Hospital's Cuts Sow Anxiety in South L.A.

Changes at Centinela deal a fresh blow to the area's healthcare


 
 

Daniel Costello | | Thursday, May 29, 2008


LOS ANGELES -- Centinela Hospital Medical Center in Inglewood has been a key healthcare provider to nearby residents for nearly a century. Now some patients and activists in South Los Angeles worry that recent cuts and other changes are diminishing its role in the community.

Since taking over the hospital late last year, its new owner has shuttered departments, laid off 13% of its 1,700 staffers and canceled most private insurance contracts, hospital officials say. As a result, many residents say they've had to seek treatment elsewhere.

Victorville-based Prime Healthcare Services Inc. said that it made the changes to keep the medical center financially viable and that access to healthcare in the Inglewood area had not suffered.

State data show that Centinela has been unprofitable for years. The hospital's previous owner considered closing the facility in the fall, before Prime bought it sight unseen.

To the disproportionately low-income and uninsured residents of South Los Angeles and other nearby communities, the recent changes at Centinela are yet another blow after a long spate of hospital cutbacks and closures throughout the area.

Robert F. Kennedy Medical Center in Hawthorne closed in 2004. Last year, Martin Luther King Jr.-Harbor Hospital near Watts shut down. Brotman Medical Center in Culver City recently filed for bankruptcy protection. Other area hospitals such as Downey Regional Medical Center have said they aren't certain how much longer they can remain open.

The closings have left the local healthcare system in its most threatened state in decades, experts say.

"This is a system, and an area in particular, that can't take many more hits," said Liz Forer, chief executive of the Venice Family Clinic, which provides free healthcare to the uninsured.

Forer said her clinic had seen a 15% increase in patients from Inglewood in recent years as more hospitals in the area failed.

"At some point, you have to ask what is too much" for the area to withstand, said Lark Galloway-Gilliam, executive director of Community Health Councils Inc., a health advocacy group.

In recent years, Prime Healthcare and its chairman, Dr. Prem Reddy, have launched an aggressive expansion program in Southern California, often buying up struggling hospitals at risk of closure.

Prime Healthcare owns nine area hospitals -- eight of them bought in the last four years -- including Sherman Oaks Hospital and Huntington Beach Hospital.

As the company has grown, its operations have come under increased scrutiny by state officials, healthcare advocates and patients.

When Prime Healthcare takes over a hospital, it typically cancels the facility's private insurance contracts. That means many Prime Healthcare patients arrive through the emergency room -- which is open to everyone, regardless of financial status -- and, if needed, are admitted for longer stays.

Because its hospitals are not bound by insurance contracts, Prime Healthcare often is able to collect steeply higher reimbursements from insurers for such patients.

Prime has also suspended some services at its hospitals -- including chemotherapy treatments, mental health care and birthing centers -- that provide relatively little income. The company tries to reduce how many days that patients remain in the hospital, although data show patients' length of stay at Prime Healthcare hospitals remains in line with national averages.

Such measures are key to what company executives say is a profit margin of as much as 15% per hospital -- far above the industry average.

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Centinela still busy

The company says it has cut only services that are rarely needed and can be obtained at other facilities nearby. And Centinela remains busy. Last year it treated 140,000 people, and it has one of the most active emergency rooms in Southern California.

State and federal data show the company's hospitals score above average on surveys that measure patient safety and the outcomes of treatment.

Even so, some residents say that the recent changes have made it harder to get the care they need.

After James Mock of El Segundo was found to have advanced colon cancer a year ago, his doctor put him on a chemotherapy regimen that requires two days of continuous treatment twice a month. On alternate weekends, he had been checking into Centinela on Thursday and staying until Saturday so nurses could monitor his care.

Because the hospital no longer has a contract with his insurance carrier, Mock is caring for himself -- at home. He visits his oncologist every other week, and an assistant hooks a catheter to a vein through his chest.

Mock gets his first 22 hours' worth of chemotherapy in an IV bag, drives home and sleeps most of the day. The next morning, he drives back to his doctor, gets a new IV bag and repeats the process. "It's a little crazy, but what choice do I have?" the 52-year-old engineer asked.

Prime Healthcare has closed seven of Centinela's 13 operating rooms, according to hospital executives.

Dozens of longtime nurses and doctors have quit in recent months, hospital staff members said. Among them: Dr. Lawrence Dorr, founder of the hospital's prestigious Dorr Arthritis Institute, which treated 1,500 patients each year. Dorr, who declined to be interviewed, and his arthritis center are now affiliated with Good Samaritan Hospital in Los Angeles.

"This is very frightening," said Dr. Doris Lyonga, a hematologist who has practiced at Centinela for more than 20 years. "First, Robert Kennedy closed. Then Martin Luther King. Clinic after clinic has closed. Centinela is a shell of itself. Where exactly are people to go?"

Centinela's chief executive, Von Crockett, said the community's access to care had not decreased as a result of Prime's acquisition of Centinela and that the changes were needed for the hospital to survive.

"Our new owners are the only reason this hospital is open," he said. "They saved us."

The number of patients visiting the ER has grown about 10%, he added, and wait times in the emergency room have fallen to an average of 15 minutes and 12 seconds from one hour and 38 minutes last year.

Crockett said the medical center's new owner was investing millions of dollars this year to replace long-neglected equipment and had increased care to the uninsured. He added that some recent changes, including the closing of operating rooms, could be reversed if needed.

"Prime Healthcare Services has increased access to care for the community members at Centinela as evidenced by an increase in the number of inpatient admissions, decreased waiting times for both patients and emergencymedical personnel in the Emergency Department," Crockett said in a follow-up e-mail.

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Accreditation status

Crockett noted that the hospital had received a "conditional accreditation" in the fall from a national accreditation organization, the Joint Commission, after surveyors found several safety issues during a surprise inspection. (The accreditation status of hospitals is available to the public at jointcommission.org, but the details of such reports are not.)

Late last month, he said, the hospital received its full accreditation after making systemwide improvements.

Others are less upbeat about Centinela's recent transformation.

Vivian Swan, who suffered a stroke a year ago, was attending rehabilitation classes twice weekly at Daniel Freeman Medical Center nearby to help regain lost motion in her hands. Swan, 71, worked as a hairstylist before her stroke but can no longer hold scissors and hasn't returned to work.

She stopped treatment this year, when Daniel Freeman suspended services. When Prime Healthcare bought Centinela, it explored the option of transferring the rehabilitation and radiation therapy programs from Daniel Freeman to its new property, Crockett said. It declined, citing lack of adequate bed space.

"They say people can go somewhere else, but that's not easy," the Marina del Rey resident said.

Prime executives said they were interested in buying more hospitals in the near future, although they didn't name specific facilities. In April, Prime Healthcare bought the majority of Brotman Medical Center's loans from its primary lender.

The Culver City hospital entered bankruptcy in the fall and has been looking for investors. It has spurned overtures from Prime, hospital executives said, out of concern about some of the company's business practices.

Brotman may soon have no choice in the matter. If the hospital can't pay its debts, the Bankruptcy Court could decide it should be sold by public auction. That decision could come within the next several weeks, Brotman executives said.

Although anyone could bid for Brotman, Prime would be in a strong position to acquire it because the debt the company recently purchased has most of the hospital's assets attached as collateral, bankruptcy attorneys said.




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