Alvarado Hospital apparently wanted a higher rate than Tri-City Hospital to care for prison inmates so the contract was lost under the decision making of the new 
owners, Prime Healthcare. It was noted in the article below that Prime plans on spending around $25 million to upgrade the hospital with a focus on the ER room so as I stated below, one more Cadillac ER room on the way, as Prime does not normally contract with insurers and charges their normal and customary rates.
Prime Healthcare Buys Alvarado Hospital In San Diego–One More Cadillac ER Room On the Way
Just as the rest of the hospitals operated by Prime, the hospital was not in good shape financially. There was no mention of doctor group contracts but all together 249 employees received lay off notices. BD
About a quarter of the staff at Alvarado Hospital has been sent layoff notices this week, according to a notice the owners sent to state employment officials.
Letters were mailed to 249 employees, including 91 nurses, that gave a 60-day notice of termination effective March 13. Other positions slated for elimination run hospitalwide, although the pharmacy may be among the hardest hit with 10 pharmacists and 13 technicians slated for layoffs.
On Tuesday, Alvarado’s owners, Prime Healthcare Services, issued a statement saying the layoffs were due to a reorganization and multimillion-dollar reductions in state and federal funding.
Alvarado Hospital layoffs target one quarter of staff - SignOnSanDiego.com
Prime has also embarked on a thinly veiled campaign to "encourage" as many other employees as they can to resign.
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