‘Medical Gridlock’ Hits County’s Emergency Rooms

Los Angeles County’s emergency medical network has been repeatedly pushed to its limit this month, with more than a dozen area hospitals simultaneously closing their emergency rooms and trauma centers to rescue ambulances on four separate occasions.

The most recent widespread shutdown occurred Monday evening when 13 hospitals in Central and South-Central Los Angeles closed their emergency rooms for about four hours, county officials said. But similar shutdowns, on a smaller scale, happen every day, creating what paramedics call “medical gridlock.”

“The bottom line is that ambulances are like planes looking for a place to land, only they’re not carrying well passengers, and it’s critical they land in a hurry,” said Fred Hurtado, president of United Paramedics of Los Angeles.

“The whole system is being stretched chronically beyond its limits,” said Dr. Gerald Whelan, associate director of emergency medicine at County-USC Medical Center.

The giant public hospital, with the largest emergency room in the nation, has increasingly restricted ambulance traffic, forcing the load onto nearby private hospitals that quickly become overwhelmed and temporarily close.

“You end up with a ripple effect that knocks out one hospital after another,” Hurtado said.

Health officials said January is typically a busy month for hospitals, with paramedic calls up about 6%.

“I think this is illustrative of how fragile our emergency system is,” said David Langness, an official with the Hospital Council of Southern California. “The slightest overusage backs it up and shuts it down.”

Last year, Los Angeles County supervisors became concerned that an irreparable blow would be dealt the county’s emergency services network if certain key private hospitals, which accept thousands of ambulances a year, were allowed to proceed with plans to permanently close their emergency rooms.

The hospitals contended that they were losing too much money treating medically indigent patients that typically arrive by public ambulance. The crisis was headed off when the supervisors provided millions of dollars in bailout funds to the hospitals.

But now, county health officials are worried about the frequency and impact of so many temporary emergency room closures.

There are county regulations governing when a hospital can declare itself full and closed to additional ambulance traffic. The rules also attempt to direct ambulances to other hospitals in the case of such closures.

However, when all the hospitals in an area close, the rule is that none may refuse an ambulance.

The situation has become so acute in Central and South-Central Los Angeles that four times in the first three weeks of January all 13 hospitals in the area have closed to ambulance traffic.

Paramedic Bobby Raya, assigned to the Boyle Heights fire station, said that he recently had to “shop around” for a hospital for a 15-year-old girl who needed treatment for a drug overdose. The three closest hospitals were all temporarily closed to ambulance traffic, he said, so the girl had to be taken from East Los Angeles to Montebello.

When County-USC closes, patients have to be flown by helicopter to hospitals in Pasadena, Hollywood or Whittier.