County-USC Doctors Say Delays Fatal

Emergency room patients regularly wait as long as four days for a bed at Los Angeles County-USC Medical Center, and some die before receiving critical medical treatment, according to sworn declarations by the hospital’s own doctors.

The emergency room’s interim chairman, Dr. Edward Newton, described the case of a 40-year-old woman with an arterial blockage in her lungs who was kept in the emergency room for more than 30 hours because an intensive care unit bed was not available. She suffered cardiac arrest and died.

“This type of delay in care is below the standard in the community and would not occur in any private hospital,” Newton said in a sworn statement signed last week.

In another case, doctors couldn’t treat a patient with shortness of breath quickly enough. “This patient died before we were able to help him. Had we had the capacity to diagnose him earlier, his life would have been saved,” Newton wrote in a January statement.

The sworn statements, filed in federal court over the past month, are part of a lawsuit by legal aid groups trying to stop Los Angeles County’s plan to cut 100 of the 745 beds at the county’s flagship public hospital beginning in June. Also filed in court this week was a report by a nationally recognized emergency room researcher warning that more people would die needlessly if the hospital were downsized.

The St. Paul, Minn., researcher, Dr. Brent Asplin -- who visited the hospital this month and in March -- described an ER in which as many as 156 patients were crowded into 43 treatment areas, exams were conducted in the hallways, and there was “no such thing” as patient privacy.

Although the medical staff has good intentions, “the quality of service in this environment is horrendous,” Asplin wrote. “Imagine trying to maintain your dignity while using a bedpan in a hallway lined with stretchers.”

In an interview Tuesday, Asplin, who has studied emergency rooms all over the nation and has published numerous journal articles on his findings, said he considers County-USC’s overcrowding the worst he’s seen.

Though County-USC doctors and patients have long complained about treatment delays, the court documents quantify the problem and indicate that it is getting worse.

“We often have to squeeze three patients, both men and women together, into one booth designed to hold two. The lights are never turned off, the noise level is high, there are no facilities to wash and there is no privacy,” Newton wrote in his January statement.

Hospital administrators don’t dispute Asplin’s conclusions, but they say they have to close beds to save money.

“This is what I get up at 3 o’clock in the morning and lose sleep over,” said Dr. David Altman, County-USC’s chief medical officer.

“I think we’ve got a huge challenge -- there’s no question about it. We’ve got to find ways to save money without reducing services.”

Health department spokesman John Wallace said the cost of caring for 600,000 uninsured patients every year is an impossible burden without more state or federal help.

“If anything, we would like to be adding more health services,” Wallace said. “It’s a matter of not being able to afford to do it.”

As it stands, noncritical patients are waiting 16 hours or more just to be treated by a doctor in County-USC’s emergency room, Newton, the ER’s interim chairman, said. If they need a bed upstairs, some are forced to wait a day or longer, he said.

According to the county Emergency Medical Services Agency, County-USC asked ambulances to stay away nearly 75% of the time last year because it had nowhere to place patients. That’s more than three times higher than in 1999. Paramedics who nonetheless deliver patients often must sit and wait for hours to transfer the patient from their gurney to one at the hospital.

The delays have extended beyond the ER into other parts of the hospital.

Those who need immediate treatment for a fractured pelvic bone can wait up to two weeks for care, Newton said. And patients who need surgery for such injuries as repeated shoulder dislocations could wait years.

In a January statement, Dr. Kate Savage, a fourth-year orthopedic surgery resident at the hospital, said a 75-year-old woman admitted with a broken hip had to wait a week for surgery because no bed was available. She developed a blood clot from lying prone for so long and died despite the surgery, Savage said in her statement.

“She would not have died had there been a bed available to allow us to operate on her earlier.”

Savage described another case, handled by a colleague, in which a 30-year-old pregnant woman with gallstones was forced to wait 10 days for surgery. She developed an infection of the gall bladder, which spread to her blood. She lived; her baby died.

In an interview Tuesday, Savage said the high volume of trauma patients -- the hospital’s top priority -- causes delays for others.

“When somebody comes in with a gunshot wound, then a little old lady with a broken hip keeps getting bumped from surgery. And this keeps happening and happening,” she said. “They just don’t have the funds and the resources, and we’re just getting cut back even more. There are going to be a lot more preventable deaths.”

In January, the Los Angeles County Board of Supervisors voted to authorize the closure of the first 50 beds at County-USC, along with the closure of Rancho Los Amigos National Rehabilitation Center in Downey. The remaining 50 beds are scheduled to be cut next year.

The lawsuit seeking to block the cuts was filed last month by the Legal Aid Foundation of Los Angeles, Neighborhood Legal Services of Los Angeles County and the American Civil Liberties Union of Southern California. They say the county is obligated by law to care for its poorest residents. A hearing on the matter is set for May 12.

“They can’t just say, ‘We’ll take all comers’ and then put it on the backs of the doctors, who have their license at risk because they’re put in a situation where they can’t provide acceptable medical care,” said Elena Ackel, senior attorney with the Legal Aid Foundation.

This isn’t the first time there has been a debate over the number of beds at County-USC. Between 1997 and 2000, the proposal to build a new hospital with only 600 beds created a rift between some county and state legislators. Critics of the plan warned that the hospital would be too small to meet patients’ needs. The hospital, now under construction, will be completed in 2007.

Doctors at private emergency rooms in Los Angeles said even the impending cutback of 50 beds would overwhelm them.

“Our system is built on the principle that the ... county is supposed to take care of the indigent patients,” said Dr. Marshall Morgan, medical director of UCLA’s emergency department, which sends some of its uninsured patients to County-USC for care. “And what they’re doing is sloughing those patients on to us.”

Dr. Ronald Kaufman, who was chief medical officer at County-USC until 2000, wrote in a court statement that the cuts will “destroy” the hospital and the trauma system in Los Angeles County.