Shutdown of Trauma Unit Defended

Los Angeles County health officials on Friday made their most detailed defense of the plan to shutter the trauma unit at Martin Luther King Jr./Drew Medical Center, saying that few patients with critical injuries would have to travel farther to receive care.

According to an analysis of patients seen at King/Drew from October 2003 through March, less than 1% of those with the most life-threatening injuries would have had to go more than an additional two miles to get to another hospital, county health department chief Dr. Thomas Garthwaite said in a letter to the Board of Supervisors.

But the study found that about a third of the patients with slightly less critical injuries would have somewhat longer trips if King/Drew closed.

The letter came on the same day that the Los Angeles City Council unanimously approved a resolution urging the supervisors to delay their vote on the trauma center shutdown.

“We feel like this decision to close this trauma center will have implications far beyond just the hospital at MLK,” said Councilwoman Janice Hahn. “We believe it will strain an already strained [trauma] network system.”

Although the City Council has no power over the hospital, the unanimity of its stance reflects the political divide in Los Angeles over the issue.

The rancor is expected to continue Monday when the Board of Supervisors hold its long-awaited hearing on the closure plan. King/Drew is owned and operated by the county, but many city residents depend on it for care.

Assistant Fire Chief Greg West testified before the City Council on Friday that city paramedics transported 918 trauma patients to King/Drew last year, and that the closure would put people’s lives in jeopardy if they have to be transported farther to other facilities.

“By longer transports, mortality will increase. We will lose more of our trauma patients,” West said.

But Garthwaite, in his eight-page letter, tried to dispel such gloomy scenarios. He also insisted that the numerous lapses in patient care found by inspectors during nine visits to King/Drew this year were proof that dramatic steps needed to be taken to make the hospital safer for everyone.

Closing the trauma unit, he said, would give officials time to fix the rest of the hospital, and in the process preserve federal funding and King/Drew’s national accreditation, which is threatened.

A new trauma center at California Hospital Medical Center on the southern fringes of downtown Los Angeles is due to open in December. Garthwaite said it would help mitigate the loss of King/Drew’s center. Harbor-UCLA Medical Center near Torrance and St. Francis Medical Center in Lynwood would also take King/Drew patients.

The key issue that has been debated for the last two month is whether ambulance travel times would increase without King/Drew. The answer appears to be mixed.

Patients coming from southwest of King/Drew could be in for longer rides, said Garthwaite. But those coming from areas closer to downtown could see shorter rides, he said.

The health department’s analysis of travel times looked at 862 patients who were treated by King/Drew’s trauma center during the six-month period ending in March.

In well over half of the cases, time was not a factor because injuries were not immediately life-threatening.

Three to six patients with definite life-threatening injuries would have had to travel farther, the report found.

Of the 133 patients with slightly less serious injuries, about one-third would have had to travel at least two miles farther to get to a trauma center if King/Drew closes. About 8% would have been two or more miles closer to a trauma unit.

“From these numbers, it would suggest that only a small number of people would have an increased chance of a bad outcome,” Garthwaite said. “Even people who do trauma networks don’t pick absolute time as a criteria, but emphasize the need to get to a hospital that can take care of you.”

Still, many in the community and some outside experts do not believe that closing the trauma unit is the right solution.

Grantland Johnson, the former California secretary of Health and Human Services, said that it was unfair for the Board of Supervisors to place such a “burden of sacrifice” on the community around King/Drew.

“If patients aren’t cared for here, they will be cared for in other parts” of the county’s healthcare system, Johnson said, speaking at a Friday morning hospital news conference organized by the Service Employees International Union, which represents many King/Drew workers.

“It’s like cutting off the good leg to save the bad leg,” said Dr. Greg Chambers, a surgeon at King/Drew. “I think the people who will suffer the most are the ones in the vicinity of the hospital and to the south.”

Critics of the county were particularly incensed that the trauma unit at King/Drew was closed the majority of the time between Oct. 16 and Tuesday. SEIU General Manager Annelle Grajeda said this was proof that the trauma unit was being closed without public notice.

John Wallace, a county health department spokesman, said that the unit has been open most of the time since Tuesday. And he said that clinical staff at the hospital made the decision to close the facility to new trauma patients for several reasons, including the lack of available surgeons and a shortage of nurses in the intensive care unit, where many trauma patients ultimately land.

Wallace said that there were nursing vacancies at all of the county hospitals, but it was most severe at King/Drew. He said that recruitment remained difficult there.

“I don’t imagine that many people would find going into such an unstable environment attractive from a career perspective,” Wallace said.

The Board of Supervisors hearing begins at 3 p.m. Monday at the King/Drew Magnet High School auditorium, 1601 E. 120th St. in Willowbrook.

Times staff writer Patrick McGreevy contributed to this report.