Centinela Action : Experts Say Don’t Rule Out Using Paramedics

Next Saturday, Centinela Hospital Medical Center in Inglewood will permanently shut its emergency room doors to paramedic patients. The only exception will be obstetrical cases.

What does that mean for those who live in Inglewood or close by? If you call 911, what can you expect?

And since the hospital will continue to accept emergency room patients brought in by a private ambulance or vehicle, should you think twice before calling a paramedic?

The answer to the last question, according to doctors, paramedics and county health officials, is an unequivocal no.

Virginia Price Hastings, who oversees the county’s paramedic operations, said people should “absolutely never” take it upon themselves to debate the seriousness of their condition and try to decide whether they should call a paramedic or a private ambulance.

Lack of Training

Moreover, she said, many private ambulance drivers do not have the same extensive training as paramedics and are not as capable of assessing a patient’s medical needs. Only one private ambulance company in the Inglewood area utilizes trained paramedics, she said.

Health experts say that those who call 911 may find that it will take a little longer for paramedic patients to get to a hospital and, once there, the wait to see a doctor could be longer.

“It may mean those individuals who in the past were seen rather readily will now possibly have an increased waiting time,” said Rhonda Stevens, director of development at Robert F. Kennedy Medical Center in Hawthorne. The most seriously ill patients will be treated first, she said.

“We don’t have the typical ‘Take a number and we’ll call you system,’ ” Stevens said.

Centinela, which has reported ballooning debts, received state permission to turn away paramedic patients. However, the hospital announced last week that it will continue to accept obstetrical paramedic patients under a one-year agreement with the county’s Department of Health Services.

Officials at Kennedy and Daniel Freeman Memorial Hospital in Inglewood say they expect Centinela’s action to create a significant increase in emergency patients at their hospitals. Centinela handles about 350 to 375 paramedic patients a month, according to the county. Typically, about 30 are obstetrical patients.

At Freeman, Dr. Bayliss Yarnell, the hospital’s director of emergency services, said the facility expects to see between 200 and 400 additional paramedic patients a month. Out of about 3,000 emergency room patients currently treated at the hospital each month, 1,000 are brought in by paramedics, he said.

Despite the predicted increase in paramedic patients, both Kennedy and Freeman said they expect to be able to handle the load without any additional staff members. For patients, the increase may translate into longer periods in the waiting room, especially for those who are not in serious condition.

“We’re stretched to the limit right now,” Yarnell said, “but we feel we can handle it. . . . We are apprehensive, but not in a state of panic.”

Yarnell said Freeman’s emergency room may become saturated with patients more frequently. In those situations, Freeman will instruct paramedics to divert patients to another hospital, perhaps one that is farther way. In January, for example, the hospital’s emergency department was closed 50% of the time because it was saturated, he said.

The likelihood that more patients will have to be diverted to a hospital that could be farther away is very much on the mind of Capt. Rick Pfeiffer, who oversees Inglewood’s three rescue ambulances. Patients who are in critical condition will be taken to the nearest hospital regardless of how crowded the facility is, but others could face a longer ride and probably won’t understand why, he said.

“It’s going to be a problem for us explaining to them why we passed a hospital,” Pfeiffer said.

Even if a particular hospital’s emergency room does become saturated for a period of time, paramedic patients should not find themselves experiencing a much longer ride, according to Hastings.

County guidelines call for paramedics to ignore requests from hospitals to divert patients elsewhere if the patient would be forced to ride more than 10 minutes longer, she said.

In any case, Hastings said, people should not hesitate to call paramedics.

Hastings said she had “numerous questions” about an internal memo that Russell Stromberg, Centinela’s president, sent to the hospital’s physicians on May 5.

The memo told doctors to “instruct your patients not to call 911 for emergency service (after May 26) as they will not be taken to our Emergency Department.” However, it noted that there may be occasions when patients will face “life-threatening situations” and will need to dial 911 for a paramedic. The memo listed the names and telephone numbers of three private ambulance companies the physicians’ patients could call.

“They are putting the private doctor and the patient into the position of trying to decide what is a real dangerous situation,” Hastings said.

Several doctors contacted were also critical of the memo. Dr. Arthur Schapiro, who serves as Freeman’s medical director and is also on Centinela’s medical staff, called the memo “idiotic.”

“He was perhaps putting people into jeopardy by asking his doctors to tell their patients not to fully avail themselves of the emergency medical services,” Schapiro said.

‘A Little Angry’

Another doctor who did want to be identified said he was angry about the memo. “I just would not instruct my patients to do that,” the doctor said.

Other doctors, however, said they did not interpret the letter to mean that doctors should tell their patients not to call a paramedic in emergency situations.

One doctor said there are times when patients call paramedics simply because they want transportation to a hospital. In such situations, there would be nothing wrong with Stromberg’s advice, the doctor said.

Stromberg said he saw nothing wrong with the memo. He said it was sent out at the request of physicians who wanted guidance on what advice to give their patients.

“We have 600 doctors on staff and none has complained to me about the letter,” Stromberg said.