SOUNDING OFF: Consider other uses for the hospital

This letter is intended to spark discussion about a topic that people in our community seem reluctant to discuss: the future of South Coast Medical Center. For many years the center has been a valuable community asset, serving the residents of Laguna Beach and surrounding communities well. But times have changed.

Today large, regional medical centers, such as Mission Medical Center and Saddleback Medical Center are better able to handle both the range and depth of new medical services and their required technologies. Community hospitals like South Coast Medical Center find it harder and harder to compete.

The basic services that local communities need most, like emergency room services, maternity and common surgical care are the least lucrative financially. As South Coast Medical Center struggles to compete, it has had to cut many of those basic, community-oriented services. The recent closing of the maternity care unit is the latest example. Patient counts for basic services at the hospital continue to decline year over year.

To make more revenue, the hospital is refocusing on premium services such as bariatric surgery (stomach bypass), breast augmentation, various “tucks” and other cosmetic surgeries, sleep disorders and, of course, high-end psychiatric services, including drug and alcohol rehabilitation.

The volume of local patients requiring these types of services can’t be very large, so one can assume the hospital must draw in out-of-town patients for these premium services.

Some people in the city seem content with this subtle but important transformation of the medical center, even though sadly South Coast Medical Center is arguably no longer the community-oriented hospital it once was. Because these high-value services now subsidize the emergency room and are effectively the economic engines that enable it to remain open, people are reluctant to openly question these important changes at the hospital.

Laguna Beach does need emergency care services. Most cities that have seen the closure of smaller, community hospitals have compensated for this through a stand-alone emergency care or urgent-care facility.

Laguna Beach should be actively exploring such an option right now. For some major emergencies, like a car accident, if you require significant medical attention you’re likely to be transported directly to Mission or Saddleback, rather than to South Coast Medical Center. Or if you go there briefly, if you require serious hospitalization, you may be transferred to Mission or Saddleback.

South Coast Medical Center is at a crossroads. The main building and its infrastructure, built in the 1950s, are starting to falter. For almost a year there has been a portable MRI X-ray unit parked in the front driveway, and for the past several months the physical plant has been either partially or wholly non-operational, replaced by two large and noisy diesel generators occupying a section of the lower parking lot along Coast Highway.

In some ways, the hospital campus is starting to look like a “M*A*S*H” unit with a hodge-podge of permanent and temporary structures. New, more stringent earthquake standards required now by the State of California cannot be met by the existing primary building.

South Coast Medical Center [representatives] claim they do not have the funds to replace the existing primary building with a new facility at this time. Arguably, aside from emergency services, the fact that the hospital has been successfully getting rid of basic services proves there is no pressing community need or associated business case for replacing the hospital.

South Coast Medical Center is now promoting the idea of building a new assisted-living facility for seniors and converting even more of the current facility “” which is now grossly underutilized “” into rehab and boutique, high-end services such as plastic surgery. Ostensibly this is to raise the money to build a new, smaller community hospital in 10 years’ time. In reality, there’s no guarantee that a new hospital will ever get built. Even if one does get built, leaving the existing main structure in place does not make sense. That would expand the footprint of the campus significantly, while still leaving the aging building grossly underutilized. Leaving this huge “white elephant” in place for non-community oriented services, while adding even more campus space for new market-rate (read: “luxury”) assisted-living senior housing, plus a few affordable senior units, and the possibility of some smaller new hospital in the future, does little for Laguna Beach and its residents.

Worse still, it impacts the surrounding community significantly in a negative way by adding more buildings and more traffic.

If the existing facility cannot be cost-effectively retrofitted and updated, and a truly resident-serving community hospital reestablished, then it is time for the city of Laguna Beach and Adventist Health (the operator of South Coast Medical Center) to seriously explore other options.

One option is to close the existing facility, level it and replace it with the senior housing. Another is to close the existing facility, level it and sell off the property for other resident-serving uses. Either option would require a careful look at noise and environmental impacts both during reconstruction and for the on-going new use.

In any case, it’s time to take a serious look at the options for a stand-alone emergency or urgent-care facility. The city (excepting those with a financial interest associated with the hospital) should be leading this dialogue.

Just because South Coast Medical Center is a nonprofit does not make it a charity whose interests automatically coincide with those of the community. The time to start this dialogue is now, in advance of any detailed proposals being submitted by South Coast Medical Center for new additions or other major changes to the existing campus.

TONY SARRIS lives in Laguna Beach.