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Inland Empire Grapples With Shortage of Hospital Beds

After undergoing staggering population growth during the housing boom, southwest Riverside County is now grappling with a serious shortage of hospital beds.

Steps are being taken to expand existing facilities and construct new hospitals, but a number of recent events have hindered several projects, further delaying the addition of much needed beds. At one medical facility, an outdoor tent has been erected to deal with emergency department overcrowding.

“The dearth of health care capacity is daunting for southwest Riverside County,” said Jim Lott, executive vice president of the Hospital Association of Southern California. “I’m not sure we know why it’s lagging. We know it is lagging,” Lott said.

At the peak of the housing bubble, thousands of homebuyers in search of less-expensive housing moved inland from the coast to bedroom communities, such as Temecula and Murrieta, that are within commuting distance to San Diego and Orange counties.

There are currently three medical centers, with 302 licensed beds, serving the area from Temecula, north to Perris, west to Lake Elsinore and east to Menifee Valley.

A fourth hospital is under construction, and a fifth is in planning stages. But the region is far below national and state averages for hospital beds.

The national ratio of hospital beds-to-population was 2.7 for every 1,000 people in 2007, according to the Henry J. Kaiser Family Foundation.

California’s rate is even lower. With 1.9 hospital beds for every 1,000 people, California ranks 49th in the nation for hospital bed availability, according to a 2009 report by the California Hospital Association.

In 2005, at the height of the housing bubble, southwest Riverside County had 1.05 licensed beds per 1,000 people, according to a 2008 report by the county’s Community Health Agency. The region also has a shortage of doctors and nurses.

Several Causes for Scarcity of Beds

Local officials and hospital executives agree the existing number of hospital beds is inadequate. Several causes are cited including rising costs of construction, tightened credit market  and rapid population growth.

Lott suggested a number of reasons why the region has fallen behind the state average, including the fact that during the boom, the region was one of the fastest-growing areas in the nation. But he took issue with claims that the cost of adding hospital beds is prohibitive.

“The cost of building is the same as any other part of California. What it is, is the reimbursement rates for commercial-insured, government-insured [individuals],” Lott said.

For the last five years, officials have been working to address the hospital bed shortage, but given lengthy regulatory and licensure processes in the state, the expense of building new facilities and the strained market for borrowing money, it could take years before there are enough beds to serve the population.

Southwest’s Plans Face Obstacles

Southwest Healthcare Systems, a subsidiary of Universal Health Services, has undertaken several ambitious construction projects to address the hospital bed shortage in Murrieta, Wildomar and Temecula. But two of the three expansion projects have become mired in regulatory problems in recent months and have yet to open.

Meanwhile, the timeline for a third project, constructing a hospital in Temecula, remains vague.

The openings of two expansions by Southwest at Rancho Springs and Inland Valley medical centers were delayed after the state Department of Public Health, Medi-Cal — California’s Medicaid program — and Medicare identified violations.

Rancho Springs currently has 96 beds, while Inland Valley has 112. The two medical centers serve a combined population of 425,000.

With the two expansions, the medical centers could double their capacity.

The $53 million expansion at Rancho Springs in Murrieta includes the addition of a two-story wing and 30 emergency treatment bays. In total, up to 112 beds will be added, according to a statement from Teresa Fleege, Southwest’s spokesperson.

At Inland Valley in Wildomar, a $41 million expansion includes increasing the number of emergency room treatment bays, ICU beds and expanding the imaging center. The facility will add up to 132 beds.

Southwest says the violations have been remedied, but the expansions have not yet opened. The expansion at Rancho Springs is complete, and Southwest is awaiting licensure from California Department of Public Health, according to Fleege.

Southwest anticipates that Inland Valley will open in the second quarter of 2010. .

Last month, Southwest obtained state approval to erect a tent outside Rancho Springs’ emergency department to alleviate overcrowding. The tent will remain in use until Southwest is allowed to use the new expansion, Fleege wrote.

Southwest has also come under scrutiny by officials in Temecula who have questioned the future of a proposed hospital that has been in planning stages for years. Southwest maintains it has not abandoned plans for the project.

“Southwest is committed to building healthcare facilities in the Temecula area in an appropriate and reasonable manner and time,” Fleege wrote.

New Murrietta Hospital on Track for Next Year

In contrast to Southwest’s troubles, Loma Linda University Medical Center is on track to open a $211 million, full-service hospital in Murrieta in the first quarter of 2011. The hospital will have 106 beds.

So far, the project has not been ensnared by any regulatory pitfalls.

“Every step of the way, we have made every attempt to be good community participants both with the city of Murrieta, as well as the state of California and the local health department,” said Bruce Christian, president and CEO of Loma Linda University Medical Center-Murrieta. Christian has been involved in the hospital project since 2007. “I think that has been a significant factor in our project being right on schedule,” Christian said.

Loma Linda partnered with Physicians Group of Murrieta LLC, a consortium of doctors from Southwest Riverside County, to construct the facility. The campus on more than 50 acres will have a hospital and a five-story medical office building, which will house approximately 60 physician offices. The hospital will offer a laparoscopic surgery center, imaging center, emergency room,  surgical suites, and general and acute-care services.

“This Murrieta project is a project that specifically addresses unmet needs in the area,” Christian said, adding,  “They’ve got tents. The fact that we are providing these new facilities and services is a huge benefit for this community in this day and age.”

Christian said a number of challenging factors can be prohibitive to building medical facilities, such as the time it takes to get a project approved to being operational.

“Probably the primary reason is economics of it right now, the difficulties hospitals face in the challenge of just balancing their budgets,” he said. “Economics are driving a lot of things that aren’t happening right now.”

Expansion Unlikely in Sun City

Financial difficulties will likely prevent any expansion in the near future at Menifee Valley Medical Center in Sun City, the third existing health care facility serving the area. The facility has 84 beds.

The medical center is owned by bankrupt Valley Health System, whose sale to Physicians for Healthy Hospitals, a coalition of 130 physicians in the Hemet-San Jacinto and Menifee valleys, was stalled recently by a lawsuit brought by Prime Healthcare Services.

Prime Healthcare’s lawyer, Michael Sarrao, wrote in a statement that if Prime Healthcare were to acquire the medical center, the first step will be improving efficiencies, followed by addressing the community’s need for more hospital beds.

Alex Denes, spokesperson for Physicians for Healthy Hospitals, said that if the sale goes through to his group, there are no immediate plans to expand Menifee Valley Medical Center.

The group’s initial focus will be financially stabilizing the hospital and preventing the further loss of hospital beds, which is a possibility if the hospital shuts down, he said.

“It’s extremely difficult to get new beds online,” Denes said. “To get licensed through the state is a time consuming and expensive process.”

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