When the ambulance arrived at the corner of Figueroa Street and Avenue 26 in Los Angeles, the paramedics found a man named Victor lying in the darkness. He had been stabbed in the back.
Another argument in the city had gotten nasty. Another victim’s rescuers would wonder where to take a patient.
Ordinarily, a stabbing victim would be taken to a nearby Los Angeles hospital for treatment. But on this Saturday night, the emergency rooms of the nearest city hospitals, County-USC Medical Center and White Memorial Medical Center in Boyle Heights were full. So instead, the ambulance headed northeast to Pasadena’s Huntington Memorial Hospital, the San Gabriel Valley’s largest hospital.
As hospitals in Los Angeles have become crowded, a ripple effect is occurring: Beds in suburban hospitals like Huntington are filling with the ill and the injured from outside the San Gabriel Valley.
By no means an epidemic in the San Gabriel Valley, the situation nonetheless has the potential, Huntington officials say, to threaten the quality as well as the cost of health care in the region.
The events during a swing shift on a Saturday last month illustrate a typical day at Huntington, licensed for 606 beds.
During the shift, the specter of Huntington’s emergency room closing loomed no farther away than a bulletin board in the Emergency Department. There, on a wall behind two-way radios and emergency telephones, the board graphically recorded which area hospitals that were, in one way or another, full.
Within Huntington’s immediate area four hospitals could take no more critically injured patients. Alhambra Community Hospital, County-USC, Garfield Medical Center in Monterey Park and San Gabriel Valley Medical Center in San Gabriel all were closed.
Yet somehow, Huntington was able to maintain enough beds for critically injured patients. In mid-afternoon, when the shift began, there were 12 beds available, and when the shift ended at midnight, 12 beds were still available.
Nevertheless, a constant stream of Pasadena’s wounded and sick flowed through the doors of the emergency room. Patients complained of constipation or headaches or back pain. Mothers carted in their feverish babies. A do-it-yourself carpenter had cut his thigh with a power saw.
And through it all, the beeps of emergency phones pierced the air.
During the shift, one man would die from a heart attack he had suffered at home. One woman who lived in a Pasadena motel would call 911 and, minutes later, in what would be her first contact with a medical professional during eight months of pregnancy, give birth to a girl.
Dozens more patients--67 in all--would be treated. And of this group, 16 would be admitted, including two who ordinarily would have gone to other hospitals had those facilities not been temporarily closed, a situation Huntington had faced in recent weeks.
On Jan. 9, for the first time recent memory, Huntington’s emergency room was temporarily closed, hospital officials said. The reason cited was crowded conditions. On two other occasions later that month Huntington was forced to close its emergency room.
Also during January, the hospital temporarily closed three times because of a lack of available critical care beds, and its trauma center closed four times. The center, with a specialized staff on duty round-the-clock, handles the emergency room’s most severe cases involving traffic accidents, gunshot and stab wounds, and extreme multiple injuries.
Betty Briggs, Huntington’s administrative director of ambulatory services, sees these closings as a growing problem. She cites more trauma cases, which she says are frequently an outgrowth of drug abuse. She also lists population growth and an increasing number of elderly residents who defer care until they are forced to go to the hospital.
Still, she says, “People think closing means locking the door. But closing is only an attempt to divert paramedics and ambulances. Even though we’re technically closed, you can’t lock the door and let somebody bleed on the ramp.”
And Barbara Kelly, an assistant head nurse in the emergency room says: “It’s not our philosophy to argue with the paramedics. You waste time arguing over where (patients) should go. And closing is not a decision based on a number. You stay open as long as you can safely care for everyone.”
While taking a break midway through a weekend shift, Dr. Donald J. Gaspard, head of Huntington’s trauma center, gave this example of how overcrowding in Los Angeles hospitals affect those in the suburbs:
Upstairs, the surgeon said, a patient who was brought from downtown Los Angeles three nights earlier was recovering from a butcher-knife wound to the chest.
Normally, the patient would have been taken to the closest trauma center, County-USC Medical Center. But it was temporarily closed because of overcrowding.
“The patients who live in the San Gabriel Valley can be well cared for by hospitals here,” Gaspard said. “The crisis is not that the black hole is creeping this way. The crisis is we really are our brother’s keeper. And when these (Los Angeles) trauma centers close, the patients roost here.”
In the case of the man with the butcher-knife wound, he had neither insurance nor a home. He represented, Gaspard said, the increasing number of uninsured, traumatically injured patients diverted from Los Angeles. Calling this a “domino effect,” Gaspard said that it is “real and it’s going to impact people (even if) they’ve got a Blue Cross policy.”
One outcome, he said, is higher operating costs for hospitals--the very reason cited by eight county hospitals within recent years for permanently closing their trauma centers. Huntington’s center is the only one now open in the San Gabriel Valley.
For the Huntington trauma center, the pace of the Saturday swing shift last month was busy, but never busy enough to require closure. And at 4:21 p.m. a nurse wiped away the word “closed” by the San Gabriel Medical Center’s entry on the bulletin board.
Then, just six minutes later, a yellow flashing light in the corridors signaled a “code yellow,” the trauma designation. Soon, a team of 20 hospital staffers, ranging from social workers to nurses, surgeons and X-ray technicians, gathered in the trauma center, the Emergency Department’s largest treatment room, to await their patient.
On the roof, a Sheriff’s Department helicopter was landing. This was the second of three trips the helicopter rescue team would make to the hospital on Saturday.
In this instance, it was a mountain rescue from the eastern county line near Wrightwood. Initially, the helicopter had been scheduled to take its 14-year-old patient to Glendale Adventist Hospital, which has no trauma center but does have 24-hour emergency care.
But the injured boy, who had smashed his head on snow and ice, began vomiting and losing consciousness. Because he had a severe head injury, combined with the other symptoms, he was now considered a trauma victim--someone whose injuries might kill him. So the helicopter changed its course from Glendale and headed toward Huntington.
Five years ago, when the county’s trauma center system was established, helicopter rescuers coming from the mountains had many more choices. Then, Pomona Valley Hospital in Pomona, Queen of the Valley in West Covina and Methodist Hospital of Arcadia all operated trauma centers. But the hospitals have since closed them.
In the case of the injured boy, the lack of a trauma center closer than Huntington did not become crucial, although the helicopter ride took longer and the boy’s pain was prolonged. Within minutes after the victim’s arrival at Huntington, in a blur of medical assessments, Gaspard and the staff concluded that the boy had no life-threatening injuries, even though his body had suffered an extreme shock.
“Trauma is the province of the young,” Gaspard said after treating the youngster, noting that many of the patients brought into trauma centers are males who are teen-agers or in their 20s. “There are 1,000 traumatic injuries a month in the county.”
Those numbers combine with the fact that many trauma patients have no insurance. At Huntington, he said, 60% are uninsured.
This means, he said, that Huntington’s trauma center has become “an expensive piece of real estate. We can’t pay the rent. We’re losing a $1 million a year.”
And this worsening situation, he said, exacerbates the overcrowding in the emergency room. The pressures on emergency rooms, Gaspard said, result from their functioning as clinics for the impoverished, for illegal aliens and for the working poor, who can’t afford insurance or have minimal insurance. Because of this, he said, people see a physician only under dire circumstances.
“There are too many people who don’t have access to good care. Society has to make a fundamental decision what to do about the patient who can’t pay--kill them, export them, package them, or care for them. But you can’t let them run around and bankrupt the health care system.”
Regardless, Gaspard said, Huntington remains committed to its emergency room and trauma center. But because of the permanent and temporary closures of trauma centers, he said, it has become more difficult for patients to get the care that is available through medical science and is rightfully demanded by the public.
To illustrate, he told the story of a worker who fell from scaffolding in Glendale and later died:
Because of the severity of the man’s injuries, he needed to be taken to a trauma center. The nearest ones, St. Joseph Medical Center in Burbank, Huntington and County-USC, were closed. So the paramedics were instructed to take him to the next-closest emergency room, Verdugo Hills in Glendale.
But when the victim arrived at Verdugo Hills, doctors there said he needed a neurosurgeon. The hospital had none. Eventually, Huntington reopened its trauma center to accept him. But four hours had elapsed from the time the man fell to when he was seen by neurosurgeons at Huntington.
“Whether he had been treated right away in a trauma center and could have survived,” Gaspard said, “is an unknown. The answer is, probably not. But if he was going to be saved, the more promptly he got the right treatment, the more likely it is that he would have been saved.”
On the swing shift at Huntington, only one case was as extreme. And neither the paramedics nor the emergency room staff could save a 64-year-old Pasadena man who had been rushed to the hospital at one of the busiest times, about 10 p.m.
Although the staff, which included eight registered nurses and two physicians, was not distracted by other emergencies, the man had arrived too late to save. As a curtain finally was drawn around the table where the man’s body lay, Dr. Michael Page and social worker Scott Skyles went to another room to comfort the widow.
Meanwhile, in the waiting room, most of the three dozen seats were filled. A dozen clipboards were spread around a counter-top desk where the staff was reviewing cases and deciding who needed care first.
A stretcher carrying the man named Victor, bleeding from a stab wound, sailed through the pneumatic doors.
In one treatment room a dilemma was being resolved with a deaf San Marino octogenarian who didn’t speak English . On a bed in the hallway, a Pasadena man who suffered grand mal seizures, was awaiting a visit from the doctor. He had been placed in the hall so the staff could keep a closer watch on him.
Next to him lay a homeless man who had been attacked on a Pasadena street. His head was bandaged, his face bloodied. He smelled like he had been drinking and he complained of pain.
Nurses began asking Victor questions he did not want to answer. His hands were soiled. He flailed around an examining table as one nurse took off his jacket. He said he had no home. And he had no insurance.
“Do you know where you are?” the nurse asked.
“L.A.” he said groggily.
“Pretty close. Pasadena.”
A Q-tip the doctor inserted into his stab wound showed that it was deep, but not as serious as it might have been. Little time would be needed to give him stitches.
By the next morning, he was discharged. And so was the other homeless man who had come three days earlier with the butcher knife wound to the chest.
Huntington Memorial Hospital now was two more beds further away from having to close its doors again.