Paramedics Assail Emergency System

Los Angeles paramedics Wednesday urged major reforms in the county’s overloaded emergency services network, charging that the system is so badly managed that it is sometimes safer for the public “ not to call 911.”

In a statement likely to put him on a collision course with local hospitals, the president of the United Paramedics of Los Angeles, Fred Hurtado, said that county policies governing the unwieldy system were designed mainly to protect local hospitals rather than to help sick patients.

Hurtado and a dozen others testified at a public hearing held by the county’s Emergency Medical Services Commission, which has been asked by the Board of Supervisors to study the current crisis in trauma and emergency care.

Increasingly, hospitals in Los Angeles County have permanently closed their trauma centers or temporarily shut their emergency rooms to rescue ambulances. This has periodically caused “medical gridlock” that forces paramedics to roam the streets looking for an open emergency room.

Hospital officials have complained of staggering financial losses from their emergency and trauma facilities, which must by law accept all patients who are brought to them, even if the patients cannot pay. County policies allow hospitals that are full to temporarily close the premises to ambulance traffic.

But Hurtado charged, “In all too many cases, they close by taking advantage of loopholes in current . . . policy or by violating the policy altogether” when they are not full.

Two doctors also challenged the legitimacy of some hospital closures--particularly of County-USC Medical Center, which, because of its size, is considered a linchpin in the entire emergency services network.

“In the month of May, I kept a tally,” said Dr. Brian Johnston, president of the Los Angeles Society of Emergency Physicians who works at White Memorial Medical Center in East Los Angeles. “They (County-USC) were closed to trauma (patients) some portion of 19 days out of 31 for as long as 24 hours at a time.” On 20 other days, the hospital was closed to other sorts of emergency patients, Johnston said.

Virginia Price Hastings, in charge of emergency services for the county health department, said that County-USC has been “legitimately closed” when her department has spot-checked local hospital emergency facilities. But she disclosed in February that a check of nine hospital emergency rooms in the county uncovered four private hospitals that were apparently closed without justification.

Private Transportation

With increasing numbers of hospitals temporarily closing their emergency rooms to rescue ambulances, Hurtado said, it may be safer in some cases for the public “not to call 911,” the emergency telephone number. He said instead they could arrange private transportation to the closest hospital with a friend or relative. This is because the rules that allow hospitals to turn away rescue ambulances do not permit them to refuse care to patients who arrive on their own.

“That’s probably true sometimes,” said Price Hastings. “It’s better to just throw them in the car and drive.”

But Robert Gates, director of the Department of Health Services, disagreed.

“I’d never advise people not to call 911,” he said.

Gates testified that the “current plight” of the county’s Emergency Medical Services system results from inadequate funding for the growing numbers of patients without public or private insurance. He said that an additional $30 million is needed to bail out the system and restore it to its level of three years ago, when there were, for example, 23 hospitals designated as trauma centers. Since then, 10 have dropped out.

Also, he said that consideration should be given “to determine whether existing resources can be better utilized.” This would include, perhaps, redesigning the trauma center system so that service areas are better balanced economically.

Hurtado outlined a number of policy changes that he said would make the system more cost-efficient and less fragmented.

He urged that the dispatching service be centralized and that fewer hospitals be designated trauma centers--but that they be subsidized. He also said that all hospitals should be required by state law to have emergency rooms that could not be closed to ambulances except for internal disaster.