While Riva is specifically addressing the situation in Los Angeles, we all know that the problem exists all over the country. This is a really good time to do everything we can to stay healthy. And keep our fingers crossed.
A double crisis
by Riva Roberta Goldman, Los Angeles, California
Regarding the COVID-19 crisis & lack of ICU beds: I have had training regarding Triage in the event of a natural disaster or multiple casualty situation. Standard practice regarding CPR is that once you initiate it, you are not supposed to stop until either the patient is revived, First Responders arrive and take over, or you are too exhausted to continue. However, as sad as it is, if there is a major disaster, First Responders may not be available, you cannot spend time doing CPR when you have injured people who have a much greater chance of survival.
At the time I am writing this, we have been warned repeatedly that hospitals are extremely close to having to decide who is within the realm of being saved and which patients should be allowed to die without wasting precious resources.
There were more trauma centers and more hospital beds in Los Angeles County when I graduated from Nursing School in 1982. In the years since, some hospitals closed their trauma centers for financial reasons. Others either went out of business or were replaced by more modern facilities with better seismic retrofitting, but with less inpatient beds. In the past week, in the middle of a pandemic, a hospital in Los Angeles announced that it will be closing in the next few months. About 450 employees will be laid off. Nurses are fighting the closure and demanding that the facility stay open at least until the pandemic is over.
The reasons for the decrease in hospital beds and trauma units is complicated. Proposition 13 must have had an impact, as well as changes in how hospitals are reimbursed for services, and shorter lengths of hospital stays.
I’ve been trying to research the exact number of inpatient beds that were at Los Angeles County USC Medical Center in 1980. I recall that it was 2000 beds. I don’t know if that was just the main building (which was featured in the opening of the soap opera General Hospital) or if that also included the number of beds in the other inpatient buildings on the grounds (Pediatrics, Psych, Women’s Hospital, and Communicable Disease). Wikipedia says that General Hospital, the main building, was built with a capacity for 3000 beds.
I do know that some wards in the General Hospital were sitting empty when I graduated. However, in the mid-1980s, when there was an increase in patients needing to be hospitalized, one of the closed wards was reopened. I know this because I was one of the Nurses who volunteered, in 2008, to be transferred to the newly reopened ward, a more modern 600-bed hospital.
I, along with others in the health care field, questioned the rationale for cutting out 1400 beds.
UCLA Medical Center built a new hospital that only has private rooms, which is great for the patients, but that reduced their inpatient capacity. The explanation that we were given……there is a network of hospitals in Los Angeles County, so if there were not enough beds in one local hospital, other hospitals could pick up the overflow.
Less hospital beds also means that there are less hospital staff than there were when I graduated. However, even in the 1990s, I saw that there was a potential for a crisis big enough that all area hospitals would be full, and that the loss of hospitals, trauma centers, and decreased beds would lead to a situation where all of the hospitals in the network would be full.
And that is what is happening right now.
Thank you Riva. That explains a lot.
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One issue that I should have caught is that the new County hospital was opened in 2008, but I never worked in it. I did volunteer to work in a different ward in the old General Hospital when they had a continuous increase in the number of hospitalized patients in the 1980s. Administration had the ability to handle that situation by opening up a ward that had been sitting vacant. But now, hospitals don’t seem to have that capability. Riva Goldman
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Thanks for clarifying, Riva. I know it matters for you to be accurate but it doesn’t change the power of your point.
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Is this what happens when hospitals, and health care itself, become ensared by the profit motive?
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