When the ambulance arrived at the corner of Figueroa Street and Avenue 26 in Los Angeles, the paramedics found a man named Victor lying in the darkness. He had been stabbed in the back.
Another argument in the city had gotten nasty. Another victim's rescuers would wonder where to take a patient.
Ordinarily, a stabbing victim would be taken to a nearby Los Angeles hospital for treatment. But on this Saturday night, the emergency rooms of the nearest city hospitals, County-USC Medical Center and White Memorial Medical Center in Boyle Heights were full. So instead, the ambulance headed northeast to Pasadena's Huntington Memorial Hospital, the San Gabriel Valley's largest hospital.
As hospitals in Los Angeles have become crowded, a ripple effect is occurring: Beds in suburban hospitals like Huntington are filling with the ill and the injured from outside the San Gabriel Valley.
By no means an epidemic in the San Gabriel Valley, the situation nonetheless has the potential, Huntington officials say, to threaten the quality as well as the cost of health care in the region.
The events during a swing shift on a Saturday last month illustrate a typical day at Huntington, licensed for 606 beds.
During the shift, the specter of Huntington's emergency room closing loomed no farther away than a bulletin board in the Emergency Department. There, on a wall behind two-way radios and emergency telephones, the board graphically recorded which area hospitals that were, in one way or another, full.
Within Huntington's immediate area four hospitals could take no more critically injured patients. Alhambra Community Hospital, County-USC, Garfield Medical Center in Monterey Park and San Gabriel Valley Medical Center in San Gabriel all were closed.
Yet somehow, Huntington was able to maintain enough beds for critically injured patients. In mid-afternoon, when the shift began, there were 12 beds available, and when the shift ended at midnight, 12 beds were still available.
Nevertheless, a constant stream of Pasadena's wounded and sick flowed through the doors of the emergency room. Patients complained of constipation or headaches or back pain. Mothers carted in their feverish babies. A do-it-yourself carpenter had cut his thigh with a power saw.
And through it all, the beeps of emergency phones pierced the air.
During the shift, one man would die from a heart attack he had suffered at home. One woman who lived in a Pasadena motel would call 911 and, minutes later, in what would be her first contact with a medical professional during eight months of pregnancy, give birth to a girl.
Dozens more patients--67 in all--would be treated. And of this group, 16 would be admitted, including two who ordinarily would have gone to other hospitals had those facilities not been temporarily closed, a situation Huntington had faced in recent weeks.
On Jan. 9, for the first time recent memory, Huntington's emergency room was temporarily closed, hospital officials said. The reason cited was crowded conditions. On two other occasions later that month Huntington was forced to close its emergency room.
Also during January, the hospital temporarily closed three times because of a lack of available critical care beds, and its trauma center closed four times. The center, with a specialized staff on duty round-the-clock, handles the emergency room's most severe cases involving traffic accidents, gunshot and stab wounds, and extreme multiple injuries.
Betty Briggs, Huntington's administrative director of ambulatory services, sees these closings as a growing problem. She cites more trauma cases, which she says are frequently an outgrowth of drug abuse. She also lists population growth and an increasing number of elderly residents who defer care until they are forced to go to the hospital.
Still, she says, "People think closing means locking the door. But closing is only an attempt to divert paramedics and ambulances. Even though we're technically closed, you can't lock the door and let somebody bleed on the ramp."
And Barbara Kelly, an assistant head nurse in the emergency room says: "It's not our philosophy to argue with the paramedics. You waste time arguing over where (patients) should go. And closing is not a decision based on a number. You stay open as long as you can safely care for everyone."
While taking a break midway through a weekend shift, Dr. Donald J. Gaspard, head of Huntington's trauma center, gave this example of how overcrowding in Los Angeles hospitals affect those in the suburbs:
Upstairs, the surgeon said, a patient who was brought from downtown Los Angeles three nights earlier was recovering from a butcher-knife wound to the chest.
Normally, the patient would have been taken to the closest trauma center, County-USC Medical Center. But it was temporarily closed because of overcrowding.