Hospitals expand, renovate as industry makes changes.

WHEN Providence Holy Cross reopened its emergency department after seeing it collapse in the Sylmar Earthquake of 1971, it was designed to treat between 17,000 and 20,000 patients every year. Now, more than 45,000 annually come through the front doors.

Hospitals across the city lose millions of dollars in management of emergency rooms every year as more and more patients come through.

And in 2004, Valley-area hospitals had to deal with the added pressure of hospital closures putting an even greater strain on emergency rooms.

At Providence Holy Cross, the increased traffic necessitates an expansion, currently underway, to increase the number of beds from 22 to 34. Dr. Michael Sarti, medical director of the emergency department; said the department will be able to handle more ambulance traffic. He said the increase of emergency patients and trauma patients, mostly people critically injured in car accidents, are both on the increase. Right now, Sarti said, there is no room for those patients.

"We run out of beds, and then you do what you have to do, you use the hallways and everything else," he said.

To avoid a negative impact on patient care, the hospital is expanding in phases. The first phase of eight new beds opened last week. By the time the third phase is complete 18 months from now, the department will feature a dedicated X-ray lab and other technological advancements which will greatly improve patient care.

For example, each bed will have patient monitoring equipment and oxygen to treat patients.

The price tag for the emergency department expansion is $7.5 million, all of which was raised by the Providence Holy Cross Foundation's capital campaign, The Golden Hour.

West Hills Hospital is also in the process of expanding its critical care unit from 16 to 20 beds and its emergency room from 14 to 32 beds. West Hills CEO Beverly Gilmore said the cost for the project is $40 million. Gilmore said that in order to provide a counterbalance to the high cost of running an emergency room, the hospital is expanding its other services, which include cardiovascular and oncology departments and increased outpatient services.

Valley Presbyterian Hospital also opened a new 188-bed patient tower in March, although the hospital has not expanded its emergency room. Valley Presbyterian is seeing an influx of patients from Northridge Hospital Sherman Way campus, which closed in November, and the new patients are helping to relieve some of the hospital's financial pressure.

In general, however, large numbers of uninsured patients and MediCal payment rates that are growing slower in Los Angeles than in other parts of the state make most emergency departments money losers.

Jan Emerson, spokesperson for the California Health Care Association, said that slightly over half of California's hospitals are losing money every year. Contributing factors include the high cost of seismic retrofitting requirements, but emergency departments play a significant role in damaging bottom lines.

"Like it or not, health care operates in the free market economy," Emerson said. "Hospitals are businesses that have to make a bottom line."

Some hospitals, Emerson said, are part of larger health care chains that can move money from profitable hospitals to troubled ones in order to keep the facilities afloat. Plenty fall victim to closure, however. As of September, eight hospitals throughout the state had closed or announced closure plans.

Emerson said that hospitals often have to develop new profitable programs in order to offset losses incurred in emergency rooms. She said that hospitals can turn to cardiac care programs, women's health units and other programs that bring high insurance payments.

Emerson said that hospitals may have to lure doctors onto their staff to make new units work, but in some cases they may find qualified doctors on staff" already, waiting for newer technology.

"Doctors really want hospitals to go to the next step, add cardiac catheterization or bypass," Emerson said. "The hospital has to make an investment in the space."

Kerry Carmody, administrator of Providence Holy Cross, said the hospital contends with its bottom line as much as anyone else.

"We struggle with the mission versus the margin like every other hospital," Carmody said.