In the emergency department at MLK Community Hospital, masked patients lay on inline stretchers in the hallways.
Others sank into chairs where nurses cared for them. Amid the jostling of people on a recent day in December, only the sickest or most seriously injured were granted one of the 29 rooms.
The rise of influenza, RSV, COVID and other winter viruses has exacerbated overcrowding that existed even before the pandemic, hospital officials said — the result of severe medical care shortages in a low-density neighborhood. income from South Los Angeles where most residents are black or Latino.
Patients present to MLK’s emergency department with minor ailments that they were unable to seek treatment elsewhere, or more serious conditions that became serious in the absence of care to prevent or manage them, a said Dr. Elaine Batchlor, CEO of MLK Community Healthcare.
When it opened seven and a half years ago, MLK’s emergency department was expected to treat 110 patients a day, or about 40,000 patients a year. Last year, more than 400 patients arrived on particularly busy days, for an annual total of more than 112,000 patients.
“We kind of put the patients everywhere we could.”
— Dr. Elaine Batchlor, CEO of MLK Community Healthcare.
Earlier in the pandemic, the crowds in the emergency department had thinned out as some people stayed away. But now, as fears of catching COVID have subsided, the number of people seeking emergency care has risen again, surpassing pre-pandemic levels, Batchlor said.
As Batchlor walked through the emergency department, she pointed to an area filled with chairs and booths. “It used to be the waiting room, but it’s completely transformed into a treatment space,” she said.
In total, MLK cut out over 200 areas for patients to be treated, including the traditional 29 rooms and an unconventional range of seating in chairs, stretchers and tents. Beds occupy what used to be the gift shop. Ambulance bays contain tents for assess and treat the patients.
“We kind of placed patients everywhere we could,” Batchlor said.
Nurses try to keep their voices low when talking to patients seated between partitions in an effort to respect privacy, competing with the sounds of children crying and coughing.
In less than three weeks this winter, the hospital requested 101 times to divert emergency vehicles to other medical facilities because it was full, according to Gwen Driscoll, vice president of strategic communications at MLK Community Healthcare.
Many patients suffer from chronic conditions, such as diabetes and heart disease, that could be managed in a doctor’s office, but “there are not enough doctors and there is not enough access in the community,” Batchlor said.
About 40% of MLK’s emergency visits could have been handled in an outpatient clinic, the hospital estimated.
“You would never see that in areas that have more resources.”
— Dr. Oscar Casillas, Medical Director of MLK Emergency Medicine
Dr. Oscar Casillas, medical director of MLK’s emergency medicine, said a pregnant woman recently needed an ultrasound because the clinic she visited couldn’t provide it. Others have an appointment somewhere else, but not for months, “for something that’s been bothering them for four or five weeks” already, Casillas said.
And some clinics send their patients to the emergency room for routine EKGs to be cleared for surgery, he said.
“You would never see that in areas that have more resources,” Casillas said.
South LA needs 1,400 more physicians, including primary care physicians and specialists, the hospital estimated in a recent report. The area served by MLK has been designated by federal agencies as a “shortage area” of medical professionals.
More than three-quarters of patients in MLK’s emergency department rely on Medi-Cal — California’s Medicaid program — and about 10% are uninsured, according to hospital figures.
Medicaid programs reimburse doctors at lower rates than private insurers, which can “reduce the number of providers who want to participate,” said Nadereh Pourat, associate director of the UCLA Center for Health Policy Research. .
Batchlor argues that these financial incentives are the root of the problems MLK patients face in obtaining day-to-day care. According to a report by the UCLA Center for Health Policy Research, Medi-Cal recipients were more likely than people who buy insurance through their employer to say they have no usual source of care or that a physician would not accept their insurance.
Some patients come to MLK’s emergency department for things as simple as medication refills.
On a rainy Tuesday, Mary Johnson came for pain medication and to help her breathe – a visit she makes every few months, she said.
Johnson said she doesn’t have a primary care physician.
“It’s so difficult right now with all of COVID,” said Johnson, 57, who is unhoused and slept in a car.
Besides, she loves MLK.
“Whatever the problem, they always take care of me,” she said. “And I know they’re going to get me out of here so fast.”
Batchlor said patients with less severe issues “come in and out very quickly.”
“And the way they do that is to see patients wherever they are,” she said – whether in a chair or stretcher or in a tent set up outside.
The crowds in the emergency department show the extreme need of the community, but are also a sign for hospital staff that they are doing things right.
“It’s the success of the work we do here,” said assistant nurse manager Jesse Lynwood. “Let the community show up.”
Batchlor and Casillas are also increasingly concerned about psychiatric patients being brought into the emergency department from outside the south. Los Angeles hospital officials say those patients were dropped off by police departments serving areas as far apart as Santa Monica, Whittier and Huntington Beach.
A report commissioned by Los Angeles County Supervisor Holly Mitchell found that among emergency psychiatric patients transported by emergency medical services, only a small fraction bypassed a closer hospital for MLK. But the report did not include abandonments by law enforcement.
At MLK’s emergency department, two tents have been set up for psychiatric patients. On average, a dozen patients are waiting for a bed or assessment in a short-term involuntary detention known as 5150, assisted by hospital-appointed “sitters” to stay with them for their safety.
The hospital has no psychiatric inpatient beds, so patients stay in the emergency room, often for days, until staff can find them somewhere else to go. The average stay is almost 35 hours for patients out of 5150 taken. A psychiatric patient stayed there for 35 days, hospital officials said.
Amid high demand for its services, MLK’s emergency department is losing tens of millions of dollars a year, says Batchlor, because Medi-Cal reimbursements don’t fully cover the cost of care.
In the last fiscal year, MLK recorded a net loss of nearly $43 million for patient care in the emergency department – a hole that would be deeper if not for the 4% of patients with insurance. private, whose care brought in more than $6 million in profit, according to figures shared by hospital staff.
A state bill that would have bolstered funding for the MLK emergency service passed state lawmakers but was vetoed last year by Gov. Gavin Newsom, who said the money was not included in the budget.
MLK officials said they are again seeking a financial injection from the state this year. During this time, they dip into reserve funds.
“It can only go on for so long,” Driscoll said.
Los Angeles Times