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L.A. County Supervisors Displeased with Harbor-UCLA ER Citation

LOS ANGELES -- The honeymoon between the Los Angeles County Board of Supervisors and its health services director finally foundered Tuesday amid fears that a second county hospital could close.

Dr. Bruce Chernof, who has headed the nation's second-largest public health system since December 2005, told the supervisors last week that the federal government would be citing Harbor-UCLA Medical Center for placing its emergency patients in "immediate jeopardy" because of overcrowding and long waits.

The citation, which has not yet been formally delivered, comes six months after the county closed all but the outpatient clinics and urgent care center at Martin Luther King Jr.-Harbor Hospital in Willowbrook. King-Harbor had failed multiple inspections and lost federal funding.

"I'm very concerned that we're entering a spiral here very similar to what happened at Martin Luther King," Supervisor Gloria Molina said.

She pointed out that federal inspectors, when they return to see if a hospital has fixed its problems, can look at anything in the facility.

Waiting times

With King-Harbor, each time inspectors returned, they found something else wrong, she said.

The long-serving supervisors, known for stormy relationships with past health directors, largely blamed Chernof's predecessor for King-Harbor's failings. But Tuesday, Chernof was the lightning rod.

The supervisors were clearly frustrated when Chernof could not tell them how waiting times at UCLA-Harbor had changed since King-Harbor closed or how waiting times there compared with those of private hospitals nearby.

There were different ways to measure the wait, Chernof said, and he was working with private hospitals to develop "appropriate data points."

"You . . . get paid an awful lot of money to know these things, and you're telling us you don't know?" Molina said. "We really don't care about your data points. We care about patients."

Chernof had prepared a report for the supervisors comparing average waiting times at three county hospitals. County-USC Medical Center, the biggest and busiest with 167,700 emergency room visits a year, had the best average "door to discharge" time: 9.1 hours from the time a patient entered the ER until discharge or admittance to the hospital.

It also had the lowest rate of patients who gave up and left before being seen: 7.5%.

The waiting time at Olive View-UCLA in Sylmar, which sees 31,800 emergency patients a year, was on average 9.8 hours, with 12.5% leaving without being seen.

Harbor-UCLA saw 82,300 emergency patients in the last year. The average wait was 12.2 hours, and 16.6% left without being seen.

Federal scrutiny

The investigation of Harbor-UCLA, conducted by state inspectors on behalf of the federal government, was prompted by the Dec. 22 death of William Harold Jones Jr., an emergency room patient who left the hospital before treatment was finished and was found dead in a parking lot across the street.

Harbor-UCLA is the third hospital owned by Los Angeles County to undergo federal scrutiny in recent months for emergency room deaths.

Federal regulators have threatened to pull funding from the Olive View-UCLA after government inspectors said the center failed to provide prompt medical screening for three emergency room patients last October. One patient died.

Before it closed, King-Harbor was cited for a much-publicized case in which workers ignored a woman writhing in pain on the floor of the ER lobby.

The next step for Harbor-UCLA is for federal officials to approve the county's correction plan.

Chernof said the facility had already responded to the expected citation by assigning more nurses and adding a physician to do triage.

Patients who are severely ill are seen right away, he said, even if a facility is crowded.

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