Palomar Pulls Plug On Downtown Escondido ER

A major change is coming to Escondido next Monday the emergency department at the old Palomar Hospital in downtown Escondido is permanently closing its doors. All emergency cases will be sent to the new Palomar Medical Center that lies a few miles west off Highway 78. The change has been in the works for quite some time as Palomar against the phaseout services that their downtown facility. Palomar officials say a number of community clinics in the Escondido area will be able to pick up the slack. KPBS health reporter Kenny Goldberg spoke about this with Doctor Heidi rebuffed and he is with the Palomar Emergency Services medical director and Gary Rotto and he is senior vice president of government and public affairs at Borrego Health. Doctor Reavis, what is prompting Palomar to close its emergency department at the old Palomar Health in Escondido? I think it's important first to note that we do not get ambulances at the downtown emergency department. At the standby -- its walk-in patients. As we look to consolidate services in the other campuses it will help the other campuses gain valuable resources. It's difficult when the resources are spread. Looking in the long-term of the health district to consolidate services to provide high quality care. You had a very long presence in downtown Escondido for decades. How disruptive do you think this change will be two people in Escondido? I think with good communication between -- on our end and resources for the patients in the emergency department with health centers that are opening their doors adding hours, it will definitely help the patients have other resources outside of the emergency department. Which most of our patients in this setting are lower acuity given that we don't receive ambulances. We've done very good communication that will be resources for the patients in the community health centers. There's about five to six health centers that are expanding hours to provide services for the patients that would normally use our emergency department. Gary you are one of the community clinics to help fill a gap. What are you planning to do? There are two things we are planning to do. We're going to be opening in urgent care clinic within our main help Center site there on Washington ---ish his Washington and North Ash. We will be expanding our hours. Right now we are open 8 AM to 5 PM and we will have we will be open from eight to five and 10 to to on Sunday. The expansion of hours and the added availability of urgent care which will include the ability to walk in. That is how we are going to help to fill that gap. We been coordinating with the good folks at Palomar to talk about what are the needs -- what have they been seen in the standby ER. I think that Doctor Reavis would agree that two thirds or more of the patients that are being seen really aren't in need of emergency services. They are in need of what we would consider urgent care. Whether it's a minor laceration that you need to have sutured. It's an upper respiratory disease. You have diarrhea, it's things that you are not going to be hospitalized for. You want to see somebody right away. And urgent care clinic that has walk-in availability is able to best serve the community. What happens if a patient comes in and they do have an actual medical emergency, a stab wound, they fell off a ladder something like that what we did the community clinic? Will call 911. If it is something that is urgent global want to get them over to the hospital right away. We will triage that right away. Doctor Reavis, emergency rooms have been used as de facto primary care center by an insured patients for many many years with the advent of Alabama care California expanded Medi-Cal to be seen any change at Palomar? I think generally with more people having the access with all that's happened is that patients that didn't have coverage insurance has the insurance now. People might be more likely to use our services now that they have coverage. But I think it's important also if we look at the report that was published a few years ago, it clearly documented that the myth out there that patients that use the ED are not sick was dispelled by the report. It should -- it showed clearly that a lot of these patients are sick. How will you differentiate a condition that requires an emergency department and one that could get service at a urgent care center? If we look just specifically at the downtown campus, something that's very important we do not receive ambulances. We see 70 to 90 or sometimes 100 patients a day. Of those patients less than 1% end up requiring admission to hospital that gives you an idea of the majority of the patients are semi-urgent or not urgent. They are just walk-in patients that are seeking healthcare again, less than 1% require admission. Gary, you are just one of a number of different community clinics that are housed in Escondido. In what way are you guys working cooperatively to make sure that there is an urgent care center opened most of the days? I can't speak for the other health centers. I know we are very much from the time that Palomar came to us and said we need to move forward with this change and how we deliver services, we said we are willing to step up. We're willing to commit to these hours. Other health centers may be doing that also. We are committed to this starting Monday which is March 14 which is a day that they will there will start to be that change. That is a ramp-up of our services, drawdown of the services that the Palomar standby ER. We have also had a couple of -- a number of consultations or committees so to speak that Palomar has helped to convene and community health centers and here's what we are doing and what will you be doing also. How do we help to communicate this to the residence not only in Escondido but in that North inland County area that need to know about this change? What I would say is it's an enhancement in redesign of services. Doctor Reavis there are some critics in Escondido say that when Palomar asked boat voters to support a bond for the new hospital in 2006 they were promised that the old Palomar Hospital would still maintain a full rate of services. Is Palomar reneging on that promise by closing the ED? That's probably a question that could be better answered through our administration. But I don't feel -- we are working -- to work with the community health centers to make sure there are resources for the patients. Also is very important to keep in mind that the main hospital is 2.7 miles from the Palomar downtown campus. Anybody that is serious enough to require -- would just call 911 and be transferred by ambulance. It's not the main emergency department -- is very close. You could actually see it from this one. Gary, what we going to add? I would say that if you survey the people -- I have not done anything scientifically but just talking with people in Escondido and if you ask about Healthcare Services the main thing is I want to know that they're getting the right services at the right time and that it's high quality they may know the hospital ADR for one think that if they know that they have the services for example our health centers less than 1 mile away. If they're able to get to it and we're going to provide transportation which we will be doing in a couple of weeks, we're going to be coordinated with Palomar, that is what people really want to know. Can I get the services that I need when I need them. I would agree wholeheartedly. I think when we looked at it it was of the five community health centers that are working with Palomar Health, they are within a 0.7 mile radius of the hospital. I'd agree 100% of like your place right time. I would like to thank our gross Dr. Jaime Rivas medical director of emergency services a Palomar Health and Gary Rotter senior vice president of government and Abrego health. On Kenny Goldberg and Mrs. Midday Edition on KPBS.