Hospital May Close Its ER

[CAL/AAEM News Service]

Hospital May Close Its ER

Downey facility says care of uninsured is too costly. Closure would be a blow to the
county's strained system.

Source: Los Angeles Times, by Jack Leonard, Times Staff Writer 
http://www.latimes.com/news/local/la-me-downey3aug03,1,538109.story?coll=la-headlines-california

Date: August 3, 2005


Downey Regional Medical Center has told Los Angeles County officials it might close its
emergency room, threatening to become the 10th hospital to cut those services since 2003
as they struggle with the cost of treating the uninsured.

If the medical center follows through, it would be the largest emergency room to close in
recent years, further straining the county's already overstretched emergency medical
system. 
 
The county has lost emergency rooms that treated nearly 136,000 patients a year, but
state figures show that the Downey facility alone saw 46,307 emergency patients last
year.

If the hospital closes, already crowded hospitals in Whittier and Bellflower would have
to absorb those patients, county officials said.

"It's going to be horrible," said Carol Meyer, the county's head of emergency services.
"Our emergency system is falling apart."

On Tuesday, the private nonprofit hospital appealed to the county Board of Supervisors
for financial aid to help cover the cost of treating poor patients. But supervisors
rejected the idea and expressed concern that paying Downey could lead to a run of other
hospitals looking for help. The county is facing its own financial crisis in healthcare,
stemming from the cost of treating the uninsured. The Department of Health Services is
expected to plunge into the red by nearly $1 billion in three years. 

"I don't know how you could ask us to subsidize a private nonprofit," Supervisor Gloria
Molina said. "Every single hospital would line up, because they have the same situation
as you do."

A closure or significant reduction in emergency services at the 199-bed center could be
catastrophic for some patients, said Dr. Jack Kennis, associate director of the
hospital's emergency care center.

Two weeks ago, he said, an ambulance brought in a 6-year-old boy who had choked on a hot
dog. His heart and breathing had stopped, but doctors and nurses were able to resuscitate
him because he had arrived quickly, Kennis said.

"If this facility were not here, the patient might have died," he said.

The issue facing the hospital is one that has hit private medical centers throughout the
region as jammed public hospitals turn patients away. A recent study commissioned by the
Hospital Assn. of Southern California found that the number of uninsured patients
visiting the county's private emergency rooms has risen by a third in the last five
years. About 2.25 million residents lack health insurance in the county, which has one of
the highest percentages of uninsured of any major U.S. metropolitan region. Most are
employed but work at jobs that do not provide health insurance. Illegal immigrants
account for about 20%.

Emergency rooms are often hit hardest because more of those patients don't have insurance
and because they are generally sicker and need longer treatment, often being moved to
other areas of the hospital for follow-up care.

Downey Regional lost between $7 million and $11 million last year because of its
emergency room services, said Robert Fuller, the hospital's chief operating officer. In
the last five years, the independent nonprofit hospital has eaten up a surplus of $60
million, with half going to treat the uninsured, he said.

Fuller blamed the county's 2002 decision to cut costs by shutting several nearby clinics,
leading many uninsured patients to turn to Downey for emergency care.

In addition, the hospital has had to treat emergency patients diverted from the county's
troubled Martin Luther King Jr./Drew Medical Center in Willowbrook, he said. Downey is
just minutes away via the Century Freeway. 

"The county has solved its problems on our backs," Fuller said.

The hospital, which has been looking at closing or downgrading its emergency room for a
year, is also reviewing other options, such as stop taking patients brought by ambulance
from outside Downey's city limits.

The hospital has also appealed to the state to raise its reimbursement payments for
treating the indigent. State officials are expected to announce a decision within the
next few weeks. Without the increased funding, a closure or downsizing of the emergency
room looks likely, said hospital President Allen Korneff. "It's a very serious, real
threat," he said.

Korneff begged the supervisors Tuesday to approve a financial aid package that would have
provided up to $900,000 to the Downey hospital for treatment of indigent patients who
live near King/Drew.

That proposal was part of a $14.7-million spending plan for county trauma and emergency
services that would also have bought new equipment for paramedics to detect heart attacks
sooner and provide incentives for hospitals to open new trauma centers. 

The plan, recommended by county health officials, relied upon a property tax hike of a
quarter-cent for every improved square foot of property — or $3.75 for a
1,500-square-foot home. Under Measure B, approved by county voters in 2002, supervisors
can raise the property taxes allocated for trauma care each year as much as inflation for
medical services. 

But supervisors rejected the plan, citing the $20.8 million the county's health
department has set aside for trauma and emergency care. In addition, they said an
increase would hit taxpayers at a time when property values are skyrocketing, seriously
affecting the property taxes already being paid by recent home buyers.

"I just can't explain to my neighbor, or quite frankly to my wife, why we're raising the
tax when we have a $20-million surplus," said Supervisor Zev Yaroslavsky.

Supervisor Yvonne Brathwaite Burke noted that Downey Regional's emergency room visits
actually declined last year, from more than 53,000 emergency patients in 2003.

Hospital officials replied that ambulance drop-offs have increased, resulting in the need
to treat sicker patients longer. 

The average stay for emergency patients, they said, has also gone from two hours to four
or five hours.

--------------------------------------------------------------------------------

Times staff writer Charles Ornstein contributed to this report.



Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/


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