Ambulances Diverted : Crisis Shuts Emergency Room Doors

The scramble to provide care for the seriously ill in the San Fernando and Santa Clarita valleys has escalated recently as more area hospitals have routinely closed their emergency rooms and trauma centers to ambulances.

Several of the Valley’s largest hospitals have been shutting their emergency rooms to paramedic runs this month. And Wednesday, the Valley’s three trauma centers shut down--an almost unheard-of occurrence, health officials said.

The emergency room at Henry Mayo Newhall Memorial Hospital in Santa Clarita has been closed for most of the past two weeks. The emergency facilities at St. Joseph Medical Center in Burbank have been diverting ambulances for at least 24 days. In December, the availability of the emergency room at AMI Tarzana Regional Medical Center was touch-and-go for 19 days, according to county records.

“We keep our fingers crossed nobody gets badly hurt when we are in the state of maximum stress and overload. That is not an uncommon scenario, unfortunately,” said Dr. John McConnellogue, emergency department director at Northridge Hospital Medical Center.

No One Has Died Yet

Hospital officials emphasize that even when several emergency rooms are closed, patients in the Valley are still reaching hospitals within 10 or 15 minutes. No one has died in an ambulance as a result of the extra time it takes to reach a hospital, paramedic officials said. In a crunch, helicopters can whisk a patient across town when the closest hospitals are full.

And even when an emergency room technically is closed, it is always open to walk-in patients. Anyone who passes through an emergency room’s sliding glass doors, whether for a broken leg, the flu or a heart attack, will not be turned away.

Local hospital administrators blame the problem primarily on the flu epidemic, a nursing shortage and timing--January is traditionally a busy time for many hospitals. When a hospital’s intensive-care beds upstairs are filled, it does not want to accept additional critically ill patients down in its emergency room. Consequently, an emergency room can sometimes look like a ghost town and still be closed to new patients.

One Los Angeles County health official speculated last week that some Valley hospitals are closing more frequently to send a tough message to Gov. George Deukmejian.

“It makes me wonder whether there is some sort of concerted effort to make a point, to raise the level of awareness that the hospitals want more money from the governor and to start putting money into the failing system,” the official said, asking not to be named because he must maintain a good relationship with the hospitals.

The crunch in emergency care has frustrated and angered paramedics. On occasion, it has also overwhelmed emergency room personnel when the closures are overruled by county health officials downtown. There is a built-in safeguard to ensure that medical emergency care is always available: When all the hospital emergency rooms in an area have declared themselves closed, county health officials have the authority to reopen them all.

‘Not the Best of Care’

During those times, “it’s not the best of care when you have numerous critical patients arriving all at once,” said Paul Hensler, president of Holy Cross Medical Center in Mission Hills.

Arthur Morin, the Los Angeles Fire Department’s paramedic supervisor in the West Valley, agreed. “I don’t think there has been a terrible diminishing of patient care,” but “the fact they are overburdened at times could have some impact,” he said.

The situation becomes most serious when the Valley’s three trauma centers--at Northridge, Holy Cross and St. Joseph--are overwhelmed. Trauma centers are geared to treat victims of violent crimes and those severely injured in traffic and other accidents.

Unlike emergency rooms, trauma centers cannot be ordered reopened once closed. Therefore, anyone who needed to be rushed to a Valley trauma center on a day like Wednesday--when all three were shut down--would have been transported to an emergency room unless he or she could have been flown to a trauma center outside the area.

At an emergency room, trauma victims might not receive the treatment provided by a trauma center’s specially trained surgeons and equipment.

“People who could have used a trauma center to save their life didn’t have access to them,” said Chief Alan R. Cowen, head of emergency medical services for the Los Angeles Fire Department, referring to Wednesday’s closures. “Would you want a member of your family that needs a surgeon to go to a local emergency room?”

According to county health guidelines, trauma patients must reach a hospital within 20 minutes. Paramedics try to deliver patients to emergency rooms in 10 to 15 minutes. With the hospital pool shrinking, helicopters are being used in the Valley more frequently to beat the clock.

That’s what happened early last week after a truck driver experienced severe chest pains in Castaic. His illness touched off a frantic search that stretched from Bakersfield to Northridge.

Physicians at the closest hospital, Henry Mayo Newhall Memorial, were tied up treating three victims of a bad car crash on the Antelope Valley Freeway. Holy Cross was also closed to more patients. A quick decision had to be made to transport the trucker by helicopter to either Northridge or Bakersfield.

Hypothetically, this is what would have happened last week if, for example, a motorist were severely injured in an accident at Valley Circle and Victory boulevards in Woodland Hills.

Had Northridge’s trauma center been closed, Holy Cross would have been the second choice. If it too was closed, the paramedic would have driven to St. Joseph, provided traffic was light enough to permit an arrival time within 20 minutes or less. If that had been impossible, paramedics either would have flown the victim to UCLA’s trauma center or driven to the nearest Valley emergency room.

Money Troubles

Compounding the uncertainty over when the gridlock will ease are the hospitals’ funding problems.

The governor aroused panic among county health officials recently when his proposed budget indicated that the hospitals would not be receiving added funds from Proposition 99, the tobacco-tax initiative passed by voters in November.

The tax, expected to produce $650 million annually, was partly intended to subsidize hospitals for treating uninsured patients. But Deukmejian wants to reduce the state’s funding of hospitals from other sources, thereby deflating the financial benefits of Proposition 99.

Hospital administrators said they were disappointed by the governor’s decision and hope that pressure from the hospital industry will change his mind.

“The state is where a lot of responsibility lies,” Hensler said. “We have been lobbying the governor for some time, but the governor is pretty adamant on his views, especially since he is not running for reelection.”

Both Holy Cross and St. Joseph lose $1.5 million a year maintaining their trauma centers, according to the hospitals’ executives. Without relief from Proposition 99, both are examining how costs can be cut.

Dan Fahey, St. Joseph’s senior associate administrator, said the hospital hopes that the county will relax some of its costly trauma-care standards, such as requiring that a surgeon be on staff 24 hours a day. If pressures don’t ease, St. Joseph might explore pulling out of the trauma-care business, Fahey said.

Regardless, the on-again, off-again bed shortage in the Valley does not begin to approach the depth of the crisis in the inner city. There, hospitals have been closing or threatening to close their overworked trauma centers for financial reasons. The inner-city hospitals handle the majority of the trauma cases--a seemingly endless stream of stabbing and gunshot victims, most of whom have no insurance.

In addition, the Valley has more hospitals than the inner city, and their resources are not as taxed by indigent patients.

Olive View Medical Center appears to be the only Valley hospital negatively affected by the crisis in the inner city. When beds are filled at County-USC Medical Center, overflow patients go to Olive View in Sylmar. Since July, Olive View’s emergency room has experienced a 34% jump in patients.

“I would say that Olive View will continue to see increases in the emergency room, and we’ll probably see more days of closures,” said Jaron Gammons, the hospital’s associate administrator.