Strong feelings continue to swirl around Escondido as Palomar Pomerado Health tries to move ahead with plans for a new hospital to replace Palomar Medical Center.

At the heart of the dispute is resentment by some Escondido leaders and residents who feel the 2004 hospital bond was passed at least in part because Escondido voters were implicitly promised that the hospital district would keep a new hospital in downtown Escondido.

But the hospital district's responsibility isn't to continue providing an anchor to guarantee downtown Escondido's economic health, nor is it to serve as a redevelopment tool for some blighted area.

Those things are all nice -- and, if they come about organically, fine.

Yet the primary and overriding responsibility of the hospital district is to provide emergency and surgical medical facilities for the inland North County area. And the district's current preference for serving the Escondido-San Marcos area in the years to come is a new, traditional, full-service hospital in a planned industrial park in northwestern Escondido.

The old Palomar Medical Center that serves the region was once state-of-the-art -- of course, Chad Everett was also once the hottest of the hunk TV doctors.

Much has changed besides Everett's downhill career slide since the Palomar Medical Center took its present form with the last tower's addition in 1974. Advances in medical science mean that what were once major procedures are today often performed in out-patient surgical facilities. Developments in medical technology mean that life-saving treatments often cost far more today than they once did -- although we're willing to pay it because they are also far more effective than earlier treatments.

And exponential growth of the area's population means that vehicle traffic in North County has become much, much worse -- making quick access for effective emergency treatment all the more challenging.

While the PPH board has made clear its intent to build a new mega-hospital in the planned industrial park, the Escondido City Council has yet to re-zone that site to allow such a project -- wanting the hospital district to pick up some of the infrastructure costs associated with a new hospital. This stalemate means the final decision is still (at least somewhat) in play.

Given that we seem to have some time to reconsider, perhaps the recent proposal by the self-ordained North County Healthcare Coalition to build a smaller hospital in San Marcos while upgrading the existing downtown Escondido landmark (the so-called "three hospital solution," which includes the already planned and far less contentious upgrade to Pomerado Hospital to continue serving Poway and Rancho Bernardo) is worth a closer look.

The fact is that with area traffic projected to become more and more congested in the years to come, more and more impassable with each decade, having decentralized emergency and major medical facilities may provide the best, most timely access for patients in the future.

After all, what use is a state-of-the-art hospital if no one can get there in a timely fashion?

Contact staff writer Jim Trageser at (760) 740-5424 or jtrageser@nctimes.com.