Plans To Restructure Health Services at UC-San Diego Hospitals Raises Concerns

Some health officials and patient advocates criticized a restructuring proposal announced Wednesday by University of California-San Diego officials to move some health programs at the university's Hillcrest campus to Thornton Hospital 12 miles away in La Jolla, the San Diego Union-Tribune reports.

The 10- to 20-year restructuring plan, which university officials have said is not final, would expand Thornton Hospital to a 505-bed facility and replace the Hillcrest facility, which does not meet state seismic standards. The plan also calls for the creation of "a bigger, state-of-the-art emergency and ambulatory care complex" and preventive health programs. The Thornton campus also would be updated with telemedicine and electronic videoconferencing technology.

Under the plan, the Hillcrest facility would continue to offer emergency and urgent care services. The Hillcrest facility currently treats almost half of uninsured and underinsured patients in the county, according to the Union-Tribune.

UCSD physician in chief Thomas McAfee and CEO Richard Liekweg on Thursday "reiterated the university's commitment to serve the poor and underinsured," the Union-Tribune reports. They said the plan would reduce costs, lessen duplication of services between Hillcrest and Thornton and increase patient care quality. McAfee said that enhanced emergency and ambulatory care programs would benefit the community.

However, some officials responded that the university should not operate a freestanding EDs without specialty services, such as bypass surgery.

County Supervisor Ron Roberts said that the move would require patients who need inpatient care to travel 20 miles to Scripps Mercy Hospital -- the only other trauma center in the area, the Union-Tribune reports. Roberts said, "This does not appear to be a patient-based plan." He added, "I'm having trouble visualizing how you can have an emergency room without having an adjacent hospital that you could admit people to if you need to."

Jerrold Glassman, chief of staff and chief of cardiology at Scripps Mercy, said the hospital does not have the infrastructure to care for all patients referred from Hillcrest.

UCSD officials on Thursday said that patients who would need to be admitted to a hospital would be "promptly and safely transported to Thornton," the Union-Tribune reports. McAfee said that only patients with serious illnesses typically require inpatient care.

Richard Butcher, a physician who treats low-income patients, called the plan "a mistake" and "not what we had in mind when we made our agreements with UCSD years ago."

Brent Eastman, former trauma director at Scripps Memorial Hospital in La Jolla, called the proposal "a tectonic plate shift" for the county health care system.

According to the Union-Tribune, state regulations prohibit freestanding EDs that do not have an intensive care unit and those that are not part of a "contiguous acute care hospital."

However, California Hospital Association officials say legislation will be introduced that would establish a special license category that would allow six freestanding EDs affiliated with acute care hospitals. The bill would establish minimum staffing requirements and reimburse care at the same rate as other EDs.

Supporters of the proposed bill say it would ease hospital overcrowding in the state. However, Association of California Emergency Physicians former president Loren Johnson said such a measure would "exacerbate" hospital overcrowding and "tak[e] advantage of the few remaining hospitals that continue to provide true emergency services."

Emergency Medical Services medical director and university ED physician Gary Vilke said that the number patients requiring hospitalization who come to EDs is small. He added that patients who come to EDs without appropriate services are transferred to other hospitals without incident (Clark, San Diego Union-Tribune, 2/4).

KPBS' "KPBS News" on Thursday reported on UCSD's consolidation plan. The segment includes comments from Liekweg (Ford, "KPBS News," KPBS, 2/3). The complete transcript is available online. The complete segment is available online in RealPlayer.