King/Drew Proposal Assailed

The proposed closure of Los Angeles County’s second-busiest trauma center, at Martin Luther King Jr./Drew Medical Center, will severely strain an already weakened trauma network and almost certainly cost some patients their lives, said doctors, police and paramedics familiar with the hospital and its patients Monday.

“Yeah, it matters,” said Capt. Roy Harvey of Los Angeles City Fire Station 64 in Watts. “Minutes are lives.”

Last year, King/Drew, which is in Willowbrook near the intersection of the 110 and 105 freeways and surrounded by some of Los Angeles’ most violence-plagued police divisions, handled 2,150 trauma patients. Among them, 1,186 suffered from blunt trauma, typical of automobile accidents, and 964 from penetrating trauma -- primarily gunshots and stab wounds.

County officials said the proposed shutdown, which would take effect in about 90 days, was necessary to save the troubled hospital. By easing the number of patients at King/Drew, officials hope the move will allow administrators time to resolve problems that might otherwise sink the hospital.

“There are some fundamental problems with King/Drew,” said John Wallace, the spokesman for the Los Angeles County Department of Health Services. Fixing them “is like trying to fix a car while driving down the freeway,” he added. Officials need to “decompress the hospital so that these changes can be made and the hospital will be there in the future.”

The trade-off, however, is that Los Angeles County’s emergency medical system will take another hit. In the early 1980s, there were 23 trauma centers in the county. Today there are 13, including King/Drew.

Jim Lott, the executive vice president of the Hospital Assn. of Southern California, said the decision to close the hospital’s trauma unit was the right call given King/Drew’s problems, which have led to repeated incidents of patients being injured, and in some cases killed, as a result of medical errors.

“They need to do that in order to maintain patient safety. That’s an absolutely hard but necessary decision for them to make,” Lott said.

Still, the decision troubles many who work in the emergency medical system.

“The issues” with the hospital “are not something we want to resolve by lengthening travel times and seeing how many people die as a result,” said Dr. Brian Johnston, head of the emergency room at White Memorial Medical Center in East Los Angeles. “If this were an experiment,” he said, it “wouldn’t get through the ethics committee.”

“No one has thought this out in advance,” said Dr. Dan Higgins, head of the L.A. County Medical Assn. and an emergency room doctor at St. Francis Medical Center, about two miles from King/Drew. “King/Drew closes and everyone suffers. Not just the poor that use that hospital; there are going to be impacts on the upper class, black, white, Latino -- they all use trauma centers.”

William Bamattre, chief of the Los Angeles Fire Department, said the department transported about 16 patients a day to King/Drew and that the closure could add as much as 30 minutes in transport time to other facilities.

“I’m very disappointed because when the issue about King/Drew surfaced, I was assured that the issues they were dealing with would not impact emergency room and trauma center,” Bamattre said.

The effect could be greatest on crime victims. Research has shown that the number of shootings that result in injury, rather than death, is determined in part by the availability of nearby trauma centers, said criminologist Richard Rosenfeld of the University of Missouri-St. Louis.

Watts and the South Los Angeles neighborhoods north of King/Drew have vastly higher rates of gunshot victims per capita than the areas near two other major county hospitals, County-USC in East Los Angeles and Harbor-UCLA in Torrance, according to a Times analysis of shooting incidents per capita based on data from the Los Angeles Police Department.

Brent Dalton, a paramedic at Station 64, said the emergency medical technicians who are the first responders to shooting scenes can only do so much.

If a patient loses too much blood in the ambulance, “we are dealing with cardiac arrest ... or full traumatic arrest, and the survivability is almost zero,” he said. “The name of the game is getting them to somewhere close.

“You are basically loading and going,” Dalton said. “We scoop ‘em up on the backboard, cut their clothes off en route and get them there.”

Paramedics in Watts already know what longer rides are like because the absence of a pediatric trauma unit at King/Drew means they must transport gravely injured children to Harbor-UCLA.

Dalton described one recent ride to Harbor-UCLA with a child of about 12, who had been hit by a car.

“His pressure was dropping and he was vomiting,” Dalton said. “It’s unnerving when you have a kid who is critical.... You are thinking of your own kids and your own family, and on the ride, we max out everything that we can do and are just sitting there waiting .”

Bryan Hubbard, a King/Drew trauma surgeon, said he expected that many patients would show up at the hospital not realizing the trauma center had been closed, particularly patients brought by what police and some doctors refer to as “homeboy ambulances.”

The term refers to a practice common among gang members. Either because they are fearful of the authorities or trying to act quickly, they will often drive wounded members of their gangs to hospitals themselves instead of calling an ambulance.

As a result, patients suffering internal bleeding are commonly dropped off at the curb at King/Drew. Gang members fleeing a shooting or stabbing are unlikely to distinguish between hospitals in an emergency, Hubbard said, and such patients would continue to go to King/Drew whether or not the trauma center were there.

Finally, the proposed closure would put further strain on other hospitals in the region, officials of those hospitals said.

“We just don’t have the capacity to take up the slack if they go down,” said Higgins, referring to St. Francis.

Lott said he was concerned about who would pick up the cost for the 170 to 200 trauma patients a month who currently would rely on King/Drew but would land at private hospitals if the trauma unit does close.

The typical trauma case costs about $250,000, and a large percentage of the hospital’s patients have no insurance, he said. “Something is going to have to be worked out there to make the system work,” Lott said. “This is more stress on an already overstressed system. We just don’t know how this is all going to work out.”

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Times staff writers Andrew Blankstein and Charles Ornstein contributed to this report.