MLK emergency package requiring general care
In the emergency room at MLK Community Hospital, masked patients lay on stretchers in the hallway.
Others sank into chairs where nurses waited. On the last day of December, only the sickest or most seriously injured were given one of the 29 rooms during the human conflict.
The rise of influenza, RSV, COVID and other winter viruses has exacerbated the pre-pandemic overcrowding, hospital officials say, the result of a lack of medical care in a low-density area. Income from South Los Angeles, where the majority of residents are black or Latino.
Patients come to MLK’s emergency department with minor illnesses that cannot be treated elsewhere, or with more serious conditions that cannot be prevented or managed, said Dr. Elaine Batchelor, 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 visited on particularly busy days, bringing the annual total to more than 112,000.
“We accommodated patients anywhere.”
— Dr. Elaine Batchelor, CEO of MLK Community Healthcare.
During the pandemic, the number of people in the emergency department decreased because some people stayed away. But now, as the fear of contracting COVID has subsided, the number of people seeking emergency care is rising again, surpassing pre-pandemic levels, Batchelor said.
Batchelor walked past the emergency department and pointed to an area filled with chairs and cubicles. “It used to be a waiting room, but it’s completely turned into a treatment room,” he said.
In all, MLK carved out more than 200 areas for patients, including 29 traditional rooms and unconventional seating in chairs, stretchers and tents. The beds are located where the gift shop used to be. Emergency shelters have tents assessment and treatment patients.
“We accommodated patients wherever we could,” Batchelor said.
Competing with the sounds of children crying and coughing, nurses try to keep their voices low when talking to patients sitting between wards to respect privacy.
Gwen Driscoll, MLK Community Healthcare’s vice president of strategic communications, said in less than three weeks this winter, the hospital had 101 requests to send ambulances to other medical facilities.
Many patients suffer from chronic conditions like diabetes and heart disease that can be managed in a doctor’s office, but “there aren’t enough doctors and there’s not enough access in the community,” Batchelor said.
The hospital estimates that about 40% of MLK’s urgent care visits could have been made in an outpatient setting.
“You never see that in areas with more resources.”
— Dr. Oscar Casillas, Medical Director of MLK Urgent Care
Dr. Oscar Casillas, medical director of MLK Emergency Medicine, said a pregnant woman recently needed an ultrasound because the clinic she attended could not provide one. Others have appointments elsewhere, but not months, “for something that’s been bothering them for four or five weeks,” Casillas said.
Some clinics send their patients to the emergency room for a routine EKG to clear them up for surgery, he said.
“You never see that in resource-rich areas,” Casillas said.
South L.A. needs 1,400 more doctors, 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” for 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 data.
Medicaid programs reimburse doctors at a lower rate than private insurers, which “may reduce the number of providers willing to participate,” said Nadere Pourat, associate director of UCLA’s Center for Health Policy Research. .
Batchelor says these financial incentives are at the root of the problems MLK patients face in getting routine 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 an employer to say they don’t have a regular source of care or that a doctor doesn’t accept their insurance.
Some patients come to MLK’s emergency department for simple things like medication refills.
On a rainy Tuesday, Mary Johnson came to help with pain management and breathing – she comes every few months, she said.
Johnson said he does not have a primary care physician.
“It’s very difficult right now with all the COVID,” said Johnson, 57, who is homeless and sleeping in a car.
Plus, he loves MLK.
“No matter what the problem is, they always take care of me,” she said. “I know they’ll get me out of here fast.”
Batchelor says that patients with less pain are “in and out very quickly.”
“The way they do it is to see patients wherever they are,” he said — in a chair or on a stretcher or in a tent set up outside.
People in the emergency department represent an urgent need in the community, but are also a sign for hospital staff that they are doing something right.
“It’s the success of what we do here,” said nurse’s aide Jessie Linwood. “Let the community be seen.”
Batchelor and Casillas are more concerned about the influx of psychiatric patients to the emergency department from the South. Los Angeles hospital officials say the patients were dropped off by police departments serving areas as far away as Santa Monica, Whittier and Huntington Beach.
Los Angeles County Supervisor Holly Mitchell ordered that only a small percentage of emergency psychiatric patients transported by emergency medical services bypass the closest hospital to MLK. But the report did not include abandonment by law enforcement agencies.
Two tents have been erected in the MLK emergency room for psychiatric patients. On average, a dozen patients await a bed or assessment in the so-called 5150 short-term involuntary detention, assisted by hospital-appointed “sitters” to stay with them for their safety.
The hospital has no psychiatric inpatient beds, so patients often end up in the emergency room until staff can find somewhere else to go. Average length of stay of 5,150 admitted patients is approximately 35 hours. According to the representatives of the hospital, the psychiatric patient was there for 35 days.
With the high demand for its services, MLK’s emergency department loses tens of millions of dollars a year, Because Medi-Cal reimbursements cover the entire cost of care, Batchlor says.
In the last fiscal year, MLK recorded about $43 million in net costs for care of patients in the emergency department — a hole that would be deeper if not 4% of patients with insurance. private, whose care has generated more than $6 million in profits, according to data shared by hospital officials.
A state bill to boost funding for MLK’s emergency services passed state lawmakers but was vetoed last year by Gov. Gavin Newsom, who said the money wasn’t included in the budget.
MLK officials said they are seeking state funding again this year. During this time, they go into reserve funds.
“It can only go on for so long,” Driscoll said.
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