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Overcrowding rises again at County-USC Medical Center

September 28, 2010 |  6:04 pm

Dangerous levels of emergency room overcrowding jumped again at Los Angeles County’s flagship public hospital during August, officials said Tuesday.

Conditions in Los Angeles County-USC Medical Center’s emergency room were overcrowded for about 98% of the month, according to a report presented to the supervisors Tuesday. Especially troubling was the near doubling of time the hospital faced “dangerous overcrowding,” from about 34% in July to about 65% in August.

Wait time in the emergency room also rose. In August, adults waited an average of 12 hours and 29 minutes from the time they were triaged until they were either admitted to the hospital or discharged, up from a wait time of 11 hours and 11 minutes during the month of July.

Los Angeles County Supervisor Gloria Molina expressed intense dissatisfaction at the conditions at County-USC, which is located in her district. She also criticized county officials' handling of the situation.

“One of the biggest dangers is to take a state-of-the-art hospital that we have and look for every nook and cranny to shove a patient into,” Molina said. “These are not temporary overcrowding situations. It’s an escalation that keeps moving."

“The option is very clear. We contract out for more beds. I know we’re going to pay the price for it. Or we start doing some real planning about how we’re going to adjust this hospital,” Molina said. “But it can’t be shoving people into different little corners here and there.”

Overcrowding at County-USC got so bad in recent months that federal officials at one point threatened to revoke Medicare funding because of an overcrowding-related issue.

Carol Meyer, chief network officer for the county Department of Health Services, which runs County-USC, said the hospital has taken many steps to relieve the overcrowding. But patient demand has increased as the hospital gave up 27% of its beds in 2008 when it moved to an earthquake-resilient building.

Meyer said the hospital has transferred some physicians and nurse practitioners from the back of the emergency room to the front, meaning that patients just entering the hospital are getting medical screening examinations quicker, from a median time of 4 hours in early August to a median time of 1 hour, 15 minutes by the end of the month.

But that change has drained away staff from the emergency room area where patients are treated, resulting in longer delays there, Meyer said. In addition, because patients are seeing a nurse practitioner or doctor earlier at the emergency room, they’re less likely to be discouraged by the long wait and to leave before seeing a doctor.

“People aren’t leaving –- a doctor has touched them,” Meyer said. “It’s less discouraging” for the patients.

In effect, the hospital has pushed the bottleneck in the emergency room further along.

“It’s like a big balloon. You fix one end, and it pops out at the other end,” Meyer said.

Meyer said officials are moving toward hiring more temporary and eventually permanent staff to keep the emergency room flowing. Efforts are also underway to pay even more private hospitals to care for uninsured patients that arrive at County-USC.

California law requires that county governments provide care for the poor and indigent.

Uninsured poor people who don’t qualify for existing federal or state government insurance programs often head to public hospitals. The county has a program that offers care to patients at a free or discounted rate, depending on their ability to pay.

-- Rong-Gong Lin II at the Los Angeles County Hall of Administration

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