Conflicting Prognoses

Joe Garcia doesn’t remember much about the heart attack that nearly took his life in October 1996, when he collapsed in the middle of the Manhattan Beach Old Home Town Fair 10-kilometer run.

He learned afterward that paramedics did all they could while rushing him to the emergency room at South Bay Medical Center in nearby Redondo Beach. There, his heart stopped again, but the medical team revived him and stabilized his condition; the next day he underwent bypass surgery at Little Company of Mary Hospital in neighboring Torrance.

“Joe Garcia would not be here today if not for us,” said cardiologist Bruce K. Jackson, who treated Garcia at South Bay and who believes that the additional three to five minutes it would have taken paramedics to reach Little Company of Mary’s emergency room would have proved deadly.

Jackson’s statement illustrates how emergency care is becoming a prime issue in the increasingly emotional debate over whether to close South Bay Medical Center.

According to a controversial study released last week by the Beach Cities Health District, the public agency that owns the hospital, the loss of South Bay’s emergency room would be no big deal. Other hospitals, including two that are three to 10 minutes away by ambulance, could absorb the load, said Henry W. Zaretsky, a Sacramento-based consultant who once ran the California Office of Statewide Health Planning and Development.

“Given the relative proximity of larger and better-equipped hospitals with emergency departments, [South Bay Medical Center’s] closure should not adversely impact district residents. Obviously, the more hospitals and more emergency rooms, the better the access, assuming they can survive economically,” Zaretsky concluded, adding that an excess of hospital beds throughout Los Angeles County make it likely that “not all existing hospitals can or should continue in operation.”

The report angered a coalition of physicians and other health care providers who are leading a fight to keep the hospital open. They promptly disputed its findings and turned up an erroneous statement that there are 25 hospitals within a 10-mile radius that includes South Bay. The actual number is 13, county health services officials, who provided the data for the study, later acknowledged.)

Built by taxpayers from Hermosa Beach, Manhattan Beach and Redondo Beach in 1960, South Bay Medical Center struggled for years as the number of patients dwindled. Last year, the private corporation that runs South Bay for the health district announced that it will shut the hospital at the end of May, leaving the health district’s publicly elected board to find a new tenant for the 203-bed facility.

Health District board members want to decide Feb. 26 among four proposals. They include an offer by hospital competitor Little Company of Mary to lease the facility for 10 years and convert it to an outpatient center and two plans by private corporations to buy the hilltop site, tear down the hospital and build an “assisted living” complex for the elderly. Only one proposal--by the physicians coalition--seeks to keep the facility operating as an acute-care hospital, including its emergency room.

Emergency room physician Mark Bell, who did his own analysis of South Bay’s service, said the district-commissioned report “is an economic assessment. . . . I looked at it at terms of community safety.”

Bell reviewed 167 cases brought in by paramedics last year and found 40 that had required life-saving care immediately.

“What is the risk of those people going another six to 10 minutes in an ambulance, and is that a risk that the residents of this community are willing to take?” Bell said.

Furthermore, the district-commissioned report used data from 1995 as a basis for its conclusion that South Bay’s emergency room was underused and not as well-equipped as neighboring facilities. Since the hospital administration changed emergency room operators two years ago, there has been an 18% increase in usage (9,104 patients, about 2,000 of whom were brought in by paramedics, during 1997), according to Bell. The hospital also has added new equipment, enabling South Bay to provide the same level of emergency care as its neighbors, Bell said. (None is equipped to handle serious trauma cases, which are sent to Harbor-UCLA Medical Center.)

Ken Johnson, a Beach Cities Health District board member, acknowledged that the board-commissioned report had some problems but said he nonetheless feels “comfortable” with its findings overall. He noted that the report is just one part of the “exhaustive process” the board has undertaken in trying to settle on a course for the facility.

“Of course it would be good to have an ER here, but is it practical? We have to weigh everything and decide what is best for the community,” Johnson said.

The proposal by the physicians’ group to keep the hospital open faces two big obstacles. One is the hospital’s poor history of attracting sufficient numbers of patients in a crowded field. The other is the coalition’s request, in its initial offer to the board, for operating capital during the first year or so after it takes over.

District officials, although not stating a preference for any of the four competing proposals, have made it clear that they do not want to divert funds from the many community health, fitness and prevention programs that have embodied the district’s shift in emphasis since it leased out the hospital in 1984. And they have continually expressed doubts about the economic viability of the hospital, which lost out in the competition for major managed-care contracts and saw its in-patient occupancy rate dip to 18% last year.

But internist John Peter Armato, a leader in the physicians coalition, said he believes that the proposal to keep the hospital open is feasible. He cited a growing list of physicians--currently more than 100--who have pledged to send patients to the hospital because they see an opportunity to have a greater say in their treatment. He also said the hospital is admitting more patients and earning higher revenues and is poised to reap the benefits of the $14 million that the current operator, Tenet Healthcare Corp., has invested in new equipment and services in the last few years.

“To close it now would be tantamount to pulling the plug just as the patient is beginning to resuscitate,” Armato said.

He said the coalition is revising its offer to require no subsidy from the district and to protect it and its community programs from risk during a period, probably of about two years, while the physicians coalition tried to make the hospital a success. The coalition also would share some of the profits with the district and would set aside funds toward costly requirements to make the hospital safe in an earthquake, he added.

Board member Johnson said he would be interested in such a proposal--if the financing pencils out.

“My reading of the board is that we’d all like to keep it open as an acute-care hospital. We’re just not sure that’s practical,” Johnson said.

Meanwhile, the debate is a painful one for residents such as Garcia, the 62-year-old runner who got a second chance at life at South Bay.

“I would love to see the hospital stay open. I love the place,” said Garcia, a Hermosa Beach resident who remembers with pride the day the medical center opened nearly four decades ago.

He returned to the Old Hometown Fair Race last fall, this time finishing in great shape, joined by physician Jackson and some of his other rescuers from the previous year. He credits the hospital’s cardiac rehabilitation program and the district’s fitness center, which he attends five days a week.

But as much as he loves the hospital, Garcia said he would not want to see its continued operation jeopardize any of the funds the district provides for the fitness center and scores of other community-based programs. Garcia is a volunteer in one such project, which sends residents to visit shut-ins in the area and provide companionship for those who would otherwise be isolated from their neighbors.

“These are awfully good programs,” Garcia said, adding that he would “hate to be in the board’s position” of choosing between the hospital and the community projects.

“If we could have both, that would be great.”