Med Center’s Proposed Cuts Worry Health Authorities

Officials at the California Medical Center in downtown Los Angeles are seriously considering drastic curtailment in the hospital’s emergency room services, a move that local health officials fear may portend the unraveling of the area’s entire emergency care system.

The nonprofit California Medical Center reported a loss of $2.6 million last year, and the emergency room was “an area of major loss,” spokeswoman Michelle Barker said.

She said that the viability of the emergency room--as well as other programs--is under review and the hospital board of directors is expected to decide what cuts to make by the end of the month.

“The signs on the horizon are disconcerting at best,” hospital Executive Director William Haug said.

Barker would not say how much money the emergency room is losing. But Dr. Alan Heilpern, in charge of emergency room physicians, estimated that the hospital may be losing as much as $1 million a month from treating indigent patients in the emergency room and then admitting them for lengthy stays.

Virginia Price Hastings, head of emergency services for Los Angeles County, said it would be a “tremendous blow” to the health care system if California Medical Center, at 1414 S. Hope St., were to close its emergency room or downgrade it. “You’d truly get a domino effect” on other emergency facilities that are already overloaded and unable to take up the slack, she said. “No one has really said they’re dropping out. But little clues have been dropped.”

Two years ago, California Medical Center was the first hospital to drop out of the county’s trauma network, after losing $2 million during five months of operation. Since then, six more have shut down, leaving 16 trauma centers and gaping holes in the system’s coverage. In December, the Los Angeles County Board of Supervisors agreed to pump $11.2 million into the system to shore it up.

About 80 hospital emergency rooms remain the backbone of the county’s emergency care network. But if California Medical Center curtails its emergency service, “I’m very concerned it will trigger a second round” of closures, this time knocking out emergency rooms, said Dr. Brian Johnston of the American College of Emergency Physicians.

While the emergency room at California Medical Center has just 13 beds and no trauma center designation, it shoulders a disproportionate share of the emergency patient load, receiving more public ambulances than any private emergency room or trauma center in the county, health officials said.

Concern about the precarious financial condition of the hospital, owned by the nonprofit Lutheran Hospital Society, has been heightened recently by the society’s pending merger with HealthWest Foundation of Chatsworth, a corporation with half a billion dollars in assets.

“Here a big, aggressive company comes in and merges with a hospital in trouble and what will be the impact on services for the poor?” one health official asked.

A spokesman for HealthWest, which owns seven hospitals, including Northridge Hospital Medical Center, said the company is concerned about bottom-line earnings but is also philosophically committed to serving the poor. As for the center’s emergency room, he said, “Every program that is losing significant money has to be looked at as to whether or not it makes sense to continue it.”

The losses at California Medical Center stem, to a large degree, from its treatment of about 10,000 indigent people each year who visit the hospital’s 24-hour emergency room. Even though they cannot pay their bills, these injured and sick people cannot, by law, be turned away until they are treated and stabilized.

“From a hospital’s point of view,” Johnston said, “there is only one door through which bad debt comes in: the emergency room.”

Dr. Marshall Burns, who was in charge of emergency room physicians at the center until a few years ago, said that the medical center “won’t survive as a hospital if they continue to run their emergency room as is.” He said that a hospital board subcommittee has studied the issue, and it said the first thing the hospital has to do “is scale back their emergency room.”

About 2,000 patients a month seek care in the medical center’s emergency room, according to Heilpern. More than 650 of them--a disproportionately high number, he said--arrive by ambulances from the Los Angeles City Fire Department.

For the most part, the patients are sicker and more costly to treat than those seeking care at suburban hospital emergency rooms, he said. They sometimes include trauma cases--victims of gunshot wounds, stabbings and automobile accidents.

About 30% do not pay the bills they run up, and the bills of another 30% are paid by the state’s Medi-Cal insurance program, which Heilpern said usually does not cover expenses.

The hospital reported writing off $4.8 million last year in uncollectible patient accounts and charitable assistance. Meanwhile, the hospital is saddled with a $55-million debt from construction several years ago of its new nine-story hospital tower.

The new tower was built in the hopes of keeping up with new medical demands expected to arise from the growth and redevelopment of downtown Los Angeles. But the re-birth of downtown has not been as dramatic as expected. Furthermore, California Medical Center, like all hospitals, faces a more competitive health care environment than ever, due to new cost controls imposed by federal health care programs.