USC, embattled County hospital tread murky water

Situated two miles away from the heart of Los Angeles, the Los Angeles County and USC County Hospital serves a population of about 1.2 million people by providing different kinds of medical care, from surgery to psychiatry.

USC became involved with the hospital in 1885 by allowing medical students to complete their residency there. According to the LAC+USC County Hospital website, there are currently 1,600 volunteer physicians, 450 staff physicians and more than 900 residents from all over the country, as well as 600 medical students. The hospital serves all kinds of people, from law enforcement officers to typical civilians.

However, despite the state-of-the-art facility and various medical professionals, the hospital faces an underlying problem. Since the mid ’90s, the LAC+USC County Hospital has been struggling with overcrowding and long wait times in the emergency room. On a typical day, the ER has 80 to 100 people waiting an average of 10 hours each.

“It is rare to see the LAC+USC county hospital waiting room not full,” said Roxane Marquez, the senior press deputy to County Supervisor Gloria Molina. “It has been notoriously crowded for decades.”

A debate on the hospital board during the mid ’90s over how many beds should be available in the ER left Molina feeling “disheartened,” because she predicted that the hospital would be crowded from the day it opened, Marquez said.

Although Molina lobbied for 750 beds to be available to ER patients, the hospital board ended up deciding that 600 beds would be enough, based on recommendations from experts. At the time of the decision, around 20 emergency rooms were in operation. Since then, they have all closed down.

“The ER used to be even smaller,” said Walavan Sivakumar, a senior in the USC medical program who is completing his residency at the LAC+USC County Hospital. “A lot of the ERs in the city are not able to function and [are] closing down, so that increases the traffic, especially of those that are uninsured or underinsured and don’t have the flexibility to go to a private hospital. More and more patients are relying completely on the LAC+USC County Hospital.”

Because the hospital is constantly overcrowded, LAC+USC County Hospital has resorted to diverting patients to private hospitals or to Rancho Los Amigos National Rehabilitation Center.

Recently, the board has also been looking into re-opening the Martin Luther King Hospital. A vote on this will take place today.

“Re-opening MLK Hospital will relieve pressure on all the hospitals in the LA area,” said Aurelio Rojas, communications director for Los Angeles County Supervisor Mark Ridley-Thomas. “If the vote passes, the hospital should be up and going by 2013.”

MLK Hospital was closed in 2007 because of poor management. Supervisors did not “have any faith that it could be turned around,” Marquez said. It is currently operating as an urgent care clinic and an outpatient ambulatory care service.

Marquez also mentioned that the new US health policy reform will help by allowing more people to purchase health insurance, which will give them more opportunity to receive treatment from other hospitals.

Because of the long wait hours, many patients end up leaving the ER because they cannot afford to wait for that long. LAC+USC County Hospital has implemented a protocol that transfers patients to other hospitals once they have been waiting for 11 hours.

“Nobody wants to see people waiting in the ER for a ridiculous amount of hours,” Marquez said. “It was instrumental not only to bring them a first-class hospital with regards to amenities — the quality of bed, instruments, etc. — but to do something about the wait time.”

Fred Leaf, senior health policy advisor to Los Angeles County Supervisor Mike Antonovich, said that the hospital is crowded because of its popularity.

“LAC+USC County Hospital is relied on by the public and the law enforcement,” Leaf said. “It’s a high demand hospital with a trauma center, and those are some reasons why it’s overcrowded.”

Leaf said LAC-USC County Hospital needs to consider what actions could be taken internally, by realizing what kinds of deficiencies are present, assessing the seasonal nature of the overcrowding and better managing its discharges.

However, this problem is not unlike other hospitals in the nation, said Dr. Philip Lumb, president of the Attending Staff Association of LAC+USC County Hospital.

“It’s unfortunate to have waits,” Lumb said. “But they are reasonably well taken care of and indeed the emergency department is one of the leaders in the nation in the pursuit of developing the algorithms to minimize wait.”

Officials credit the more recent influx of patients to the flu season and also the H1N1 virus. Marquez agreed the swell in numbers was expected because “the colder it gets, the sicker people get.”

Lumb said the hospital is an asset to USC because it shows the care USC has for the community around it, but that USC would not take any action in altering hospital policy.

“[USC] would probably not wish to be too involved with hospital policy because that’s not their level of expertise,” Lumb said. “The policies that a hospital develops to take care of patients, to support its administrative functions, to support its community function, really are all in compliance with state and federal regulations … and also county regulations.”

However, Marquez said she still thinks it is a shame that more patients aren’t treated in the facility.

“It’s like a flawless diamond ring that is too small for your hand,” Marquez said.