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An Inside Look at a Health Crisis

Steve Lopez / POINTS WEST

March 28, 2004|Steve Lopez

The day paramedics rushed me to the emergency room at County-USC Medical Center after a bicycle accident, an army of wounded was already there. It was 1 o'clock on a Friday afternoon and 151 people were waiting to be seen by the 13 doctors.

That's a typical number of patients, Dr. Sean O. Henderson later told me. He's vice chair of the ER unit, which treats about 400 people a day. They wheeze, stagger and roll through the door with everything from earaches to bullet wounds, and those with relatively minor problems often wait into the next day before getting treated.

I had the privilege of going to the front of the line with "blunt head trauma," a concussion and amnesia, Henderson told me. "You kept asking, 'Where am I?' and 'What am I doing here?' "

L.A. County Supervisor Zev Yaroslavsky has an answer for the first question. I was at ground zero, he said, in the nation's healthcare crisis.

This was no surprise. Several times during my three-day hospital stay, doctors or nurses went slack-jawed when I talked about following up with my own doctor or using my own pharmacy.

You have health insurance? they asked in amazement.

Of the 45,000 patients the hospital admits each year, only 5% have private health insurance. I was taken there because it was the closest trauma unit.

For three days and nights, I was in the domain of the working poor. They've got no insurance, no regular doctor and nowhere else to go. Roughly 30% of them are undocumented immigrants the hospital is required to treat.

"It's a significant portion of the county's healthcare costs," Yaroslavsky conceded, "but the undocumented population also makes up a significant portion of L.A.'s economy. There are people who want to make undocumented immigrants the boogeyman for every problem, but if we didn't have them, L.A. would still have a healthcare crisis."

David Altman, the hospital's chief medical officer, told me 50% of all patients have Medi-Cal, 5% have Medicare and 40% have nothing at all.

"Until America decides healthcare should be a right and not a privilege," Yaroslavsky said, "those who get sick and have no health insurance will end up in ER. One in five people in the nation has no health insurance, but in L.A. County, it's one in four. That's 2.5 million people. It's 1 million kids, and half of all the students in the L.A. Unified School District."

Emergency rooms will get even more jammed, Yaroslavsky said, as the ranks of the uninsured grow while the number of hospital beds declines through closures and budget shortfalls. This means that if you're in an accident or have a heart attack, you could end up taking a number at the nearest ER.

I was lucky because my injuries turned out to be relatively minor. But when I was admitted, 62 of the 151 patients awaiting treatment were classified as acute major medical cases. ER chair Ed Newton, who treated me along with Dr. Renee Magana, made news last year when he and other doctors said delays in care had been a factor in the deaths of four patients at County-USC.

State investigators did not substantiate those claims, but faulted the hospital for staff shortages, delays in care and other problems. Henderson said some problems still exist, but Altman, the chief medical officer, said the hospital is making fixes despite budget constraints.

The hospital has even bigger problems in the wards, where I was eventually transferred. After suffering what were diagnosed as seizures, I was taken to a room crowded with five or six other patients. I had no curtain for privacy and no buzzer with which to call for help.

The only patients with real pillows had brought them from home. Hospital-issue was a fiber pad as thin as a doormat.

We all shared one bathroom, the only TV had been brought in by a patient's relatives, and I overheard a nurse answer complaints of inattentiveness from the wife of a stroke victim.

The nurse politely apologized, but said she couldn't do anything about understaffing.

Maybe the answer is to shut county hospitals -- some of which are paralyzed by archaic bureaucracies or the kind of nightmare now being exposed at King/Drew Medical Center -- and contract with private ones. But that isn't going to happen at a time when the number of hospitals is shrinking.

I left County-USC even more convinced that some form of national health insurance, whether public or a combination of public and private, is the way to go.

"We're the only industrialized nation other than South Africa," Yaroslavsky said, "that doesn't provide healthcare for every man, woman and child."

Whatever the politics, I have new appreciation for trauma doctors and staff who do noble work where it's most needed. Henderson, on the job since 1989, said there's a proud sense of mission at the teaching hospital, which was founded in 1878.

When he parks his car in the morning, he walks past a long line of poor patients voluntarily making arrangements to pay whatever they can for the help they received.

Unfortunately, Henderson said, "You get very good at death-telling." He recalled the case of a teenage boy and star student cut down last year by a stray bullet from a drive-by shooting. The bullet lodged in his brain and doctors told the family there was no hope. So the father asked them to pull the plug.

"Here's a kid at the top of his class," said Henderson.

Doctors "pulled the tubes out while the father held his son's hand," he said. "And you do this in the middle of 151 more people waiting to be seen."

*

Steve Lopez writes Sunday, Wednesday and Friday. (My thanks to doctors Newton, Magana, Henderson, Costanzo DiPerna, Dena Amr, Tamara Alexandrov and Michael Hahn; physician's assistant Lee Slajer Jr.; and nurses Mercedes Lopez, Abiodun Akerele and Fiorella Caraisco.)

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