UC San Diego's proposal to move its trauma center and inpatient hospital from Hillcrest to La Jolla wouldn't be realized until 2015 or 2020, but it's already drawing widespread criticism.
Hospital and community leaders have accused UCSD of abandoning the county's indigent population and said the plan would worsen an already taxed emergency room situation at hospitals south of Interstate 8.
UCSD's 386-bed acute care hospital in Hillcrest serves 124,000 patients a year, nearly half of the county's poor and uninsured.
Nearly half of all trauma patients are transported north to Hillcrest.
If the plan goes through, Scripps Mercy Hospital, located a few miles from UCSD's Medical Center in Hillcrest, would need to pick up the slack.
Todd Hoff, the chief operating officer for the 173-bed Scripps Mercy Hospital in Chula Vista, called UCSD's move "illogical."
He said abandoning patients in an area struggling to meet demand is senseless.
It's also breaking with UCSD's responsibility toward taxpayers as a government-funded teaching hospital, he added.
The three major hospitals in the South Bay , Scripps Mercy Hospital, Sharp Chula Vista Medical Center and Paradise Valley Hospital , lost a combined $40 million in the last two years, Hoff said.
The Scripps facility more than doubled its loss from $7 million 2003 to $14.5 million in 2004 due to a rise in providing unfunded care, he said.
"There has been an increase in Medi-Cal (the state-subsidized health care program for the poor) and Medicare patients (the federal government health program for the elderly)," Hoff said. "Medicare is woefully under-funded and Scripps hasn't seen a rate increase in four years with Medi-Cal."
Hoff said Scripps hired him earlier this year to better the hospital's fiscal woes.
"I will try to cut costs in half this year," Hoff said.
In an effort to achieve this goal, certain services and programs will have to be cut, he said.
It also means trying to renegotiate reimbursement rates, he added.
Hoff wouldn't comment on the rates, but he said in 2004 a big chunk , $9.8 million , was lost in giving care to nonpaying clients.
UCSD's plan to expand the 119-bed Thornton Hospital in La Jolla to more than 500 beds and try to compete with three existing hospitals , Scripps Green and Scripps Memorial hospitals in La Jolla and Sharp Memorial Hospital in Kearny Mesa , doesn't make sense, he said.
These hospitals serve an area rich with Medicare patients and people with insurance.
Moving the trauma center is equally illogical in Hoff's view: "Driving from Hillcrest to La Jolla takes 30 minutes (without traffic), trying to get there at 5 p.m. (during rush hour) is just inconceivable."
UCSD defended its plan by saying that trying to rebuild the aging Hillcrest facility to meet the state's earthquake safety requirements would be too costly.
"In addition, by consolidating our inpatient beds in a new university hospital on UCSD's main campus, we will better serve the patients who come from all over the county for specialized hospital services," said Dr. Edward Holmes, UCSD's vice chancellor of Health Sciences and the dean of the School of Medicine in a written statement earlier this month.
The $750 million project calls for building a larger emergency room and ambulatory care center in Hillcrest.
"This new vision recognizes that the future of medicine is outpatient care," Holmes said.
But Ruth Riedel, the chief executive officer at the Alliance Healthcare Foundation, a San Diego-based nonprofit group working to improve health care for the poor, questions the success of "free-standing" emergency rooms.
"The free-standing emergency room in Los Angeles is still in its pilot phase," Riedel said.
"We don't know about its effectiveness."
Dr. James Dunford, who works as an emergency room doctor at UCSD and coordinates the city's emergency program, said that "the idea of a free-standing hospital that has expandability may sound scary at first, but it represents an opportunity to get something on the table."
He said doctors are generally concerned about the financial difficulties facing South Bay hospitals.
"We are in a health-care crisis and that's something that needs to be discussed on a federal level," he said.
He finds the talks that UCSD's plan has sparked may be a good opportunity for the community to collaborate on the real problem , a lack of access to affordable health care for all.
But Riedel said it's unlikely that this plan will bring competing health-care systems together.
She said it would be better if the state and federal governments loosen regulations on seismic requirements, which cost California hospitals hundreds of millions of dollars.
Nobody knows what kind of damage would be done to hospitals in the event of an earthquake, she said. But instead of spending millions of dollars on retrofitting hospitals, the money could be better spent by helping the uninsured.
"They will have nowhere to go," Riedel said.