Centinela Hospital Decision Leaves a Void : Shutdown Shuts Out Emergency Obstetric Patients

An Inglewood hospital’s decision to close its emergency room to patients brought by paramedics has sent county health officials searching for another nearby facility with the expertise to treat newborns and their mothers.

Carl Williams, director of hospitals for the county’s Department of Health Services, said talks are under way with Marina Hills Hospital in Ladera Heights to take obstetric patients when they are turned away from Centinela Hospital Medical Center, beginning April 26.

While paramedics will no longer be bringing any patients to the facility, concern is greatest about obstetric and newborn care because Centinela is the only hospital in the immediate area with an obstetrics unit.

As such, paramedics routinely transport such cases to the 50-year-old, nonprofit facility, health care officials said.

Centinela, which cited ballooning debts in winning state approval March 17 to stop accepting patients brought to it by paramedics, will continue to provide emergency services to people who come to the hospital on their own and to those transported by private ambulance.

“I am concerned about the care of not only high-risk mothers, but also low-risk mothers,” said Williams, adding that the county had attempted to convince Centinela to continue treating obstetric patients brought in by paramedics.

The hospital’s decision to stop accepting some patients brought by paramedics drew an immediate response last week from two neighboring hospitals. Officials of those hospitals say they fear they could be stuck filling the obstetrics void created by Centinela. In the low-income area served by the hospitals, some women have no regular physician and receive birthing services at emergency rooms, said hospital and other health care officials.

Robert F. Kennedy Medical Center in Hawthorne asked the state Department of Health Services on March 20 to allow it to stop taking patients brought in by paramedics beginning April 26. The 274-bed hospital is concerned primarily that it will face a large increase in obstetric patients that it cannot adequately care for in its emergency room, according to Robert Shaw, the hospital’s president.

“The time spent with an obstetrical patient in labor can be up to five or six times that (spent) with a normal emergency patient,” Shaw said in an interview this week. “ . . .You can step away for a minute and there is a serious complication.”

That concern is echoed by officials at Daniel Freeman Memorial Hospital in Inglewood. Vice President Jim Barber said Wednesday that the 203-bed hospital, which shut down its obstetrics unit five years ago, is pressing county officials to quickly sign an agreement with another hospital such as Marina Hills to handle such cases.

“Paramedic runs to our hospital will increase beyond the level where we can safely manage high-risk patients,” warned Barber, who estimated that 150 obstetric cases were brought to Freeman by paramedics last year.

“This is 1989. We should not be delivering high-risk mothers in the emergency department, and we are going to be,” Barber said. “And we think that is an outrageous and unnecessary situation to be in.”

Marina Hills’ executive director, Robert Shell, confirmed that officials at the 103-bed hospital have met with the county about accepting obstetric patients brought by paramedics.

The hospital, formerly called Ladera Heights Community Hospital, has an obstetrics ward, but no emergency room, he said.

Williams said he is optimistic that the county can reach some sort of agreement with Marina Hills.

If the county is unable to strike a deal with Marina Hills or some other hospital, some non-emergency obstetric patients--for example, a mother who appears to giving a normal birth--may wind up being taken to county-operated Martin Luther King-Drew Medical Center in Willowbrook. That hospital has already been confronted with crowded conditions.

“They are delivering as many babies as they can handle,” Williams said.

Critical obstetric patients would be taken to the nearest hospital with an emergency room, Williams said.

Local hospital officials contend that Centinela’s decision to stop taking paramedic patients is yet another example of the county’s escalating health care crisis brought about by the state’s refusal to ante up enough money.

In the past five years, 16 hospitals in the Los Angeles metropolitan area have closed their trauma centers or emergency rooms, according to the Hospital Council of Southern California.

Centinela President Russell Stromberg said that his hospital in fiscal 1988 carried $8.4 million in unpaid bills and donated services. He estimated that more than $1 million of that is directly attributable to obstetrics patients brought to the hospital by paramedics.

Stromberg agreed that Centinela, as a nonprofit hospital that receives substantial tax benefits, has an obligation to provide services to people who may not have the money or insurance to pay. However, he said the hospital has reached a breaking point.

“We have a responsibility to give as much charity care as we can afford to give, and we have absolutely reached our limit,” he said. “. . . . We can’t be forced to go out of business.”

Stromberg said that he recommended a year ago to Centinela’s board of directors that the facility stop accepting paramedic patients, but the board was reluctant to follow his advice.

Because of its location, Centinela treats a sizable number of poor mothers, some of whom do not even qualify for Medi-Cal, Stromberg said. For some, their first visit to a doctor comes when they deliver their baby in the emergency room, he said.

As such, the chances that the mother or infant may develop complications that result in longer, more costly, hospital stays are heightened, he said. Although some such patients qualify for state assistance and the hospital eventually receives some money to defray the cost of their care, many patients either do not qualify for assistance or refuse to apply for it, he said.