L.A. County emergency rooms reject more patients.

Arise in the number of ambulances being diverted from hospital emergency rooms in Los Angeles County is adding fuel to the controversy over new nurse-to-patient ratios that went into effect in January.

During the first three months of the year, 33 percent of ambulances arriving at hospitals in L.A. County were diverted to other facilities. That's up from 26.7 percent for the like period a year earlier.

Industry officials are seizing on the numbers as evidence that the nurse-to-patient ratios, which went into effect Jan. 1 and require at least one nurse for every four emergency patients, are forcing hospitals to turn away ambulances for fear of falling out of compliance with the new law.

"The only two variables that could account for the change are flu volumes and nurse staffing, and we ended up having a very light flu season," said Jim Lott, executive vice president of the Healthcare Association of Southern California, a regional hospital industry trade group.

Not everyone is convinced the numbers are proof the new law is disrupting emergency care, including the county's director of emergency services, who believes that the law is just one factor stressing the system.

"It reflects issues related to what we have called the perfect storm," said emergency services director Carol Gunter.

Among the factors cited by Gunter are a growing difficulty in finding doctors willing to sign up for emergency service call panels and continuing high numbers of uninsured patients.

Also muddying the picture: despite an overall reduction in diversion in 2003 there was a sharp, unexplained spike in diversions last December--just before the law went into effect--when they doubled from December 2002.

(Lott contends that early publicity about a potentially deadly flu season prompted large numbers of walk-in patients prior to the holidays, overcrowding emergency rooms.)

In any case, hospital officials say the Los Angeles figures support early findings in a statewide survey they are conducting of some 300 hospitals. So far, the survey has found that diversions are up more than a third statewide this year because of a nursing shortage that makes it difficult to meet the new staffing mandate.

"These numbers have been holding steady every week since we have been doing this," said Jan Emerson, vice president of external affairs for the California Healthcare Association, the state trade group.

The group plans to use its data to support a lawsuit it brought against the state, seeking a change in what it considers the most onerous provision of the law--a requirement that hospitals be in compliance with the ratios at all times. It wants the rule to refer to staffing levels at the beginning of shifts, so extra nurses won't be needed when nurses break or otherwise leave their posts.

Jill Furillo, Southern California director of the California Nurses Association, which sponsored the ratio law, said that even if the law is causing more diversions, that only means that patients are being treated at hospitals better able to take care of them. She also questioned why hospitals were not ready to meet the mandates of a law passed in 1999.

"It was improper planning on their part. This all was predicted," she said.

Revolving Struggle

Struggling Primedex Health Systems, Inc. has announced that it has reached a tentative agreement with Cerberus Capital Management, L.P. for a $160 million credit facility that will pay off nearly all its existing long-term debt, including its capital leases.

The Los Angeles-based company operates 55 diagnostic imaging facilities statewide but has been struggling since taking on more than $100 million in debt over the last several years to finance a big expansion.

Primedex defaulted on $16.3 million in convertible junior debt last year but filed a prepackaged bankruptcy proceeding to alter terms of the debt that it emerged from in October. The facility will not pay off that debt. Losses have been posted in three out of the last four quarters.

Staff reporter Laurence Darmiento can be reached at [phone] ext. 237 or at [e-mail].