Hospital Meets Wish but Bucks the Trend

Eight years ago, a little-known local shoe store owner died, bequeathing $3.5 million to a small East Los Angeles hospital for the expressed purpose of building a new emergency room.

Nobody knows if Dominick J. DeBartolo had ever even visited the hospital’s old emergency facility--four beds scrunched into a dark hallway in an area the hospital administrator likened to a “shoe box.”

But the idea of renovating the place would seem like a good one. The timing, however, has left something to be desired.

Santa Marta Hospital this week will open a newly constructed, significantly expanded--from 4 to 11 beds--emergency room at a time when many hospital officials countywide are complaining that emergency rooms are unprofitable and are looking for ways to drastically curtail or even eliminate this service.

“This is bizarre. Maybe it’s a reverse trend,” said Los Angeles County Medical Assn. spokesman Robert Caverley when he learned of Santa Marta’s move to build a new emergency facility.

Against the trend

“They’re definitely bucking the tide,” said David Langness, an official with the Hospital Council of Southern California, who pointed to the closure or curtailment of emergency services at six hospitals in Los Angeles County in the last three years.

The latest cutback occurred Friday, when Centinela Hospital in Inglewood downgraded its emergency room to “standby status,” thus diverting all rescue ambulances, which tend to bring hospitals their sickest and poorest patients. The hospital, however, will continue to accept ambulances carrying obstetrical patients.

Most health care officials agree that Los Angeles suffers from a serious shortage of emergency room beds, so Santa Marta’s move to add to the supply was hailed as “the responsible thing to do” by Fred Hurtado, president of United Paramedics of Los Angeles.

Dr. Jorge Diaz, an emergency room physician at Santa Marta, praised the hospital for upgrading a badly needed service for the nearby community, which is 95% Latino and 50% working poor. But Diaz acknowledged that “most people must think we are crazy. . . . Only time will tell whether this will be a death blow to the hospital.”

He noted that the hospital has no control over what kinds of patients arrive at the emergency room, either by ambulance or under their own power. But if it’s anything like before, he said, many will not be able to pay their bills. In all cases, doctors are obliged by law to treat and stabilize anybody who arrives in need of emergency treatment.

State health statistics show that the 110-bed nonprofit hospital--owned by the Daughters of St. Joseph, a small order of Roman Catholic nuns based in Spain--shoulders one of the heaviest loads of uncompensated care costs of any private hospital in the county.

Patrick Petre, hospital administrator, acknowledged that the expansion of Santa Marta’s emergency room is not a “risk-free” move. But he said that the overall economic prospects are good.

Although many of the patients who come to the emergency room have no insurance or money to pay their bills, Petre said that 70% are insured through Medicare or Medi-Cal. Overall, he said the emergency room generates good business for the hospital, generating 65% of all hospital admissions.

To boost the percentage of paying patients, Petre said an intensive marketing campaign has been launched to encourage local industry to send their injured--and insured--workers to the hospital.

“People don’t understand that East Los Angeles is a good market,” Petre said. “There’s lots of business and industry here.”

In addition, he said, the emergency room treats many traffic accident victims by virtue of its proximity to the busy Long Beach-Pomona freeway interchange. The hospital is at 312 N. Humphreys Ave.

“There are lots of traffic accidents, especially when it rains.” Petre said. “Nicely dressed people on their way to work come in here all banged up.”

Mostly, Santa Marta serves the local community. Its big drawing card, Petre said, is its small, homey atmosphere and affiliation with the Roman Catholic Church. The hospital was founded in 1924 as a 10-bed maternity clinic, operated out of a house. The current facility was built, largerly with donations, in 1971.

Today, crucifixes are placed above every hospital bed, and the place still abounds with nuns, who live in a small nearby convent.

About 80% of the nurses and doctors are Latino.

“We serve the blue-collar working people of East Los Angeles. . . . They want basic medical care without the bells and whistles. . . . The daughter comes here to have her baby. Her son comes to have his tonsils out and grandma comes for her hip fracture.”

State health statistics show that Santa Marta has one of the heaviest charity care loads in the county. Among the county’s major private hospitals during 1986 and 1987, Santa Marta had the the third-highest share of uncompensated care costs--defined as a combinations of charity care, bad debts, and bills left unpaid by insurers or non-charity patients.

Despite this burden, Santa Marta managed to make a profit last year of $300,000, Petre said.

Petre attributed this to vigilant cost-control efforts in purchasing supplies, for example, and to the fact that, unlike many other hospitals, Santa Marta has “very little debt” due to building expansion and construction.

He pointed out that the hospital’s new wing, housing the 11-bed emergency room as well as an expanded intensive care unit, laboratory, X-ray facility and pharmacy, was paid for by DeBartolo’s bequest, which almost doubled in amount during its investment before building.

What prompted the man’s generosity toward the hospital or his interest in the emergency room has not been determined. “We have no idea what his connection with this hospital was,” said Petre, who added that DeBartolo apparently had no surviving family to shed light on the gift. Under the terms of the bequest, the hospital was required to spend the money on its emergency room.

“The only way around it would have been to petition the archdiocese (of Los Angeles),” which acted as custodian of the money, Petre said.

Meanwhile, there is one other hospital in Los Angeles that also has embarked on a multimillion-dollar venture to build a new emergency room. Century City Hospital plans to open a “24-hour basic emergency room” in October, said Deborah Ettinger, hospital marketing official.

“We feel there is such a dense population here in West Los Angeles, that it’s certainly needed,” she said of the new nine-bed facility. Marketing studies, she said, have shown that, given the neighborhood, patient population and services to be offered, the facility will be profitable.

“More power to them,” said Langness at the Hospital Council. “It’s wonderful they’re opening one. I hope they can help with this situation, but the situation is so serious that any hospital that opens a new facility can expect their losses may be serious.”