Preventable Deaths at County Hospitals Claimed by Staffers

In a powerful venting of frustration at the quality of health care for the poor in Los Angeles County, more than 40 county doctors and nurses have signed sworn declarations attesting to “preventable” patient deaths and “unnecessary” suffering they have witnessed due to overcrowded, under-funded county health facilities.

“It is sad to say, but I believe we provided better quality medical services 13 years ago than we do today,” said Dr. Haragopal Thadepalli, chief of infectious diseases at Martin Luther King Jr./ Drew Medical Center. His statement was released Tuesday at a news conference at the hospital.

Legal aid attorneys collected the declarations during the last two months in preparation for public hearings that county supervisors have scheduled for Monday to consider $55.7 million in proposed health care cuts to offset anticipated losses in state revenue. Dozens of pediatric facilities, outpatient health centers and family planning clinics would be closed and 800,000 patient visits annually would be eliminated if state funds cannot be found to bail out the programs.

Graphic Descriptions

The scenarios detailed in the affidavits by health professionals, including medical department chiefs at county hospitals and health clinics, included descriptions of overcrowded county hospital emergency rooms where patients with critical conditions wait for days and sometimes die before being admitted to the hospital for care. They gave lengthy accounts of overloaded obstetrical services that have forced women to give birth in hospital hallways and of surgical backlogs that have postponed operations for life-threatening conditions for months.

One doctor recounted, for example, how a young homeless woman with a kidney stone obstruction had been discharged from Harbor UCLA Medical Center to the streets at a time when she had a tube from her side to collect urine. She was told to come back for surgery in a month, but the patient could not maintain the tube. She sustained repeated infections and probably has lost kidney function as a result, the doctor who treated the patient said.

The chief of pulmonary diseases at King, Dr. Albert Niden, pointed out a lack of “effective, prompt outpatient care” as the cause for “an increasing incidence of death among young asthmatics.” And at Harbor, the chairman of neurology, Dr. Mark Goldberg, described the hospital as “operating on the knife’s edge.” He said patients with brain tumors wait up to 30 hours in the emergency room before evaluation, and up to three months for an initial, scheduled appointment. Other ambulatory care clinics are similarly jammed.

At the county’s comprehensive outpatient health clinics, medical care has also been compromised, doctors said. Dr. Linda Velasquez, a pediatrician at the Edward R. Roybal Comprehensive Health Center, said she has seen an increase in children suffering from tuberculosis, syphilis and measles and has seen children die in county emergency rooms from dehydration.

Melinda Bird, an attorney at the Western Center for Law and Poverty, said the proposed county cuts would devastate an already crippled county health care system. After a two-month investigation, she said, attorneys have concluded that the system cannot withstand any cuts whatsoever.

Court Action Vowed

“If they cut even $1 million, we will go to court to stop it,” she said. “And if they don’t correct the problems that these declarations have pointed out, a lawsuit is very likely.”

In the last 10 years, legal aid attorneys have filed four lawsuits against the county on the issue of health care for the poor. State law requires that county health care for the poor meet minimum standards of adequacy and that it be comparable to what is available in the private sector.

The county’s funding of health services has repeatedly come under attack from health care advocates. And this latest report by legal aid attorneys hearkens back to a similar report issued two years ago.

In a June, 1987, report, the Legal Aid Foundation of Los Angeles concluded that the county’s six hospitals and 47 health centers were so poorly funded and understaffed at that time that the quality of care is “unacceptable by any standards of availability and quality.” Again, the report was based on interviews with 50 county physicians, nurses and health care workers.

Bird said that the county’s health services have deteriorated significantly since then. “Poor patients risk needless and preventable deaths as a result,” she said.

Some Charges

The declarations she released at a press conference at King hospital Tuesday included the following:

* Dr. Gerald Whelan, associate director of the department of emergency medicine at County-USC Medical Center, stated that patients wait for days on gurneys to be admitted to the hospital, which is “medically unsafe.” He said the fire marshal has repeatedly cited the hospital for hazardous overcrowding.

* Walter Smith, a nurse in the department of emergency medicine at King, stated that “some patients have died in the emergency room because they did not receive the close monitoring that they would have if they would have been admitted in an intensive care unit, where they belonged.”

* Maggie Glenning, a nurse in the emergency room at Harbor, stated that the facilities are already “stretched past our limits.” She said that after women give birth, they are often sent home as little as six hours after delivery because of a shortage of postpartum beds.

* Mary Allison, a nurse at Women’s Hospital, stated that the labor and delivery floor of the hospital is “chronically understaffed” and ill-equipped to provide adequate patient care. There are not enough delivery rooms and women are sometimes forced to deliver their babies in hallways.

* Dr. Christine Klasen, co-director of the AIDS clinic at County-USC, said patients may wait two or three days to be admitted to a bed. Facilities are so crowded, she said, that in “a room where there should have been 20 people, there were 40 people.”

Robert Gates, director of health services, was not available for comment, his spokeswoman said.