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Pasadena

Emergency Med Care Geo-Equity?  Impossible in Socialized System by Wayne Lusvardi 9/21/07

Californians contemplating whether their legislators should adopt mandatory employer-paid health insurance or universal health care a la Massachusetts should consider what is happening in East Pasadena, where the closure of the former 165-bed St. Lukes Hospital in 2002 left a perceived void in geographic medical care for the area. 
 
Tenet Health Care, a private investor-owned acute care hospital corporation, subsequently bought the hospital but couldn't make a go of it partly because hospitals no longer draw patients only from the surrounding community.  The hospital was sold to Cal-Tech which also couldn't make use of it as an educational facility and presently has the property in escrow with an undisclosed developer.  

Activists Roberta Marti, Chairperson, EmergencyCareNow and Gene Masuda, Eaton Blanche Park Neighborhood Association, are advocating a City-sponsored urgent care center in East Pasadena, at the former St. Lukes Hospital site on the basis of "geographical equity."  The nearest hospitals, Huntington Hospital in West Pasadena and Arcadia Methodist Hospital, are both some six miles away from East Pasadena.  - See here:
http://www.pasadenalivingmagazine.com/_ArticleManager/publish/article_2810.shtml
http://pasadenaweekly.com/article.php?id=4955&IssueNum=84
http://www.coremg.net/newspapers.php?paper=pasadenaindependent&storyid=1203   

Contra Marti and Masuda, medical care "geographical equity" for East Pasadena is impossible because the emergency medical transport and care system has been geographically socialized.

The emergency ambulance and medical care system is socialized in California by court decree.  The L.A. County Health Department can divert City ambulances to alternate hospitals within a driving time of 20-minutes.  So no matter if an urgent or emergency care center is located in East Pasadena, or at Huntington Hospital in West Pasadena, if their emergency rooms are full, you may end up in a hospital in Baldwin Park or Alhambra or Glendale.  This is mostly because of the large number of uninsured economic migrants (God bless them) who must depend on the emergency care system as their only level of medical care and are overwhelming the system.   
 
Activists Marti and Masuda apparently don't even know the difference between "emergent" care (immediate threat to life, limb, or eyesight) and "urgent" care (needed within 24-hours, i.e., "walk-in clinic"). Which is it they are advocating we have no idea since they use the terms interchangeably.  A rough guide to the levels of emergency medical system care is as follows (this may vary in each community): 

a.  Trauma Care (surgery, blood transfusion within 1 hour) 
b.  Emergency Care (threat to life, limb, or eyesight)
c.  Private Urgent Care Clinic (can wait 24 hours)
d.  Pharmacy (walk-in, 24 hours, minor ailments only)
e.  Primary Physician (by appointment up to 1 month wait)
f.  Hospital Dispensary (by appointment)
g.  WILD CARD - if you have a family physician, you can beat the emergency care system and have the doctor admit you to a hospital for tests or pain relief or treatment. 

Since Huntington Hospital, the only remaining hospital in Pasadena, already has plans to expand their emergency room, what good would an "urgent" care center in East Pasadena serve which would be distant from expert trauma and emergency medical teams and expensive body scanning equipment?  Under a socialized system it is not geographic proximity that delivers better care but the availability of expert medical teams and equipment at your destination treatment facility. Some hospitals are designated trauma centers; others are not.  Urgent care centers typically do not render immediate treatment for threats to life, limbs, or eyesight; emergency hospitals do.    

Additionally, by California law hospital emergency rooms must re-open at the top of each hour even if they are full up and closed.  In other words, access to an emergent care center in East Pasadena depends on if they are not full; or if full, an arriving ambulance can hit the 5-minute re-opening window each hour. 
 
Emergency medical care access also partly depends on the luck of the draw of where a city ambulance will be diverted by County public health officials who act as the "ground traffic controllers" of the system.  No doctor is involved in such diversion decisions (as I understand it).  Patients in a city ambulance with vague symptoms sometimes have a cardiac arrest en route to the wrong care facility.     

Emergency medical ambulances do not have a doctor on board and cannot administer some life-saving drugs. A Pasadena friend of mine told me when he had a recent stroke he was diverted to Verdugo Hills Hospital in nearby Glendale.  But shockingly Verdugo Hills Hospital didn't have the Tissue Plasminogen Activator (tPA) which must be administered within the first three hours of a stroke.  He was eventually re-diverted by his brother-in-law doctor to Glendale Adventist Hospital, which had the drug. An "urgent care center" may not have the tPA drug to administer at all.

Put differently, it may be just as likely for an urgent care center at St. Lukes Hospital in East Pasadena to have emergency patients from lower income neighborhoods in Baldwin Park, unincorporated South San Gabriel, and North West Pasadena, as it is from the upscale neighborhoods of Eaton-Blanche, Eaton Canyon, or Chapman Woods in East Pasadena.  The concept of neighborhood-based emergency medical services, like the concept of neighborhood schools, has been usurped long ago in Pasadena by the courts and the legislature.
 
So much for "geographic equity" for emergency medical care for East Pasadena.  That possibility was lost perhaps forever when citizens and legislators passively allowed out-of-control economic migration and the courts socialized the emergency medical transport system.  That community leaders such as Roberta Marti (Democrat and prominent member of the California Senior Legislature) and Gene Masuda (past candidate for City Council) are unaware of this is not encouraging. 
 
If we could design a perfect emergency medical care system but politicians got no credit for it and newspaper chains sold no more newspapers covering the story, it is unlikely the perfect system would ever come into being.  However, if we designed a dysfunctional emergency medical delivery system but politicians got credit and newspapers sold copies, it would be deemed highly successful by virtue of its publicity and political capital.  A quiet and privatized preventive emergency medical care system of signing up with a family physician in advance of any medical emergency will never get any notice by the cognitive elites.  
 
Oddly, activists Roberta Marti and Gene Masuda also make no mention that there are two privately-run "urgent care centers" in or near Pasadena operated by Health Care Partners and that a newly-built private medical office park in East Pasadena remains vacant without any tenants.
 
By the way, under a universal medical care system the "wild card" system described above of personal physician admissions to hospitals, circumventing the hospital emergency room system, for all we know may go by the wayside. 
 
That neither the mainstream newspapers in Pasadena, the Star News or Pasadena Weekly, understand this or will not disclose how the system works, possibly for fear of political incorrectness, also doesn't speak well for the prospects for local democracy. How can citizens be asked to continue to legitimize democracy in California, or municipal government in the City of Pasadena, a nearly all-liberal city rife with hidden government, if they remain uninformed by the media, elected officials, and neighborhood leaders even about their own basic emergency medical lifeline system? CRO

copyright 2007 Wayne Lusvardi

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