For three-quarters of a century, the county's flagship public hospital called a cavernous Depression-era building home. Los Angeles County-USC Medical Center was drab, with few windows. Most wards housed six patients to a room, few were air-conditioned.
At the end of a two-day move that should be completed by tonight, the county's neediest patients instead will be cared for in a $1.02-billion state-of-the-art facility.
On Friday, the courtyard between the old and new facilities bustled with staffers pushing carts filled with forms and linens. On State Street, ambulances ferried patients to the new building.
Equipment there is generations ahead of the old hospital. Ninety percent of the rooms are designed for just one patient, each equipped with a flat-screen TV and phone. Automated carts -- used only one other place in the nation -- ferry linens, meals and waste through a dedicated hallway without a human porter.
But for all the bells and whistles, skeptics worry a more basic commodity falls short: beds. The old hospital, located two miles east of downtown Los Angeles, could admit as many as 824 patients. The new facility has a maximum capacity of 600 beds, a drop of more than 25% and one that has some advocates for the poor worried.
Already, county health officials have had to open up overflow space for about 45 patients at a facility in Downey, 14 miles away.
The decision to downscale the new County-USC was made by county supervisors in 1997 amid concerns that a larger facility would be too costly to build and run.
Since then, 14 emergency rooms have shut down, including the one at long-beleaguered Martin Luther King, Jr.-Harbor Hospital in Willowbrook, south of Watts.
"The county has reduced its capacity and continues to do so, not based upon the needs of the population, but upon its own budgetary constraints. Sooner or later, we may see a serious problem," said Dr. Brian Johnston, medical director of the emergency department at White Memorial Medical Center, a mile south of County-USC. "The private sector and public hospitals are interdependent, and if they can't carry the load, then it falls to us."
Johnston and others say the first major test of the smaller hospital will be the coming flu season. The key may lie in how much more efficient the new facility proves to be -- something staff and observers hope will compensate for fewer beds.
Making County-USC more efficient has been a driving goal of hospital administrators in recent years. Seven years ago, patients endured waits so long that three patients in a 10-month period died and numerous others were endangered. One man waited 84 hours before getting a bed.
Now hospital officials use a "surge plan" that sends patients to other wards during periods of dangerous overcrowding in the emergency room.
Another program was set up to identify the emergency room's most frequent users and match them up with "care managers" to help them get housing, receive substance-abuse treatment and help them take medication.
Delays diagnosing X-rays and preparing prescription medication have been reduced, part of efforts to send patients home faster. In 2003, a patient's average length of stay was 6.6 days; it fell to 5.2 days this year. As a result, emergency-room patients' average wait time for a bed fell from seven hours, which was the case two years ago, to three hours.
Administrators hope they can be even more efficient in the new facility.
The old hospital sprawled over the center's 72-acre hilltop campus. Patients had to be taken from one building to another just to get MRI scans used to diagnose torn ligaments and tumors. Trauma patients arriving by helicopter were still an ambulance ride away from the emergency room.
Now, all those services are in one location. And because the hospital has fewer floors and faster elevators, doctors expect that patients will spend less time traveling from, say, the operating room to the recovery room.
"It cuts down on the number of steps . . . and allows us to concentrate our resources where they're needed," said Dr. Glenn Ault, medical director of County-USC's operating rooms.
New equipment should also shave minutes off the time it takes to deliver care. The new facility will have seven CT scanners -- devices that take pictures of the body's insides to look for internal bleeding, blood clots and cancer -- up from three at the old hospital. The new machines scan the chest, abdomen and pelvis in less than three minutes; the old machines take 30 minutes.
Emergency room equipment has been upgraded with cameras, ultrasound monitors and other devices mounted from the ceiling, opening up valuable bedside space for doctors and nurses. The emergency room has been expanded from 94 beds to 131 beds.
Yi Yi Myint, 50, a Laguna Hills woman who was transferred to the new hospital Friday, marveled at the stark differences.
"Everything is clean, and it's high-class. Everything is special for the guests," said Myint, who was recovering from surgery to remove a cyst.