In February, Nashville-based HCA Healthcare announced that it would close Regional Medical Center’s trauma center, completely eliminate major heart attack services and reduce stroke services effective August 12.

The company backed away from those plans in mid-July after a coalition of medical personnel, including some of the hospital’s doctors and nurses, as well as community members, patient advocates and elected officials raised the alarm at a series of rallies and demonstrations outside HCA hospitals.

Instead, the hospital downgraded its trauma center from Level II to Level III — which advocates said posed a threat to patient safety because the center provides a lower level of care, does not require specialists on site around the clock and relies more heavily on transferring patients with serious problems to other facilities after they are stabilized.

Instead of eliminating the ST-segment elevation myocardial infarction (STEMI) program, which deals with severe heart attacks, those services were cut. One of the cuts affected the hospital’s catheterization lab, where cardiologists insert catheters to diagnose heart problems. On August 12, the lab was converted from a 24-hour lab to one that is open only during the day.

Stroke care was to be reduced from “comprehensive” to a level just above “primary,” although the company said the facility would still be able to care for 97% of patients.

An April county report said the Regional Medical Center is the only trauma center and the only comprehensive stroke center in the east of the county, and reducing services could have a “cascading effect” on the county’s entire health care system as other facilities would have to fill the gap.

Delayed access to health care could potentially lead to more deaths and other negative health outcomes and have a “disproportionate impact on communities of color and low-income communities in East San Jose.”

Williams said that in addition to restoring services cut earlier this month, the county also intends to reinstate obstetric services that HCA eliminated at Regional in 2020. However, the lower level of services implemented Aug. 12 will remain in place in the meantime, a hospital official said.

“We have been serving this community for over 25 years. We have invested over $500 million in capital improvements at Regional Medical Center and believe this is the best path forward for our organization,” said Jackie Van Blaricum, president of HCA Healthcare’s Far West Division.

Reduction in benefits forced the district to act

The cuts at Regional Medical Center were far from HCA Healthcare’s first foray into reducing services in the city.

In 2004, shortly after purchasing downtown San Jose Medical Center, the company closed the hospital, which included a trauma center, and consolidated its services at Regional Medical Center.

Susan Ellenberg, president of the Santa Clara County Board of Supervisors, said the county has no plans to expand its hospital system, but concerns were raised after the HCA cut maternity units during the pandemic.

“When Regional Medical Center began reducing critical services for East San Jose residents and continued to reduce them, we ultimately reached the point where it felt irresponsible to allow them to continue to reduce care for this vulnerable population without intervening,” Ellenberg said.

“It reminded us of a similar pattern at San Jose Medical Center, where HCA closed one practice after another because it wasn’t profitable enough and eventually closed the entire center. We didn’t want that to happen again,” she said.

Because the hospital was previously a nonprofit, coalition members, including senior local and state politicians, have been calling on Attorney General Rob Bonta and Governor Gavin Newsom to intervene in the planned closures and cuts, but so far none of these attempts have been successful.

Critics of the company accuse HCA of putting profits before people and have raised objections to a planned major expansion of Good Samaritan Hospital in western San Jose, near Los Gatos.

One of the elected officials who led the fight against the cuts at HCA was Supervisor Cindy Chavez.

“I’m really hopeful that this means that the services that our entire community, and especially the East Side, so desperately need will be protected going forward,” Chavez told KQED. “I’m really grateful that the community raised their voice and really was heard. I really can’t stress enough how life-saving this move is for our entire community.”

Supervisor Sylvia Arenas, who grew up in East San Jose, said the East Side’s working-class community deserves equal access to health care.

“These are our people who may be working two jobs, children who may be living in poverty,” Arenas said. “When emergencies increase, you really need to have the best care possible that is closest to you. And that’s exactly what the county hopes to accomplish with this agreement.”

Williams, the county’s executive director, acknowledged that the county had only eliminated a $250 million budget deficit earlier this year.

He said the county will be able to cover the cost of buying Regional through a “substantial” reimbursement the county recently received from the Federal Emergency Management Agency for its pandemic-related expenses, but did not provide details. The county could also issue lease revenue bonds and use Regional as collateral to finance the purchase, he said.

This story has been updated.