Staff at Doctors Medical Center will have an additional role to fill on Dec. 1: They will become the medical caregivers to Stanislaus County's poorest residents. One week from tonight, when Stanislaus Medical Center closes its doors, Doctors will step in to provide emergency, surgical and in-patient services to Medi-Cal patients and those without health insurance.

It is a role for which DMC has been preparing since January, when the Stanislaus County Board of Supervisors selected the hospital's proposal to provide inpatient care to county patients.

Officials on both sides say the goal is to make the transition as seamless as possible for patients.

Bob Beehler, DMC's chief operating officer, estimates the overall patient load will increase by 15 to 20 percent. DMC's emergency room probably will experience the biggest impact.

Traditionally, people without health insurance or regular access to a doctor turn to hospital emergency rooms for treatment when they get sick.

"We'll be moving to more double, triple, even quadruple coverage in the ER," said Dr. Prentis Tom, a DMC emergency room physician.

Last year, SMC's emergency room was the busiest in the county with approximately 44,000 visits. This year, the number has fallen to about 39,000.

DMC officials estimate about 40,000 patients a year already use their emergency room -- which could translate into long lines in the waiting room.

"A lot of the admissions into Stanislaus Medical Center came from their ER. When their ER closes, those patients ... may not know to automatically come here. They could go to Memorial (Medical Center)," said Darlene Blom, who worked at the county hospital 20 years before joining DMC's staff five years ago. She is now director of patient care services, overseeing the respiratory care and oncology units.

Or, if their medical crisis isn't a full-fledged emergency, they could still be treated at SMC's urgent care center.

The Stanislaus County Health Services Agency will operate an urgent care center in the old emergency room to accommodate patients who come to SMC not knowing the emergency room has closed. The urgent care center joins the county's system of outpatient clinics.

Stanislaus Medical Center patients aren't the only ones dealing with impending change. Some SMC employees will become DMC employees.

Fifty-four SMC employees have accepted full-time positions so far, according to Doctors spokeswoman Catherine Larsen. Most of the new hires have joined the nursing staff, she said, but departments such as housekeeping, medical records and laboratory also have added employees from SMC.

In addition to the 54 employees, DMC will gain the services of 30 student physicians when the family practice residency training program relocates. The physicians will work in the emergency, surgical and orthopedic units, said Dr. John Payne, director of the residency program.

DMC will join the county in sponsoring the residency program, which is operated in conjunction with the University of California at Davis Medical Center.

Construction crews are building sleeping quarters, meeting rooms and offices, and installing lockers and showers to accommodate the residents.

Even though county health officials and DMC administrators are collaborating to make sure the transition goes as well as possible, Blom said it's impossible to anticipate every glitch.

"We know there are probably issues we haven't thought of," she said. "We'll just have to adapt as they come."

What's not being left to chance is the task of informing patients about preventive care once they leave the hospital and making sure they understand the county's outpatient clinics still exist to serve their needs.

One plan is to schedule patients for follow-up appointments before they are even discharged from the hospital.

"We will rely on (the Health Services Agency) as a link to understanding the county system," Blom said.

Reprinted by permission of Modesto Bee.