Trauma System on Verge of Collapse, Official Warns

The head of the Los Angeles Fire Commission, citing experiences of city paramedics scrambling to find a hospital to accept critically ill patients, warned Wednesday that the county’s trauma and emergency room medical-care systems are at the stage of “imminent collapse.”

Harold Kwalwasser, appearing before the county Emergency Medical Services Commission, said pressure on the overburdened system must be relieved “to solve this crisis before, to be blunt, it starts killing people.”

One member of the county panel, Dr. Janesta E. Janzen who said she spoke for trauma-care physicians, agreed that the “present system is falling apart and needs to be revamped and adequately funded.”

Kwalwasser, joined by the city’s chief paramedic, Alan Cowen, described how paramedics and their patients have been turned away recently from hospital emergency rooms on the grounds that the facilities were overcrowded.

Several times this month, paramedics searched frantically to find hospitals for accident or crime victims because the nearest emergency rooms could not accept them, Kwalwasser said. He noted that on Jan. 13, emergency rooms at 17 city hospitals--including those belonging to four trauma centers--were closed to new patients.

Patient Passed Over 12 Times

As paramedics searched for other facilities, Kwalwasser said that one patient was passed over by more than a dozen hospitals before finally being placed.

“The City of Los Angeles does not have the paramedic service that is capable of coping with dragging patients all around the city looking for a hospital room,” he added.

Although no deaths were linked to the delays, Kwalwasser said the lack of emergency room care not only endangered those patients but forced others to wait longer for available ambulances.

“If we can’t put an ambulance on scene quickly, where we can give the appropriate first-aid care, you know and I know that we are putting at risk every heart patient and other patients as well,” he told the commission.

“We see things getting worse fast. . . .” Kwalwasser said. “This system is going down quickly. It has gone off the edge and is on its way down.”

After hearing the testimony, the county commission recommended that the Department of Health Services require that no hospital could turn away emergency patients except by order of its administrator. Currently, medical staff members on duty can declare facilities at capacity and decline added patient load.

The commission also recommended that a patient can be denied admission only if another hospital is less than 10 minutes away.

To become policy, the recommendations must be accepted by county Health Services Director Robert Gates.

The fire commissioner’s warnings come as the county seeks to cope with a reduced trauma-care network that was rocked by the departure of seven private hospitals from what was once a 23-hospital system.

The county’s trauma network had been established about four years ago to guarantee victims of serious accidents or wounds a maximum 20-minute ambulance ride to a highly specialized emergency room with a specially trained staff. But private hospitals began dropping out after complaining of the increasing costs of treating indigent and uninsured patients.

County supervisors agreed last month to provide $11.2 million as temporary assistance to the trauma network. Health officials said Wednesday that the remaining private hospitals have agreed to stay in the system for at least another nine months.