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L.A. County Trauma System Ailing : Officials Fear Breakdown in Emergency Room Care

December 04, 1987|CLAIRE SPIEGEL | Times Staff Writer

The last time Altrus Hunter needed to be rushed to the hospital, paramedics came right away. But it was an hour and 10 minutes before the 60-year-old man with breathing difficulty finally arrived at a hospital that would treat him. And by then it was too late.

Hunter died Nov. 9, a day when all the emergency rooms at the four hospitals closest to his home in South-Central Los Angeles were reported to be full and unable to accept any more ambulances. Hunter was taken by paramedics to one of these hospitals--the county's Martin Luther King Jr./Drew Medical Center--but the wait was so long there that the paramedics grew anxious and scrambled to line up care for him at a fifth hospital, Memorial Hospital of Gardena.

Hunter died soon after he arrived at Memorial, and the hospital's administrator later reported to county health investigators that Hunter had not received "expeditious" care.

The case of "this unfortunate gentleman," as a doctor at Memorial Hospital wrote later, is the tragedy of a man who might well be alive if he had received timely hospital care. It may be the worst in a series of recent incidents, including one on Nov. 22, when a 3-year-old boy with an asthma attack had to ride 48 minutes in an ambulance that was looking for an open emergency room to treat him.

Health officials fear that these cases may signal the looming breakdown of the system that provides emergency care in Los Angeles County. In the last year, several financially pinched trauma centers have shut down permanently, putting tremendous pressure on the 90 emergency rooms in the county that are licensed to accept ambulance traffic.

"Our trauma system is in great jeopardy," said Chief Alan Cowan, who is in charge of the city Fire Department's paramedics, who made more than 200,000 runs last year. "And now the problem is spreading to our emergency rooms, which are our front-line defense. . . . It's like we've got a tire with multiple holes."

More and more emergency rooms are routinely filling up and closing to ambulances, especially on weekends. This creates serious gaps in service, particularly in the inner-city area, fire officials said.

Records of hospital closures obtained by The Times show that emergency rooms at the four hospitals serving South-Central Los Angeles were closed to ambulances or accepting only certain types of cases about 54% of the time from September through October, the latest two-month period for which statistics are available.

The King/Drew Medical Center's emergency room and trauma center--which is the bulwark of care in South-Central Los Angeles--was open without restriction only 35% of the time, and in some cases was closed because of "saturation" for days on end. Even County-USC Hospital, with the largest emergency room in the nation, became overwhelmed last month and closed for as long as an entire weekend--which is "mind boggling" said Dr. Gregory Palmer, the city Fire Department's medical director.

The president of the United Paramedics of Los Angeles, Fred Hurtado, said there are about 10 emergency rooms serving the inner-city area. "If even one or two of these are closed, we got a problem. . . . The problem is compounded with each additional closure, and the risk to the public increases exponentially."

Health care officials stress that emergency room closures have not compromised care for patients in the most dire medical straits--those who are in extremis, suffering from blocked airways and uncontrollable hemorrhages, for example. Even if an emergency room is closed, it must accept these patients, as well as all foot traffic.

The biggest impact of emergency room closures is on those patients traveling by ambulance who are not in imminent danger but are nevertheless in critical condition--suffering from heart attacks, gunshot wounds, strokes, spinal injuries and so on.

"What I dread," said David Langness of the Southern California Hospital Council "is the first day that a patient dies being shuttled from one hospital to another."

He said a catastrophe is bound to happen since emergency room closures have about doubled in the last year. "It used to be that 15 or 20 emergency rooms would close at some point during the weekend. Now it's more like 30 to 40," he said.

To those who tried to save him, Altrus Hunter appears to be a victim of a breakdown in emergency care.

A hospital source familiar with his case said: "There's no reason for him to be dead. This didn't have to happen."

Hunter's neighbors called the 911 emergency telephone number at 3:51 p.m. on Nov. 9, when Hunter, a widower who lived alone and suffered from emphysema, suddenly doubled over with a breathing attack.

The former truck driver, who was enrolled in the Cigna Health Plan, had been sick for years, said his daughter, Lynda Baker of Cleveland. He kept at least three portable oxygen tanks in his tiny apartment in the 700 block of E. 87th Place. He never removed the air hose from his nose, not even when he drove or slept, she recalled.

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