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No end in sight for overcrowding at L.A. County public hospitals, new chief says

The new chief of Los Angeles County’s public hospital system said Tuesday that overcrowding is worsening at County-USC and Harbor-UCLA medical centers –- a situation he is concerned will continue to deteriorate even after the federal healthcare reform law is implemented in 2014.

The comments by Dr. Mitchell H. Katz represent a sharp change in tone by the Department of Health Services, which operates the county’s four public hospitals. Previously, Carol Meyer, the recently-retired chief network officer, had indicated officials believed that overcrowding would diminish after 2014 because newly insured patients, once offered a choice, could opt to seek care at a private facility.

But new research from Massachusetts indicates that public hospitals that serve as the safety net for the poor actually saw more crowding once that state required near-universal health insurance in 2006, Katz said.

“I don’t think that this problem is going to get better on its own anytime soon,” Katz told the Board of Supervisors at Tuesday’s meeting.

“The Massachusetts experience has been that as people got a form of health insurance, their utilization actually increased. So that the safety net providers in Massachusetts are actually seeing more patients now than they used to see,” Katz said.

Katz’s statement came as new data shows that overcrowding at County-USC, the county’s flagship public hospital northeast of downtown, is worsening again after a brief improvement late last year. In February, the wait was 12 hours and 11 minutes, up from 10 hours and 34 minutes in December.

On Tuesday, Supervisor Gloria Molina said the county is now paying the price for a decision to build the new facility with 224 fewer beds than were available in the original building. Molina, the sole dissenting vote against building a smaller replacement facility of 600 beds, said the county since has had to pay private hospitals to take care for patients.

Calling the hospital "very dangerously overcrowded,” Molina said she didn’t know whether her colleagues on the board who voted for the smaller hospital –- Zev Yaroslavsky, Don Knabe or Michael D. Antonovich -– were ready to acknowledge that more beds are needed at County-USC.

“You have to admit your mistake,” Molina said. “I don’t know if they’ll be willing to accept it.”

In the short term, Katz said the hospital is working to divert some emergency room patients who are not critically ill to be evaluated at an outpatient diagnostic area. The hospital is also seeking to accelerate discharges of mentally ill and substance abuse patients who no longer need acute care.

Katz said he would also like to transfer patients who are using hospital beds at $1,100 a day, when appropriate, to substance-abuse centers, which cost $90 a day, or boarding care centers, which cost $15 a day.

Katz also warned against relying on the current strategy of transferring county patients to private facilities, whose care the county must still pay for, according to state law. Katz said that when those transfers happen, the county loses money from the federal government.

In an interview after his remarks to the board, Katz said he plans to focus on the short-term solutions to overcrowding for now. But if those solutions fall short over the next four to five months, “then I think we’re going to have to look at building more beds,” Katz said.


County-USC's emergency room deemed 'dangerously overcrowded'

'Dangerously' overcrowded conditions persist at L.A. County-USC Medical Center's emergency room

New L.A. County health services chief reports for duty, says he's ready for challenges

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

Comments () | Archives (8)

When my husband and I planned for an early retirement we were both in our 50's. Not only were we retiring, but we were moving to Nashville, TN. Since we resigned from our jobs, we knew we would have to buy health insurance and dental insurance in Tennessee. We purchased a PPO family plan, for just my husband and me, through "Wise Medical Insurance" . We paid for the family plan ourselves, initially, the cost was a little less than $400 a month for both of us. Our co-pay was very reasonable at $25 each per office visit.

Back when the re-build of County-USC was being bantered about, those of us who worked out of the ER couldn't believe the thought of down-sizing was being entertained. The ER closures, diversions and wait times were bad then because of lack of beds, now it's incredibly worse. Cut your losses and build another facility, planning for even more beds. If you don't have to open a floor, plenty good. But it's there if it's needed...

Another idiotic short-sighted committee. The one thing Los Angeles has a prolific industry in. They had data from the MA hospitals and a staggering statistic of a population doubling in ten years, much of that attributed to the poor. In addition, this city is prone to natural disasters on a grand scale. What if we have a massive quake?

I was recently at USC County Hospital in Los Angeles. It's incredibly crowded. I was there for 7 hours. I have no health insurance but I am employed, so I paid for my treatment. I saw virtually no one go to the payment window during my long wait. I assumed everyone declared themselves indigent so they wouldn't have to pay the low rates, yet many had cell phones, decent clothes and lots of children. No one spoke English and most I would assume were Mexican citizens, which really irritated me. Papi is out raking in tax free money and mom is doing the same while I have to pay. It's not fair.

Newport, I've used LAC/USC almost all my life, paid or received free care base on my income level at the time. I would also like to point out they provided me with outstanding medical care.

Your race based remarks, which you know they are, are based solely on your twisted opinions. I'm sure there were also quite a few white and asians using LAC/USC services when you were there, which you so conveniently failed to mention.

I'm now in Colorado Springs, they have a similar service called Peak Vista, for which there is now a 8 month waiting period to enroll, and there are just as many whites as there are people of color using the service, and the numbers are increasing due primarily to the insane cost of health insurance, loss of jobs and stagnant wages.

And for all of you whining about the wait at LAC/USC, when you look at the alternative, you have nothing to complain about, and everything to be thankful for.

There are quite a few closed hospitals that the county could take over and refurbish for a fraction of the cost of building new hospital facilities.

There are even more sections of the county that could use a few clinics.

Building a bigger hospital isn't going to solve the real problem. The issue is that people are using it as a first line of treatment for medical problems that have been with them for years.
The county could spend far fewer dollars on setting up more neighborhood clinics THROUGHOUT Los Angeles County. They could even pay to staff them, cover malpractice, and provide primary care, heading off issues before they require hospitalization.
There's no doubt that one of the big problems are the growing number of uninsured from all socio-economic groups. The clinics would have to operate on a sliding scale, but still --this is far better than investing the tens of millions in building a larger hospital.

It is always expected that public hospitals have more patients and overcrowding is cannot be avoided. So if you have enough money, don't hesitate to go to private hospitals. In fact they have more facilities and render more quality and efficient services.


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