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One hospital after another makes plans to cut or close
LA County's sick health care system

By Behzad Raghian | October 8, 2004 | Page 2

LOS ANGELES' public health care system is spiraling deeper into chaos after last month's announcement that the County Board of Supervisors plans to close the trauma center at Martin Luther King Jr./Drew Medical Center.

King/Drew is located in impoverished South Los Angeles, a predominantly minority community with one of the highest rates of uninsured residents in the country. Its trauma center--the second-busiest in LA County, and one of a small number that specialize in immediate life-threatening injuries, such as gunshot wounds--currently treats about 2,150 patients a year.

But community groups are speaking out to save King/Drew. Immediately after the board decision, activists began candlelight vigils at the hospital and "house meetings" to spread the word, with plans for more protests in the future. "If they pull trauma out of here, they might as well put a graveyard up in its place," one resident of South LA, who was visiting a friend just treated in King/Drew's trauma unit, told the Los Angeles Times. "They're building hospitals in Iraq--what about us?"

On the heels of the board's decision about King/Drew was last week's announcement that the Robert F. Kennedy Medical Center in Hawthorne would be closing down on December 31. And as Socialist Worker went to press, officials at Northridge Hospital Medical Center's Sherman Way campus said they would close the facility's emergency room immediately.

The Sherman Way emergency room was shut down by the county Department of Health Services because of a shortage of on-call surgeons and specialty doctors--the result of an earlier announcement that the entire facility would close by the end of the year, leading trauma center staff to look for other jobs.

These latest announcements are a hammer blow to the largest public health system in the country. The impending closure of RFK Medical Center puts it on a long list of hospitals preparing to close down entirely--including the Sherman Way facility and ELAStar Community Hospital in East Los Angeles.

Trauma centers and emergency rooms have been specific targets. RFK will be the sixth LA County emergency room to close its doors due to financial problems in the last year--and the latest among nearly 20 to shut down over the past two decades. Meanwhile, King/Drew's more sophisticated trauma center--one of about a dozen countywide with the resources and staff to specialize in life-threatening injuries, such as car accidents, shootings and stabbings--will also close if the county board gives its final approval in a vote planned for November.

Every new shutdown creates another hole in a system that has been stretched to the breaking point. "It becomes a domino effect," said Carol Meyer, the county's head of emergency services. "What happens is those patients seeking emergency care go to the next hospital, which increases their load and potentially delays care."

Delaying care will mean the difference between life and death for at least some of the trauma cases--particularly gunshot victims--that currently go to King/Drew. The closure is expected to add as much as 30 minutes in transport time to other facilities.

Meanwhile, the Watts and South Los Angeles neighborhoods near King/Drew have much higher rates of gunshot victims than the areas near two other major county hospitals, County-USC in East Los Angeles and Harbor-UCLA in Torrance--but these trauma centers aren't being threatened.

The board's decision is especially galling considering the origins of King/Drew. The hospital was built in the aftermath of the 1965 Watts riots--following an investigation into the causes of the upheaval that found a grossly inadequate system of health care for the predominantly African American community. Community activists say that the county is now recreating the same conditions in health care that contributed to the riots.

Choosing to close King/Drew is "ludicrous," says Bryan Hubbard, a trauma surgeon at the hospital. "People will be dying in the streets or dying in transport to other facilities."

The proposed shutdown would put further strain on other hospitals in the area--for example, increasing the number of trauma cases by as much as 50 percent at neighboring St. Francis Medical Center, already the busiest private trauma center in the country. "We just don't have the capacity to pick up the slack if they go down," said Dr. Dan Higgins, head of the LA County Medical Association and an emergency room doctor at St. Francis. As Mark Louden, another doctor at St. Francis, put it, "I love to take care of people, but I hate doing it badly. If we don't have enough resources, people are going to suffer."

All of these same issues are at work in the county trauma system as a whole. Since 1980, 10 medical centers have dropped out of the countywide trauma network, leaving 13 to serve the entire system.

Two years ago, LA County voters approved Measure B, which increased property taxes to provide an additional $150 million a year for trauma care. But with each individual trauma case costing an average of $250,000 and a large percentage of patients uninsured, this sum isn't enough to fix a much larger problem. "Without permanent funding, the trauma system will collapse by the end of the year," says Higgins.

Beyond the specific problems of trauma care, the public health system as a whole is staggering under the weight of a huge financial crisis. The county's 80 or so emergency rooms often treat such ailments as chest pain and infections--in other words, providing basic medical care for the uninsured. The financial gap between the funds coming in and the cost of serving a patient population with such a high percentage of uninsured is growing.

The problem at King/Drew is especially serious because of recent revelations of serious lapses in care, including neglect that contributed to the death of at least five patients in 2003. Because of this, the national Joint Commission on Accreditation of Healthcare Organizations voted to begin the process of revoking King/Drew's accreditation--a severe blow that could lead to the loss of $14.8 million in private insurance contracts, and a possible $200 million in federal funding.

County officials claim they are responding to the threat to King/Drew's accreditation by shutting down the trauma center. Trauma services, they claim, are costly and labor-intensive, putting a strain on other departments. But the real problem is a lack of adequate resources.

For example, King/Drew faces a particularly sharp shortage of permanent nursing staff. Nearly half of the hospital's 312 nurses are "traveling" nurses, who are hired for an eight-week stint and are therefore new to the hospital. The board's "solution" at King/Drew will reduce the overall amount of care available and stress an already overburdened system by sending patients to other hospitals.

Response to the board decision about King/Drew was immediate. "They're taking everything from us, everything from our little neighborhood," resident Elnora Bright told the Los Angeles Times. "It's like they think we don't care enough, don't fight enough. It's like, 'Let's do it to them. They don't care.'" As another resident, Wilbur Sims, put it, "It's all politics. They can say what they want about money and all that, but Mexican and Black people in this neighborhood have been saved in that trauma center. I've been saved myself when I was shot."

Seven days after it announced plans to close the trauma center, the county board--under growing pressure from the community--voted to hold a public hearing on the issue, though its original proposal already required a hearing. The decision came at a meeting that was packed by angry residents from the neighborhoods served by King/Drew.

Rev. Frederick Murph of Brookins Community AME Church was cheered when he told the supervisors that the community felt under siege. Playing off the repeated claims by county officials that their plans would "decompress" the hospital's problems, he said, "Let me tell you, supervisors, if you close the trauma center, you are going to decompress the community, and it's going to explode."

Organizations involved in the ongoing battle over King/Drew are the Korean Immigrant Workers Advocates, the California Nurses Association, Clergy and Laity United for Economic Justice, and Action Grassroots Empowerment and Neighborhood Development Alternative (AGENDA).

AGENDA organizer Esperanza Martinez, fresh off a victory against Wal-Mart's plan to build a superstore in Inglewood, said, "I think that eventually if we don't get together and organize and hold these officials accountable, the whole hospital will be closed down. South L.A. is an epicenter of poverty. There's so much violence – so many people dying of gunshot wounds here...This hospital is a huge resource for us."

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