South L.A. needs more than a hospital

The county’s decision to close Martin Luther King Jr.-Harbor Hospital is a sad one that will deal a severe blow to the health of the people of South Los Angeles.

It is particularly distressing because the establishment of a comprehensive teaching hospital in the heart of this community in 1972 represented such a pivotal change and such a hopeful moment. The decision to open the facility in Willowbrook, just south of Watts, was aimed at correcting the health injustices cited by the McCone Commission, which in the wake of the 1965 L.A. riots had issued the following statement as part of its findings:

“Statistics indicate that health conditions of the residents of South-Central Los Angeles are relatively poor and facilities to provide medical care are insufficient. . . . Life expectancies are considerably shorter . . . [and] the number of doctors in the southeastern part of Los Angeles is grossly inadequate as compared to other parts of the city. . . . The hospitals readily accessible to the citizens in southeastern Los Angeles are also grossly inadequate in quality and in numbers of beds.”

Yet today, more than four decades later, it is both regrettable and shameful that the commission’s findings still describe the conditions of South Los Angeles.

Based on virtually every health indicator, the South Los Angeles area remains among the most disadvantaged and underserved communities in the nation. Diabetes rates are 44% higher than elsewhere in the county, hypertension rates are 24% higher, HIV/AIDS rates are 38% higher, and asthma rates are 11% higher. In South L.A., more people die of lung cancer, stroke, diabetes and heart disease than in any other place in L.A. County, according to government figures.

A whole generation of young people is being lost in South L.A. -- the infant mortality rate is 20% higher than the overall figure for the county, and for African Americans in South L.A., it is more than double the countywide figure. At the same time, homicide rates among South L.A. adolescents and young adults (ages 15 to 34) are off the charts when compared with the countywide rate -- an alarming 200% higher.

And just to finish the picture, South L.A. has the highest percentage of children and the second-highest percentage of adults (after Metro L.A.) without health insurance in the county.

In a fair world, the community with the most dire health conditions in the county would have the strongest and most comprehensive health delivery system, right? But not in this world. Several months ago, the California Endowment, the private nonprofit foundation that I run, commissioned a respected consulting firm to study the health needs and healthcare capacity of South Los Angeles. The findings paint an alarming picture of a broken healthcare system that failed to meet the needs of residents even before the closure of King-Harbor Hospital. The findings include:

* Emergency and trauma services: There is a high demand for trauma and emergency services in South Los Angeles, where the population faces critical chronic-disease conditions and is prone to violent injuries. Yet South L.A. has had the lowest number of emergency-room treatment stations per person than any other part of L.A. County. As any doctor will tell you, minutes count when dealing with trauma care and can literally mean the difference between life and death. However, with the closure of the hospital, South L.A. patients must now travel longer and farther to receive care. For uninsured patients, the closest subsidized, county-run hospitals to King-Harbor are eight and 11 miles away.

* Inpatient services: According to our analysis, South Los Angeles needs an estimated 2,100 hospital beds. Yet the number of beds after the closure of King-Harbor is about 700. In terms of hospital beds per 1,000 residents, South L.A. ranks among the lowest urban regions in the country. Nationally, the average is about 3 beds per 1,000 residents; California has an average of 2; West Los Angeles has about 4, and South Los Angeles has about 1 bed per 1,000 residents. The result: further strain on overcrowded emergency rooms (because patients are forced to stay in the ER when no beds are available) and negative effects to quality of care.

* Primary care and specialty services: A 2005 survey of South Los Angeles residents indicated that they are routinely forced to wait longer than other L.A. County residents to get an appointment for care at a doctor’s office or clinic. The wait times for seeing a specialist border on the ridiculous: Six months to a year is routine. A quarter of the community clinics in South L.A. under contract with the county report that they are too full to accept new patients. This creates delays in early diagnosis and subsequent treatment of disease. And although it is true that King-Harbor will continue to provide urgent care and primary-care services at the site, the primary-care services that the county provides there decreased while the hospital was in crisis and they continue to fall, especially as workers are reassigned and the community remains confused over remaining services. Prenatal, mental health, rehabilitation and elderly services also are in short supply compared with other areas of the county.

So what do these data tell us? While the saga and closure of King-Harbor has been politically charged, with racial tension and divisiveness serving as persistent undertones in all the discussions and decisions, it is abundantly clear that what is happening must be treated first and foremost as a health issue.

Furthermore, we must immediately rethink how to address these unmet needs. Forty-two years have taught us that, at a minimum, this community requires a fully functioning, comprehensive hospital that delivers high-quality care. The closure of the hospital was based on a fundamental breakdown in the management of the facility -- not on a determination that the community did not need the facility. There is no question that every effort must be made to open a new hospital in South Los Angeles.

At the same time, we recognize that a hospital alone will not and cannot address the broader social determinants -- such as economic opportunities, education, affordable housing, safety and nutrition -- that significantly contribute to the health status of the South Los Angeles residents. The opening of a new hospital should be viewed as a critical and necessary first step, but certainly not the only step. We will fail again if we convince ourselves that we can stop there.

From the standpoint of the McCone Commission and those who fought to open a medical center in South Los Angeles after the 1965 riots, the closure of King-Harbor represents a dream deferred, to use the famous words of poet Langston Hughes.

This time, we must do better. We must not only revive the dream of a high-quality comprehensive hospital that responds to the community’s needs, but launch a broad-based and holistic effort to address the underlying causes of ill health and ultimately empower residents to lead healthier lives.

Robert K. Ross, a doctor, is president and chief executive of the California Endowment, a private health foundation created in 1996 to expand access to affordable, quality healthcare.