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Hospitals Dread Possible Effects of Closing King/Drew Trauma Center

September 18, 2004|Jia-Rui Chong and Solomon Moore | Times Staff Writers

Six patients a day. That's how many people, on average, in need of lifesaving care will need to find other hospitals if Martin Luther King Jr./Drew Medical Center's trauma unit closes as proposed in the coming months.

It might not sound like a crisis. But some healthcare officials fear it will be.

King/Drew, the second most-used trauma center in Los Angeles County, saw about 2,150 trauma patients last year. With the county now planning to close the unit, neighboring hospitals will have to pick up the slack.

The added patient load would increase the number of trauma cases these hospitals handle by as much as 50%. Each patient often requires the attention of more than a dozen doctors, nurses and other professionals, and the average cost of one trauma case is $250,000, according to the Hospital Assn. of Southern California. Half of these patients are uninsured. Moreover, the trauma unit at county-owned King/Drew has more experience dealing with gunshot wounds than surrounding hospitals.

"To take on another five to six trauma patients a day -- that's huge," said Byron Schweigert, chief executive at Long Beach Memorial Medical Center. "It will probably be sporadic -- two or three on weekdays and 12 on weekends. But that's far beyond what we deal with."

The county plans now to distribute many of the patients to Harbor-UCLA Medical Center and St. Francis Medical Center in Lynwood. Officials said they are counting on California Hospital Medical Center downtown to pick up some of the load.

"Our first choice is to have California come in and be at the north end and basically distribute among the three," said John Wallace, spokesman for the county health department. If that doesn't work out, the county will have to redraw its map of where to send patients who have been in accidents or been shot.

A spokeswoman at California Hospital Medical Center said the hospital is still talking to county officials about the possible shift and expects to decide by early November.

Schweigert worries that a significant portion of trauma patients might find St. Francis full and head down the Long Beach Freeway to his hospital.

The concern comes after county supervisors announced that the trauma center may close as part of an effort to reduce stress on the hospital, which has been buffeted by months of criticism from regulators for the way it cares for patients.

Just this week, a national hospital accrediting group began the process of revoking its seal of approval from the hospital. County officials say the threat of just that was a factor in their decision to recommend shutting the trauma unit.

Because trauma patients sometimes take priority over regular emergency room patients, others without life-threatening injuries may wait much longer, health officials said. The long waits could force ambulances to try to find other hospitals as they wait for beds to free up.

Hospitals are also worried that members of the public who do not know the distinction between an emergency room and a trauma center will flood local hospitals, thinking that King/Drew cannot treat such things as chest pains. King/Drew, located in Willowbrook, plans to keep its emergency room open, a facility that served 45,000 patients last year.

Emergency rooms treat serious illnesses like heart attacks and infections. But they leave those with more immediately life-threatening injuries from such things as gunshots and car accidents to trauma centers. For example, county guidelines for paramedics and first responders say that people who are shot in the head, chest or back qualify for trauma, while those shot in the arm or leg should go to an emergency room.

St. Francis, the busiest private trauma center in the county, saw about 1,500 trauma victims last year.

"We could see a few hundred more" if King/Drew closes, said Daniel Higgins, an emergency room physician and head of the county medical association. "But one of the problems is not just having a trauma center, but having a surgeon there and a blood bank ready to go and an ER doctor and an in-house operating room and an ICU and enough beds to put people in after the operation."

Higgins' colleague, the emergency room's co-director Mark S. Louden, also worried about the kinds of traumas St. Francis will see once King/Drew closes.

Only 27% of the trauma cases that came into St. Francis last year were "penetrating trauma," such as gunshot or stab wounds, and 73% involved "blunt trauma," such as falls, according to county data. But 45% of King/Drew's trauma cases -- 964 last year -- involved penetrating trauma, which means that St. Francis doctors will have to work on a different kind of injury than they are used to.

Carol Lee Thorpe, vice president for community services at St. Francis, said the hospital is willing to help the county take on the King/Drew load but shared Higgins' concerns about inadequate staffing and about how the extra patients will affect the quality of service the hospital provides.

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