L'r- - •� P � v`� !. a. �.. ---�-r.<.'�.- LL L 14- /17/2 qV/-r c-- Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed namer ?- Address 24 -2- i r)f Phone/Fax/Emall - / TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CECT, Tenet Corporation Subject: loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, i ✓ d % _T '4'.`\c:b Gam. VN Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature r\ X) pc-�� Printed name Address Phone/1=ax/Emali TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Toriakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept, of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, ~ �` �-+`r �t �7'lGG7 r'�.G: 'G�✓-L.G c,u ��c, �} <° t- � r . c IIIY-� ��. . !�lLc.� G��L:,•1=i,,w�l ��^�.�Z�,t�:,,'r-� ,�.- (:'G"'�.r: .,.'s..0 C.G- G6..1. � J,i v Lo^�.- � � ,.. � ...Jai .,. !_ ,� .,J !r� t� , t��J �4�V.J✓L'� f'.+{,,. "L-' ..;11'.1/ °"' 1.�r���.• ;�-•/ice:.• �rY,�.,.��c,�,.,, �-' .f- 7�.; ;�..� -��.... f-- Gr�`�c:. �' y �7� eke- -�-ze,.:.�G" +L/ .+- �.''�t�-' .�d;.,'.-,ww� �64L/ � - J°c�.-�'`'"r.✓ ,��' �j ��:.� _�,�.��� .� �ccZ7 --�' 6G l �i� Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities, Sincerely, , Signature-- >> 1-eCl'Cas: Printed name� 't;r-r //A/-11=- cY Al Address-,..24 V1 Phone/ /Emall_ A)-46 4� -lv ! / TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, go f A ;' s ', : Z/ 1 . 1ecL Y' Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature _ .,, - a Printed name Gr, a_ "f'E Address 6 :2 L 4 Phone/Fax/Email TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me Wotwwhat you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature ' �, �..... Printed name_ r 1775 Address Phone/Fax/Email_ .� LIZ- �9 /�/ 176 TO: Congressman George Miller Governor Cray Davis Assemblyman Torn Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop.. Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name G���vS t',L � /V Lr Address Phone/Fax/Email TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Hied. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature �- Printed name 1 lv t k + Address Phone/Fax/Email 0 � TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, -- �",� "°� 7-)4 s � nu . U IV t}e J Please let me know what You will do to make acute care hearth services available to our West Contra Costa County communities. Sincerely, Signature itJ Win--' Printed name torr i e ol�.Nrr�n Address 8 �ivv ' 'e Nc r,i7— -a122 l A wi-a-A Phone/Fax/Email I I TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Centra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject. Loss of Emergency Department and Intensive Care Beds In Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Centra Costa County communities. Sincerely, Signature (. �!Z Printed name /11 — 'OWIf Address (434--& -"�enj cox- t l Phone/Fax/Email / / TO. Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature -�--- Printed name �/-& � Address to�' Fax/Emaii, TO: Congressman George Miller Governor Gray Mavis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Merry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Slgnature 'j-- . Printed name • 11,s AddressCit V v_VN TLC , r PhonE Fax/Emall,S`-15- j s Please let me knew what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature Printed name Address Phone/Fax/Email / — - TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med'. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature_- ' Printed name.U c_ lin\' N \ tom-! Add ress_ Phone/Fax/Email l C / '1 5_ t-1-cl'9� I TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject. Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinhole. In particular, i Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature • t Printed name Address. Phone/Fax/Email I / TO: Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and EI Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services ,ferry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely, Signature_- 13 �Printedname Nl rx*-I s Ru.(,o",rT Address Phone/Fax/Ercall I 1 TO. Congressman George Miller Governor Gray Davis Assemblyman Tom Torlakson Contra Costa County Supervisors Mayors of Pinole, Crockett, Hercules, Rodeo and El Cerrito West Contra Costa Healthcare District Art Lathrop, Contra Costa County Emerg. Med. Services Gil Martinez, California Dept. of Health Services Jerry Barbakow, CEO, Tenet Corporation Subject: Loss of Emergency Department and Intensive Care Beds in Pinole I am concerned about the proposed closure of the Emergency Department and acute care beds at Doctors Hospital of Pinole. In particular, Please let me know what you will do to make acute care health care services available to our West Contra Costa County communities. Sincerely,, Slgnature-_- �, .� Printed name `- 0/s- Address ,3--/ d55� 1= }UL Phone/Fax/Ercall J0-7ST- e.53,2 / r: t w � s t . i ftm#2074000 J 1 r i 4 k+ own o 4 r Y » s f o. f } It" • . doo& loop" -a y w � P r„r,rrr ; ok ` s MONO a s � N + 2071000 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill L.ockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We appose plans to close acute care services at DMC in Pinole, which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City,Zip Phone# 13t Zl_ Email: 2)Print Name Address City, Zip Phone# Email: 3) Print Name Address City, Zip_ _ Phone# `c Email; 4)Print'Name Address City Zip Phone# WA Q Email. &107 5) Print Ndne Address 41110 (eVZI-'A IT City,Zip Phone# CA 14�-1 i Email: b)Print Name Address City,Zip Phone# - , X10,,`'elelC' C� rx/, 0 5;7'(-5f;7 Email: 7)Print Name Address City,Zip Phone# [Email: Send to.* Save Our Services, P.O. Box 681, El Cerrito, CA 94530 N4ToTen%Aaol.com * Hotline: 510-273-2245 Deep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkerna,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a fu11 service,earthquake sound Doctors Medical Center in Pinole and San. Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City, Zip Phone# ' k , q 41,-'j C� Email: 2)Print Name Address a�v�uGL i ' r 7 7 QCACI,' Fera-h 0?r, L� City, Zip Phone# .S i''O Z G L. C r'-� Email: 3)Print Name Address LI'N-D#4 -Tctrn.o-r q// City,Zip A n t r o C.H JR Email: 4)Print Name Address Cit} Zip Phone# —t;.6 0 Pilo 4Email: S) Print Name Address City, zip Phone# Email: 6)Print Name Address City,Zip Phone# Email: 7)Print Name Address City, Zip Phone# Email: Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTenetQaol.com * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Clary Sloan,CED,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Directut,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical.Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. l)Print'Na ­_... Address ` 7 Phone# , ( Email: tlf' 1 <= i 77 2}'Print Name Addre!"s Ci%,Zip Phone# c L, - :,�z 6 if Ercall: 3) Print Name Address City,ZiP / .Phone# t -,2!3 .,;� ,�.► f'� ! " �' Email: 4)Print Name , . Address Citry, Zig - �, ., Phone# Email: S)Print Name ' ' Address City,Zip A Phone# c;) C6 < , ti Email: 6)Print Name Address / ° C {'Lt tf r� cam-iue C14k city,Zip t + Phone# S a z q._ 5°b_7 Email: 7) Pttt•Name Address City, � ° .Phone# w. 1'71) �'� . r'�%r Email: Send to: Save our Services, P.O. Box +681, Bl Cerrito, CA 94530 NOT_0 enetnaol.cam * Hotline-, 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole, which will worsen the current shortage of hospital beds, emergency and acute care services. 1) Print Name Address City,Zip Phone# 5-/0 : 7-(),P i O (2 + ' j 4�J-7 �/'� Email: 2)Print Name Address l�L.�:� ity, Zip Phone# Email: 3) Print Name Address City, Zip -R-u p L o Phone# � ,V-? (r = Email: 4) Print Name Address City, Zip Phone# Email: 5)Print Name Address City, Zip Phone# Email: 6) Print Name Address City, Zip Phone# Email: 7)Print Name Address City, Zip Phone# Email: Send to: Save Our Services, �P.O. Box 1 I68+�#1�f,�SEl Cerrito, CA 94530 iynTOTcnet(&,aol.Coltl * Hotline: 510-2 /.3-2245 Keep Doctors Medical Center Open in Pinole An open Petition To: Jeffrey Babakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California.State Senate Tom.Torlakson,CA State Assembly Diane Bortz,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at UMC in Pinole, which will worsen the current shortage of hospital beds, emergency and acute care services. l)Print Name Address -41"A-e - City,Zip 1 c ` Phone# -6` lam;. - 2— Email: 2)Print Nacre Address ki L/*?A67;f R:,jAj j�&6& City,Zip , f Phone# f Email. > 3)Print Nacre Address fa s City,Zip Ziip,., Phone# e, /" l= O% Email: 4) PAnt Name Address f Cit',Zi Phone# Email: 5)Print Name Address C� l Cityr�Zip r ,,g qV5� 7 j Phone# ( rim i A' Email: 6)Print Name Address Un C Ia. it) 0 1-AA 'N Ole City, Zip Phone# Email: 7)Print Name Address r City,_ i Phone# �� - -- Email: Send to: Save our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTenet&a-Ql.eom * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CED,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor 'West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo, with sufficient capacity to serve our communities. We oppose plans.to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1) Print Name Address City. Zip .-- Phone Email: 2) Print Name Address City, Zips Phone# Email: 3) Print Name Address /J _ city,zip ° Phone# t IT� #�? � , ' " Email: 4)Print Name Address City,Zip y Phone# -VV - 1; &4 Q,14 �U 7 rlllail. fn b�. j( y,� Yet •,�• - ,rw.._ 5)Print Name r` Address 700 ( 2 IX -,-y City,zip Jwy 1 y 7 J p, -y1 /f�� Phone# 3 Z,57 .� 4�C Y r ..7 / � a''r `.."'u✓✓{y i (! fir✓" Email: 6)Print Name Address 91 K . .�- City,LipPhone# Email: 7)Print Name Address ') Li �> City,Zip ; , . ; Phone# ] j / 1 Ems: Send to: Save tour Services, P.O. Box 681, El Cerrito, CA 94530 NoTo e=@Wl com * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Dianne Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils 'Vi?'e,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We appose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. i)Print Name Address City,Zip Phone# 510 6.et 2)Print Name Address RC( t�el if\/ 1,( ) I Irk City,Zip I Phone#-51C 6- Et "' C' ' ' Email, 3)Print Name Address Cit,Zip Phone# Email: 4)Print Name Address _ f City,ZipPhone# 7s� -64--u ?j- Ec /' S Email: 5)Print Name Address Ci,�j',fid} Phone . G 1i 131,c,rte• `I�f Ernail. {)Print Name Address < �< del! t rig e - Com, Zip Phone .2 3 - 3 }N54 '' Emil. 7)Print Name Address n,cZip Phone# s 1q ..Zo v--4� � c>u �;' Email. Send to: Save Our Services, P.O. Boz 681, El Cerrito, CA 94530 NOTDTenet ra aol.com * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jefrrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a fiffl service, earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plansto close acute care services at DMC in Pinole, which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address c s;. City, Zip 0 Phone# 0) -44;�� Email: 2) Print Name Address City,zip Phone# Y -c7l C4 Y Email: 3)Prin Name Address 4j City,zip Phone# Email: 4)Print Name Address City,zip Phone.# (2c 0g&D'4- 4'7 -e'k '-)Cby- Email: 5)Print Name Address City,Zip Phone# 77 q1 '-Y 5 Email: 6)Print Name Address C' Phone# Email: 7)Print Name Address ' / city,Zk.m Phone 1"de?) Email: Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 1q!2-T-QTeiictna aolxom * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,.Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkenia,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1) Print Name Address City, .p Phone## �' ' '' '•- IsL 7 Email: 2) Print Mame Address t j ,�, t' ,1 c, i 61 V, Cit Phone# /V y,V, &r 4- YJ � Email: 3) Print Name Address X;�r City, Zin- ` , Phone# "I f 7.; �' (l., Email: 4) Print Name Address City, Zip 1 Phone# Y , : i�le Email; 5) Print Name Address City, Zip Phone# S 1 () A - Email: 6) Ph t Name Address ;.j yy !t.>} City,Zip Phone# Email: 7)Print Name '), j . Address City,Zip I Phone# tr 72. -,2 79 Email: Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTcnrttu;aol.corn * Hotline: 511 -273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Banta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkerna,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1)Print Name Address -7 C . PIC Phone# !0 4 -7 City,j1p i"'.. '"C VI Email: 2) Print Name Address L'(' City, Zip cq Phone# t -e V Email: 3) Print Name Address , 't ' fJ /r' ,,, 1' '� l tA Dl*� City, ZipPhone# Email: t '4) Print Name Address I— r, q -7 t, ea, Ci ZI'p Phone#,�!Z-4' XY" L cz Email: 5) Print Name Address 10 VY Aj Zip Phone# 5; 6- Email: 6) Print Name Address A; City, Zip Phone# Email: z 7)Print Name Address .4 H Z V, City,Zip,- Phone 4 17 i- a U �. ta— Email:---- Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 N oIaeng&-a Q I xv on * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,GE©,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CECT,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California state Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical.Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose planus to close acute care services at'DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1) Print Nam Address City,Zip Phone# ,G--, <, 4 _ C Email• 2)Print Name Address 06 't ��2 CL7t,� City, Ziff) ; Phone# �"I Email: 3) Print Name Address LIZ- 3 �.�. —� ..... �.. . ,�•.� � ��c�--,rte-�..-f �`c..- { City,Zip Phone# J c{ Email" 4) Print Name ' t , ' '`a Address r City, Zip r Phor OZ -� Email: 5) Print Name Address City, Zip Phone# 5/"1 -- Email: 6) Print Name Address Ip E �', Phone# - " i " Email: Ci 7) Print Name t" Address City,Zip Phone# Email: Send to: Save Our Services, I .O. Box 681, El Cerrito, CA 94534 NoToTenet!ri'aol.cotn * Hotline. 514-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Tortakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkerna,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service, earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1) Print Name Address e-IT Pry C'' City, Zip Phone#*;#y - 2) Print Name Address VI J YTI-h 'I City, Zi Phone f-1-6) — " .0 A Email: 3)Print Name Address 4� V (n, Y, zi Phone# Email: 4)Print Name Address City, ZipPhone# Croc" Email: 5)Print Name Address N-7 A-41A& City,ZipPhone# 2v- L.� - el'c4- 44 Email: 6) Print Name Address I(- L /T Cat� Zip a_ Phone -/4 & �4 /�A:'�Z- 5 Email: 7)Print Name Addres City,Zip T;, 27 —,c,)LCA �J Email: Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole and San Pablo, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1)Print Name , �. - ,i.,t�,a rfi-'' Address City, Zip Phone# �L/g Z. G 5.1/1; Z - /' '_' .� Email: 2) Print Name Address City,Zip a Phone# Y -d..Y t G !�4 0 jEw � �'�y �_ t,� Email: 3) Print Name,,y»� �-�r f J Address } / [,.'" / mfr,�,L.+ f S._✓ ``a .^s 'rr '4✓ ,,' <+..{+ 4,+'" /"w.✓ 'V City, ZipPhone # r-- '' Email; 4)P ' t Name Address f - n rc'I A11C.- P-- �Wc- Cith Zip 11Phone# 13 t � I ? Email: 5)Print Name Address Cit�p Phone# -+' l rtiO e7 4Sze Email. 6) Print Name Address City,Zip _ Phone# i t o I--f �� � �, � Email: 7)Print Name Address City, Z Phone# 2 J. Aue'L-4 Email: 6,e.,, r s r€ cr= • �A Send to: Save Cour Services, P.A. Box 681, El Cerrito, CA 94530 toTo`i'enet(c%aol.cotn * Hotline: 510-273-2245 :deep Doctors Medical Center Open in Pinole An Open Petition To: IdRey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Guy Sloam,CEO,Doctors Medical Center Bill Laccky+er,CA State Attorney General Richard Rainey,California State Senate Then Toriakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkerna,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our conommnuties. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City,Zip Mav 4-t-n e ZC} V Phone# 70 Email: 2) Name Address t- City,Zip y Phone# , Email: 3)Print Name Address t a� � _ I? City,zip 'V Phone one# ri. 4)Print Name Address r City,Zip Phone# s ic; 5)Print Name Address 75 � Gcf City,Zip Phone# Email: 6)Print Name Address City,Zi ,^ Phone# # 7)Print Name Address City, Zip ,� t 1 Phone# Email. Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTeS ul.com Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakaw,CEO,Tenet Healthcare Carp Representative George Miller,US Congress +Mary Sloan,CFA,Dors Medical Center Bill Lockyar,CA State Attorney General Richard Rainey,Califcmtia State Seagate Tom Torlakson,CA State Assembly Diane Elonta,Director,CA Dept,of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uillma na,Contra Costa County Supervisor West county City Councils We,the undersigned, ware committed to a full service, earthquake sound Doctors Medical Center in Pinole, with suffic ent capacity to serve our communities. We appose plans to close acute cam services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City,Zip �"73`s vt' Phony# 4—C Ernail-. .l , 2)Print Name Address f�t� �� � � � t�.,' �� �.'�t✓ 1 A1C �7�'``�,r. �� City ' a Phone# 45 Z f Gtt�7 'moi - / Email: 3)Print Name Address City,Zip Phaone# - G? Email: 4)Print Name Address ,h bC r City,Zip Phone . o-741 --0 i '- Email: 5)Print Name j Address /I Lgr r ,1 City,Zip Phone# t. EEmaail: t)Print Name Address SO Anal CLc City,Zip Phone# 'I 0-7--Q"- �- V41 L4 0 - �i� 1 Email. 7)Print Name Address V c R r., a t".tk K A k L l t,.s a c�"t-t C? City,Tip , Q 4 tj Phone# '7 o2; (4;?— 7 Eamaih: Send to: Save Our Services, P.O. Box +681., El Cerrito, CA, 94530 11 ToToTenet(o,a oLcolln Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,GCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. l) Print Name Address City, Zip Phone _ Ltk b 0 a t C Irl. Email: A , 2) Print+Name Address V (r�} yy^ City, Zip Phone# \ 7 . I ". A 3 S"IU Email: 3) Print Name Address t �� f.+�.Iv�j,:.,t" 4 N L��'V1'�•'I°" J��yi � ��f� ,'GV' j, 1 ",� r Ci Zi Phone# '' p > Email: ?;rrt Ott v a 4) Print Naipe Address A(4 Gil City p Phone# , "LZ ` ` � 0 �t -1 I Vt' q Email: ML(+rs k. C? d 1)t • c:oYrt 5)Print Name Address City,Zip Phone# o ,l 537 4 (1 -7 Email: CIOM-M n) A -1c 011 6)Print Name Address c Z + C a v� z i C a o ta..g; is S'r- City, Zip Phone# V C _;r. �? �t 4r5 v Email: 7)Print Name ti r-. Address ' -71 1 Phone# ..� :.� Email: JKSWR LL �" l�.tc .CJ Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTenet@aol.com Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill LAockycr,CA State Amy Gerontal Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bo nts,Director,CA Dept„of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uillxnsa,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care servicers at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City, Zip Phone# -75 f' -- 5`417 Qt; �} 'b�r Email: 2)Print Name Address } City, Zip Phone# ,�- 1 : A/111 L 10 -j- u-j I.q Email: 3)Print Name Addressr- e e t'V e n + v4 c �.�t; V:�S cz e5 {L.n d.moo, CA City,Zip c e Phone# U t� `+l� Email: r 4)Print Name Address City,Zip Phone# Email: S)Print Name Address City, Zip Phone# Email: 6)Print Name Address City, zip Phone# Email; 7)Print Name Address City,Zip Phone# Ernaih Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 Neslaoct ol.e otn * Hotline: 510-273-2245 Keep Doctors Medical Center Open In Pinole An Open Peddon To- Jeffrey Barb akow,CEO,Tenet Healthcare Corp Representative George Miller,us Congress Gary Sloan,CEO,Doctors Medical Center Bill Lour,CA state Attorney General Richard Rainey,California State Senate Tom Torlabon,CA State Assembly Diane Bonita,Director,CA Dept.of Heath Services Art Lathrop,Ditector,CCC Fxwmgeacy Medical Services Gayle Uilkema,Contra Costa County Supervisor west County City Councils We,the undersigned,are committed to a full samce,earthquake sound Doctors Medical Center in Pinole and San. Pablo,with sufficicrit capacity to serve our communities. We oppose plans to close scute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address r Henrietta 0. Festin !- Z"f GSL c 1 r`✓" BW Join St.Apt,1316 � Finale,{;A 94584-131$ city,Zi Phone# �` - --- ' Email; 74t 2)Print Name Address N4 Q r U-T .s Email: 3)Print Name Address city,zip / ) Phone# 'Vi�J k !��„ J--,�.�•Y s r i� x•i"' ,r� .�C.' f`id ,.,r4.'r'j{,..+"• Email; 4)Print Name Address City,Zip Phone# Ln o 1-6 , C (A C7LW'0 q - ;.i( , Email: r t��.►i.+�-rw.4�.d . , 5)Print Name As { ,'72- 5- City,Zip Phone# 77/ �G'rr), ) cA I?q-4 te'lC+�'vC1 9t/ 1�letr'jr tGrs�r 6)Print Name Address t ( 'C " �og t St t r-t ax r,cr City,Zap Phone# meq Pi acr.- Cid- 4' Email. .. Tj Print Nance Address City,Zip Phone# 7 , ; fiend to. Save Our Services, P.O. Box 1811 El Cerrito, C.A. 94530 lutoToTe:aet&oI-WMt * Hotline. 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,CJS Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Utlkema,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose pians to close acute care services at UMC in Pinole, which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address ZA Ltd C) ( � { 1" C'[t CA-4,r'`' CA . City,Zip Phone# r 1 C, - ,) 1 Email: 2)P �T- N Address ` ` a 'qj' Dam Ci ip Phone# 6 rq n &-3 Email: 3)Print Name Address City,Zip �,, Phone# Zi wa'j , I- q Email: 4)Print Name Address City,Zip Phone# Email: 5) Print Name Address City, Zip Phone# Email: 6)Print Name Address City,Zip Phone# Entail.: 7)Print Name Address "City,Zip Phone# Email: Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTenettn?aol.com * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffity Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State AtWmCY General Richard Rainey,California State Senate Torn Torlakson,CA State Assembly Diane Bonts,Director,CA Dept of Health Services Art Lathrop,Director,CCC;Emergency Medical Services Gayle Udk==,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service, earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We appose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1)Print Name Address Ci Phone# � P vt `;. 5 Email: ; c z !C� t t-I 2)Print Name Address 1 C-A .n � ,, City,.zip Phone# q '2' �\4-0 t.0 C-k- CAI Email: 3)Print Name Address City,Zip Phone# 7 z 4 7 :r 'r F�.D l S Email. 4)Print Name Address city,`zipj Phone# # I ►.�r~7 , O'A L� Email: - 3 J --1 6P kv, 5) /Print Name Address 09 City,zip 'j,� Phone# i ' ) .7 ; �f Email: r�7 r y rt .t 6)Print Name Addrescz, ,J City,Zip Phone# 1 =it �; n 6 Lt 11001 Email: 7)Print Name Address City,zip Phone# Email. Send to: Save Our Services, P.O. Bog 681, Bl Cerrito, CA 94530 NoToTenrtCaol•cosn * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Carp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Laclry+er,CA State Attorney General Richard Rainey,California State Senate Tam Torhrkson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uillmn,Contra Costa County Supervisor West county city Councils We,the undersigned,are committed to a fall service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1)Print Name Address City,Zip Phone# �T l D .tt 7 - ' 7= 4 `ll 01 -7 i' Email: 2)jPrint Name r��+ Address City,Zip Phone# eez r'02 7 R./ ;,C7- ;�: �" ; ,'. 4.. Email: 3)Print Name Address 373 City,zip`�' Phone# 4)Print Name Address ��.�.'"'� Lam' r �.�{ �•�� t��-� ""'' �' I� ���,1C.,� 'r'.,,. �'� -'�,='1s✓'� � ;7i'��� City, Phone#r.,Vl 'f) 1-u ,3 2 ' -� Email: 5)Print Name Address 1 � 7 ilk! ', / ' City, / Phone# Email: 6)Print Name � � `�' r Address ' j City,Zip ' t.� , , ,�-, Phone# Email: 7)Print Name Address Kar:,4 C-1- t 2-t( co.Lcr id'I e- City,Zip -d V ,p ,C�4 �tS pFno ail:hone# ,`{`{ Send to: Save Our Services, P.O. Bax 681, El Cerrito, CA 94530 NoTaT .eorn * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEG,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEG,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Torn Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned,are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1) Print Name Address E04 6 c'r c: 1 J e e VC(A il) A (C-)(;) 9, 1140 Ptom" City,Zip ,bur4­r') 3 Phone# � I0 a .3 Email: 2)Print Name Address Citip / Phone# ..�c.--s� iac. -@_.,e,,, l._...l .' Email: 3)Print Name Address J&Pf OJ C 4 L I)eAjlfI el t 'r�S C r Ci ,Zip Phone# �c `c� Q X-C..U c e 5 Email: 4)Print Name/ J`� J' Address ,s City, Zip fi+ Phone# e' ;:5,o) :.;,Z "1' 3 6 Email: 5)Print Name Address r C15-o ? Un X/'_� INM Zip Phone# 0 / Email: �► 6) P " e Address cA City,Zip Phone# 7 -' Email: ' CA r�, 7)Print Name Address _ City,Zip Phone# vo " ` < fit`- " ll� ' ' � Email` Send to. Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NaTaT_caa I.comi * Hotline: 510-273-2245 Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Carp Representative George Miller,US Congress Gary Sloan,CE©,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We, the undersigned, are committed to a full service,earthquake sound Doctors Medical Center in Pinole and San Pablo,with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole, which will worsen the current shortage of hospital beds, emergency and acute care services. 1) Print Name Address City,Zip Phone# G Email. 2) Print Name Address City, Zip,� �f 3 Pho Z --,9 ,f(C� Email: 3) Print Name � / jg Address c �{ '" T O N t�yt T7 a � T ff T r Ap City,Zip A l bny) C4410 Phone# (51515,11 - *0(07. Email: 4)Print Name Address City, Zip. Phone# a 11 6-7 CS �- 4.ev/:t) '17�F Email: 5)Prin ame Address (K as 16.x._... -51Y 6 CF city,z' t'� e t.�t..( , 5"" Phone# Email: 6) Print dame Address L�,-I 0 // �— Z City,Zip _ Phone# C Email: 7)Print blame Address City, Zip Phone# Email: Send to. Save Our Services, P.O. Box 681, EI Cerrito, CA 94530 Hotline: 510-273-2245 ce'ater Opel' ,,,�„oawavf DodOrS MOVM*W** :,dxslov�:r soot"Im CCCVOOVWY ��� � � � cvw � GOW to Lt tf~ � 1/ ,r� �' ✓' "rw`r�• ���„wrrrirrr"r ,� �r(,,y�`"�-'"_ ,23V 3) tom►• ,��-, a G PA r3 w �t 7�f P •ter � t � ... �'} � � .T�� TWO IL 4 . •, eep► Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Carp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical:services Gayle Uilkema,Contra Costa County Supervisor Vilest County City Councils We,the undersigned, are committed to a(tall service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address Uaa* id-z Phone Email: 2)Print Name Address City,Zap Phone# C� ,4Ff .. r._ � t. r,- 3)Print Name Address City,ZipPhone#= .�. Email: 4)Print Name Address , 9N;V City,Zap Phone# NA IA,;wr7l Email: 5)Print Name Address 'i Li +, , &A 5 City,zi I L Phone# N A- r M Ll S fi Email: 6)Print Name Address City,Zip Phone# Email: 7)Print Name Address City,Zip Phone# Email: Send to: Save Our Services, P.U. Box 681, El Cerrito, CA 94530 NoToTenet aoLcom Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City,Zip � � �/` Phone# �.,1 b-aL vi 14 Email: 2)Print Name Address f vq p vt. D- 0 O.-C , City ip �� Phone# { �? Email: 3)Print a Address ( f&rnp(ole tle Ck— Co Ct'3Yt City,Zip Phone# l Email: LAS ( { } 4)Print Name Address City,Zip �j Phone# 161 2 _ T-7, ilk tk it �. �� Email: 5)Print Name _ Addres City,Z p Phone# -- moi't Email: 6)Print Name �- Address City,Zipf 1 Phone# / VI A 4,b/i e 7 Email: 7)Print Name, Address ( o_ City,Zip � � Phone# �A Email: Fend to: Save Our Services, P.O. Boa 681, El Cerrito, CA 94530 NoToTenet a@aoLcom Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds, emergency and acute care services. 1)Print Name Address C t i Phone# Email: 2)Print Name Address City,Zip Phone# L i �, �9� Email: 3)Print Name Address / VA City p Phone# Email: 4)Print Name Address City,Zip Phone# Email: 5)Print Name Address City,Zip �,� t Phone# Email: 6)Print Name Address 0 &'ge-L A. City, ip Phone# , l Email: 7)Print N Address el/-V,0 r-I2A A +'ii' J Ci Zi Phone# - Email: o, Send to: Wave Our Services, P.O. Boz 681, El Cerrito, CA 94530 NoToTenet@aol.com aol.com Keep Doctors Medical Center Open In Pinole " Te: s + rprbripa7v,Com,TWA c«pw►cmP Mutt-u GWY cm Ducom Me"Camew 80lAdcyw,CASoft A ny Gmaul Richwd .C id0nda t+A Sauft 'Ton Torfmbmav,CA SW#Aumubly Dim* 10101',CA DvpL*fHwM So v . Aft �s��O,Dom"„CCC i We,tt undmidwalcd, to a fall mvkv.outhgwke sound Docum Medical Caor in Pinole, with 'StCOPWity ID•true our`COMNi We OPPM ph=1D ckm mft am awAm at DMC m Pinoie,whwh Will wrttsett the of hospW beds,amwVmwy aid 11cuft cane sazvkes. 1)Fflm Nam A*km ID lcityou r 'ma c �. 9 4 S�7 7� 2)Prat Nine ®`1 V�L L V " rl �a k G H S a re� C"Y'ZlP E L Sc)u9 WT f- ?-c) 3 Pboae# SIC,- 0 !t Qo Ems: cam, # "iLA - 18 wmwnvwmm BMW: 4)Print No= Addmm City,ZIP Phone# 3)Prityt Nun t t L 't Addmn City,Zip s � # \0 `1 13R k-0 9,C, 6)Pft Nemse Mhus City,Zip t� l P'hme ama k 7)Print Nsrne aty"np Lf Send to; Save Our Serviu% P.O. Boz 681, El Cerrito, CA 94330 NoToTenet@aoLcom Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEG,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEG,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State senate Tom Torlakson,CA state Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkerna,Contra Costa County supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address R City,Zip Phone# .s 1 L)) l �_ �. L S -7 Email: 2)Print Name Address S City,Zip Phone# r C--A cl y 5` Email: 3)Print Name Address l L City, Phone# Email: 4)Print Name r Address .ni to 14> tJ' r City,zip Phone# Email: 5) Name Address City,Zip Phone# 6)Print Name Address �04- LW I ---------- City,Zip Phone# y OA Email: 7)Print Name Address City,ZipPhone# t Ems: Send to: Save Our Services, P.U. Bog 681, El Cerrito, CA 94530 NoToTenet@aol.com Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tena Healthcare Corp Representative George Millar,US Congress , Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose Plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address City,Zip Phone# Email: 2)Print Name Address City,zipj ,� �"'�� � � Phone# C— V l Email: 3)Print Name Address � a City,721p Phone# � r Email: 4)Print Name Address PIJF— City,dipPhone# �'� c Email: -7 5)Print Name Address 0, City,Zip Phone# 2>`70 -- 3 Email: 6)Print Name Address �e� � . City,Zip Phone# $ c; D.Rtk=Lr Ll X? Email: 7)Print NameAddress C ,Zip Phone# _ 273 Email.: Send to: Save Our Services, P.O. Boa 681, El Cerrito, CA 94530 NoToT'enet@aaoLcom Keep Doctors Medical tenter Open in Pinole An Open Petition To: defrrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill L.occkyer,CA State Attorney General Richard Rainey,California State senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County supervisor west County City Councils We,the undersigned,are committed to a f W service,earthquake sound Doctors Medical Center in.Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute rare services at DMC in Pinole,which will women the current shortage of hospital beds,emergency and acute care services. 1)Print Name AddresZvi Y s 1 C` > Phone# Zip�� # tl' 2 Email: 2 Print Name Address '53 C10,zip Phone -'> Email: 3)Print Name Address 3 7- City,Zip Phone# C-.r-� Email: 4)Print Name Address City,Zip Phone# --" VA 0 �4 1 Email: AU, 7 5)Print Name Address v , L P-e City,Zi Phone# 3 70 SZ 6 6 en-' Email: 6)Print Name Address t V c,; city,Zip Phone# 70.7 Email: ?)Print Name Address 7 -3 S—_-_5 d z Irv' 1_ ( i City,Zip - 4 {y Phone# � �{ .S 7 Email: Seng to: Save Cour Services, P.O. Boz 681, Bl Cerrito, CA 94530 NoToTenet*aol.com Keep Doctors Medical Center Open in Pinole An open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Carp Representative George Miller,US Congress , Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a hill service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address 4�- City,Zip y Phone# Email: 2)Print Name Address l U �2---- City,zip,�,y Phone 0 (;1 Email: 3)Print Name Address City,Zip Phone# f.lpd- <, w # j o�3 Email. 4)Print Name Address //0 • Y,Zip t {' f 64 Email: 5)Print Name Address V4 % VI 0, N- ten se . 1 g6(, t"I City,Zip Phone# v C 'Ltj I Ci Email: c` • °' o►.. 6)Print Name Address City,Zip Phone# -. M/I AT7ti'C 2-- '. 6 Email: 7)Print Name Address City,zip Phone# { �!� G mail: end to: Save our Services, P.O. Boz 681, El Cerrito, CA 94534 NoToTenet@aol.com Keep Doctors Medical Center Open in Pinole An Open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a fidl service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address C Aq r,Iq i, city.Zip Phone# ry)ELl Email: 2)Print Name Address City,Zip Phone# PY A Email: nj.- L 4 4PWI�T Q1 3)Print Name Address �j I LI z I M 10 trg M,A 7,(L-) COL t-r-7) �o Czip I Phone# ,tAU V I-L _q ex� (P Email: 4)Print Name Address City,Zip Phone# Email: 5)Print Name Address City,zip Phone# Email: 6)Print Name Address City,zip Phone# Em-ail: 7)Print-Name Address City,zip Phone J Email: Send to: Save Our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTenet@,aol.com Keep Doctors Medical Center Open in Pinole An{open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Torn Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address ULkLVt - ew City, "p Phone# ' - Email: -----. 2)Print Name _ Address -»� -...._ 1 :,. `E �-� i"""ce• � City,Zip Phone# i Email: 3)Print Name Address A)fto$ 44�rL-w City,Zin, Phone# CW11 „5't - 1 Email: 4)Print Name Address C Vti.. City,Zip . , Phone# tcz3: Email: 5)Print Name /J Jy j Address V M i eff 1 { City}zi ?L Phone# Email: 6)Print N e ,Address City,Z” Phone# Email: 7)Print ame Address 7 City,Zip Phone# Email: Send to: Save Our Services, P.O. Box +681, El Cerrito, CA 94530 NoToTenet@aol.com Keep Doctors Medical Center Open in Pinole An open Petition To: Jeffrey Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tom Torlakson,CA State Assembly Diane Bonta,Director,CA rept.of Health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service, earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. l)Print Name Address Ci Phone 1 ' Email: -' 2)Print Marne Address City,Zip Phone# 2.2 . Ic� Email: 3)Print Name Address City,Zip Phone# Email: 4)Print Name Address City,Zip Phone# Email: 5)Print Name Address City,Zip Phone# Email: 6)Print Name Address City,Zip Phone# Email: 7)Print Name Address City,Zip Phone# Email.: Send to: Save our Services, P.O. Box 681., El Cerrito, CA 94530 NoToTenet@aol.com Keep Doctors Medical Center Open in Pinole An Open Petition To: Jef my Barbakow,CEO,Tenet Healthcare Corp Representative George Miller,US Congress , Gary Sloan,CEO,Doctors Medical Center Bill Lockyer,CA State Attorney General Richard Rainey,California State Senate Tam Torlakson,CA State Assembly Diane Bonta,Director,CA Dept.of health Services Art Lathrop,Director,CCC Emergency Medical Services Gayle Uilkema,Contra Costa County Supervisor West County City Councils We,the undersigned, are committed to a full service,earthquake sound Doctors Medical Center in Pinole, with sufficient capacity to serve our communities. We oppose plans to close acute care services at DMC in Pinole,which will worsen the current shortage of hospital beds,emergency and acute care services. 1)Print Name Address, Ct:Ze,6L ` Phone# CK q:53k Email: •G 2 Print Name/' � Address 1�rn •oO City,Zip Phone# . Email: 3)Print Name Address Ci Zip Phone# ..--- 1 CA Email: ' 4)PrintName Address , L,1.12j2 &Z" City,Zi" Phone# ° Email: 5)Print Name r jN�,o n 5; Address A Qui - City,Zip Phone# -- Email: 6)Print Name Address City,Zip Phone# Email: 7)Print dame Address City,Zip Phone# Email: Send to. Save our Services, P.O. Box 681, El Cerrito, CA 94530 NoToTenet@aol.com