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Los Angeles' ER Crisis

August 28, 2004

Re "Domino Effect Feared From Closures of Emergency Rooms," Aug. 24: All the recent talk about hospitals and emergency rooms closing in and around Los Angeles is alarming, to be sure, but what is left unsaid is even more disturbing. The reason for the closures is cited as "uninsured patients"; a familiar euphemism for undocumented aliens.

The problem that the media refuse to speak about is real, and we are at the brink of social collapse if we do not address the situation soon. When you consider the costs associated with uninsured drivers who couldn't care less about our laws, unregistered vehicles being driven without required smog checks and foreign-born drivers who don't have a driver's license and can't speak English, then hospital closures are really just the tip of the iceberg in a continuing spiral of decay with no end in sight.

Fred Romero

Simi Valley


There is more than one "domino effect," and you have touched the tip of the iceberg.

As emergency departments close, patients will find other emergency departments and rapidly push them further past capacity limits that they have already exceeded. A significant percentage of those patients will require admission to those hospitals, and their inpatient units will be overwhelmed. The excess admitted patients are typically "boarded" in emergency department beds, further limiting the capacity of those ERs to bring in new patients and extending waiting-room times for those patients who require emergency treatment.

The domino effect extends further into the community, as paramedics find emergency departments saturated and are unable to bring in new patients from the 911 emergency care system. Many of them will have to drive extended times to find an available emergency department bed, decreasing their ability to respond to the next 911 call in a timely fashion.

So even though USC's data show an increased capacity in numbers of emergency department beds, it is a paper fallacy -- the reality is that those spaces were filled a long time ago, and the crisis will worsen rapidly as emergency departments close and access to emergency services is further compromised.

Not to be melodramatic, but there are people who will suffer, and some who will die, as a result of the domino effect.

Eric Alcouloumre MD

Associate Dir. of Emergency Services, Hoag Memorial Hospital, Newport Beach


It becomes clear that, with all of the anticipation of terrorist attacks and the long-awaited earthquake known as "The Big One," it is time for the federal government to help by providing the funds promised for homeland security.

It might be a good idea to impose a small surcharge on the profits of the insurance companies to go toward emergency rooms so they can be prepared for the needs of the uninsured and insured. We cannot afford to be without emergency service as it is. How long before people are dying in the corridors while waiting for treatment and the emergency personnel are making mistakes because of exhaustion?

Jack Tatham


Perhaps in deference to political correctness, your article does not mention the 800-pound gorilla at the heart of this crisis: the illegal aliens that overwhelm emergency room facilities with uninsured patients.

This problem is compounded because uninsured patients (including illegal aliens) often use emergency rooms for the treatment of routine medical problems, and emergency rooms are the most expensive treatment venue.

This costly use is itself compounded as community clinics are overwhelmed or closed.

William S. Davis

Yorba Linda


As a disabled senior and someone who worked and paid into the system, I'm lucky enough to have insurance. However, if the county thinks it's going to close more emergency rooms or if it thinks that putting an initiative on the November ballot is going to save its skin, wake up, our elected brothers and sisters!

First, I'll vote no on this, and second, I'm sick and tired of the county trying to get us to foot the bills for the illegals and gang members. I'll withhold the 3% phone bill tax.

Vince Watson

West Hollywood

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