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Pressed in Case of Emergency

With Memorial's ER preparing to close and the one at King/Drew in trouble, Downey and other nearby hospitals are growing anxious.

October 15, 2006|Mary Engel | Times Staff Writer

It was just 9 a.m., and already patients filled the 22 emergency room beds at Downey Regional Medical Center and spilled over into chairs in the hallway.

Chief nurse Andrew Greene managed the mayhem with the practiced calm of a Buddha in blue scrubs.

This recent weekday, after all, was only slightly busier than usual: The emergency room typically is full by noon. It stays full until midnight.

"We've had a lot of abdominal pains, chest pains, falls, hip injuries," Greene said, checking his clipboard. Patients ranging from 11 months to 80 years had broken arms, pneumonia and enough upper respiratory infections to spark fears among staffers of an early flu season.

For an emergency room network as stressed as Los Angeles County's, it's a scary thought.

The network of 75 public and private hospitals is still reeling from last month's announcement that Centinela Freeman HealthSystem will close the emergency room at its Memorial campus in Inglewood in December, becoming the 10th hospital in Los Angeles County to do so in five years.

Now Downey and other nearby hospitals are watching with growing anxiety as the county tries to stave off a loss of federal funding that could doom its long-troubled Martin Luther King Jr./Drew Medical Center in Willowbrook, just south of Watts.

King/Drew's emergency room treated more than 47,000 patients last year. Memorial, formerly known as Daniel Freeman Memorial Hospital, treated about 38,000. If both were to close, "85,000 patients -- 235 patients a day -- would have to go someplace else," said Carol Meyer, director of the county's emergency medical services. "The ripple effect would be profound."

King/Drew serves a densely populated area that includes South Los Angeles, Compton and Lynwood.

Two of the nine private hospital emergency rooms that have already closed were nearby.

Healthcare professionals and residents worry that the heavily minority and impoverished neighborhoods will be left without the medical care they need. Only the more sparsely populated Antelope Valley in the county's far north has as few hospitals.

Losing emergency rooms outside the South Los Angeles region hurt the network overall but didn't have a major effect in the immediate area, Meyer said.

"If you drew a five-mile radius around those hospitals, there were multiple other choices," she said. "You don't have that in the South-Central L.A. area. And five miles is a long way in such an urban area."

The only hospital within five miles of Memorial is its sister institution, Centinela, also in Inglewood, where emergency services and some other departments will be consolidated. Only one hospital -- Lynwood's St. Francis Medical Center -- is within five miles of King/Drew.

Residents of these neighborhoods want to know they have a reliable source of care. Gary Fuller, 48, lives just across the 105 Freeway from King/Drew, and he and other family members have used the emergency room there several times over the years. Last week, his best friend was in the hospital after suffering a stroke and being admitted through the emergency room.

"If they hadn't gotten him here in time," said Fuller, "he would have died."

The county's last-ditch plan to save King/Drew would keep the hospital's heavily used emergency room open. By eliminating or transferring other services and turning over management to Harbor-UCLA Medical Center, the county is hoping to persuade a federal agency to reconsider pulling the plug on funding.

But the still-evolving plan would reduce inpatient beds from about 252 to 42, at least initially, and that in turn would limit the emergency care King/Drew could deliver.

"With only 42 beds," said Downey's chief operating officer, Robert Fuller, "they will be full in three hours."

Overflowing waiting rooms are the most visible but not the only reason emergency rooms get backlogged. If no inpatient beds are free, emergency patients who need hospitalization continue taking up ER beds, and ambulance paramedics wait longer to hand off new patients.

"If you increase the time paramedics spend on hospital parking lots," Fuller said, "that would have an impact on the whole L.A. Basin. Ambulance response times are going to go up, and some poor lady in Beverly Hills having a heart attack is going to have to wait longer."

When crowding is most extreme, hospitals go on "diversion" and turn ambulances away, making them go farther.

Some hospitals are on diversion most of the time. Last year, public hospitals, including County-USC and Harbor, were closed to ambulances an average of about 20 hours a day. Some private hospitals, including St. Francis, the one closest to King/Drew, were closed for 12 hours or more.

"We know that St. Francis operates pretty much at capacity now," said Jim Lott, executive vice president of the Hospital Assn. of Southern California.

The next nearest hospitals to King/Drew is Memorial Hospital of Gardena, 6 1/2 miles away, and Downey, about seven miles. But the ripple effects could extend farther than that.

'Big Problems'

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