Hospital Officials Defend Decision to Close Emergency Rooms : They Cite Lack of Monitored Beds, Misunderstanding

Officials from two San Gabriel Valley hospitals that received warnings for closing their emergency rooms when empty beds were available say they have been unfairly criticized by county inspectors.

Greater El Monte Community Hospital and Inter-Community Medical Center in Covina received warnings last week after inspectors made spot-checks of their emergency rooms in late January.

County health officials said Greater El Monte Community Hospital closed its emergency room on Jan. 27 even though there were three empty beds among the six in the emergency room.

Closed to Ambulances

The inspectors said Inter-Community closed on Jan. 31, although 10 of 13 beds in its emergency room were empty.

Both emergency rooms were only closed to ambulance traffic.

Jeffrey P. Winter, administrator of Greater El Monte Community Hospital, said the hospital did nothing wrong in closing its emergency room that day.

Winter said four of the emergency room’s six beds are equipped with medical monitors and all of the monitored beds were in use. Just before the inspector arrived, one monitored bed was vacated.

He said even though there were empty beds, none had the necessary monitors that enable the hospital to care for critically ill patients.

“Everything was done strictly to proper procedure,” Winter said “It’s absurd to accept one more critical patient when you don’t have a monitored bed available. When those beds are full, we close.”

Winter said he intends to ask the county to modify its guidelines to allow emergency rooms to close when they run out of monitored beds.

A Misunderstanding

Duane Carlberg, administrator of Inter-Community Medical Center, said the complaint against his hospital was the result of a misunderstanding with the county’s Medical Alert Center, which is responsible for tracking emergency room closures.

Each time a hospital closes its emergency room, it is required to report to the center. Carlberg said the nurse responsible for contacting the center was out that day and was replaced by a nurse who is usually assigned to the obstetric’s department.

He said the replacement nurse reported that the “facilities were saturated” and “closed to criticals.” The nurse meant only that the hospital’s critical care section, which includes the intensive care and coronary care units, could not accept any more patients.

The county, however, thought the nurse meant the entire emergency room was closed.

“It was a communications problem,” Carlberg said.

Carlberg said the hospital has discussed the problem with its staff and clarified the county’s closure guidelines to make sure there will be no further problems.

Emergency Room Rules

Virginia Price-Hastings, the county’s chief of paramedics and trauma hospitals, said the warnings were issued to make sure the hospitals understand the rules about closing emergency rooms.

“What we’ve observed is that there are no deliberate attempts to get around the guidelines,” she said. “Some hospitals just don’t understand.”

During the county’s spot-check, White Memorial Medical Center in East Los Angeles and Dominguez Medical Center in Long Beach were also issued warnings for closing their emergency rooms when empty beds apparently were available.

The warnings carry no penalty, although Price-Hastings said repeated and willful violations could eventually result in the revocation of a hospital’s state license.

Inspectors also visited Daniel Freeman Memorial Hospital in Inglewood, Centinela Hospital Medical Center in Inglewood, Harbor General/UCLA Medical Center in Los Angeles, California Hospital Medical Center in Los Angeles and Kaiser Foundation Hospital in Harbor City. Those hospitals were legitimately closed to ambulance traffic, Hastings said.