In Willowbrook just south of Watts, Martin Luther King Jr.-Harbor Hospital serves a population that is poorer and less likely to be insured than anywhere else in Los Angeles County. Many in surrounding neighborhoods have heard over the years about the mismanagement and botched care that have put the hospital on the brink of collapse. But most say they don't know where they would go if King-Harbor closed.
"What are people going to do if they don't have cars and depend on public transportation?" asked Frederick O. Murph, senior minister at Brookins Community AME Church. "What if they have a stroke in the middle of the night?"
Those were precisely the sorts of questions that led Los Angeles County supervisors to open the hospital 35 years ago in the aftermath of the Watts riots. At its peak, the hospital, formerly known as King/Drew, was a teaching facility that offered such high-level services as neurosurgery.
But it has been unable to meet minimum federal standards for patient care since January 2004. After the hospital failed what was billed as a make-or-break federal inspection last fall, the county slashed more services, ended physician-training programs and reduced the number of beds to 48 from about 250.
The current Board of Supervisors says it will be forced to close virtually all that remains of King-Harbor if it fails another crucial federal inspection -- which in turn will trigger a loss of $200 million in federal funds -- that was conducted last month. The board expects to hear from investigators by Wednesday.
The county has a plan for closing King-Harbor: An urgent care center and clinics for diabetes, high blood pressure and other outpatient care would remain open. Ambulances would be directed to emergency rooms at other hospitals. The county would staff more beds at its other hospitals and pay to add beds at some private ones.
Nevertheless, the 73 other public and private hospitals in the county's already stressed emergency network are bracing for greater backlogs and longer waits. The seven nonprofit community health clinics near King-Harbor, some already at capacity, fear an onslaught of new patients. And healthcare advocates predict that people who already delay getting help because they don't have insurance or a regular physician will go without treatment altogether, with fatal consequences.
"In five years we're going to see the already horrendous statistics on heart disease, cancer and diabetes in that community escalate," said Lark Galloway-Gilliam, executive director of Community Health Councils, an advocacy group for the poor and underinsured.
Similar predictions were made in 2005 when county supervisors closed King-Harbor's trauma center, one of just 13 highly specialized departments countywide for treating the most severe gunshot and car crash injuries. King-Harbor's trauma center treated more gunshot victims than any other, and local activists said many patients would die if they had to be taken to more distant facilities. Hospitals warned that the loss of such a heavily used trauma center in a network that once numbered 23 would overload those that remained and put all trauma patients at risk.
Neither forecast has come to pass, according to county and hospital officials. They credit the relative stability to the opening that year of a new trauma center at California Hospital Medical Center in downtown Los Angeles and to the addition of staff and beds at Harbor-UCLA Medical Center near Torrance and at St. Francis Medical Center, which is less than three miles from King-Harbor.
As has often been the case, King-Harbor's defenders are skeptical of such claims.
"There are children getting shot in our neighborhoods all the time," said LaTanya Hull, 37, a mother of six who lives about a mile from the hospital. "There may be other places to take them, but we would have to go across town. And in that time. . . one of them can pass away."
Where both sides agree is that emergency rooms, which treat conditions as varied as broken arms and heart attacks, are overflowing, even with King-Harbor's still open.
The county's public-private network of emergency rooms sees far more patients than do trauma centers -- 3 million in 2005 compared with 19,000 trauma cases. Hours-long waits attest to the overload. The situation worsened after 10 private hospitals, including three in South Los Angeles, closed their emergency rooms in recent years. The Hospital Assn. of Southern California helped the county determine how many extra emergency room and inpatient beds would be needed if King-Harbor closed. But even such preparation won't eliminate delays. And some things resist planning altogether.
"We can do a lot of re-scrambling of ambulances to take care of the ER traffic," said Jim Lott, the association's executive vice president. "But it's the patients who walk into the hospital or drive in on their own that we can't predict."