After the initial shock and awe of the announcement to close the trauma, stroke and heart attack treatment services at Regional Medical Center (RMC) had subsided, most of us providers spent the better part of the week scrambling for jobs.
The 258-bed East San Jose hospital plans to shut the services starting Aug. 12. RMC is owned by HCA Healthcare, which oversees over 180 hospitals around the country and the United Kingdom.
During the ensuing chaos, there has been a common theme of conversations in the emergency and operating rooms, the intensive care unit and the hospital floors. The stoppage of services will be disastrous to the local community. The poor and marginalized will be disproportionately affected.
RMC closed its obstetric and newborn services in 2020 in the midst of the COVID pandemic. There have been no gastroenterology and limited nephrology coverage among other essential missing services since last year. The continued systematic closure of essential health services is a redlining of the marginalized communities in a city with the highest rate of homeless youth per capita.
The first hour in trauma, stroke and heart attack care is considered the golden hour for improving outcomes. Dr. Renee Hsia, an emergency department physician at UC San Francisco, and her colleagues have shown the damaging impact of trauma center closures with a 21% increase in mortality with increase in driving distance. The outcomes are similarly adversely affected for stroke and heart attack with services closures.
The nearest level trauma centers are the county-owned Santa Clara Valley Medical Center in San Jose and the private Stanford Hospital in Palo Alto, and both are farther away from East San Jose. The transfer of patients there for a higher level of care takes days, currently. They do not have excess resources, beds or staffing capacity to absorb the RMC closures, where the volume of trauma patients seen is comparable to each of the two institutes.
Add the travel time in the Bay Area to the equation for time-sensitive critical illness, and you will be hard-pressed to find an optimist.
East San Jose demonstrates the Silicon Valley paradox. The food and housing-insecure population in the third-richest county in the United States has long had limited access to health care. We need to flip the approach on its head by coming up with ideas to improve health services and not strip them down.
San Jose Mayor Matt Mahan and Councilman Peter Ortiz’s surprise at the news and their deep concerns indicate that the decision to close the services has been made unilaterally without involving any of the other stakeholders. For Councilman Oriz’s family, the hospital has been a lifeline for families in the community who now feel abandoned. The county has an obligation to improve health care access in the region.
Santa Clara Valley Health System had been in talks to take over RMC in the past. They both serve essentially the same populations. It only makes sense that RMC be incorporated within the Valley Health System.
It is imperative that the county acts quickly. Hospital providers are looking to abandon the sinking ship of Regional Medical Center, and once the wheels of closing the services have been set in motion, it would become nearly impossible to turn them back with no providers. The provision of life-saving treatment to a marginalized community should not be determined by the balance sheet.
Dr. Varun Kapur is a trauma surgeon and ICU physician at Regional Medical Center.