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Jorge Gonzalez leaned back comfortably in a mauve, medical exam chair that resembles, somewhat appropriately, a living room recliner as he quietly absorbed the diagnosis: At 29, the Santa Rosa landscaper had a stomach ulcer.

A few hours earlier, Gonzalez was one floor above, in Santa Rosa Memorial Hospital's emergency department, literally crying before the pain-killers kicked in. Once stabilized, he was moved to Memorial's new "clinical decision unit," a quiet, eight-bed observation unit that removes patients with non-life threatening conditions from the fast-paced emergency care for severely injured or ill patients.

"This thing is the bomb," Gonzalez said. "Every hospital should have this facility. The nurses and doctors are so nice."

Located on Memorial's basement level directly under the catheterization labs, the unit is where medical staff can calmly monitor such things as gastrointestinal bleeding, severe back pain and headaches, kidney stones or asthma attacks. The goal is to improve patient flow through the emergency department.

It's also an example of new medical services that Sonoma County hospitals have added, or are planning to add, to lure patients in a market that is increasingly competitive.

As the federal health-care law takes effect, such innovations as Memorial's clinical decision unit are intended to help hospitals redefine themselves as places where patients get better and stay that way.

The efforts range from emergency department expansions to a medical fitness center to greater collaboration with medical groups and community clinics.

By 2014, the provisions of President Barack Obama's Affordable Care Act are to take effect, including an expansion of Medicaid, a requirement that almost everyone pay for health insurance and creation of a health insurance exchange system.

While the future of the law remains under political pressure from Republicans, the forces that provoked the overhaul — rising health-care costs, insufficient Medicare reimbursements and the high cost of treating the uninsured — will continue to influence health care delivery.

Sutter Medical Center is expected to open its doors in 2014, an "ideal time to open a new hospital," said Mike Purvis, chief administrative officer.

The new hospital will feature a 24-station "universal care unit" that provides greater care flexibility as well as cost savings. All rooms will be private, reducing the number of times patients have to be moved, as well as the rate of hospital-acquired infections.

The new hospital takes into account trends toward fewer hospital admissions, shorter hospital stays and the growth of outpatient treatments. Nonetheless, possible future expansions to add beds are built into the design.

Mike Cohill, a senior vice president of Sutter Health and interim CEO of Sutter Pacific Medical Foundation, said one way Sutter Health is trying to improve patient care and reduce hospital admissions is a demonstration project called Advanced Illness Management, or AIM.

The pilot program, currently being tried at Sutter-owned Alta Bates Summit Medical Center in Berkeley, provides a full-range of home health services, including nursing, therapy, dieticians and social workers. Sutter officials said the program could be brought to Sonoma County in the future.

And St. Joseph Health System-Sonoma County, which operates both Memorial and Petaluma Valley Hospital, has big plans.

Among them is a two-story, 80,000-square-foot medical fitness center that would integrate health, fitness, and clinical programs, such as physical therapy. The facility, with a projected opening date of 2013, would be similar to one at Queen of the Valley Medical Center in Napa, which is serving as a prototype within the St. Joseph health-care system.

Another Memorial project calls for expansion of emergency/trauma services from 19 patient bays to 26 patient rooms. The plan calls for a single-story expansion that would increase the size of the hospital's emergency department from 9,280 to 13,508 square feet. Construction could begin in 2012 or 2013, and it could open as early as 2014.

"When the new emergency department is done, it will give us a new fresh look," said Kevin Klockenga, CEO and president of St. Joseph Health System-Sonoma County.

At Palm Drive Hospital in Sebastopol, CEO Richard Polheber is looking at ways of collaborating with federally subsidized community health centers that are key players under the new health-care law. Billions of dollars have been slated for federally qualified health centers, which are expected to provide a significant portion of the primary health-care services for the newly insured.

Polheber, former CEO of the Arizona Association of Community Health Centers in Phoenix, said he's met twice with Dr. Jason Cunningham of the Sebastopol Community Health Center, part of the West County Health Centers, to discuss strategies.

One area of cooperation involves combining "talents in managing the most difficult patients," those with chronic illnesses that are expensive to treat.

"It could be in the millions of dollars for some patients," he said.

One of only three hospitals with certified primary stroke center, Palm Drive is also the hub of a robotic telemedicine program that serves six rural hospitals in Northern California. Last year, the hospital moved its hand and physical therapy program to a larger site at 968 Gravenstein Highway South.

Before she became the new CEO of Sonoma Valley Hospital last year, Kelly Mather helped Mendocino Coast Hospital in Fort Bragg redefine itself as a "healing hospital," a sort of cultural shift in the way hospitals approach patients. It is part of the national wellness trend that promotes health awareness and healthy living in a community.

Mather, who was brought on at Sonoma Valley six months ago, has a multi-pronged strategy for getting the hospital back on stronger financial ground.

This includes partnering with a larger hospital, such as Marin General Hospital. It already has joined Prima Medical Foundation, a joint operation of Marin General Hospital and the Marin IPA physicians group.

"We are resurrecting from the ashes and things are going well," Mather said.

At Healdsburg District Hospital, CEO Evan Rayner is moving to certify its Kozel Stroke Institute as a primary stroke center, joining the three other primary stroke centers at Kaiser, Palm Drive and Memorial Hospital.

Healdsburg's affiliation with Memorial Hospital could provide a larger pool of physicians for the smaller hospital, while St. Joseph patients might benefit from Healdsburg's off-site wound care program, which offers the North Coast's only doctor-directed hyperbaric chambers.

At Kaiser, integrated health care that focuses on wellness, health living and prevention, is already the norm. Kaiser includes electronic health records, My Health Manager, an online tool for communicating with Kaiser doctors, schedule routine appointments, get lab test results and refill prescriptions.

In October, Kaiser unveiled its $233 million hospital tower, doubling its emergency and intensive-care capacity. The tower has the room for expansion that will increase the total number of licensed beds from 173 to 197.

Local hospital executives are not waiting for what is expected to be a definitive U.S. Supreme Court ruling on the Obama health-care law.

"We're all marching forward with the original intent" of bringing about health care change, said Judy Coffey, senior vice president and area manager of Kaiser operations in Marin and Sonoma counties.

You can reach Staff Writer Martin Espinoza at 521-5213 or martin.espinoza@pressdemocrat.com.