ERS IN CRITICAL CONDITION MORE TRAUMA CENTERS MAY CLOSE AS CARE CRISIS WORSENS.

Byline: Troy Anderson Staff Writer

Los Angeles County supervisors say their recent vote to close the trauma center at a South Los Angeles hospital was a last-ditch effort to stop federal officials from closing the entire hospital and triggering the collapse of the L.A. region's teetering system of emergency medical care.

Indeed, just two days after the supervisors' vote Sept. 21, officials of Robert F. Kennedy Medical Center in Hawthorne announced they would shut its doors - and its emergency room - by year's end.

Northridge Hospital's Sherman Way campus has been ordered by state regulators to close its emergency room today.

And those follow the closure of six hospital emergency rooms in the county in the last 14 months.

Statewide, the number of acute-care hospitals has dropped from 525 in 1993 to 413 last year.

A decade ago, Los Angeles County had 23 trauma centers - where patients receive emergency treatment for the most serious kinds of wounds, such as from gunshots and car crashes. Today, the county has only 13 trauma centers.

``Instead of a perfect storm, it's more like hurricane season in Florida,'' said Mark S. Gamble, the regional vice president of the Hospital Association of Southern California. ``It's more like wave after wave after wave.''

Experts say they expect more hospital closures as the emergency care crisis worsens - a result of a growing uninsured and aging population, nursing shortages, the shrinking capacity of public hospitals and clinics and a federal Medi-Cal reimbursement disparity that gives hospitals in the San Francisco Bay Area 26 percent higher payments than those in Los Angeles.

Statewide, 79 percent of hospital emergency rooms are losing money, and Los Angeles County hospitals lose the most - $143 million in fiscal 2002-03.

Statewide, one in five people is uninsured - the fourth worst rate in the nation. And it's even worse in Los Angeles County, where one in four people is uninsured.

County Supervisor Zev Yaroslavsky said that, if federal officials closed Martin Luther King Jr./Drew Medical Center, it would create a ripple effect of closures of other hospitals overburdened by nearly 50,000 patients, mostly uninsured, who no longer could use MLK.

``There is a meltdown taking place of the emergency room system in the county because all these private hospitals are closing,'' Yaroslavsky said.

``When you throw in the 47,000 annual emergency room visits at King, if that were to shut down, it would exponentially exacerbate the meltdown we are in the midst of now.''

Dr. Thomas Garthwaite, director of the county Department of Health Services, said people seeking medical care at both public and private emergency rooms throughout the county are already waiting hours - or even days - for care.

``We are really talking about the collapse of access to emergency care,'' Garthwaite said.

``If you are bleeding from a gunshot wound, do you get surgery in the emergency room in time to maximize your chance of survival? That's the debate we're having. When do we reach that level of collapse?

``We are already there in terms of waits. But what if you are put in front of the line and that's not fast enough?''

Los Angeles City Councilman Martin Ludlow criticized the Board of Supervisors for ``amazing hypocrisy'' in its vote to close one of the county's 13 trauma centers - only two years after convincing voters to tax themselves to save the system.

Critics say they heard the same dire scenarios when the $1.5 million ``Measure B Saves Lives'' campaign aired TV commercials warning voters that the trauma care system would collapse unless they approved the parcel tax.

The assessment passed with the support of 73 percent of voters.

Of the proceeds, most of the money - $140 million - is used to keep county hospital emergency rooms open.

Of the remainder, private trauma centers receive $18.6 million, $6 million goes toward public health bioterrorism-related activities, $4.4 million to pay for air transport of trauma patients from the Antelope and San Gabriel valleys and $1 million for administration.

Providence Holy Cross Medical Center in Mission Hills, which treated 1,384 people at its trauma center last year, used its Measure B revenue to keep its trauma center open and pay for the care of indigent and uninsured patients.

``It's kept us open, but we haven't come up with a lasting cure for this ailment,'' said Dr. Chris Samuel, the trauma center medical director. ``Personally, I think the funds should have been invested in the private hospitals more.

``When Measure B passed, I thought there was a little bit of deception used to motivate the public to vote for it, but trauma service only got a fraction of the money. The rest of the money went to bail out the county's health-care shortfall.''

Critics who say the supervisors are sacrificing the trauma center at MLK for political reasons also predict that its closure will trigger a domino-effect of closures throughout the county.

``Two years ago, this same Board of Supervisors asked voters to approve a property tax to shore up the deteriorating trauma system,'' said Bart Diener, assistant general manager of Service Employees International Union, Local 660, which represents 50,000 county employees. ``Now they want to close one of the busiest trauma centers in the region.''

Los Angeles City Councilwoman Janice Hahn said she doesn't buy the argument that the supervisors have to close the trauma unit to save the hospital.

``I'd like to know if every alternative was explored to save the hospital before they agreed to close the trauma center down,'' Hahn said.

Kris Vosburgh, executive director of the Howard Jarvis Taxpayers Association, said the supervisors allowed problems at MLK to fester for years without addressing them.

``In the private sector, if doctors, nurses or administrators prove to be incompetent, they are fired,'' Vosburgh said. ``One has to ask why an entire department has to be closed? Does the county lack the ability to make changes in personnel to improve services? That in itself is a scandal.''

Federal officials have threatened to yank $200 million in annual funding for MLK and revoke its accreditation unless longstanding problems are fixed, including a spate of patient deaths, medical errors and the fact that nearly half of its nurses are temporary workers.

Officials believe closing the trauma center - which treats a constant stream of gunshot victims in one of the poorest and most violent parts of the city - will relieve stress on the rest of the hospital, allowing a turnaround specialist to address management and other problems.

Last month, the supervisors voted 3-1 to begin the process of closing the trauma unit, which treats about 2,000 patients annually. A public hearing will be held before a final vote is taken.

County health officials have recommended allocating Measure B funds to Harbor-UCLA Medical Center in Torrance and St. Francis Medical Center in Lynwood and other hospitals that would take the additional trauma cases if the trauma unit at MLK closed.

Garthwaite said federal officials' threats to close MLK are real.

And until the roots of the health care crisis are addressed - the large number of uninsured people, thousands of people flowing across the borders in search of free health care, and skyrocketing medical expenses - he said the county's health system will continue to limp from crisis to crisis.

``A huge effort has to be made every once in a while to call it to everyone's attention to put a Band-Aid on it,'' Garthwaite said. ``And until you attack the basic problem, it's always going to be on the edge of disaster.''

Troy Anderson, [phone]

troy.anderson(at)dailynews.com

CAPTION(S):

photo

Photo:

Providence Holy Cross Medical Center's trauma unit team cares for a 90-year-old female patient. Such facilities are in increasing danger from an emergency care collapse that no one can seem to heal.

John Lazar/Staff Photographer