Hanging On : Families Say Closing County Coma Ward Would Be Death Sentence

For years, the families of the comatose and near-comatose patients in the long-term nursing care unit at the county’s Rancho Los Amigos Medical Center in Downey have been hanging on.

They hang on not with the hope of some medical miracle that will let their loved ones walk again, but because they can’t let go as long as there is a blink of an eye, the slight squeeze of a hand, perhaps a smile, some sign of life.

These are patients, 18 in all, who can’t cry out when they are in pain, turn when they get sore or lift their arms for a drink of water.

“He can’t walk, he can’t talk, but he blinks, twice for yes, once for no,” said Caroline Lopez, whose brother, Paul, suffered a paralyzing injury in a traffic accident 27 years ago.

Now the county, in a cost-cutting move, is evicting these patients from the skilled nursing ward it operates at Rancho--and the families wonder how much longer they will be able to hang on.

The husbands and wives, mothers and sons and sisters of the patients in Ward 1101 are convinced that closing the skilled nursing unit will be tantamount to a death sentence.

“All these patients will die,” said Robert P. Kennemur, 55, who drops by the ward daily to be with his wife, Diane, even though she has not been able to respond to him for 20 years.

“These patients are among the most helpless people on the planet, incapable of feeding themselves or even turning themselves over in bed,” said Francisco Rodriguez, whose sister is one of those in Ward 1101.

The families argue that there is no place else in the county, no private nursing home or convalescent hospital that can match Rancho, recognized nationally for its excellence as a rehabilitation hospital.

Lillian Gilbert, whose son, Mark, suffered massive brain damage in a car crash in 1975, said that she tried and failed to find a nursing home for Mark before she got him into the county’s long-term care program, which at the time was at Long Beach General Hospital.

“We couldn’t find a nursing home that would accept Mark,” she said. “We would go shopping and they would say they had no bed.”

Kennemur, whose wife was a deputy public defender in Fresno County, said that as a result of an insurance settlement he can afford to put her in just about any nursing home. After he put her in private nursing facilities he would find her lying with soiled bedclothes because the nurses would not clean and bathe her.

“We suffered nearly six years in the private sector. It was a godsend when we got her in here,” he said. “My wife is rarely sick and she never gets bedsores.”

Bedsores are the biggest problem for these patients. If they lie in one spot too long, sores develop, can grow rapidly, become infected and be life-threatening. At Rancho, the family members said the patients get turned many times each day.

Eleanor Brice, whose daughter Desiree is one of the patients, is among those who fear that a move to a private nursing home might be a “death sentence” for her daughter.

Brice cites the poor care her aunt receives in a nursing home. One recent day, Brice said, “My aunt was sitting in the hallway, crying, when I got there. She was begging, ‘Please take me to the bathroom,’ and the nurses just walked by and said they would be right back. Sometimes she can’t wait and has to do it in her bed.”

Gilbert, whose son is in a room across the hall from Brice’s daughter, said the families will do everything they can to prevent the closure of the nursing unit, including appeals to county officials, demonstrations, perhaps a lawsuit.

“How can we live our lives and just stick our people in some nursing home and walk away and forget them and let them be stuck in a room and die?” she asked. “We can’t do it. We have to fight.”

But the county is not backing down and says the patients must be out by Oct. 1, when it will shut the skilled nursing ward in a budget cutting move.

Closure of the skilled nursing unit is among about $45 million in cuts being made at the hospital. Other reductions call for eliminating beds used by patients crippled by diabetes, short-term heart attack recovery patients and those who need reconstructive surgery for burns.

The hospital, ranked seventh among rehabilitation hospitals in a survey of the nation’s hospitals by U.S. News & World Report, is expected to be privatized within three years, although the Board of Supervisors has not made a final decision.

Consuelo Diaz, chief administrative officer at Rancho, said patients will only be sent to a nursing home that meets the regulatory requirements of the federal Health Care Financing Administration, which oversees federally financed health care programs.

“Knowing the people who license the facilities in our area I have to believe they are adequate to care for our patients,” Diaz said. Efforts will be made to place each patient in facilities specializing in the type of service they need, she said.

The families complain that Supervisor Deane Dana promised them that they would never have to move their loved ones again when Long Beach General shut down and the patients were moved to Rancho in 1984.

Dana was not available for comment Wednesday, but an aide, Dennis Morefield, acknowledged the promise. “It was made in good faith, but the county’s financial situation and outlook have changed,” he said. “We are still trying to find some way to help them, but given the economics of the day I am not sure what can be done, if anything.”

That the skilled nursing unit is being held up as an example of excellence is somewhat of a switch.

In March, 1992, it was cited for numerous violations of federal regulations that restrict the drugging and physical restraint of patients. Inspectors said the facility reeked of fetid odors, the floors were strewn with debris and patients were left unbathed in dirty hospital gowns.

But families said the report was a turning point. During a visit Wednesday by a Times reporter and photographer, the unit was immaculate, the floors and walls so clean they appeared polished. Stainless steel medical implements were so clean they reflected light like a mirror. The sheets were spotless.

The family members say that aside from problems relating to care, they are most concerned about losing the bonds they developed with each other.

On Wednesday, James Hatfield was in a room with two other men, both his age, all three injured in their 20s.

“The moms are like sisters and the sons are like brothers,” said Lillian Gilbert.

A few feet away, Herbert and Letitia Hatfield watched their son, James or “Buzz,” and said that moving him was unthinkable.

“Nobody knows a [nursing facility] as good as this one. Nobody,” said Herbert Hatfield, a retired steelworker.