It's time for Doctors Medical Center officials to begin preparing for what seems an inevitable shutdown. It's time for Kaiser to brace for an onslaught of emergency patients at its Richmond facility.
It's time for leaders at John Muir Health, officially a nonprofit organization, to look in the mirror and ask how they can live with themselves.
John Muir's Walnut Creek facility holds the lucrative contract as the county's designated trauma center. With that should come a social responsibility to help more needy portions of the county.
Absent a bailout, Doctors will run out of cash sometime between March and May, current projections show. No one should be surprised by this.
In 2011, the West Contra Costa Healthcare District, which operates the hospital, sought and received voter approval for a $47-per-house tax increase.
We backed Measure J, but warned that district and hospital officials needed to move quickly to restructure the operation and find a way to keep it going. Back then, it was clear that, even with the tax money, the district would go broke in 2014.
The projection then was this summer. Declining hospital inpatient volume has shortened its life expectancy a few months. But emergency room visits have not declined. And that should be great cause for concern.
The inpatient visits will probably be absorbed by nearby hospitals in a somewhat orderly manner. But the lack of an emergency room at Doctors will create a chaotic situation. Most residents in distress will go to the next nearest facility.
Kaiser, which is not designed to take in patients who are not enrolled in one of its plans, will have no choice but to provide care to all emergency patients showing up at its door. That's the law.
To a lesser extent, Sutter's Alta Bates Summit Medical Center in Berkeley is in the same boat. So, while John Muir has a moral obligation to assist, it's in Kaiser's and Sutter's financial interests to help out, too.
Whatever aid they do provide would probably be only stopgap. In which case Doctors Medical Center cannot continue on its own. That's clear. It must find a new permanent source of funding or a larger hospital to absorb it. Given Doctors' high level of uninsured and poorly insured patients, that will not be easy.
But without emergency resuscitation, death is certain. It's only a matter of time.
The Fresno Bee: Fresno County coroner should be appointed
The Fresno County Board of Supervisors is serving the public's interest by taking a hard look at the elected coroner-public administrator's position with changes in mind for 2015.
Unimaginable as it is, candidates for the job aren't required to have even the most basic of medical qualifications. They only have to be registered to vote in the county.
This creates a scenario in which a coroner with no background in medicine can overrule the findings of a forensic pathologist in determining cause of death. Unfortunately, the best overhaul of the position — switching to a medical examiner-coroner appointed by the Board of Supervisors — wasn't on Monday's agenda.
Supervisors instead will choose between keeping the current system or assigning the coroner's duties to the sheriff and the public administrator's duties to the district attorney.
The rationale cited by supervisors favoring a sheriff-coroner is that the county will save money and the public will receive better service. An analysis by County Administrative Officer John Navarrette, however, pegs potential savings at just $50,105 in the first year.
Interestingly, Navarrette's report states: "The Coroner has yet to make the facility a Forensic Regional Center; the Sheriff has the desire and the resources to make that facility into the regional center for which it was designed.
"The county does have a state-of-the-art coroner's facility adjacent to the Juvenile Justice Campus. In fact, the quality of the building's design and the technology inside is among the reasons why the county should appoint a medical examiner instead of reverting to the sheriff-coroner system that was in place until 1978. That facility will attract a top-flight medical examiner — something that isn't likely to happen if the medical examiner has to report to a publicly elected sheriff.
In addition, Sheriff Margaret Mims has plenty on her plate in maintaining public safety and running the jail — both difficult tasks. She also is highly involved in implementing Assembly Bill AB 109, the realignment of the state's prison system in which more persons convicted of crimes serve time locally. And she is seeking $80 million in state funding to replace the 66-year-old south annex jail — a bid we endorse.
The Fresno County Grand Jury last month completed its investigation of the coroner's position and concluded: "Ultimately, we feel that Fresno County should adopt the appointed Medical Examiner-Coroner model in place in the Counties of Los Angeles, San Diego, Ventura and San Francisco. This is the most professional way to structure the coroner's office function. Fresno County has achieved a size (and) stature, and has the facilities to attract and support a full-fledged Medical Examiner in the near future."
We concur with the grand jury.
Marin Independent Journal: Shifting gears in Marin County planning process
After months of study and debate, a special county-selected citizens committee has come up with more than 60 ideas for cutting red tape in the county's planning process.
The most significant message from the committee is the county needs to improve its customer service, providing clear and helpful instructions to applicants and reducing the time and cost involved in the planning system.
The first takes a change of image, from expectations of a potential ordeal snarled in red tape and rising costs to a road map that is clear and not as hazardous.
This image leads too many residents to avoid the planning process and well-intentioned safety checks, banking on chances they won't get caught and fined.
Anything the county can do to present a helpful image and reduce costly delays would be a step toward persuading residents to follow the rules.
The county Regulatory Improvements Advisory Committee was formed after the controversial withdrawal of George Lucas' proposed Grady Ranch film studio near Lucas Valley. After the county Planning Commission had endorsed Lucas' plan and as it was before county supervisors for approval, the county learned that some state regulatory agencies had not signed off on the plan, even though it had been in the works for years.
By the time the plans were presented to supervisors, all of the approvals should have been in place and factored into Lucas' plan.
Lucas, also citing warnings of a prolonged legal fight with neighbors, withdrew his plan, and with it its promise of hundreds of jobs and much-needed local tax revenue.
Supervisors vowed to reform the planning system so the mistake would not be repeated.
They formed the 12-member advisory committee. Its preliminary report recommends county planning staff work "constructively" with applicants and help detail possible obstacles to approval. That includes a clear "flow chart" for the approval process, with review by numerous local, state and federal agencies often involved in larger projects.
That doesn't mean the public should get short shrift. Their requests for information and ability to comment deserve to be treated with the same customer-friendly approach as afforded builders.
But the goal should be to remove last-minute surprises and, as with Lucas' plan, fingerpointing over who left important loose ends on such an important and well-debated project.
The committee's recommendations cover a variety of planning issues, from creating an "express permitting" process to updating the county's various community plans.
The recommendations will be presented to county supervisors early next year.
It's too late for Lucas' studio proposal, but many of the recommendations may be welcomed by those who find the county planning process a costly and time-consuming hassle, rather than helpful.
U-T San Diego: San Diego avoids new self-inflicted black eye
It's been a rough year for America's Finest City in the court of national public opinion. It wasn't just having Mayor Bob Filner be exposed as a serial groper and then driven from office. Earlier in the summer, there was also the case of Jeff Olson.