About the scariest thing anyone can say to the Rose Medical Center emergency staff these days is “June 14.”
The worry is not a natural disaster or an outbreak of disease. June 14 is the day the University of Colorado Hospital, now at East Ninth Avenue and Colorado Boulevard, will close – with all its services moving to Aurora.
Rose expects 30 percent to 40 percent of the patients who once relied on University’s emergency room to migrate down the street to them.
“We don’t know what’s going to happen, but we’re basically preparing for more patients,” said Dr. Don Lefkowits, chief of Rose’s emergency department.
University is the first of three hospitals with emergency rooms scheduled to leave Denver over the next few years.
The Veterans Affairs Medical Center, which doesn’t offer emergency services, is also moving. It will build a new facility at the Fitzsimons campus in Aurora, along with University and The Children’s Hospital.
St. Anthony Central is moving to Lakewood.
The moves leave the remaining hospitals – including Denver Health Medical Center, Rose, Presbyterian/St. Luke’s Medical Center and St. Joseph – bracing for a wave of patients, especially poor, uninsured patients.
The Children’s Hospital, University and St. Anthony Central treated 120,000 people in their emergency rooms last year, according to data provided by the hospitals.
Mayor John Hickenlooper has assembled a group of hospital, community and political leaders to assay the impact of the hospitals’ departures.
“In particular, we are concerned about the impact on emergency rooms,” said Katherine Archuleta, the mayor’s senior policy adviser.
Emergency rooms are a pressure point because ER care is expensive. In Denver, the average cost of an ER visit was $519 in 2004, according to the Medicare Provider Analysis and Review. ER visits make up about 12 percent of all hospital visits.
Emergency rooms also are often the only option for people without insurance. Federal law requires anyone who needs emergency care to get it, regardless of their ability to pay.
The mayor hopes the group will make recommendations about “what are the next steps we as a city need to take to serve those most in need of care,” Archuleta said.
Adding to the jitters for Denver hospitals’ staff is the inability to predict how many patients will follow the departing hospitals to the suburbs – and how many will continue to use hospitals in the city.
“It’s a bit of a crapshoot,” Rose’s Lefkowits said.
West Denver’s access falling
To get a better idea of who uses which hospital emergency room, the Colorado Hospital Association gathered data on hospital admissions from ERs by ZIP code.
The data given to the mayor’s committee show that:
Neighborhoods in west Denver, Lakewood and Wheat Ridge were the top five areas with admissions to the hospitals that are moving – and which will lose ready access.
Aurora neighborhoods were significant users of the hospitals that are moving. They will gain easier access.
Anticipating more patients, Rose is spending $1.8 million to expand its emergency room, adding three ambulance bays and five beds, as well as adding two full-time emergency physicians and six to eight nurses and technicians.
Presbyterian/St. Luke’s plans to double its emergency-room beds to 22, according to a hospital spokesman.
At Denver Health, leaders plan to create a separate pediatric emergency department and a streamlined triage system for emergency-room patients.
Denver Health also has devised a plan to convert beds in its urgent-care center to emergency beds in a crisis.
“We’re already slowly expanding coverage,” adding residents and physicians to most shifts in the emergency department, said Dr. Stephen Wolf, an emergency department physician.
As the city’s public, “safety net” hospital, Denver Health saw 91,584 people in its emergency room and urgent-care center in 2006.
The department is so jammed that it is on “divert” – meaning ambulance crews are notified that new emergency patients can’t be accepted – 14 percent of the time.
On a recent Friday afternoon, all of Denver Health’s 42 emergency department beds were full. Three were occupied by people under arrest who were shackled to their beds and who would be released to the custody of police.
Two patients lay on gurneys in a hallway, and one man, picked up by police for standing naked on a city bridge, was escorted to one of the city’s last psychiatric units.
“I’m crazy as I can be,” the man announced to a nurse. “And I like to take off my clothes.”
This was, Wolf said, a quiet afternoon. Denver Health doctors say they expect fewer days like this in the future.
“We’ll definitely need to ramp up capacity,” Wolf said.
Departing hospitals pitch in
In addition to its emergency rooms, Denver has half a dozen clinics that serve indigent and uninsured people.
David Lack, executive director of one of those – Clínica Tepayac – said he is not expecting a great increase in patients.
“I hope they are already coming to us,” Lack said. Many patients don’t need emergency care, Lack said. “What they really need is to be seen in a clinic,” he said. “There are more efficient, cost-effective ways of getting health care than heading over to the ER.”
A 2004 Institute of Medicine report estimated that as many as half of emergency-room visits aren’t emergencies.
Officials at the hospitals leaving Denver insist they are not abandoning the city.
Children’s, which saw 45,000 kids in its emergency room last year, is working with St. Joseph to open a smaller emergency room adjacent to St. Joseph Hospital.
That facility, currently under construction, can see 15,000 kids a year and will be open by the time Children’s moves to the Fitzsimons site in October, said James Shmerling, the hospital’s chief executive.
Shmerling said the hospital’s 7.5-mile move should not disrupt emergency-room care for children.
“I don’t perceive us as leaving Denver,” Shmerling said.
Computer-assisted reporting editor Jeffrey A. Roberts contributed to this report.
Staff writer Karen Augé can be reached at 303-954-1733 or kauge@denverpost.com.
