Administrators at St. Joseph Hospital say the future of health care on the North Coast will arrive with the opening of the new Northeast Tower, a state-of-the-art, $140 million patient care facility being constructed on the hospital's campus in Eureka. When it opens in late summer of 2011 (its original spring debut has been postponed due to construction delays), this three-story building will house an expanded Emergency Department with 20 treatment bays, a surgical suite featuring eight operating rooms, a full-floor Intensive Care Unit, 79 new patient care beds and much more. In short, it will be a gleaming testament to the sophistication of 21st Century American medicine.

Of course, the major challenges facing the future of health care in this country have little to do with technology or even quality of care; no, our main afflictions are the escalating costs and diminishing access to that care. Health care practitioners in at least one department at St. Joe's worry that those problems will only worsen in the new building.

That's because, once the new Emergency Department goes online, the hospital will eliminate its Urgent Care Center, which, according to the physicians and nurses who work there, has become an increasingly valuable resource for North Coast residents, especially since waiting lists at other area medical offices can be as long as three months or more.

"Clinics are full," said Roxanne Spencer, a registered nurse who works at the Urgent Care Center. "We kind of act as a safety net for people who can't get in to see their doctors, or people who are new to the community and need their meds refilled, or people passing through who don't want to go to the ER." In the new building, all patients seeking immediate treatment will be funneled through the emergency room. Spencer thinks that process won't benefit patients. "It's just going to make it much harder, I think, to access care," she said.

Hospital officials insist that won't be the case. They say that the elimination of the Urgent Care Center -- which is the only such center in Humboldt County -- in no way represents a reduction in services. It simply means that patients will be channeled toward the best possible care. Hospital spokeswoman Leslie Broomall said in a written statement that the transition will actually be in the best interests of patients, whether they're seeking emergency or urgent care, "because it ensures they will have access to the state-of-the-art technology and the most highly skilled team of emergency staff available in Humboldt County."

That may be true, but those patients will also be charged emergency room rates, which far exceed those in the Urgent Care Center, nurses say. Urgent Care sees patients from many walks of life, including newcomers to the area, school kids who need sports physicals, travelers on their way through town, mental health patients who need prescriptions filled, plus many St. Joe's employees and their families. For patients with insurance, the typical co-pay at Urgent Care is $25. It's twice that at the emergency room, Spencer said. But the real victims, she added, will be low-income patients -- "particularly people who make a little too much money for MediCal, or who either have jobs that don't have good insurance or no insurance at all. They're going to be stuck with the bills."

The billing system itself is rather complicated, since hospital fees and physician fees are charged separately. That's because, with rare exceptions, California law prohibits hospitals from hiring doctors directly. (The purpose of the law is to keep corporations and other groups from influencing the professional judgment of doctors.) So the physicians at St. Joe's ER and Urgent Care Center were essentially self-employed as a unit, dubbed North Coast Emergency Physicians. That is, until the first of this month, when the group was acquired by a national physician-owned group called CEP America.

The upshot of all this is that the docs who work at St. Joe's Emergency Department and Urgent Care Center (until it closes) are now part of CEP America, which is responsible for setting the prices on the medical side of things. According to CEP spokeswoman Allison Whitney, the prices for almost all emergency room services at St. Joe's will actually go down under the new group's management since they're able to average out costs across their wide network of hospitals.

On the hospital side of things, emergency fees will not change, said hospital spokeswoman Courtney Hunt-Munther. However, those fees still represent a steep increase for patients who would otherwise have gone to Urgent Care.

Michael Christian, another nurse at the Urgent Care Center, said that this move by St. Joe's is consistent with larger trends in America. "There's a health care access crisis in this country, and now [we're] funneling people toward the most expensive type of care possible," he said. Christian's colleague, Urgent Care RN Bonnie Hamant, said the decision was probably made for financial reasons. The hospital, she said, failed to sufficiently advertise the Urgent Care Center, which resulted in many patients saying they didn't even know it existed until they went there, or others who saw it as just another emergency room. At any rate, it hasn't been financially successful, Hamant said, which is probably what landed the center in St. Joe's cross-hairs.

"Their history is to close things that don't make money, whether it serves the community base or not," she said. "So I'm not surprised they made this decision, but I think it's just unfortunate because more and more providers are retiring. And we are seeing people for their basic medical needs." Under the new system, Hamant envisions patients with relatively simple needs -- like, say, getting a prescription refill -- being forced to wait in an ER full of patients who are seriously sick or injured. "They're gonna end up being in a huge vat of people," she said.