HEALTH-CARE 'STORM' BREWING? REPORT CITES FACILITY CLOSURES, FEWER INSURED.

Byline: Troy Anderson Staff Writer

The closure of health-care facilities, the rising number of uninsured people and a growing and aging population has Los Angeles County's emergency medical system heading into a ``perfect storm'' that could jeopardize the health of all county residents, according to a new report.

The Emergency Medical Service Commission, which oversees the county's emergency medical system and authored a report on the looming crisis, will hold a public hearing Thursday on the issue. Experts say the waits in emergency rooms - already as long as eight hours in some cases - are expected to get worse when a new law takes effect Jan. 1.

The law, intended to improve patient care, will limit the number of patients a nurse can care for. Health officials, who say the state already faces a shortage of 5,000 nurses, believe the law could have the unintended consequence of forcing hospitals to turn patients away or violate the new ratios. California is ranked 49th out of 50 states in the number of nurses per capita.

The law comes at a time of reduced state and federal reimbursements for hospitals that care for Medi-Cal and the county's 2.4 million uninsured patients, shrinking hospital bed capacity and federal requirements for hospitals to prepare for terrorist attacks without adequate funding, according to the report by the commission, which is charged with overseeing the county's emergency medical services system.

``It's a perfect storm because you have all these things coming together at one time in one place within the next 12 months,'' said James Lott, executive vice president of the Hospital Association of Southern California.

The brewing storm is also the result of a 7.4 percent increase in the county's population between 1990 and 2002 while 27 hospitals have closed their doors, leaving 81 hospitals with emergency rooms.

New seismic safety standards will cost hospitals $24 billion statewide, an expense that will be too prohibitive for many hospitals and will force the closures of more hospitals in the county, according to the report.

Of the 378,253 people who called 911 and were taken by ambulance to hospital emergency rooms last year, only 9 percent went to county hospitals, down from 14 percent in 1996, placing a growing burden on the private hospitals.

Meanwhile, the percentage of time ambulances deliver patients from crowded emergency rooms to other hospitals has grown from 9 percent in 1995 to 57 percent this year at county hospitals. At private hospitals, ambulance diversions have increased from 6 percent in 1995 to 20 percent this year, tying up paramedics who are unable to respond to new 911 calls.

``The waits have really gone up,'' said Carol Gunter, director of the county's Emergency Medical Services Agency.

Dr. Thomas Garthwaite, director of the county Department of Health Services, said the situations in emergency rooms have reached ``unsafe levels'' and that the county's four public hospitals are no longer taking as many transfer patients from private hospitals because ``we have patients in our ERs waiting for several days to get into beds.''

Another pressure on the health system is the loss since 1993 of 11 hospitals that served as trauma centers. In all of Los Angeles County, only 13 hospitals are now designated as trauma centers that can handle life-threatening injuries around the clock. They treated 19,161 patients last year. Currently, about 30 percent of the county's population lives in areas without a trauma center.

Last year, county voters approved a parcel tax measure to raise $170 million a year to keep hospital emergency rooms and trauma centers open and to help hospitals prepare for biological or chemical terrorist attacks. Measure B raised property taxes by 3 cents per square foot, or about $42 for a 1,400-square-foot house.

Estimating that the nurse-patient ratio law will cost $956 million a year by 2008, the California Hospital Association has proposed a ballot measure for November 2004 that would raise $700 million to $800 million for emergency medical services statewide through a fee on telephone bills.

But critics say the state already has the sixth-highest tax rate in the nation and that voters are overwhelmed with all the proposed taxes that cities, counties and other agencies have proposed since the election of Governor-elect Arnold Schwarzenegger, who promised to roll back taxes and hold the line on spending.

``Whatever taxpayers provide, there are going to be some who say it isn't enough,'' said Kris Vosburgh, executive director of the Howard Jarvis Taxpayers Association.

Karen Hanretty, spokeswoman for Schwarzenegger, said he would like to get rid of the costly mandates that make health insurance so expensive.

``Obviously after he takes office, this will be among his top priorities,'' Hanretty said. ``He realizes California has a health-care crisis. He is currently in the process of appointing the new administration and his proposals will be forthcoming.''

Troy Anderson, [phone]

troy.anderson(at)dailynews.com

IF YOU GO

The Los Angeles County Emergency Medical Services Commission will hold a public hearing on the emergency room crisis 9 a.m. to noon Thursday at the Hall of Administration, 500 W. Temple St., downtown.

CAPTION(S):

box

Box:

IF YOU GO (see text)