The first meeting started around 7:30 a.m. Nurses, doctors, business owners, families, school board members and most of all, members of the community crowded together on a quiet stretch of beach near the San Clemente Pier. Among them was Carol Wilson, a 69-year-old lifelong Californian. Although the retired marketing executive hated early mornings, she didn’t mind showing up for a cause that she considered a matter of life and death.
She joined about 200 people who donned red t-shirts and chattered as they stood in the sand. Despite the hour, the air was abuzz. Their fire truck red shirts stood in stark contrast to the gloom of the chilly morning and the green palm trees that towered over them. Their message — Save San Clemente Hospital — was emblazoned on their shirts.
“The energy was just amazing,” Wilson said. “Everybody was so behind saving the hospital, and super enthusiastic that we could make this happen.”
After the group’s leaders and the mayor of San Clemente stood on a picnic table to rally support for their cause, someone launched a drone in the air to capture the moment. The group had positioned themselves to spell out the letters on the word printed in bold on the back of their shirts: SOS.
It was December of 2014, before the city council meetings, the legal battles, the protests and the hospital’s eventual closure in 2016 that lingers in the memories of residents of San Clemente and the surrounding cities. Now, as coronavirus threatens to overwhelm the nation’s hospitals, people began rallying once again, pressing state officials to reopen the community institution. This time, they hoped, they would have a better chance.
In late March, Gov. Gavin Newson announced that the state would need at least 50,000 more beds for coronavirus patients. The state has opened arenas, developmental centers, leased two hospitals and even a U.S. navy ship all for more bed space. While California has managed to increase its bed count, officials are still preparing for a worst case scenario, and the state’s department of health released guidelines on how to prioritize patients should hospitals become overwhelmed.
“If you look what’s going on right now in California, you’ve heard of a lot of hospitals that are stepping up and they are doing something to contribute,” Wilson said. She doesn’t believe MemorialCare are likely to follow suit in San Clemente. “The city would certainly reopen it, but I think it’s going to have to get out of the hands of Memorial.”
Steve Cullen, a doctor who worked at San Clemente Hospital, was a partial owner for a brief time and was just shy of his 20-year anniversary there when it closed, immediately thought of the hospital when the pandemic hit. He wasn’t the only one, he said, describing the emails and texts that flew between community members and former medical professionals who had worked at the hospital.
“We all thought, “Why not open San Clemente Hospital again?” Cullen said. “A lot of the fellow nurses and colleagues that fought this fight with us would send us emails and text saying, ‘Hey are we going to open up San Clemente to take care of COVID patients?’”
Los Angeles County and San Diego County each have some of the highest numbers of cases and deaths in the state, and they border Orange County, the home to San Clemente, to the north and south respectively. Although Orange County has been spared the numbers of its neighboring counties, it still is one of the more affected areas in California, with over 3500 cases and nearly 76 deaths as of May 10, according to the Orange County Health Care Agency.
The San Clemente Hospital, which had 73 beds and served the cities of San Clemente and Dana Point, could help to ease the bed shortage, its supporters argue. The hospital also served patients from the cities of San Juan Capistrano and Laguna Beach, which although closer to other hospitals, could be diverted to San Clemente if necessary. In 2013, MemorialCare released a report that designated parts of these cities “Medically Underserved Areas.” According to data from the Health Resources and Services Administration, these designations still hold today.
But the healthcare group that owns the still-empty hospital, MemorialCare, maintains that reopening the hospital at this point would be impossible.
Tony Struthers, the vice president of MemorialCare, wrote in an email to the San Clemente Times that the healthcare group has no plans of reopening the hospital because there is not an existing need.
He said that MemorialCare’s other facilities and other health care systems already had “capacity to address any surge in COVID-19 patients at their existing medical centers,’’ including the Fairview Developmental Center.
The Fairview Developmental Center sits in Costa Mesa, about a 30-minute drive from San Clemente. Some residents argue that that is too far.
Gus Gialamas, an orthopedic surgeon in San Clemente and former chief of staff and one-time partial owner of the San Clemente Hospital, also recalled thinking about the empty hospital as soon as the pandemic began.
“The issue is that we pushed to have this at least available to have the healthcare agency look at the place and say, ‘You know what? Here’s an infrastructure that’s already here,’” Gialamas said.
Carol Wilson often thinks about what having that hospital close meant to her. One day in 2000, she was struggling to breathe. She was rushed to the nearest hospital — San Clemente Hospital. After she was admitted, she lost consciousness and stopped breathing altogether. When she came to, she was on a ventilator. Wilson suffers from the autoimmune disease myasthenia gravis, which causes the immune system to attack itself. She maintains that the reason she is alive today is because of that hospital.
“The ER at that hospital just saved so many lives, mine one of them,” Wilson said.
When the hospital initially closed, the proximity of the beds and emergency room was important to the communities it served, where people over 60 make up over a quarter of the population, according to census data. When closing the hospital, MemorialCare did not want to leave this population without medical services. Instead, the company planned on opening an alternative facility in place of the small hospital.
“We envisioned a new modern ambulatory center that would better meet the community’s future health care needs and transform the campus into a health care destination,” Struthers said in 2016. This meant that the hospital would become an urgent care that legally could not have an emergency room.
Because of her condition, Wilson was in the hospital at least once a week. It was then that she got to know Dr. Cullen, her doctor, and the hospital staff. These were the people in the place that saved her life.
“I know that if I got into a situation that I got in before, the hospitals that I’m aware of would be a minimum 20-minute drive,” Wilson said. “And that’s just to get to the hospital. That’s not to get into an ER room, not to get to a doctor.”
The city resisted the company’s efforts to convert the hospital into an urgent care center, re-zoning the land to only allow for a hospital with an emergency room. In response, MemorialCare sued, upset that they could not move forward with plans for an outpatient urgent care center they believe would be more convenient for providing medical care, and at a lower cost to patients. Outpatient facilities are often less expensive due to lower co-pays, according to the United Medicare Advisors.
At a public hearing in April 2016, then Councilmember Tim Brown denounced the healthcare company’s move.
“They chose to file a punitive frivolous lawsuit, which seeks to prohibit the resolution of our vital community needs,” Brown said.
Only last year was a settlement between the city and MemorialCare reached from the lawsuit filed in 2016: MemorialCare has until June 2020 to sell the property, or it must hand it over to the city.
Underlying the debate about whether or not the hospital should re-open to combat the coronavirus crisis lies an even bigger question: Should the facility have closed in the first place?
When MemorialCare first bought the hospital in 2005, Debbie Weddle had been working there for 24 years, working her way up the ranks until she eventually became the administrative health supervisor. She recalls in the early days walking down the hallway with the MemorialCare CEO at the time, Diana Hendel. At this point, Weddle had worked under the ownership of another healthcare group and a group of physicians. She asked Hendel what it was going to be like working for MemorialCare.
“I remember her very clearly saying it’ll be a fairly easy ride their first year, but after that, if you don’t get on the train, you’re going to be off the train,” Weddle said. “And I’ve never forgotten her saying that.”
Weddle soon learned Hendel’s words had credence. She remembers certain services being phased out. Within the first couple years of their ownership, Memorial decided to take out the open MRI machine. They then went on to get rid of the urology department. One by one, the hospital lost different procedures and departments.
Where the services were offered, and where patients were often transferred to, was Saddleback Medical Center in Laguna Hills, a city about 20 minutes north and inland. The hospital in San Clemente was another campus to Laguna Hills medical center, which served as the main campus.
These declining inpatient numbers and the resulting decline in profits were the primary reasons MemorialCare cited for closing the hospital. Before the closure, Struthers said that the hospital averaged only 11.6 inpatients a day.
“Like many small hospitals across the country, the San Clemente inpatient facility has continued to experience declining volumes,” Struthers said to a local paper in 2016.
At a public hearing held in April 2016, several community members testified to the necessity of the hospital in the region. One testimony came from a former paramedic who had worked in San Clemente from 1982 to 1996.
“I know that people can and will die in the extra minutes that it will take to travel from South Orange County to a hospital in Mission Viejo or Laguna Beach or Laguna Hills or beyond,” he said, naming the nearest hospitals to San Clemente.
Traveling north to these hospitals is the only option for San Clemente residents, as the city is bordered by a military base on the south, a forest preserve to the east and the Pacific Ocean to the west.
“It was clear to me that they didn’t understand community, even though they were a community-based hospital,” Gialamas said. He went on to say that it made sense the hospital had less patients towards the end, because it simply offered less services. “If you have a hamburger stand and you don’t have buns, you’re not going to sell many hamburgers,” he said.
Gialamas and Cullen, along with another former hospital worker filed a lawsuit against the hospital in May 2016, just before it officially closed. They argued that the hospital could not close before the county Emergency Medical Services conducted a full impact assessment on the closure and that the Department of Public Health’s seven-page statement was inadequate. But under state law, MemorialCare’s lawyers argued, the healthcare group did not need permission from any health agency for the hospital to close. Any guidelines from the county emergency medical services were merely that — guidelines, not requirements.
“The closure process required MemorialCare to notify the California Department of Public Health and work with the department, as well as Orange County Emergency Medical Serves, to plan for the impact that the closure might have on other facilities,” the court documents from MemorialCare’s lawyers read. “It has done so.” The argument goes on to state, “The reality is that MemorialCare can close the [hospital] and suspend emergency medical services with or without CDPH’s approval.”
Gialamas remembers seeing his attorney, a young woman fresh out of law school, sitting across from MemorialCare’s team of lawyers.
“I thought, ‘Wow, this is, this is how it is in the real world,’” Gialamas said. “When you’ve got the band of attorneys against a small fry like us.”
Ultimately, they felt MemorialCare’s insistence on the hospital’s closure always came down to a matter of profit. According to the American Hospitals Association 2019 report, outpatient revenue is trending to overtake inpatient revenue. Analysts say this is likely because outpatient services do not involve lengthy overnight stays which cost hospitals more money. Additionally, an inpatient center with an emergency room cannot turn a patient away if they cannot pay. So, the hospital faces a higher chance of not receiving payment at all.
“In a lot of ways, I understand what they were saying about why they wanted to turn it into an urgent care. An outpatient center makes a lot of money,” Gialamas said. “But I guess we took exception to the fact that they made a commitment to our community and now they were reneging on this commitment to keep an emergency room and community hospital in our town.”
The hospital is part of a non-profit healthcare system and was registered as a non-profit on its tax forms.
“If you can operate a hospital, if you can pay all your bills, if you can pay all your employees, if you can provide such a valuable service to the community and at the end of the year, if you have $1 in the account that you’ve made, what’s the problem with that?” Cullen said.
While it has not reopened the hospital itself, MemorialCare came to an agreement with the city and implemented mobile drive-thru testing in the empty parking lot in late March.
After the testing center at the former hospital site was opened, the San Clemente city council voted to send a letter to the governor to look at reopening the hospital to treat non-COVID patients.
“This hospital closed not on account of dereliction or dilapidation,” the letter reads. It goes on to state, “The closure of this hospital has left our community without access to an emergency service along the 40-mile stretch between Oceanside and Mission Viejo, an unsettling reality even in ordinary circumstances.”
MemorialCare has not responded to a request to comment on the letter. In an interview, Struthers said MemorialCare did not discuss and has no plans to re-open the facility for the crisis and maintains that testing is the most pressing need of the crisis.
“The existing hospitals have handled a pandemic to this point very easily,” Struthers said.
MemorialCare had, and still has, an upstanding reputation in Orange County. Last year, readers voted for the top two spots in the local paper’s list of best hospitals in the county to go to MemorialCare facilities, with the number two spot going to the Saddleback Laguna Hills center.
Despite the fact that so far, hospital occupancy has remained under 50% across Orange County, Wilson and others view the decision to keep the hospital closed as just another example of MemorialCare’s failure to consider the concerns of the community.
Since the pandemic started, the now 75-year-old immunocompromised Wilson has been sure to stay inside for her safety. Though she’s doing what she can to protect herself, she can’t help but think about MemorialCare’s decision not only to close the hospital, but to leave it closed all these years.
“Not only do I feel it’s a tragedy, which I do, I feel it’s negligent,” Wilson said. “And it was artificially created.”
Gialamas echoed her sentiments.
“That was an opportunity lost,” he said of the decision to leave the hospital shuttered.
In just the past few weeks, hundreds of residents have protested the state’s stay-at-home orders right across the street from where four years ago, Save San Clemente Hospital protestors spelled out SOS. On April 25, during a heat wave, the county’s beaches and golf courses re-opened. After the move drew large crowds to the coast that weekend, Gov. Newsom ordered all beaches in Orange County closed. Whether or not the protests and brief opening will have an impact on community case count remains to be seen. According to the county health care agency, May 1 marked the highest number of reported cases, with 163 new cases. And since the beginning of May, 1,142 new cases have been reported, which constitutes nearly one-third of the total number of reported cases since the pandemic hit Orange County.
Steve Cullen now works at a hospital in Laguna Beach, about 20 minutes from where the empty structure in San Clemente sits. Based on the case numbers he’s seen at his hospital, he’s not sure reopening the San Clemente Hospital would be necessary, even with the rising instances of people gathering. In spite of that, he still believes that MemorialCare should have made the space available, because “the expectation was there.”
“When we started this fight we really thought we were going to win because we thought we had right on our side,” Cullen said.
A spokesperson for the county supervisor’s office said that the county feels confident the existing hospital infrastructure can handle any case increases, though it is hard to anticipate what the future of this virus might hold.
In one month, the city of San Clemente will be able to use eminent domain to seize to property, according to The Orange County Register. In December, the city announced that it would start looking for bidders to buy the hospital and in late January, California had one of the nation’s first coronavirus cases.
“Two months ago we had no idea what this crisis was going to look like,” Gialamas said. “And if somebody tells you they know exactly what it’s going to look like a month from now, don’t believe them because nobody knows.”