San Diego Union-Tribune (Sunday)
EL CAJON HOSPITAL SITE STILL EMPTY AFTER 20 YEARS
Delay raises broader questions on who gets easy health care access
Kaiser Permanente bought a patch of East County land in 2002.
El Cajon believed the health care giant would soon build a new hospital.
Twenty years later, the city is still waiting. And when officials recently asked for an update, they were told: Next decade. Maybe.
“East County definitely needs another hospital,” Deputy Mayor Michelle Metschel said during a public meeting in June, where the council brainstormed ways to pressure the company into moving up its timeline. “Promises are just going by the wayside, and it’s not fair to the community.”
The delay also raises broader questions about who gets easy access to health care.
North County has seen a surge of new facilities in recent years, Kaiser’s included, while East County essentially has one hospital, La Mesa’s Sharp Grossmont.
The same disparity can be seen nationwide.
“The basic problem boils down to reimbursement,” said Nathan Kaufman, a San Diego-based health care consultant and managing director of Kaufman Strategic Advisors.
When many patients rely on government assistance like Medicare or Medicaid, hospitals pull in far less money. Private insurance companies typically pay between 1.6 and 2.5 times what Medicare offers, according to a 2020 analysis by the nonpartisan Kaiser Family Foundation.
For example, knee and hip replacement paid with private insurance could earn a provider more than $30,000, one foundation study from 2017 showed.
The Medicare rate was less than half that.
While East County’s population has increased, U.S. Census data shows nearly a fifth of El Cajon living below the poverty line.
In comparison, only about a tenth of the people living near Kaiser’s inprogress San Marcos Medical Center are poor, and San Marcos’ median household income ($86,408) is tens of thousands of dollars higher than El Cajon’s.
Add in inflation and other rising costs and it becomes very hard to keep a hospital in the black, Kaufman said.
“Those of us working in the industry expect a huge access problem,” he added.
Reimbursement is somewhat less of a problem for Kaiser, because it controls and administers its own health plan. The company’s main concern is efficiency, operating the right number of locations to adequately serve its premium-paying members.
A local Kaiser spokesman blamed the wait in El Cajon on leaders at company headquarters, based in Oakland.
“The delay was not to our liking,” Rodger Dougherty, senior director of public affairs for Kaiser in San Diego, told El Cajon’s council.
Construction was impossible without money from top brass, he said. “We need a hospital here, we want a hospital here, but we have to work within our own corporate structure.”
When asked for comment, representatives at the national office directed questions back to Dougherty.
The City Council discussed ways to lean on Kaiser. One option would be to pass an ordinance charging extra fees to owners of vacant lots. Another would be to essentially start the permitting process now, to reduce red tape ahead of construction.
“I understand the difficulties developers have,” Councilmember Phil Ortiz said during the meeting. “But at a certain point, it seems like you need to ensure that people are being good neighbors.”
Four of the five council members directed staffers to research all options. (Steve Goble recused himself from the discussion because he lives near the area and therefore could be affected by development.)
The site was once El Cajon Valley Hospital, according to city records. It was known as Scripps Memorial Hospital East County when it shuttered, a Scripps spokesperson said.
Metschel, the deputy mayor, said she gave birth to her daughter there.
Now the southwest corner of Greenfield Drive and East Main Street sits empty.
Officials said the 25 acres have become a breeding ground for campaign signs and an occasional trash dump, though public records say there haven’t been “a significant number of recent code violations.” El Cajon nonetheless has to pay to monitor the area without pulling in the taxes they’d get from a hospital.
Kaiser’s current timeline would delay an environmental review until 2030, city officials said. Construction wouldn’t begin until 2034 and the project wouldn’t be completed until 2035 at the earliest, though there is no contract holding the company to those dates.
“I have trouble stomaching the idea of waiting until 2035 on a possibility,” Mayor Bill Wells said.
Dougherty, the company spokesman, later said the project remained too far out to estimate how large the
complex might be or what it could cost.
He noted in an email that membership growth in North County made San Marcos a higher priority than El Cajon.
Nearly 143,000 of Kaiser San Diego’s 633,525 members live in East County, making it the smallest area in the region, according to a spokesperson.
The company has long affiliated with hospitals it doesn’t own to insure coverage in far-flung places, though it has no agreement like that in East County.
For 40 years, Kaiser was a one-hospital operation in the area, serving the bulk of its members at its Zion Avenue medical complex in Grantville.
That changed in 2017 with the seven-story, $850 million San Diego Medical Center in Kearny Mesa — which is closer to East County than many options.
Kaiser broke ground on its 38-acre, $400 million San Marcos spot in 2020.
Research Director Merrie Monteagudo contributed to this report. blake.nelson@sduniontribune.com paul.sisson@sduniontribune.com