County Check Finds Space in Shut Emergency Rooms

In a spot-check of nine hospital emergency rooms that recently reported themselves closed to ambulance traffic because of overcrowding, Los Angeles County health officials found that four had empty beds and were apparently closed without justification.

There appear to be various reasons for the inappropriate closures, including ignorance of county regulations that define when a hospital may temporarily close, said Virginia Price Hasting, the county’s chief of paramedics and trauma hospitals. She said she had no way of knowing whether the hospitals were deliberately trying to avoid receiving ambulances that often carry patients who cannot pay the medical bills.

In the case of Inter-Community Medical Center in Covina, 10 of the emergency room’s 13 beds were empty on Jan. 31, and there were no patients waiting to be treated, Hasting said.

Similar situations existed at White Memorial Medical Center in East Los Angeles, Dominguez Medical Center in Long Beach and Greater El Monte Community Hospital, she said.

The county’s assertion that some hospitals are not playing by the rules governing temporary emergency room closures is made at a time when the county’s emergency services network is being stretched to its limit.

Hospitals increasingly are closing their emergency rooms to ambulances for short periods of time, leaving ambulances roaming the streets for an additional 20 minutes in search of an available hospital bed, according to Fred Hurtado, president of United Paramedics of Los Angeles. Ambulances, he said, are increasingly confronting “medical gridlock.”

“Now it turns out that about 40% of the hospitals (in the county spot-check) are operating outside the closure guidelines,” Hurtado said. “I would not ascribe that to random chance or blissful ignorance. Hospitals are either taking advantage of the rules or they’re outright violating them.”

“It makes you wonder what’s going on,” Hasting acknowledged.

In some cases, she said, ignorance of the rules may result from high turnover of hospital personnel. And suburban hospitals, she said, are less accustomed to high patient volume and “tend to close sooner than downtown hospitals would.”

David Langness, an official with the Hospital Council of Southern California, said that the problem of overcrowded emergency rooms is moving from the central city to the suburbs, where hospital officials may not be familiar with the closure guidelines.

Confusion With Terminology

Duane Carlberg at Inter-Community suggested that this may have been the case at that hospital. He said that a veteran nurse mistakenly closed the hospital to ambulance traffic because she was confused by the terminology of county closure policies.

But Hurtado said, “I think in many cases it’s just a matter of the hospitals not wanting to see more patients and making a decision of convenience for the hospital rather than for the patient.”

Hasting said that local hospitals are clearly burdened with an overwhelming number of emergency patients. But when reports of medical gridlock surfaced last month, she said, she suspected there might also be “some game-playing” by hospitals trying to shield themselves from ambulances carrying medically indigent patients.

Spot-checks of hospitals were begun at that time.

A visit to White Memorial’s emergency room on Jan. 26, she said, revealed that eight of the 18 beds were empty and staffing was adequate to handle additional patients. The hospital, which receives 350 rescue ambulance runs a month, was informed in a recent letter that its closure to ambulance traffic on that day was not warranted, Hasting said.

Hospital President Harvey Rudisaile said that he has not yet received notification of this from the county but that he plans to investigate immediately. He said that the hospital has occasionally closed its emergency room, but “only after we’ve researched and determined that we are full.”

Hasting charged that another unwarranted hospital closure occurred Jan. 27 at Greater El Monte, where four of 10 beds were empty and there were no patients waiting to be seen. Hospital officials declined to comment.

This month, Hasting said, her staff found similar problems at Dominguez Valley Medical Center. The hospital’s emergency room receives 400 rescue ambulance runs a month and was subsidized, until recently, by the county to help offset losses from medically indigent patients. Hasting said hospital personnel did not appear to know how to follow county emergency room rules.

‘No Problem’ Found

Hospital Administrator Michael DiVernieri, however, said he has been assured by a subordinate of Hasting that “no problem” was discovered in the emergency room operation. That official could not be reached for comment Tuesday.

Other hospitals recently spot-checked by the Health Services Department are: Daniel Freeman Memorial Hospital, Centinela Hospital Medical Center, Harbor General/UCLA Medical Center, California Medical Center and Kaiser Foundation Hospital in Harbor City.

Those hospitals were legitimately closed to ambulance traffic, Hasting said. “They were really maxed out.”

She said the hospitals that appear to have violated county closure guidelines are being sent letters reminding them of the rules, but they have not been fined.

Recurring violations, she said, could jeopardize their licenses.