No Harm Seen in King/Drew Unit’s Closure

In the two months since Martin Luther King Jr./Drew Medical Center shut its trauma unit, there have been no deaths or cases of serious harm that have clearly resulted from the closure, paramedics, hospitals and county health officials say.

Dr. Marc Eckstein, medical director of the Los Angeles City Fire Department, said paramedics would be quick to raise the alarm if patients were dying.

“If they have a patient they felt was salvageable, their emotions become very vocal, and we’d hear about it. I have not heard of it,” Eckstein said.

The Rev. Frederick O. Murph, senior minister at Brookins Community AME Church, warned last fall that the city’s black communities would “explode” if the trauma center were closed. Now he says not enough time has elapsed to know for sure whether the closure has harmed patients.

“It’s only been two months,” he said. “As time goes on, I think you’re going to hear about lawsuits from families that have lost loved ones due to the amount of time it took to get them there.”

Murph was one of many who predicted disaster before the county Board of Supervisors voted in November to close the trauma center. Before the closure was completed March 1, the unit served about 1,800 patients a year in the part of the county with the highest rates of shootings and homicides.

During heated debate last fall, community members, politicians, Los Angeles Fire Chief William Bamattre and some medical professionals warned that the county’s fragile trauma network would collapse and patients would die because of longer transport times.

Officials now cite two main reasons those dire predictions apparently have not come true: Neighboring hospitals have filled the need for trauma care, and trauma is down citywide, although not in the areas surrounding King/Drew.

The number of trauma cases typically increases substantially during summer, when people drive more, children are out of school and tempers rise with the temperature, health officials said. They warn that a final verdict on the trauma system won’t be available until the summer months are past.

“We may have a false sense of security to say the system can handle it,” Eckstein said.

“Right now it’s working, but trauma is down and it’s a seasonal lull,” he added.

Closing the King/Drew trauma center has meant that some patients spend more time in the ambulance going to an emergency room.

But because California Hospital Medical Center, just south of downtown Los Angeles, opened a trauma center in December, other patients now have a shorter ride.

Those who used to go to King/Drew’s trauma center now go to California Hospital or the St. Francis or Harbor-UCLA medical centers, which all received additional county money.

In March of last year, 142 trauma patients were treated by King/Drew’s trauma unit. County officials said that since the closure this March, 13 patients with major injuries have been dropped off at the hospital -- most by family or friends -- and were treated at King/Drew’s emergency room, which remains open. California Hospital’s trauma unit saw 164 trauma patients in March, only some of whom would have gone to King/Drew.

Comprehensive data on how the closure has changed the time spent transporting patients to hospitals will not be available for several months.

Preliminary figures from paramedics and hospital officials suggest that transport times in some areas have grown by 10 to 15 minutes.

Even with those increases, trauma patients in South Los Angeles are arriving well within the half-hour drive time required by county policies, said Carol Meyer, director of the county’s Emergency Medical Services Agency.

In parts of Los Angeles County with no trauma centers -- including the Antelope Valley, Malibu and the San Gabriel Valley -- patients routinely do not get to a hospital as fast.

Compton is one area where travel times clearly have increased since King/Drew’s trauma center was closed.

“If we’re on the extreme north end of town, it was four minutes to get to King/Drew,” said Deputy Chief Jon Thompson of the Compton Fire Department, which runs the city’s ambulances. “Now those patients have to go to Harbor, which takes 15 to 17 minutes now, without traffic.”

Compton officials said the average travel time in trauma cases has increased from five minutes in March and April of last year to 9.5 minutes this year. Thompson said he was not aware of any cases in which the additional time had made a significant difference for patients but said it had caused nerve-racking rides for his paramedics, who are trained to believe that every second counts.

Darnell Johnson, a paramedic at the Compton Fire Department’s Station 13, recalled picking up a man last month who had been shot in the head near Alondra Boulevard and Nestor Avenue. What would have been a five-minute drive on city streets to King/Drew was now a 12-minute trip on the Harbor Freeway to Harbor-UCLA Medical Center near Torrance, Johnson said.

En route, the man lost his pulse and his heart stopped. Johnson said doctors later told him the patient died.

“I remember being in the back, thinking, if we were going to Drew, we would have been there,” Johnson said. “He’s probably going to die anyway, but who knows? Maybe he would have made it.”

Several doctors said that although that conclusion is tempting, it is rarely the case.

“A few minutes one way or another almost never has an outcome impact,” said Dr. Bruce Stabile, chairman of the department of surgery of Harbor-UCLA. The hospital has coped well with a nearly 13% increase in trauma patients compared with last year, he said.

Eckstein, similarly, said that “at the end of the day, there’s a fairly small percentage of trauma patients for who 10 minutes is really going to make a critical difference.”

But it is that small percentage that concerns many who opposed the closure.

“I think it’s way too early to make the assessment that everything is fine,” said Los Angeles Councilwoman Janice Hahn, who last fall had predicted that “people would lose their lives” from the closure. “While we may have not seen any major catastrophes, I believe it’s only a matter of time until a major disaster results in someone’s death.”

Some African American leaders also question the closure.

Murph said that for many blacks in South Los Angeles, including himself, opening a trauma center at California Hospital and closing King/Drew’s looked like taking services from the black community and giving them to a largely Latino one.

“It’s almost as if someone is saying African Americans are no longer a viable part of the community, and we’re going to shift resources to other communities,” Murph said.

King/Drew actually serves more Latino patients than African Americans, hospital officials said. Blacks make up almost 30% of the patients at California Hospital.

Still, Murph said, questions persist.

“Given the fact that there is a high incidence of cases in the Watts-Willowbrook area, why would you shift the center to another area? What is the rationale?”

County health department chief Dr. Thomas Garthwaite and members of the Board of Supervisors said when they decided to close the trauma center that the reason was to “decompress” the troubled hospital. By reducing the number of acutely ill patients, who require intensive nursing and medical attention, hospital officials could free resources to improve King/Drew’s many serious problems, they said.

Repeated lapses in medical care have led to several deaths of patients at the hospital. In February, the facility lost its accreditation from a national healthcare agency. It will have to restore its accreditation before the trauma unit can reopen.

Dr. Roger Peeks, medical director at King/Drew, said closing the trauma center has helped the hospital’s overall situation: “There’s not as many people, and they don’t have to wait as long.”

Officials of Navigant, the firm hired to manage King/Drew through its crisis, agreed.

“It’s been quite helpful in achieving our improvement,” said Kae Robertson, managing director of Navigant. “It’s allowed us to fix basic processes, do training and recruit full-time staff.”

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Closing the gap in trauma care

Since the closure of King/Drew’s trauma unit on March 1, neighboring hospitals have extended the areas for which they are responsible.

Trauma cases treated

*--* March 2004 March 2005 King/Drew Medical Center 142 13* California Hospital Medical Center 0 164 Harbor-UCLA Medical Center 189 213 St. Francis Medical Center 95 132 Totals 426 522

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*Since the closure, 13 trauma patients have been dropped off at King/Drew’s emergency room.

Source: Los Angeles County Department of Health Services