Hospitals Dread Possible Effects of Closing King/Drew Trauma Center

Six patients a day. That’s how many people, on average, in need of lifesaving care will need to find other hospitals if Martin Luther King Jr./Drew Medical Center’s trauma unit closes as proposed in the coming months.

It might not sound like a crisis. But some healthcare officials fear it will be.

King/Drew, the second most-used trauma center in Los Angeles County, saw about 2,150 trauma patients last year. With the county now planning to close the unit, neighboring hospitals will have to pick up the slack.

The added patient load would increase the number of trauma cases these hospitals handle by as much as 50%. Each patient often requires the attention of more than a dozen doctors, nurses and other professionals, and the average cost of one trauma case is $250,000, according to the Hospital Assn. of Southern California. Half of these patients are uninsured. Moreover, the trauma unit at county-owned King/Drew has more experience dealing with gunshot wounds than surrounding hospitals.

“To take on another five to six trauma patients a day -- that’s huge,” said Byron Schweigert, chief executive at Long Beach Memorial Medical Center. “It will probably be sporadic -- two or three on weekdays and 12 on weekends. But that’s far beyond what we deal with.”

The county plans now to distribute many of the patients to Harbor-UCLA Medical Center and St. Francis Medical Center in Lynwood. Officials said they are counting on California Hospital Medical Center downtown to pick up some of the load.

“Our first choice is to have California come in and be at the north end and basically distribute among the three,” said John Wallace, spokesman for the county health department. If that doesn’t work out, the county will have to redraw its map of where to send patients who have been in accidents or been shot.

A spokeswoman at California Hospital Medical Center said the hospital is still talking to county officials about the possible shift and expects to decide by early November.

Schweigert worries that a significant portion of trauma patients might find St. Francis full and head down the Long Beach Freeway to his hospital.

The concern comes after county supervisors announced that the trauma center may close as part of an effort to reduce stress on the hospital, which has been buffeted by months of criticism from regulators for the way it cares for patients.

Just this week, a national hospital accrediting group began the process of revoking its seal of approval from the hospital. County officials say the threat of just that was a factor in their decision to recommend shutting the trauma unit.

Because trauma patients sometimes take priority over regular emergency room patients, others without life-threatening injuries may wait much longer, health officials said. The long waits could force ambulances to try to find other hospitals as they wait for beds to free up.

Hospitals are also worried that members of the public who do not know the distinction between an emergency room and a trauma center will flood local hospitals, thinking that King/Drew cannot treat such things as chest pains. King/Drew, located in Willowbrook, plans to keep its emergency room open, a facility that served 45,000 patients last year.

Emergency rooms treat serious illnesses like heart attacks and infections. But they leave those with more immediately life-threatening injuries from such things as gunshots and car accidents to trauma centers. For example, county guidelines for paramedics and first responders say that people who are shot in the head, chest or back qualify for trauma, while those shot in the arm or leg should go to an emergency room.

St. Francis, the busiest private trauma center in the county, saw about 1,500 trauma victims last year.

“We could see a few hundred more” if King/Drew closes, said Daniel Higgins, an emergency room physician and head of the county medical association. “But one of the problems is not just having a trauma center, but having a surgeon there and a blood bank ready to go and an ER doctor and an in-house operating room and an ICU and enough beds to put people in after the operation.”

Higgins’ colleague, the emergency room’s co-director Mark S. Louden, also worried about the kinds of traumas St. Francis will see once King/Drew closes.

Only 27% of the trauma cases that came into St. Francis last year were “penetrating trauma,” such as gunshot or stab wounds, and 73% involved “blunt trauma,” such as falls, according to county data. But 45% of King/Drew’s trauma cases -- 964 last year -- involved penetrating trauma, which means that St. Francis doctors will have to work on a different kind of injury than they are used to.

Carol Lee Thorpe, vice president for community services at St. Francis, said the hospital is willing to help the county take on the King/Drew load but shared Higgins’ concerns about inadequate staffing and about how the extra patients will affect the quality of service the hospital provides.

Louden is also worried that increasing the number of trauma patients when the hospital already needs more nurses, operating rooms and equipment such as CT scanners could spell disaster.

“I love to take care of sick people, but I hate doing it badly,” said Louden. “If we don’t have enough resources, people are going to suffer.”

Even though only 2% to 3% of the patients admitted to Harbor-UCLA’s emergency department require trauma care, a hospital has to expend many more resources to care for them. Sometimes up to 12 people -- including nurses, surgeons, anesthesiologists, respiratory therapists and X-ray technicians -- will cluster around a trauma patient. Typical emergency room cases involve two to three people. Trauma patients may also require longer stays in the more expensive intensive care units.

Gail Anderson Jr., medical director at Harbor-UCLA Medical Center near Torrance, isn’t sure how many more patients his hospital would have to handle, but he said, “If we take three, four, 500 more, we’re going to need significant help with anesthesia, nursing, surgeons, blood banking.”

And it’s unclear, some experts said, where the money will come from.

“There is physical capacity among the remaining trauma centers,” said Jim Lott, a spokesman for the Hospital Assn. of Southern California. What there isn’t is enough funding, he said.

The county, Lott said, needs to put more money into funding for private hospitals that take care of uninsured trauma patients. Right now, there is little incentive to treat trauma, he said.

Indeed, about 10 medical centers have dropped out of the countywide trauma network since the 1980s, said the medical association’s Higgins. Only 13 now serve the entire county. Two years ago, Los Angeles County voters approved Measure B, which increased property taxes to provide $150 million a year for the trauma system. But critics dismissed it as a Band-Aid solution to a much larger problem.

Higgins backs Proposition 67 on the November ballot, which would help raise money for emergency services though a phone surcharge. Higgins believes it would improve trauma care by supplementing the wages of on-call doctors who treat the uninsured. Opponents say the surcharge will be too costly to consumers.

By cutting back on the number of critically ill patients coming to King/Drew, county supervisors said their overall goal is to save the rest of the hospital.

Although running a trauma unit is costly, county officials say cost did not factor into their decision. In fact, they said, it might cost the county more to pay private hospitals to treat patients who would have been sent to King/Drew.

Even so, criticism from politicians continues to mount. U.S. Reps. Juanita Millender-McDonald (D-Carson) and Diane Watson (D-Los Angeles) held a press conference at the hospital Friday to urge county supervisors to change their minds.

Millender-McDonald told the crowd that she has written Tommy G. Thompson, secretary of Health and Human Services, and requested federal aid to prevent the closure of King/Drew’s trauma unit and help with averting the loss of its accreditation. “If Tommy Thompson drags his feet, I’ll have to go to George W. Bush,” she said.

While county officials said they will try to shield the biggest trauma center, County-USC Medical Center, from an influx of trauma patients, at least one physician there was still worried. That hospital handled 4,567 trauma cases in 2003.

“We can’t afford one more patient,” said Peter Gruen, chief of staff at County-USC and a representative on the county’s trauma hospital advisory committee. “We’re having difficulty taking care of the people we’ve got now.”

Gruen likened the scene in the trauma unit now to Scarlett O’Hara’s encounter with a room full of injured Confederate soldiers in the movie “Gone With the Wind.”

“She is stepping over patients. People are moaning and groaning and bleeding. But there are people moaning, groaning, bleeding and dying. It’s a very, very difficult environment to work in and it’s going to get worse.”

Times staff writer Steve Hymon contributed to this report.