County-USC Closure Seen as Peril to 911 System : Health: Indigent patients would flood other hospitals and overextend resources, experts say. Alternate proposal calls for closing Harbor and Olive View facilities instead.

Disaster experts warned Tuesday that closure of County-USC Medical Center would cripple the emergency 911 system, lead to deaths and force the closure of financially struggling hospitals by diverting too many patients their way who could not pay for treatment.

“What we would have is a disaster,” Alan Cowen, chief of paramedics for the Los Angeles City Fire Department, told the county Health Crisis Task Force.

As an alternative to closing County-USC, it was suggested that two other big public hospitals--Harbor-UCLA Medical Center in Torrance and Olive View-UCLA Medical Center in Sylmar--be closed.

That proposal came from County Emergency Medical Services Agency chief Virginia Hastings, who said there were more hospitals in the coastal area and San Fernando Valley to soften the blow than there are Downtown.

Although advisory in nature, the proposal clearly put closure of the two hospitals into the mix of various health service cuts being considered by the task force.

“We have to give her proposal very serious consideration,” said Burt Margolin, a former state legislator who is heading the task force. “It will be a key factor we will weigh in the coming days. We are looking for ways not to close facilities, but if we have to engage in a process of assessing how do you best preserve the most critical and most vital services, what she said today was very important testimony.”

The five-member panel was appointed by the Board of Supervisors to study a recommendation by county budget chief Sally Reed that would close County-USC, which handles just over one-quarter of all trauma cases in the county.

Reed’s proposal to close the facility is part of a plan to correct a $1.2-billion shortfall in the county budget. In all, Reed proposed cutting $655 million in health services. She would also like to close four comprehensive health centers and 25 county clinics, slash $54 million from mental health services and cut public health programs 20%.

Reed said she considered closing Harbor and Olive View but decided to recommend closing County-USC because of its age--it opened in 1932--and because it is so badly in need of upgrading that a replacement hospital would cost more than $1 billion.

The disaster experts and hospital officials appeared in almost universal agreement that closure of County-USC, particularly its busy trauma center, would flood the health system with sick patients and quickly overextend available resources, leading to deaths and other hospital closures.

The doomsday scenario was based on a number of factors. One was the inability of other hospitals in central Los Angeles County to absorb all the emergency calls now handled by County-USC. City paramedics took 10,640 patients to County-USC during 1994, more than 2,000 of them gravely injured or ill trauma patients. At the same time, many of those patients were poor, without any health insurance.

Experts who have studied the problem say that if the county followed through on its plan to close health centers and clinics, the indigent and sick patients would call 911, knowing that an ambulance would be sent and they would be taken to a hospital. All hospitals with emergency rooms are obligated to take 911 patients whether they can pay or not.

“If they don’t have a . . . walk-in clinic [close by], they are going to call and access our system, which I might add is already terribly overburdened,” said Cowen, the city paramedic chief. “Our 911 system will be absolutely inundated. . . . Blood is going to flow from the people that don’t make it to the trauma centers.”

Hastings, responsible for coordinating public and private health services during earthquakes, fires and other disasters, said, “The numbers of [911] patients are so large that we would start moving out to find open hospitals, and within a [short time] every hospital in the county would be filled.”

Those views were shared by more than a dozen private hospital administrators and emergency room physicians who also appeared before the budget panel.

Dr. Brian D. Johnston, an emergency room physician and president-elect of the Los Angeles County Medical Assn., called Reed’s budget plan “a recipe for hospital closure.”

“In six months or a year you are going to have major closures. You are going to have closures of emergency departments and closures of hospitals,” Johnston said.

“What’s the choice? Do you close to protect yourself, or do you bankrupt yourself and then close?”

The Board of Supervisors asked the task force to produce a report on the cuts, along with suggestions of alternatives, by July 25.