South Bay Facing Crunch in Emergency Medical Services

Citing financial woes and patient overload, one South Bay hospital is dropping emergency care of patients brought by ambulance, another is seeking to do the same and a third with multimillion-dollar debts declared Tuesday, “We can’t keep on indefinitely.”

The moves have triggered fears that a new crunch on emergency care is under way in Los Angeles County. Although the hospitals will continue to see walk-in patients, some others cases typically brought by ambulance--including heart attacks, poisonings or other sudden ailments--will be refused.

In Inglewood, Centinela Hospital Medical Center, which is running an $8.4-million deficit from charity cases and bad debts from unpaid bills, received state approval Friday to turn away ambulances beginning April 26. The hospital will continue to treat people who come to its emergency room on their own.

On Monday, the Robert F. Kennedy Medical Center in neighboring Hawthorne, fearing a resultant increase in emergency cases, particularly obstetric, also filed a request with the state Department of Health Services to decline cases brought in by paramedics.

The Kennedy Medical Center wants the change to take effect when Centinela’s does, and state officials say that there appears to be no legal barrier to granting that request.

At the Hospital Council of Southern California, spokesman David Langness said the approval of cutbacks in Centinela’s emergency room opens the door for similar requests from other hospitals.

“The domino effect (of cutbacks) that we’ve been predicting for the last three years” is about to take place, Langness said.

Daniel Freeman Memorial Hospital, which handles up to 7,000 ambulance cases a year, is looking closely at the situation.

Officials said they have no intention of ending care of ambulance patients “at this time,” but, Vice President James Barber said, “That doesn’t mean we are not looking at it very carefully.” Emergency services at Daniel Freeman currently are in the red about $4 million a year, he said.

“We can’t keep on indefinitely. We would like to work on a positive solution rather than close that community service,” Barber said.

Even without a formal closing of ambulance care, Barber said the Daniel Freeman emergency room already is too full to take ambulance cases 22% of the time--up from 9% a year ago. Barber said the percentage of time that the hospital must send ambulances elsewhere is bound to increase once Centinela Hospital stops taking ambulances.

Barber said the retreat of Centinela and Robert F. Kennedy hospitals will put a greater burden on the hospitals that remain willing to take ambulance cases.

“We have witnessed the disintegration of the trauma system in Los Angeles County. That was bad enough. Now we are seeing the domino effect on emergency rooms,” he said.

“There will be fewer hospitals open to emergency services, and they will get overloaded in a hurry,” Barber said. “As hospitals drop out of the system, we are witnessing a breakdown of access of millions of people, potentially, to emergency service departments.

“Paramedics will have (to) travel longer distances and that is a quality-of-care issue for the patient in the ambulance,” Barber said, adding that the longer runs also may mean ambulances will be scarcer.

The Centinela closing will affect the many low-income mothers who cannot afford prenatal care but end up at the emergency room for childbirth. Losses at Centinela have resulted in part from the hospital’s heavy emergency obstetrics load.

Barber blames Gov. George Deukmejian for the financial crunch, asserting that the governor “hijacked” the Proposition 99 tobacco tax funds, approved by voters in November, that were earmarked for emergency services.