DATE: October 9, 2001
TO: Board of Supervisors
SUBJECT: WORKING TOGETHER FOR RESPONSIBLE REGIONAL EMERGENCY SERVICES AND FACILITIES

SUMMARY:
San Diego County's impressive safety net of emergency services is in jeopardy. The fine balance of supply and demand on which the emergency medical system operates is fragile, and is being tested like never before. In light of the recent attacks in Washington, D.C. and New York, it is more important than ever to make emergency medical services available when needed. Today's action is the first step in preserving these critical services.

Recommendation:
CHAIRMAN BILL HORN AND SUPERVISOR DIANNE JACOB
Direct the Chief Administrative Officer to refer $500,000 for the Mexico Awareness and Proper Use of Emergency Rooms Public Education Campaigns and $3 million to contribute to an East County emergency facility to the October 16th one time tobacco settlement dollars discussion.

Fiscal Impact:
There is no fiscal impact as a result of this request. If funded, there will be a one time cost for the public education campaigns of $500,000 and a one time cost of $3 million for an East County emergency facility.

BACKGROUND:
As the regional government responsible for improving the health of the residents of San Diego County, it is in this Board*s best interest to keep its citizens as well informed on health issues as possible. There are two pressing educational issues that must be addressed.

Mexico Awareness Public Education Campaign

Because of the close proximity of Mexico and its affordable prices, thousands of San Diego County residents travel into Mexico, often to vacation or sightsee. Just 20 minutes south of the border lies beautiful ocean resort towns such as Rosarito and a little farther south, Ensenada. However, these vacation destinations often come with a price. Travelers confront many issues not faced in the United States. All too often, citizens don*t prepare or educate themselves on how a foreign country operates prior to entering our bordering neighbor.

This tragic fact became all too clear on August 24, 1999 when Valley Center resident Donald Kraft and his family were involved in an automobile accident in Mexico. Because of liability laws in Mexico, Kraft was not allowed to leave the country for appropriate medical care for nearly 20 hours after the accident. Mr. Kraft unfortunately died 13 days later.

Recent statistics show that on Federal highways in the States of Ensenada, Mexicali and Tijuana alone 855 Americans were involved in motor vehicle accidents, resulting in 1,753 serious injuries and 214 deaths.

On October 19, 1999, this Board of Supervisors approved the development of a public education campaign to better inform County residents of necessary steps to receive emergency medical treatment in Mexico.

Appropriate Hospital Emergency Room Use Public Education Campaign

Every day, more than 2,500 San Diegans call 911 for medical help, ride in an ambulance, or are treated in an emergency room. Injuries are assessed, illnesses treated, lives saved.

It is estimated that between 60-80 percent of those utilizing this region's hospital emergency rooms are not emergencies. At the same time, it is not uncommon for local hospital emergency rooms to be on bypass, which means that the emergency room is full except for the most critically injured. By decreasing the use of non-emergency use, our hospital emergency rooms will be better able to care for people in need of emergency care.

A part of the solution is getting the word out to discourage people from using the emergency room for their non-emergency health care needs. It is critical that this region's already limited resources be used in the best manner possible and that people use the hospital emergency room only for true emergencies.

On June 20, 2000, this Board approved the development of a public education campaign to decrease hospital emergency room use for non-emergencies. By implementing this campaign, everyone in this region will benefit from the results. Residents will get more appropriate care without waiting in long lines. Our emergency rooms will be better able to care for the true emergencies that enter their doors. And, precious healthcare dollars will be saved by less use of expensive emergency room visits.

Tobacco Settlement dollars have opened an opportunity to fund these two worthwhile campaigns. Estimated cost is approximately $500,000 for both public education campaigns.

Need for an Additional Emergency Facility

Last June, Scripps East County hospital closed its doors, leaving thousands of East County residents without an emergency room within 1 hour of their residence - more if there is traffic. According to local Fire Chiefs, before its closure, Grossmont Hospital was already on bypass between 10-15 percent of the time. The closure was expected to add an additional 24,000 emergency room visits annually. This indeed has happened.

From June 2000 to June 2001, Alvarado, Grossmont and Kaiser saw astronomical increases in bypass rates; 71%, 125%, and 326% respectively.

This is truly a regional dilemma. When East County residents have an emergency and are diverted to other area hospitals, the entire system is backlogged. The East County needs another emergency facility - the San Diego region needs East County to have another Emergency Room to help alleviate some of this stress on the system.

Scripps East County has been unoccupied since last June. Since that time, it is possible that the license has expired and because of SB 1953 in 1994, any new occupant would have to dedicate millions of dollars to
retrofit the building. It is questionable that this building will remain an acute care hospital.

Since June of 2000, a group of East County doctors has been working on getting an emergency medical facility built in East County. By dedicating $3 million in one time dollars to an East County emergency medical facility, it increases the chances of a successful partnership and will benefit the entire Emergency Medical Services System.

San Diego County's impressive safety net of emergency services is in jeopardy. The fine balance of supply and demand on which the emergency medical system operates is fragile, and is being tested like never before. In light of the recent attacks in Washington and New York, it is more important than ever to make emergency medical services available when needed. Today's action is the first step in preserving these critical services.
We urge your support.

Respectfully Submitted,

BILL HORN
Chairman
Fifth District

DIANNE JACOB
Supervisor, Second District