Grappling with serious structural damage and the onslaught of hundreds of injured people, many hospitals and clinics across Los Angeles continued Tuesday to buckle under the strain of Monday's shattering earthquake.
In the hard-hit San Fernando Valley, doctors turned a hospital parking lot into an emergency room, desperate kidney patients sought alternative care after five dialysis clinics closed, and quake victims waited in line for hours for treatment of broken bones, mashed hands and cut heads and feet.
Officials released details of several quake-related deaths at Los Angeles hospitals, including two babies born dead to quake-stressed mothers and a car crash victim who died when a power outage halted his ventilator.
Psychiatrists told of traumatized quake victims, including one young man who was trapped under rubble at a collapsed Northridge apartment complex and was forced to listen as three of his roommates died after being pinned in the wreckage.
Hospital officials reported Tuesday that more than 530 people were hurt badly enough to be admitted, while another 2,333 had been treated and released. The total casualties were almost 1,000 higher than the number of people injured during the 1992 riots, although more than 50 people were killed in the riots. The earthquake has claimed at least 40 lives.
More than 700 patients--many of them in intensive care--were moved out of quake-damaged facilities and transferred to other medical centers.
In the Valley, which bore the brunt of the temblor beneath Northridge, three hospitals--the Veterans Administration facility in North Hills, Holy Cross Medical Center in Mission Hills, and Olive View-UCLA Medical Center in Sylmar--were closed indefinitely because of structural damage and loss of water and power.
Among the dozens of others that sustained enough damage to require them to move out some of their patients were St. John's Hospital and Health Center in Santa Monica and the Kaiser Permanente Hospital in Panorama City.
Because of structural problems discovered late Monday, the county's psychiatric hospital, part of the County-USC Medical Center complex near Downtown, had to move out its patients and also close doors to a large number of outpatients.
Childrens Hospital Los Angeles suffered some structural damage, and, like several hospitals in the area, canceled elective surgeries.
At least eight earthquake victims were admitted to Childrens Hospital, including a 23-day-old infant with a broken leg. The baby's mother said it could have been caused when a clock fell on her while she was nursing the infant.
At Cedars-Sinai Medical Center, 25 patients had been admitted to the hospital for serious injuries by midday Monday, and at least 100 more were treated for lesser injuries and sent home.
"The emergency room was jammed," said Ronald Wise, a spokesman for the hospital. He added that Cedars-Sinai is part of the countywide emergency response network, and its staff was well prepared.
"We had 12 doctors and 15 nurses, plus technicians, and they immediately went into the disaster-response mode. Everything worked very smoothly. We were able to take on all comers," Wise said.
Two of the busiest hospitals in the region Tuesday were Northridge Hospital Medical Center, where doctors and nurses cared for patients in a parking lot, and Granada Hills Community Hospital, where there was no heat or water.
At the Northridge facility, near the powerful earthquake's epicenter, more than 300 people had been treated since the quake for broken bones, glass cuts, bad bruises and stress problems.
Tired nurses and doctors set up a makeshift emergency room in a parking lot where they evaluated patients under the hot sun, separating those who needed immediate care from those who could wait a while. A row of portable toilets stood nearby.
"Most everyone slept here last night," Dr. Paul Karis, chief of emergency medicine, said of the hospital staff. "People haven't had a shower. There's no running water. The toilets are in the parking lot."
Karis said the quake also knocked out the hospital's CAT scan and magnetic imaging equipment, needed to diagnose head and spine injuries. "We don't know when they're going to be back up," he said.
As regular staffers grew exhausted, more than three dozen doctors, nurses and psychiatrists were brought into the hospital under a federal medical relief program.
One of them, Dr. Steve Salenger, chief of staff at Patton State Hospital in San Bernardino, said he counseled anxious earthquake victims as well as exhausted doctors and nurses Tuesday.
Salenger said one victim, a young Desert Storm veteran, was trapped for more than three hours under the rubble of the Northridge Meadows apartment complex where 16 people died, including three of the man's roommates.
"He couldn't move, and he could hear one of his roommates slowly choking to death each time there was a slight settling of the rubble," Salenger said.
"Since coming here, he's been withdrawn. He's afraid to be alone. He's sleeping in the hospital because he's afraid to go anywhere else."
Karis said two babies were born dead at Northridge when their mothers went into quake-induced labor.
At Holy Cross, 20-year-old Lionel Ventura died when the earthquake knocked out power to his ventilator, according to the Los Angeles County coroner's office. Coroner's investigators were told that Ventura had been at the hospital since December, when he was injured in a car crash.
Elsewhere in the Valley, five kidney dialysis centers were put out of operation by the earthquake, affecting an estimated 300 patients who need the blood cleansing treatments to stay alive, health officials said.
"It's just wild and woolly," said Linda Black, administrator of the St. Joseph Regional Dialysis Center in Burbank. "Individual patients are wandering around . . . calling to find a place to get treatment. There are so many that just don't know what to do. I can't tell you how many people have called me, frantic."
Several hospitals canceled routine appointments and elective surgeries to handle emergency patients.