The emergency room of Providence Holy Cross Medical Center has been gripped in chaos on more than one occasion. With few beds available and long waits for care, trauma patients have even had to be treated on gurneys in hallways. Why? Because of hospital closures, Southern California is on the brink of a healthcare crisis, industry insiders say. “We have a very serious situation in Los Angeles County,” Jim Lott, executive vice president of the Hospital Association of Southern California, said. “If you consider hospital care, 10 hospital E.R.s (emergency rooms) have closed in the last five years.” Providence Holy Cross has been particularly placed under stress, as two nearby health care facilities within a six-mile radius of its Mission Hills base , Northridge Hospital Medical Center – Sherman Way Campus and Granada Hills Community Hospital , have closed. This has contributed to a loss of 446 patient beds in the area, estimate Holy Cross officials. On average, the hospital operates at 97 percent bed capacity. And, on occasion, the hospital has exceeded its bed capacity by as much as 10 percent. Adding to the problem is the fact that, as hospitals close, demand for care has increased by 29 percent, Lott said. This has lengthened the time it takes for ambulances to arrive at scenes of emergencies. At an average of 11 minutes, Los Angeles County response times were once the best in the nation. Now, it takes an average of 23 minutes for ambulances to arrive on scene, twice the amount of time it took when the county topped the nation in this area, according to Lott. “Unless there’s some changes in infrastructure in finance, one or two more medium hospitals could close,” Lott predicted. “That could thrust E.M.S. (Emergency Medical Services) into a crisis. The whole system gets affected. Even if it occurs in downtown Los Angeles, it could affect the Valley.” The fact that people are living longer and needing more medical care in their older years will only tax a strained system further, said Dr. James V. Luck, CEO and medical director of Orthopedic Hospital in downtown Los Angeles. “I think there may be an approaching crisis,” Luck said. “I wouldn’t go so far to say that that very crisis exists today, but we’re clearly heading in that direction. If something isn’t done, it may reach crisis level.” What’s responsible? So, what’s responsible for the hospital closures? “It certainly isn’t the case that we’re not spending enough money on healthcare,” said John R. Graham, director of health care studies at the Pacific Research Institute. Graham, along with Lott, participated on a panel about health care reform at the Valley Industry & Commerce Association’s 19th annual Business Forecast Conference Nov. 8. Graham cited the number of people who turn up at hospital emergency rooms without paying as contributing to the problem. He said that the uninsured aren’t the only ones to blame for this, as about half of patients who request emergency room care and fail to pay for services actually have insurance. However, one out of every three patients who show up to emergency rooms is uninsured, according to Lott, and hospitals are absorbing 95 percent of the costs of treating them, he continued. “Reimbursement for inpatient care is a crucial component in this whole story for the near term,” Luck said. “We need to be sure that hospitals get adequate reimbursement in order to cover their costs. The reason so many hospitals have closed is because the cost of operating a hospital is greater than the reimbursement that most insurance companies pay, including what government programs will pay.” Lott, for one, believes that the government will have to begin footing the expenses hospitals pay for treating the uninsured or risk a crisis situation. The state-mandated seismic repairs that hospitals have been ordered to make following the Northridge Earthquake factor into the problem as well, Lott said. In the Valley, this issue is playing out most prominently at Encino-Tarzana Regional Medical Center, which is locked in a battle with its Real Estate Investment Trust as to whether Tenet, which owns the hospital, or the REIT , Long Beach-based HPC Inc. , is responsible for making millions of dollars in such repairs. It is arguably more feasible for the hospital to close, which would add to the strain Holy Cross and other regional hospitals are under. Whether more beds is the solution to the problem is not for certain, Luck believes. “I think there are quite a large number of factors, some of which favor the need for hospital beds and some of which indicate we may not need as many hospital beds,” he said. Outpatient care This is because, at present, technology has made it possible for a vast number of patients to be treated without needing inpatient care. “Biomedical research is coming of age,” he said. “For decades, we’ve done the background work to give us the tools to help us understand human physiology at the cellular level. That is going to lead to major breakthroughs in the treatment of disease. It’s not going to happen overnight. However, major breakthroughs will occur much more frequently.” Luck isn’t alone in his thinking. While many Valley hospitals are expanding, they are not necessarily adding more inpatient beds in the process. Overall, he thinks that if advancements are made in the way disease is treated, the number of patients who visit hospitals will decline. “We do and will have a short term problem, but I think, long term, research and technology will help us greatly,” he said. “Quite a few hospitals have closed. It is going to probably be challenging. For a period of time, an awful lot will depend on what happens in technology.”
