House Calls runs monthly. Today's column is written by Wayne Bunn, a case manager at Sutter Coast Hospital.

There is so much talk in the community and through the media about the concerns of patients being transferred out of Sutter Coast Hospital.

This is not a new concern for our hospital. We regularly transport patients out of the area for specialty services or higher level of acuity needs. We also transfer patients for services that can be provided locally because not all medical specialty services have 24-hour call coverage.

California requires that hospitals report the number of patient transfers, and the reasons why patients are transferred. From 2007 through 2012, Sutter Coast Hospital reported that a total of 3,909 patients were transferred out for specialty services that could not be provided locally. The top three reasons that patients were transferred out were: 1) cardiology; 2) orthopedic surgery; and 3) neurology.

In an emergency, patients are transported to Sutter Coast Hospital by friends, families, first responders, or emergency personnel from Del Norte Ambulance or Cal-Ore Ground Ambulance. Once the patient arrives in the emergency room, the patient is assessed by the emergency room physicians and staff.

Sometimes the patient is transferred from the Emergency Department, although it is also possible that a patient may require transfer after being admitted to the hospital if, after further testing, the treating physician determines that special medical needs cannot be met or are not provided locally.

When it is determined that a patient has medical needs that cannot be met locally, the transfer of a patient is initiated to the closest hospital where those needs can be met. These are typically St. Joseph's Hospital in Eureka, or to Providence Medford Medical Center or Rogue Regional Medical Center (formerly Rogue Valley Medical Center) in Medford.

If the closest hospitals cannot accept a patient in transfer, the next nearest hospitals are contacted. There are many reasons a patient may not be accepted for transfer to the closest hospital, including lack of hospital staff or available beds as well as the unavailability of medical specialty physicians.

There are situations where a transfer to a large tertiary treatment hospital is the first choice, rather than attempting transfer to the closest hospital. Situations such as motor vehicle accidents with an individual experiencing multiple or extensive traumas, burns, pediatric specialty needs, or psychiatric specialty care are a few examples of this.

In some cases, a transport team from the receiving hospital comes to transport the patient from our hospital. This is especially true in the case of a high-risk newborn or in some pediatric cases.

The time that it takes to transfer a patient wvaries, depending upon the mode of transportation. In some cases, a ground transport via private vehicle or ground ambulance may be adequate.

Because of our geographic isolation, patients are often transported by air ambulance, usually via twin-engine, fixed-wing airplane. In addition to the flight time, there is also the ground ambulance time transporting the patient from Sutter Coast Hospital to the Crescent City airport, and then the ground ambulance from another airport to the receiving hospital.

It takes approximately 20 minutes for the air ambulance transport from the airport in Crescent City to Medford or Eureka. It is approximately 40 minutes to Eugene or Redding. The air ambulance transport time to Portland, Sacramento, or San Francisco is about one hour.

En route, the flight nurses and paramedics are responsible for the patient from the time that the patient is picked up at Sutter Coast Hospital until the patient is turned over to the medical staff in the receiving hospital.

Of course, the hope is that you will never need to be transferred for specialty medical services not available locally. But for some of us this will become reality. With the assistance of the professional and dedicated staff at Cal-Ore Life Flight Ground and Air Ambulance, Del Norte Ambulance and Sutter Coast Hospital, we will continue to assist in transferring a patient to the closest hospital where their medical needs can be met.

Once the specialty care has been provided out of the area, and patients are medically stable for transfer back or discharge from the hospital, they return to Del Norte/Curry County to continue the healing process and to resume the local activities in the beauty of this region that we have chosen to call home.

Dr. Sandy Saunders,medical director of Valley Emergency Physicians, the organization that staffs Sutter Coast Hospital's Emergency Department, stated in a July Coastal Voices, "We transport patients out of here nearly every day due to acute conditions that would be better served elsewhere. We are good at this - it won't be a new practice."

When it is not possible to stay at Sutter Coast Hospital due to acuity or specialty services needed, we will transfer you to the closest, most appropriate hospital for you to be treated.