Sharply Split on Curbs at King/Drew

Los Angeles County officials and community activists disagree sharply about the reasons behind frequent diversions of ambulances from the trauma center at Martin Luther King Jr./Drew Medical Center in the last four weeks.

Since Oct. 16, the trauma unit has been closed to ambulances 81% of the time, causing critically injured patients to be diverted to other hospitals. Patients arriving by other means have been treated.

The ambulance diversions have occurred, the county says, not because the trauma center could not handle the influx, but because of nursing shortages in the intensive care unit, where trauma patients often go once doctors have stabilized them.

King/Drew has long had a shortage of ICU nurses, but officials said the situation worsened Oct. 16. Since then, there have frequently been seven to nine patients throughout the hospital waiting for beds in the ICU, but not enough nurses to serve them, said Dr. Thomas Garthwaite, director of the county Department of Health Services, which operates King/Drew.

The unit’s nursing administrator also voiced concerns to hospital managers that there was not enough staff to safely treat patients, Garthwaite said.

“People were being boarded in the trauma unit, and that certainly is not ideal,” added health department spokesman John Wallace.

But opponents of the county’s plan to close the trauma center are skeptical.

Community activists suspect that the county is trying to shut down the center piecemeal in advance of an expected Board of Supervisors vote to close the trauma unit. That vote could be taken as early as Monday after a public hearing.

Some residents believe that the county “is conducting a field experiment so when the [hearing] comes along, they can just pull the curtain aside and say, ‘We in fact closed trauma a month ago, and everything’s worked out fine,’ ” said Dave Martin, a lawyer for Friends of King/Drew, a group of doctors and community leaders.

The battle over the future of the unit intensifies today, when the Los Angeles City Council is expected to pass, as it did once before, a measure calling on the Board of Supervisors to delay the closure.

Councilwoman Janice Hahn, a vocal critic of the closure plan, is proposing that the county hold off until a consultant completes an assessment of King/Drew.

She also expressed some skepticism at the timing of the ambulance diversions.

“It makes a mockery of the [public] hearings,” she said. “They’re making these decisions outside of the process.”

Community mistrust of the county’s actions has long marked the debate over the future of King/Drew. In recent months, the move to close the trauma center has increased the friction.

Numerous problems have plagued the county-run hospital in the unincorporated community of Willowbrook, just south of Watts. In the last year, it has had a series of lapses in patient care, including several that contributed to deaths, according to regulators.

The county confirmed last month that a 28-year-old patient had died after a nurse turned down the audio alarm on his vital-signs monitor, then failed to notice that his heart was barely beating.

Last year King/Drew’s trauma unit handled about 2,150 patients, many of whom had suffered life-threatening injuries in car wrecks or from gunshots.

In the 21 months before October, according to county records, the center diverted ambulance patients about 4% of the time, usually because trauma bays were full. But since Oct. 16, the unit has accepted ambulance patients less than 20% of the time, according to county records.

County officials insisted that the diversions were not in any way related to Monday’s hearing and that hospital administrators made the call to turn away ambulances because there was not medical personnel available.

The pressure on the ICU should come as no surprise, Garthwaite said. “We have been progressively losing ground in trying to hire nurses,” he said.

Specialty nurses, particularly those in the ICU, have been extremely hard to find, he said. The highly publicized medical lapses at King/Drew have made recruiting there difficult.

And, Garthwaite added, the nurses who are working have been spending much of their time away from bedsides to answer questions posed by the federal regulators and the national accreditation commission that have been investigating problems at the hospital.

County officials say they want to close the trauma unit to let managers at King/Drew focus on correcting problems in the rest of the hospital. The county recently hired an outside consulting firm that has taken over day-to-day management of King/Drew, including evaluating the performance of doctors and nurses.

The ambulance diversions have been felt by hospitals in the vicinity.

At St. Francis Medical Center, about two miles from King/Drew in Lynwood, the number of trauma cases in October was 121, up from 91 in September, said Dr. Daniel Higgins, who works in the emergency room. So far, 37 trauma patients have come into St. Francis this month, which means November’s numbers could be as high as October’s, he said.

“It is palpable when they go on diversion,” added J. Peter Gruen, a neurosurgeon and chief of staff at County-USC Medical Center northeast of downtown Los Angeles. Gruen said he did not have concrete numbers but his impression was that County-USC saw an additional four or five patients at most when King/Drew’s unit closed to ambulances.

Even one or two extra trauma patients can cause havoc, because they get priority over other sick or injured patients waiting in the emergency room, he said.

But Gruen said that although trauma cases had backed up the emergency room, they had not overwhelmed the rest of the hospital, in part because County-USC had found success in hiring more nurses.

He said the high diversion rate at King/Drew had made him rethink his concerns about major problems occurring at County-USC if its sister hospital’s trauma center was closed.

“If the place goes on diversion and the system is able to survive and people are getting decent care, then maybe we don’t need that center,” he said.