For L.A.’s ‘battlefield hospital’, latest COVID surge comes with a familiar beat
A man with painfully swollen legs from congestive heart failure lies on a stretcher outside the emergency room, staring at a leaden sky that threatens rain. A woman helps her husband in a triage tent, after his dialysis center refused to admit him after a positive coronavirus test.
Arriving at the emergency department at Martin Luther King Jr. Community Hospital, people are treated in field tents, hallways, cubicles, former administrative offices and ambulance bays. Many are waiting in the open with coughs and sore throats to get tested for the coronavirus. Others come for all sorts of chronic illnesses that perpetually curse South Los Angeles.
A year ago, MLK was arguably ground zero for hospitals beleaguered by a brutal winter surge of COVID-19.
Today, he finds himself in a place that is both strange and familiar during this wave of the incredibly contagious variant of Omicron: crowded, often frenetic, but under control for an institution accustomed to dealing with the confluence of social misfortunes. and medical.
COVID-19 was particularly deadly here last year due to the underlying poor health of the community. But the number of patients was offset as non-COVID-19 patients stayed away for fear of catching the virus. The main crisis was in the intensive care unit.
This time, hospital officials say the virus is more widespread but not as deadly. This has flooded the emergency room with people who are less sick and whose pre-existing conditions have been exacerbated by the virus.
Dr. Elaine Batchlor, the hospital’s chief executive, said this month that only Antelope Valley Hospital has a higher patient-to-bed ratio in Los Angeles County.
But she noted that the pre-pandemic day-to-day reality here was only different to a degree: The emergency department typically sees nearly three times the number of patients it was designed for.
Before COVID-19, administrators had to convert the ER waiting room to cubicles to treat more patients and move the waiting room in heated and air-conditioned tents in the ambulance bay. Three more field hospital tents have been donated during the pandemic – but they are likely to be needed even if COVID-19 cases decline.
“We’ve been a battlefield hospital from the start,” MLK spokeswoman Gwen Driscoll said. “So we know how to handle the volume.”
During this surge, most COVID-19 cases are mild enough for patients to be tested, given medication and discharged. But given the number of people arriving, the hospital is full. And like other facilities, it is understaffed as the coronavirus infects healthcare workers across the state.
The result is something of a quick tourniquet for most COVID-19 patients, with long stays mostly for the unvaccinated, who are more seriously ill.
“We’re seeing a lower percentage of people being admitted to hospital,” Batchlor said. “We are seeing shorter lengths of stay.”
The lack of adequate health insurance in South Los Angeles and the shortage of doctors force residents to go to the emergency room for conditions that are otherwise largely untreated, such as heart, kidney and lung disease, stroke, diabetes and mental illness.
The emergency department was designed to treat 40,000 patients a year when it opened in 2015. Before the pandemic, it was seeing up to 110,000.
“We wouldn’t be like this today if our community had proper access to medical care,” Batchlor said. “The reason all these people are in our emergency department now is because there’s nowhere to go. … Yes, it’s COVID now, but it’s COVID in more of these basic access disparities.
Jordi Gonzalez, nurse in charge of the emergency room, started at 6:30 a.m. one morning this month with 25 patients from other departments in emergency beds, leaving only four open.
“Because we’re boarding as many as we have this morning, we’re pushing through the hallways,” he said. “Obviously it’s not ideal to be in the hallway here.”
There are other factors causing overcrowding: COVID-19 patients need to be isolated to prevent the virus from spreading, taking up valuable rooms. And during this peak, it was difficult to transfer people to skilled nursing and mental health facilities, which are also understaffed but not required by law to admit new patients, as emergency services are.
The early morning is the quietest time of the day. “Our volume is going to explode between 7 and 11 a.m.,” Gonzalez said. They usually don’t empty the waiting areas until 3 or 4 am the next day.
At 7:30 a.m., people started pouring in, many with symptoms of COVID-19.
Latima Russell, 37, brought her son Aaron to the triage tent to see a doctor and get tested for the virus. He had had a bad cough for three days and she had back pain. They went to St. Francis Medical Center the day before and waited over seven hours without ever seeing a nurse.
“They didn’t do a test or anything. I just left,” she said. “Here they get you in and out.”
A nurse performed an initial triage assessment to determine the severity of their case in five minutes. They were moved to chairs outside the ER, where a nurse came out with a swab to test Aaron.
“OK mate, I only need to be in your nose for about 10 seconds in one nostril,” she said.
He turned his head, cried and started crying before she could count to two. A doctor examined him. His oxygen level was normal and his other vital signs were good. He wrote the mother a prescription for an over-the-counter Tylenol elixir, so her Medi-Cal plan would pay for it, and they left.
Jahnee Desselle, 32, sat in the same area outside waiting to see a doctor, while more acute patients were moved inside. She had body aches, chills and labored breathing that kept her awake all night. She is not vaccinated, insisting that her religion does not allow vaccinations. She had just returned from a family alligator-hunting reunion in Louisiana and, if she were to test positive, she suspected she had caught the virus there.
Dr. Adam Ash approached.
“What is going on?
“I woke up this morning having trouble breathing. For the past few days I have had pain in my chest. And I had a real earache and a sore throat. I felt like throwing up, and some chills. It’s been going on for the past week.”
He reserved her in the “breathing tent” for further observation.
On Wednesday, the emergency room gained access to an adjacent county building to add up to 18 additional treatment spaces.
Batchlor hopes the spikes in COVID-19 will force state lawmakers to take notice of the broken system in poor communities of color in California. She attributes much of MLK’s ongoing overcrowding to Medi-Cal not paying medical providers enough to provide the preventative and behavioral health medical treatment the community needs.
“If they had these things, they’d be healthier, they wouldn’t be as vulnerable to COVID, they wouldn’t be as sick when they get COVID, and you wouldn’t see the crowds you see in that emergency department. today.
“It’s part of the multi-level health system that we’ve created in this country,” she added, “and communities like this are at the bottom of that system.”