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The MLK Emergency Department requires routine care

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In the emergency room at MLK Community Hospital, masked patients lay on wheeled stretchers lining the hallways.

Others sank into chairs where nurses attended to them. In the crowd of people on the last day of December, only the sickest or most injured got one of the 29 rooms.

The rise of flu, RSV, COVID and other winter viruses has exacerbated overcrowding that existed before the pandemic, hospital officials said, the result of a severe shortage of care in a low-income South Los Angeles neighborhood where the majority of residents are black or Latino.

Latoya Hawkins and her 4-month-old daughter, Royal Collier, are in the emergency room at MLK Community Hospital.

(Francine Orr/Los Angeles Times)

Patients come to MLK’s emergency room with minor illnesses that they couldn’t treat elsewhere, or with more serious illnesses that have become dire because of a lack of care to prevent or manage them, said Dr. Elaine Butclore, executive director MLK Community Health Care.

When it opened seven and a half years ago, the MLK emergency room was expected to see 110 patients a day, or about 40,000 patients annually. Last year, more than 400 patients were admitted on particularly busy days, and more than 112,000 patients were admitted in just one year.

“We kind of accommodate patients wherever we can.”

— Dr. Elaine Butclor, Executive Director of MLK Community Healthcare.

Earlier during the pandemic, emergency room crowds had dissipated as some people stayed away. But now that the fear of catching COVID has subsided, the number of people seeking emergency room care has risen again, surpassing pre-pandemic levels, Bathchlor said.

As Bathchlor walked through the emergency room, she gestured to an area full of chairs and cubicles. “It used to be a waiting room, but it’s been completely converted into a treatment room,” she said.

A man is lying on a stretcher in a hospital

Ruby Harvey was taken to the emergency room with COVID-19 pneumonia.

(Francine Orr/Los Angeles Times)

In total, MLK set aside more than 200 areas for patient treatment, including 29 traditional rooms and an unconventional array of seating in chairs, gurneys, and under tents. The beds occupy what was once a gift shop. Ambulance bays contain tents for assessment and treatment sick people.

“We kind of accommodated patients wherever we could,” Butclor said.

Nurses try to keep their voices low when talking to patients sitting between partitions to respect privacy, competing with children’s cries and coughs.

According to Gwen Driscoll, vice president of strategic communications at MLK Community Healthcare, in less than three weeks this winter, the hospital had 101 requests to divert ambulances to other medical facilities because they were full.

Paramedics push stretchers near parked ambulances

Ambulances line up outside MLK Community Hospital.

(Francine Orr/Los Angeles Times)

Many patients have chronic conditions — such as diabetes and heart disease — that can be treated in a doctor’s office, but “there aren’t enough doctors and there isn’t enough access in the community,” Bathchlor said.

The hospital estimates that about 40% of MLK’s emergency visits could be handled in the outpatient clinic.

“You’ll never see that in areas that have more resources.”

— Dr. Oscar Casillas, MLK Medical Director of Emergency Medicine

Dr. Oscar Casillas, medical director of MLK’s emergency department, said a pregnant woman recently came in needing an ultrasound because the clinic she visited couldn’t do one. Others have appointments scheduled elsewhere, but not for months, “for something that’s been bothering them for four or five weeks,” Casillas said.

And some clinics send their patients to the emergency room for routine EKGs to get clearance for surgery, he said.

A sheriff's deputy watches as paramedics tend to a man on a stretcher

A Los Angeles County Sheriff’s deputy escorted the patient to the emergency room at MLK Community Hospital. The nursing staff works together to hold the patient.

(Francine Orr/Los Angeles Times)

“You would never see that in areas that have more resources,” Casillas said.

South Los Angeles 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 health care providers.

More than three-quarters of patients at MLK’s emergency room rely on Medi-Cal — California’s Medicaid program — and about 10% have no insurance, according to hospital data.

Medicaid programs reimburse doctors at lower rates than private insurers, which can “reduce the number of providers willing to participate,” said Nader Pourat, associate director of UCLA’s Center for Health Policy Research.

Batclor argues that these financial incentives are at the root of the challenges MLK patients face in receiving day-to-day care. Medi-Cal recipients are more likely than people who get insurance through their employer to say they don’t have a regular source of health care or that a doctor won’t accept their insurance, according to the report from the UCLA Center for Health Policy Research.

A man in a hat is lying on a hospital bed

Rod Berryman waits in the emergency room outside MLK Community Hospital.

(Francine Orr/Los Angeles Times)

Some patients come to MLK’s emergency room needing things as simple as medication refills.

On a rainy Tuesday, Mary Johnson came in to get pain medication and help with her breathing — a visit she makes every few months, she said.

Johnson said she doesn’t have a primary care doctor.

“It’s very difficult right now with all the COVID,” said Johnson, 57, who is away from home and sleeping in his car.

Also, she loves MLK.

A woman with a walker sits between the partitions

Sophia Sibirian tries to sleep in a cubicle while she waits for test results at MLK Community Hospital.

(Francine Orr/Los Angeles Times)

“No matter what the issue is, they always take care of me,” she said. “And I know they’ll get me out of here so soon.”

Butclor said patients with less serious problems “come in and out very quickly.”

“And they do that by seeing patients wherever they are,” she said — whether it’s in a chair, a gurney or under a tent set up outside.

Crowding in the emergency room is a sign of dire need in the community, but it’s also a sign to hospital staff that they’re doing something right.

A hospital patient, covered with a blanket, rests on a chair in the hallway

Patient MLK lies with a blanket in the hallway of the emergency room.

(Francine Orr/Los Angeles Times)

“That’s the success of the work we do here,” Assistant Nurse Manager Jessie Linwood said. “What a community is.”

Bathchlor and Casillas are also concerned that psychiatric patients are being brought to the emergency room from outside of South Los Angeles Hospital. South Los Angeles Hospital officials say such patients are being dropped off by police departments serving areas as far away as Santa Monica, Whittier and Huntington Beach.

The report, requested by Los Angeles County Executive Holly Mitchell, found that of emergency psychiatric patients transported by EMS, only a small fraction made it past the nearest hospital for MLK. But the report did not include landings by law enforcement agencies.

Two tents for psychiatric patients have been set up in the MLK emergency department. On average, a dozen patients a day are waiting for a bed or an exam in the short-term incarceration, known as 5150, which has “sitters” assigned by the hospital to stay with them for their safety.

A man in one shoe sits under a blanket between empty hospital beds

Daniel Meraz is waiting at MLK Community Hospital with a possible foot infection.

(Francine Orr/Los Angeles Times)

The hospital has no inpatient psychiatric beds, so patients stay in the emergency room, often for days at a time, until staff can find them somewhere else. The average length of stay of patients at 5150 receptions is about 35 hours. One psychiatric patient stayed there for 35 days, hospital officials said.

Amid high demand for its services, MLK’s emergency department loses tens of millions of dollars each year, That’s because Medi-Cal reimbursement doesn’t fully cover the cost of treatment, Butclor said.

Last fiscal year, MLK took a net loss of nearly $43 million on emergency room care — a hole that would have been even deeper if not for the tiny 4% of privately insured patients whose care generated more than $6 million profit, according to the data of hospital employees.

A state bill that would increase funding for MLK’s emergency room passed state lawmakers, but vetoed last year by Gov. Gavin Newsom, who said the money was not included in the budget.

MLK officials said they are seeking a financial infusion from the state again this year. In the meantime, dip into reserve funds.

“It can go on for so long,” Driscoll said.

The baby sits as the mother and the health worker take care of him

Royal Collier, 4 months, is at MLK Community Hospital.

(Francine Orr/Los Angeles Times)

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