Hospital’s Trauma Load Is to Be Cut

Paramedics will take significantly fewer trauma patients to Martin Luther King Jr./Drew Medical Center to give the troubled hospital a chance to fix its many problems, Los Angeles County health officials announced Friday.

With sanctions from government inspectors and accrediting agencies massing against King/Drew, officials said the trauma unit’s annual patient load would be cut by 18%, or about 500 patients.

Highly prized by the hospital and its supporters, the unit is the second-busiest in the county behind County-USC Medical Center. The recent inspections did not find fault with the care there.

The King/Drew unit now treats more than 2,700 patients a year, most of them from the surrounding South Los Angeles area. It sees more gunshot victims than any other county hospital 781 in 2002, the latest year for which statistics were available.

The change by the county, which is to take effect Feb. 16, involves redrawing the geographic boundaries of King/Drew’s service area. It means that some trauma victims will face longer ambulance rides and that other area hospitals especially Harbor-UCLA near Torrance will have to take in more patients.

King/Drew has been reeling from a wide variety of allegations in recent months. Health inspectors found in January that errors in medical and nursing care last year might have contributed to the deaths of five patients. Those included the case of a 20-year-old man who was found lying dead on the floor after being neglected for 18 hours.

In addition, a national accrediting group revoked the hospital’s ability to train aspiring surgeons and radiologists. The decision takes effect in June.

“The problems cited clearly require some significant corrective action, so we want to make certain that there isn’t a patient load that would present or create an environment where patients are unsafe,” said Fred Leaf, chief operating officer of the county Department of Health Services.

Leaf said that the hospital would still be busy but that accepting fewer patients would give the county a chance to evaluate the staff, offer more training for employees and restructure the hospital’s administration.

Dr. Jean-Claude Henry, chief of King/Drew’s trauma unit, could not be reached for comment.

“I think overall, from the community perspective, for us to take less trauma cases is probably good,” said Dr. Thomas Yoshikawa, chief of internal medicine at King/Drew.

He said there would be some risk involved in lengthening ambulance transport times. But he added: “We don’t have enough funding to take care of all the patients, and that’s an issue.”

Los Angeles County is divided into 13 service areas for trauma victims. Each area sends patients to a particular hospital. The new boundaries will affect areas south and west of the hospital.

The change will be most noticeable for residents of southern Compton. As the crow flies, the city is closer to King/Drew, which is directly to the north in Willowbrook. But those people will now be transported to Harbor-UCLA.

Residents of parts of Inglewood and Hawthorne who once went to King/Drew will now go to either Harbor-UCLA or to the UCLA Medical Center in Westwood.

Dr. Bruce Stabile, chairman of the department of surgery at Harbor-UCLA, said that his hospital hadn’t been “actively campaigning for a change,” but that it should be able to handle the increased patient load.

“We are expecting an increase; I hope it’s not a surge,” he said. “The problem with trauma is that sometimes it’s feast or famine, in the sense you can go days without major trauma and then have several in one day.

“If it was a steady flow, it would be easy to manage. The problem is, sometimes you have more than one casualty from a major accident.”

County officials said longer transport times for patients might be offset by more prompt treatment of patients at other hospitals.

King/Drew at times faces a nursing shortage in its emergency room, which can be swamped.

Mike Metro, a battalion chief of emergency medical services with the Los Angeles County Fire Department, said he doubted that transport times would be affected much. He said they depend on traffic patterns.

“The benefit will be to get a patient to a trauma center that can handle them,” he said.

County Supervisor Yvonne Brathwaite Burke, whose district includes King/Drew, said, “Hopefully, this means there will be less of a wait” at the hospital’s busy ER.

She said she did not consider the county’s move a sanction, but more an effort to improve care.

The reductions in trauma care at King/Drew actually began last month, when county officials decided that trauma victims from the eastern San Gabriel Valley no longer would be helicoptered to King/Drew.

County officials hope the privately run California Hospital Medical Center in downtown Los Angeles can begin accepting more trauma victims this summer, diverting as many as 1,000 patients annually from King/Drew and County-USC.

Trauma is not the only service to be downsized at King/Drew.

Despite strong community protest, the county has proposed downgrading its neonatal unit, effectively stripping it of its capacity to take care of the sickest babies.And the hospital’s 22-bed monitoring ward was closed last year because of staff shortages.