Medical Desert

MEDICAL DESERT highlights the closure of San Pablo Doctors Medical Center and its impact on the medically underserved community of West Contra Costa County. RN Maria Rosario says of San Pablo DMC: “It serves 250,000 people in the community and we have the neediest people in the county.” The loss of the area’s only community hospital not only affects the neediest residents, but all residents of the Greater Bay Area. Surrounding hospitals will suffer from the ripple effect as ambulances are diverted and emergency transit times and ER wait times increase.

Discussion Guide


The discussion guide is meant to foster conversation about hospital closures and urgency at how a medically underserved population could lose emergency medical care, and cultivate an activism of health awareness.


  • Medically Underserved
  • Hospital Closures
  • Emergency care access


  • When you hear the phrase “Medical Desert” what do you imagine?
  • How might the closure of a hospital impact the community? What about surrounding communities?
  • What services might this affect?
  • Is the case of San Pablo DMC an outlier when it comes to hospital closures?
  • What are the ideal functions of a hospital? (e.g. who should it serve? what about cost?)
  • What would you propose as an ideal solution for the situation with DMC?
  • Imagine that you have a nonlifethreatening urgent medical need (e.g. a dislocated limb, bone fracture, stitches required, puncture wound, etc.) and there is no immediate emergency care for your insurance type…what do you do?
  • In the documentary, Eric Zell discusses the cost of care from government reimbursements. Maria Rosario makes a statement referring to the DMC closure as a result of institutional discrimination, and Wayne Furlong highlights similar closures in the Greater Bay Area. Is this an outlier situation with DMC and are there, if any, systemic issues?

Facts and Resources


1. Hospitals affected by a nearby ER closure may experience a 5% increase in mortality rates.

2. Between 1996 and 2009 from the number of Emergency Rooms dropped from 4,884 to 4,594; while ER visits increased from 90.3 million in 1996 to 136.1 million in 2009.

3. Two studies have concluded that as distance from a hospital increases, so does mortality with a rate of 1 kilometer equal to 1%.

4. According to the American College of Emergency Physicians, the United States earned a “D+” overall for Emergency Care System and California earned a “C-”

5. The only other hospital in the designated Medically Underserved Area of West Contra Costa County is Kaiser Richmond.

6. Approximately 32% of West Contra Costa County Residents live in poverty.

7. Approximately 80% of payers are on Medi-cal or Medicare.

8. DMC has 25 ER beds while Kaiser offers an additional 15 ER beds.

9. In 2009, DMCs total ER visits numbered 40,473 (approximately 110 visits a day) and was “the destination for approximately 71 percent of all ambulance transports for the West County area.”

10. Estimated Travel Times from San Pablo DMC without traffic to nearby hospitals

Hospital I Distance (in Minutes)

Kaiser Richmond - 8

Alta Bates Summit Oakland -15

Alta Bates Berkeley - 16

Children’s Hospital Oakland - 16

Kaiser Oakland - 16

Highland General Oakland -19

Sutter Solano - 25

Kaiser Vallejo - 23

Contra Costa Regional Martinez - 23

Marin General Greenbrae - 27

John Muir Concord - 27

Kaiser Walnut Creek - 31


Meet the Filmmakers