California Hospital had been seriously considering creation of a trauma center for 14 months. The hospital had put together a panel of specialists, including neurosurgeons and orthopedic surgeons, and had found radiology technicians who could be on call at night. Hospital managers had reserved two operating rooms for trauma patients and made sure they were heated to 72 degrees, warmer than operating rooms for other surgeries.
They set aside an eight-room wing of the intensive-care unit and arranged for extra beds in other intensive-care areas. They enlarged the curtained-off areas around four beds in the emergency room to allow a larger number of doctors, nurses and technicians to gather around patients.
For The Record
Los Angeles Times Saturday December 25, 2004 Home Edition Main News Part A Page 2 News Desk 1 inches; 61 words Type of Material: Correction
Trauma center -- An article in Friday's California section about a new trauma center at California Hospital Medical Center in downtown Los Angeles said the trauma center at Martin Luther King Jr./Drew Medical Center would stop seeing patients Feb. 1. The exact date of the shutdown has not been determined; officials have said it would be between late January and mid-February
They were ready to open in July, but last-minute concerns about whether California would get enough patients to cover its cost scuttled the plan. The county's proposal in September to close King/Drew's trauma center, located 10 miles south, helped to restart negotiations between the hospital and the county. On Nov. 16, the Board of Supervisors approved a seven-month contract with California Hospital that would pay a maximum of $3.98 million for about 1,000 patients. On Nov. 23, the board voted to close King/Drew's trauma center.
The first call for "code trauma" over California's loudspeakers -- also transmitted by pager to trauma team members -- came about 10 a.m. Dec. 1.
Los Angeles city paramedics were bringing in a man who had fallen on a sidewalk at the intersection of 5th and Hill streets. Witnesses told firefighter-paramedic Douglas Nuttman that the man had possibly been hit by a car or suffered a stroke. Because the man was not fully conscious and suffered multiple cuts, Nuttman decided this was a possible trauma case and headed to the nearest trauma center: California.
"There was an overwhelming response," Nuttman said recently. "They had a bed open and waiting. There were security guards available to us. There was a full trauma team in the ER. There were several well-wishers and onlookers."
"A normal trauma team is eight to nine people -- doctors, nurses, ER technicians," he said. At California, "there were probably 20 to 25 people in the room."
Some hospital administrators approached him after he transferred the patient from the ambulance's backboard to the hospital bed.
"They all wanted to know where we came from, how we knew they were open, what criteria the person had met, that kind of thing," Nuttman said. "They were really excited."
More cases followed in unpredictable clusters, Myles, the trauma manager, said. One Friday, the hospital saw six stab wounds, then no trauma patients for days. Then, three victims came in with gunshot wounds, one right after the other.
In the first 14 days, the hospital treated three "hangman's fractures," a rare break in certain neck bones that might happen when, for instance, a person is not wearing a seat belt and hits his or her chin on the dashboard of a car.
Many of California Hospital's new trauma patients come from the northern part of the area served by King/Drew, health officials said.
King/Drew's trauma center, which saw about 1,800 patients this year, is handling an average of only about three patients a day, half of its former load, said John Wallace, a spokesman for the county's Department of Health Services. Most of the other patients are now being taken to California, he said. (The emergency room at King/Drew remains open, and the trauma unit will treat patients until Feb. 1, 2005.)
King/Drew, which is in Willowbrook, just south of Watts, has been under intense scrutiny by federal regulators and national accreditors after medical lapses contributed to several patient deaths. The L.A. County Board of Supervisors hired an outside consulting company to identify problems and begin making changes over the next year and voted to close the trauma center in a last-ditch effort to relieve pressure on the troubled hospital.
Many local activists and politicians, saying they hold the trauma center in high regard, have protested the closure. They worry that the added time to transport gunshot or stabbing victims to the next closest facility could lead to deaths.
The county intends to review California's performance in mid-January and then decide how to proceed.
"We're talking a lot of what-ifs, and we're only talking three weeks," said Carol Meyer, director of the county's Emergency Medical Services Agency. "From everything I've heard, they're doing a good job."