An influential hospital group is joining the debate over how many inpatient beds should be housed in the new Los Angeles County-University of Southern California Medical Center, which was badly damaged in a 1994 earthquake.
Despite the glut of inpatient hospital beds in the area, the new LAC-USC hospital will need at least 750 beds or it won't be able to handle the demand for emergency and critical care in East and South Central Los Angeles, says Jim Lott, senior vice president of the Healthcare Association of Southern California. An HASC affiliate, the National Health Foundation, recently released a study to support that claim.
The scale of the new hospital is being debated by the five-member Los Angeles County Board of Supervisors, which is expected to make its decision later this year.
Although a large rebuild has some staunch supporters, other political leaders have been considering a smaller facility. Earlier this year, two hospitals offered to subcontract their excess capacity to the county for indigent care (Feb. 17, p. 46).
Already dating to the Depression era, LAC-USC was damaged severely in the 1994 Northridge earthquake, and more than half its 2,000 beds were removed as a result. What's more, because of more stringent safety laws taking effect in the next decade, the facility will be useless without at least a major overhaul.
From one point of view that doesn't seem so bad. Even without LAC-USC, its service area will have a surplus of more than 3,100 beds by 2005 (with a surplus of more than 8,700 beds for Los Angeles County as a whole).
Unfortunately, the region then would be desperately short of critical-care and emergency room capacity, according to the National Health Foundation study. Without a rebuilt LAC-USC hospital, by 2005, demand for such care could exceed capacity by as many as 428,000 visits per year.
"You cannot run trauma services in a freestanding mode," Lott says. "It has to be built with an appropriate number of beds; otherwise, it would place emergency room patients in danger."
Lott says less critical patients-making up one-third of current emergency room volume-could in fact be sent to other facilities, but he is adamant about preserving critical-care capacity.
Many consultants, however, argue that the excess inpatient capacity should be addressed, contending most patients and services could be handled in other locations. They suggest building a smaller hospital that is extremely acute, much like an oversized intensive-care unit.
"In my personal opinion, the county would be better served to take the money (it plans) to spend and fund it out in the community," says Charles Gabbert, a principal with Irvine, Calif.-based Delta Consulting.
But Gabbert says the flood of heart attack, gunshot and stabbing victims treated at LAC-USC can't be absorbed easily by other hospitals. Meanwhile, uninsured patients won't be attractive business to other hospitals.