Growth Factor : Health care: Ojai Valley Community Hospital plans a tenfold expansion of its emergency room.

Even on the busiest of days, the nurses in the emergency room at the Ojai Valley Community Hospital are not likely to miss a sudden change in a patient’s condition.

The tiny, 500-square-foot treatment area has just four beds separated by sliding curtains, shelves jammed tightly with medical supplies and a portable defibrillator parked against one wall.

Outside, a narrow hallway triples as a waiting room for families, conference area for doctors and an entrance for paramedics.

“I can hear and see and keep my eyes on everyone,” nurse Jacqueline Smith said. “But there’s no privacy for patients at all.”

That, however, may soon change. If all goes according to plan, the cramped emergency room will be expanded tenfold next year, adding three treatment areas and considerably more elbow room for staff.

The 116-bed hospital is also tentatively planning to double the size of its adjacent skilled-nursing facility, add a day-surgery center and redesign the main entrance on Maricopa Highway in west Ojai.

“It would begin to take on the feeling of a medical campus,” said James Van Duzer, the hospital’s executive director.

Two trends, he said, are driving the hospital’s multimillion-dollar expansion.

The first is a push throughout the health-care industry for hospitals to perform more services on patients who never spend the night. The second is the size of Ojai’s elderly population and the scarce supply of high-quality nursing-home beds in the county.

“We know that people over 80 are the fastest growing segment of the population,” Van Duzer said.

The hospital hopes to expand on a parcel owned by Holy Cross Lutheran Church. The church has agreed to relocate and is trying to buy a 52-acre parcel next to Nordhoff High School not far away.

As with hospitals across the country, Ojai Valley Community Hospital has struggled in recent years to fill its 50 beds for general care, which are occupied only one-third of the time.

In contrast, the hospital’s 66 skilled-nursing beds are often filled, with a long waiting list.

For the Ojai Valley hospital, the expansion marks a major step forward after several years of financial uncertainty and rapid changes in top management.

Since 1981, the hospital has seen eight top managers and three owners, including Affiliated Medical Enterprises, which filed for bankruptcy protection in 1991.

A year ago, Portland-based Brim Cos., which specializes in operating small hospitals in rural areas, bought the hospital for $4 million.

“We felt the Ojai Valley definitely has potential,” said Steven Taylor, president of Brim Healthcare Inc. “Part of our vision at the beginning was to improve facilities and improve services.”

Since buying the hospital, Brim has shown its commitment to the facility by spending $2 million to replace aging equipment, a boost that some members of the staff say has been long needed.

The company has also actively courted area doctors, on which the hospital depends for referrals, and taken pains to study the medical needs of the community.

“They have always been very upfront and straightforward from Day 1,” said Dr. Jeffrey McManus, president of the local physicians association.

The most high-tech piece of equipment arrived in late October. It is a sophisticated $1.2-million head-and-body scanner, which hospitals say is the most advanced in Ventura County.

Previously, the hospital contracted for a portable scanner on a trailer two days a week. When emergency scans were needed, patients were transported to hospitals in Ventura.

Shaped like a large doughnut, the state-of-the-art scanner spins in a circle taking pictures as a patient is slowly pushed through the large opening on a table.

The scanner is capable of producing three-dimensional computer images that can reveal a brain tumor, facial fractures, a slipped disc or the buildup of plaque in the aorta.

According to Taylor, the hospital’s goal is to increase its share of Ojai Valley patients. The hospital now captures less than 50% of the valley’s sick, with the rest seeking care in Ventura, Oxnard or Santa Barbara.

By placing greater emphasis on outpatient services and long-term care, Brim officials hope to boost the small hospital’s profits at a time when many similar size facilities are in danger of closing.

In 1994, the hospital posted a slim profit of just over 1% on an operating budget of about $13.2 million. The hospital had lost money for three years.

Kim Ballew, chief financial officer, said the losses began in 1990 when managed care first became a force locally. Since then, the volume of patients staying overnight has been cut in half.

To compensate, the hospital built up its physical therapy department and began performing more lab work for local physicians. It also closed a chemical dependency program that received little use as insurance companies stopped paying for such care, converting those beds to long-term nursing care.

As evidence that an outpatient surgery center is needed, hospital officials point to the jump in such minor surgeries from 565 in 1990 to 691 in 1994.

During the same period, the overall number of outpatient visits increased from about 12,000 to 16,000.

And while emergency rooms at larger hospitals often lose money through uninsured patients, Ojai Valley Community Hospital manages to break even. Less than 1% of the hospital’s patients are indigent.

The typical patients at Ojai Valley’s emergency room are injured hikers, horse riders, residents with the flu or a sore throat, and elderly people who have fallen and hurt themselves.

The hospital has treated only two serious gunshot wounds in two years. And the most serious trauma patients are taken by helicopter or ambulance to Ventura County Medical Center if they are stable.

Besides giving patients and their families more room and privacy, the larger emergency room is also intended to give them a better impression of the hospital.

“The E.R. is the first place many people come when they visit your hospital,” she said. “If they have a good experience in the E.R., then next time they need services, they’re going to choose your hospital.”