Aid to Private Emergency Rooms May End : System Suffers Another Jolt as Queen of Angels Nears Closure

Los Angeles County will no longer be able to continue subsidizing private hospital emergency rooms that accept thousands of rescue ambulances each month because of the governor’s recently announced fiscal policies, county Health Services Director Robert Gates said Monday.

Gates made the disclosure in an interview following a “summit” of 19 public officials who gathered downtown to voice grave concerns about the county’s overloaded emergency services network. The network has been periodically crippled when key hospitals temporarily close their emergency rooms at once, triggering what paramedics call medical gridlock. County officials said the system may be devastated by the governor’s newly proposed budget.

Even as county Supervisor Ed Edelman called attention to the county’s “very fragile” emergency services network, the system got another jolt. Queen of Angels Medical Center began refusing all new patients Monday in preparation for closing down its aging 404-bed facility overlooking the Hollywood Freeway and merging Friday with Hollywood Presbyterian Medical Center.

Queen of Angels had been considered a “key provider” of emergency care, receiving 400 rescue ambulance runs a month. The net effect of the merger, health officials pointed out, will be an overall reduction in the number of emergency beds available to paramedics responding to 911 distress calls. The tightening comes at a time when the county’s emergency medical network has already been pushed to its limits on several occasions this month.

In recent weeks, about a dozen key private and public hospitals that accept hundreds of rescue ambulances each day have periodically been so full that they have all at once temporarily closed their emergency rooms to ambulance traffic.

Concern Arose Last Year

Last year, county supervisors became concerned that an irreparable blow would be dealt to the county’s emergency services network if certain key hospitals 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. A crisis was headed off when the supervisors provided millions of dollars in bail-out funds to the hospitals and promised to continue those subsidies assuming that Proposition 99, the tobacco tax, passed.

Proposition 99 did pass, generating a profound but short-lived sigh of relief in health care circles. Additional revenue of about $650 million was projected from the tax, with much of the money expected to be used to reimburse hospitals and physicians for providing medical care to indigent patients who typically enter a hospital through its emergency room.

But Supervisors Kenneth Hahn and Ed Edelman charged Monday that emergency services will not benefit in the least because the governor in his proposed budget has diverted the new revenue to purposes other than health care.

“He’s robbing the cigarette tax money and using it for general state purposes,” Edelman said.

As a result, Gates said he informed hospital representatives on Friday that the county will no longer be able to continue to subsidize private hospital emergency rooms. “The fact is we don’t have the money,” Gates said.

The only way to continue the subsidies would be for the Board of Supervisors to find an alternative funding source or for Gov. George Deukmejian or the Legislature to alter the budget. The board is to consider the matter at this morning’s meeting.

In a letter to Hahn, Gov. Deukmejian explained that his budget proposal attempts to balance a great assortment of needs and that he is pleased, overall, to have been able “to maintain and expand funding for local government.”

Deukmejian said that demands placed on the budget by Proposition 98, the school funding proposition requiring a commitment of more than $400 million to school and community colleges, means “it will be necessary for us to reduce funds for a number of local health-related programs.”

Stephen Gamble, president of the Hospital Council of Southern California, predicted that hospitals “right and left” will soon be reexaming whether they will let their emergency rooms remain open without subsidies to help defray the cost of treating medically indigent patients.

The closure of one or two key emergency rooms, he said, could trigger mass closures, knocking out the whole network.

“And once it (the system) is shut down,” Gamble said, “it’s murder to get it back up.”

Hahn declared, “There’s a disastrous future unless we get this money.”

Private ambulance companies have provided the Hospital Council with a memorandum citing several recent cases that show “how transport times are being extended because of various (emergency room) closures” in recent months.

They reported, for example, that on Jan. 15, paramedics were summoned to transport a patient from a nursing home to Glendale Memorial Hospital, which turned out to be closed to emergencies. The ambulance was then diverted to Hollywood Presbyterian Hospital, but within a few blocks of that hospital the dispatcher notified the driver that Hollywood was also closed, and the ambulance was redirected back to Glendale Memorial.

Last Tuesday, paramedics were dispatched to a board and care home to transport a patient to Brotman Medical Center. En route, the driver called Brotman, only to learn that the emergency room was closed. He called two other hospitals, which were both closed, before finally transporting the patient to Daniel Freeman Hospital.