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

March 22, 2011 |  9:51 pm

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.


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