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L.A. County May Lose 10th ER

Memorial Hospital in Inglewood is looking into shifting patients to its sister Centinela campus and other sites in a bid to save money.

August 28, 2006|Charles Ornstein | Times Staff Writer

Centinela Freeman HealthSystem is considering closing the emergency room at its Memorial campus in Inglewood, a step health experts and patient advocates say could further destabilize Los Angeles County's fragile emergency care network.

The health system said it is reviewing a plan that would shift the patients treated in Memorial's emergency room to its Centinela campus, also in Inglewood, about 1 1/2 miles away. A decision is expected within 30 days.

Memorial, formerly known as Daniel Freeman Memorial Hospital, treated about 38,000 patients in its emergency room last year. Centinela treated about the same number, but it has room to handle more, officials say.

If the Memorial emergency room is closed, it would mark a major turning point for the 358-bed hospital, which has had three owners in the last five years. Earlier this year, the health system moved obstetric services from Memorial to 370-bed Centinela.

"These are tough decisions," health system President and Chief Executive Michael A. Rembis said in an interview. "We are losing a lot of sleep over this. We're going to do what we believe is best for the community."

But Carol Meyer, director of Los Angeles County's emergency medical services agency, called the prospect "devastating." She noted that nine emergency rooms had shut their doors in the county in recent years, but said: "This is going to be the biggest one yet."

"I want the public to know that their healthcare system is in jeopardy," she said.

If the plan goes forward, the hospital system said it would add two new urgent-care centers -- at Memorial and Centinela -- with extended hours to increase access to urgent and primary-care services.

"I don't think parents are well served waiting six or eight hours for antibiotics for their child" in the emergency room, Rembis said. "You can get access to care quicker, faster and far less expensive going to an urgent-care center."

But community leaders say they feel betrayed by the news.

"It's a good business model but it's very bad for healthcare," said Lark Galloway-Gilliam, executive director of Community Health Councils Inc., a consumer advocacy group. "I am so angry. The sad thing is we don't have any control over this situation."

Galloway-Gilliam said she is particularly upset because community leaders took the health system's side earlier this year in a contract dispute with Blue Cross of California. If negotiations had fallen through, Memorial could have been forced to close, hospital officials say.

The emergency room at Memorial must remain open at least until mid-December because of an agreement between the state attorney general and Tenet Healthcare Corp., the hospital's former owner.

When Tenet purchased Daniel Freeman Memorial from a nonprofit chain in 2001, it agreed not to close the emergency room for at least five years.

That deal remains in effect even though Tenet sold Memorial, Centinela and a third, 166-bed hospital in Marina del Rey to a private investment group led by the facilities' managers in 2004.

At the time of the most recent sale, the new owners said they would keep all three emergency rooms open.

Last month, Centinela Freeman borrowed $65 million by mortgaging the Centinela and Marina hospitals. Some of that money was used to pay off a higher-interest loan to investors, Rembis said, though he would not provide specifics.

Memorial was not included in the mortgage transaction, leading community leaders, including Galloway-Gilliam, to question whether the hospital would be put up for sale.

Rembis said Memorial was left out because it has a long track record of financial losses. In order to make the hospital viable, it will have to "look very different in the future," he added.

One scenario being discussed calls for cutting the number of inpatient beds and replacing them with some combination of rehabilitation services, a skilled nursing unit, long-term acute-care beds and a hospice.

The health system said it had hired the Camden Group, a consulting firm, to analyze its options and the potential effect of closing the Memorial emergency room. The study found that nearly two-thirds of the emergency room patients at Memorial and Centinela were treated for non-emergency and non-life-threatening conditions, the system said.

Data submitted by Memorial to the Office of Statewide Health Planning and Development showed that Memorial treated 16,000 patients last year that it characterized as "severe," representing about 42% of all emergency room patients.

Details on emergency room visits last year at Centinela are not yet available on the agency's website.

Jim Lott, executive vice president of the Hospital Assn. of Southern California, said the emergency room at Centinela can absorb some of the patient load currently seen by Memorial, but he is concerned about whether other area hospitals can too.

"It's not like you can just pack up all the patients and move them to Centinela," Lott said. "You just can't control EMS traffic."

Emergency rooms can be a financial drain on hospitals because, by law, they are required to screen and stabilize any patient who comes to them, regardless of insurance status.

By comparison, hospitals without emergency rooms can offer only those services with acceptable profit margins and screen which patients they admit.

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