Strained to the Limit : Sprawling, makeshift and crowded with poor patients, Mid-Valley Hospital fills the gap between the quake and the new Olive View.

Times Staff Writer

For 15 years, the only place where thousands of San Fernando Valley poor people could get medical care close to home has been a collection of aging buildings and trailers sandwiched between a bowling alley and an auto body repair shop on Van Nuys Boulevard.

Mid-Valley Hospital in Van Nuys is strained to its limit.

The services are so inadequate and the number of patients seeking care is so large that more than half of the Valley residents who need to be admitted to a county hospital are forced to travel to distant County-USC Medical Center in East Los Angeles.

All this stands to change dramatically with next month's reopening of Olive Medical Center in Sylmar. When Olive View becomes fully operational, the Valley will have its own full-fledged public hospital, just like five other densely populated areas of Los Angeles County, including the east, south central and west sides of the city.

Patients who now must wait up to 10 hours in cramped clinics at Mid-Valley will have shorter waits in much nicer surroundings at Olive View.

Wheeled Across Lot

Emergency-room patients wheeled in gurneys across a parking lot--rain or shine--to reach the Mid-Valley intensive care unit will have a short elevator trip from Olive View's emergency room to its ICU.

Mental health patients, who frequently wander out of the psychiatric emergency ward into a Mid-Valley waiting room, will be placed on a separate, locked ward in Olive View.

In short, the $120-million Olive View Medical Center is "going to be like a real hospital," said Dr. Stanley Korenman, an associate dean of the UCLA School of Medicine, for which Olive View will be a teaching hospital.

What's more, county officials say, Valley taxpayers will start receiving a fairer share of county health funding.

Doctors and administrators at Olive View say the state-of-the-art equipment and laboratories at the new facility will enable specialty physicians to conduct research which, in turn, benefits the community.

Every Room Has View

Every patient's room in the impressive glass building has a view either of the San Gabriel Mountains or the sprawling San Fernando Valley below. The 506,690-square-foot facility is nearly five times the size of Mid-Valley, which was bought by the county after the 1971 earthquake as a temporary replacement for Olive View.

Although Mid-Valley services are spread out in three deteriorating buildings and an assortment of trailers, Olive View is one modern, self-contained building.

What's more, it will provide a number of services that now do not exist in the Valley, notably a county-operated maternity ward and a psychiatric ward for indigent children.

If Olive View can hold its own through threatened budget cuts in public health care, officials plan to phase in all services at the hospital by 1988.

But even at its worst, Olive View administrator Douglas Bagley said, the new facility will offer the same basic services provided at Mid-Valley, but much more efficiently and with greater comfort for patients.

Olive View will operate like the five other county hospitals--County-USC, UCLA-Harbor General Medical Center, Martin Luther King Jr. General, Rancho Los Amigos and High Desert--in its mission to serve the poor.

7% Can't Afford to Pay

County health officials estimate that about 115,000 people, or more than 7% of the Valley area's 1.5-million population, need public health services because they cannot afford a private hospital.

Of the Valley residents who checked into a county hospital in 1982-83, 4,893, or 57.8%, went to County-USC because of the inadequacies at Mid-Valley, according to the county Department of Health Services.

A citizens' committee that recommended the rebuilding of Olive View to the county Board of Supervisors in 1981 said: "Retaining Mid-Valley as a county hospital was viable for only a very short time because of gross inadequacies in the physical plant and the lack of any space in which to carry out modernization."

The committee also said that requiring the Valley poor to travel to County-USC "would deprive Valley patients of adequate access to care."

Bagley said the "entire question" of whether to rebuild Olive View was one of accessibility of health care for the poor.

"If accessibility is of no concern," Bagley said, "then we would build a central facility in the middle of the county and say: 'Get there as best you can.' "

Other Uses Studied

But what was intended to be a temporary facility at Mid-Valley became a fixture during the long years of often turbulent political maneuvering that led to the final decision in 1983 by the supervisors to rebuild Olive View. Although Mid-Valley will close as a hospital when Olive View opens, other potential uses are being studied.

"This place was never designed to function as a county hospital," Bagley said of Mid-Valley. "The physical space arrangement forced the hospital to adapt procedures to the limitation of space arrangements."

The poor conditions at Mid-Valley have been tolerated, officials said, only because the county had plans for bigger and better quarters.

"The day the hospital was purchased, it was overloaded," said Richard Cordova, associate administrator. "But no one wanted to invest because we knew we would be going to a new hospital."

No one can recall any patient dying as a result of Mid-Valley's inadequacies.

But, UCLA's Korenman said, "What you're doing in a sub-par facility is you're increasing the risk level."

Dramatic Changes Await

Hospital officials pointed to a number of deficiencies that Valley patients have endured at Mid-Valley. By way of contrast, they said, dramatic changes are in store for patients treated at the new facility.

For example:

Emergency room. In Mid-Valley's emergency room there are 10 beds to accommodate between 80 and 110 patients a day. It is strained to its limit by the afternoon or evening, prompting doctors to make snap decisions as to who stays and who is stable enough to be transferred either to a hospital ward or to County-USC's emergency room, said Dr. Vena Ricketts, senior emergency room physician.

Patients who come to the emergency room seeking treatment for a wide range of medical conditions are forced to wait an average of four to six hours if they are not in need of immediate attention.

Among frequent and often non-emergency conditions cited by Ricketts are cuts, sprains, vaginal bleeding and gonorrhea.

"It's a rarity to have a bed available," Ricketts said.

Such was the case for an Encino man without health insurance who recently went to the emergency room complaining of chest pains. He was quickly examined and it was determined that he required 24 hours of monitoring in a special emergency room. But, because there were no free beds, he was put on a gurney and wheeled into the crowded observation area.

Eight hours later, a bed was free. But by then another man had suffered a seizure and bit off his tongue, spouting blood. Amid frenzied activity and the man's sucking, gagging noises, the new patient was whisked to the one empty bed--the one meant for the Encino man.

Soon after this, with no sign of a free emergency room bed, doctors decided to admit the man into a general hospital ward.

18-Bed Emergency Room

In the new hospital there will be an 18-bed emergency room.

"It will immediately cut waiting by at least a third," Ricketts said. "We will be able to admit at a greater pace and mobilize quicker in a better facility."

She said staff will be able to keep a bed free for trauma patients, which will help prevent the constant juggling of patients.

Triage. Patients entering the Mid-Valley emergency room report to a makeshift hallway triage center--a cardboard table and metal folding chairs--where treatment priorities are determined and vital statistics and medical histories taken within earshot of a horde of other waiting patients.

"Before, we had people passing out in the hallway because they gave their name to the nurse and then waited to be called," Ricketts said. "We had to compromise privacy to determine if they were really emergency cases."

The new hospital will have its own triage emergency room and patients will be examined in privacy. The hospital's emergency room system will have a separate laboratory and admitting area, Ricketts said.

'Treated Like Human Beings'

Patients will still have to wait, but will be "treated more like human beings," she said.

Intensive care unit. To get to Mid-Valley's intensive care unit from the emergency room, patients must be pushed in gurneys and wheelchairs, intravenous bottles and medical apparatus in tow, across a parking lot, between trailers, delivery trucks and trash bins. When it rains, a plastic tarp is held over the patient.

Like the emergency room, the eight-bed intensive care unit at Mid-Valley Hospital is not big enough to meet patient demands. Those who are too sick to be transferred to another hospital's ICU are frequently "bumped" out by patients who are sicker, doctors said.

"Our ICU is the worst in the country," said Dr. Irwin Ziment, chief of internal medicine.

"I would never go to our ICU," Ziment said. "It's physically demeaning. The beds are close together. You're almost in bed with the patient in the next bed. There's no privacy. I would never want to be a patient there."

Three Intensive Care Units

Olive View will have three modern, spacious intensive care units totaling 42 beds. State-of-the-art equipment will monitor patients, who, doctors said, will be more comfortable in the new unit.

Helipad. When a helicopter ambulance arrives at Mid-Valley, it lands across the street. A police team stops Van Nuys Boulevard traffic. The patient is wheeled across the thoroughfare.

The new Olive View will have its own helipad, which will be just steps from the emergency room.

Psychiatric unit. At present, indigent psychiatric patients requiring hospitalization are admitted to a 32-bed ward between Mid-Valley's radiology area and cafeteria, with a locked hallway door separating them. (Another 24 Valley patients are at County-USC.)

The entrance to the emergency psychiatric ward shares a hallway with a hospital admitting area and financial screening room. Lost and disoriented mental patients frequently enter the admitting area.

"We try to get them to come in this door so they don't get confused and walk into the waiting area," Cordova said. "It's not a good deal, but there is no office space anywhere else."

Consolidated Mental Services

Olive View will consolidate all mental health services on a locked, 80-bed floor, complete with recreation rooms and a kitchen. Olive View also will have the first psychiatric ward in the Valley for poor children. Now, poor families with mentally ill children must take them to Camarillo State Hospital.

The list of new services continues.

Laboratories, pharmacies and radiology areas are to be centralized. Patients no longer will have to wander through a maze of buildings.

Olive View will also provide the first county-run maternity ward in the Valley. Because there is no county obstetrics ward at Mid-Valley, indigent women previously had to go to one of three private hospitals in the East Valley or to County-USC Medical Center in East Los Angeles to give birth.

Ward to Open in July, 1987

In the 1983-84 fiscal year, Valley mothers accounted for 1,738 babies, or 10% of the total delivered at County-USC, said officials with the county Department of Health Services. Another 900 were delivered at St. Joseph Medical Center in Burbank and the now-closed Lake View Medical Center in Lake View Terrace, which are reimbursed by the county for obstetric services. Serra Memorial Health Center in Sun Valley was recently put under county contract for obstetric care.

The maternity ward will not open until July, 1987,

because one had not been in the original plans for the new hospital. The Board of Supervisors in November decided to add the $5.4-million unit because of a 25% increase in births at county facilities in the past five years with the trend expected to continue, county health officials said.

A children's intensive care unit and double the number of operating rooms are also planned, along with orthopedic surgery and neurosurgery services.

Olive View also will have a public cafeteria, chapel and gift shop, none of which are available at Mid-Valley.

And even more basic, waiting rooms will be spacious and comfortable and waits will be shorter at Olive View for people such as Concepcion Norio.

Norio, a young mother, sat for hours in a flimsy plastic chair at Mid-Valley, cuddling her child and stroking his feverish forehead, waiting to see a pediatrician. When they left eight hours later after seeing the doctor and getting a prescription filled, both were in tired tears.

County officials say that such scenes, which have been repeated thousands of times during the past 15 years at Mid-Valley Hospital, will end next month at Olive View Medical Center.

"Patients," Dr. Ziment said, "deserve to be treated with more dignity."

VALLEY INPATIENTS

At county hospitals*

Mid- County- Community Community Valley USC total Totals 3,575 4,893 8,468 42.2% 57.8% Van Nuys 804 768 1,572 North Hollywood 449 828 1,277 Pacoima 441 729 1,170 Burbank 113 364 477 Sepulveda 226 228 454 Canoga Park 212 229 441 Sun Valley 164 267 431 Sylmar 195 232 427 Reseda 210 190 400 San Fernando 82 207 289 Sunland-Tujunga 76 154 230 Northridge 91 135 226 Chatsworth 107 109 216 Newhall-Saugus- Valencia 69 118 187 Encino-Tarzana 92 83 175 Granada Hills 87 74 161 Studio City 41 66 107 Sherman Oaks 46 48 94 Woodland Hills 50 31 81 Calabasas 20 33 53

* Figures for 1982-83, the most recent year available

Source: Los Angeles County Department of Health Services

Out of the Rubble

COMPARING SERVICES

Services Mid-Valley (now) beds (total number) 123 emergency room capacity for 25,000 visits yr maternity ward no childrens' psychiatric ward no adult psychiatric ward 30 beds 24-hour emergency psychiatric care 10,000 visits walk-in clinic (for any non-emergency 10,000 visits medical problem) childrens' intensive care unit no adult intensive care unit 9 beds isolation rooms for AIDS, hepa- titis and other contagious patients 6 rooms operating rooms 3 orthopedic surgery no neurosurgery (for head injuries) no eye clinic yes dental clinic yes pediatric clinic 9,300 patients cardiology yes public cafeteria no chapel no helipad no total square footage 135,000

Services Olive View (soon) beds (total number) 160 in late April 350 in 1987* emergency room capacity for 50,000 visits yr maternity ward in 1987* (34 beds) childrens' psychiatric ward 18 beds adult psychiatric ward 62 beds 24-hour emergency psychiatric care 18,500 visits walk-in clinic (for any non-emergency 15,000 visits medical problem) childrens' intensive care unit in 1987* 6 beds adult intensive care unit 36 beds isolation rooms for AIDS, hepa- titis and other contagious patients 28 rooms operating rooms 6 orthopedic surgery yes neurosurgery (for head injuries) yes eye clinic yes dental clinic yes pediatric clinic 13,000 patients cardiology yes public cafeteria yes chapel yes helipad yes total square footage 500,000

* Subject to Board of Supervisors' approval of additional funding

Source: Los Angeles County Department of Health Services

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