California Medical Center

It is 9 p.m. at California Medical Center's emergency department as Dr. Randall Sword arrives for the late-night shift. He faces a sea of faces in the waiting room. All 13 beds are occupied, and so are two gurneys in the hallway. He throws open the doors to the brisk night air and counts four ambulances, two police cars and a police motorcycle. "Look," he says. "Here comes a fire truck!"

Officials at the California Medical Center in downtown Los Angeles are seriously considering drastic curtailment in the hospital's emergency room services, a move that local health officials fear may portend the unraveling of the area's entire emergency care system. The nonprofit California Medical Center reported a loss of $2.6 million last year, and the emergency room was "an area of major loss," spokeswoman Michelle Barker said.