‘Poor Management,’ Care Delays Cost Lives at Los Angeles County-USC Medical Center

In a front-page story, the Los Angeles Times reports that three patients in the last ten months have died at Los Angeles County-USC Medical Center because "specially trained nurses" were not available during night shifts or Sundays to provide emergency dialysis -- a "dramatic example of how poor management and a lack of accountability aggravate delays in care for patients who desperately need it in the largest public hospital in the West." Christine Powers, the "first dialysis patient to die," entered the hospital on Aug. 2, 2000. Initially, County-USC physicians placed her in intensive care, but when her condition worsened around 6 p.m. that evening, a kidney doctor "ordered emergency dialysis." Although County-USC, a trauma center, is "contractually obliged to provide emergency dialysis around the clock," the hospital "relied for years on outside companies ... to send nurses" after hours and hospital administrators "acknowledge the nurses from these companies did not always show up." In Powers' case, "no nurse could be found," and Powers died about four hours after the emergency dialysis was requested, never having received the dialysis. The Times reports that although doctors had been "complaining about delays in dialysis" for "more than two years" before this incident, the "problem wasn't fixed" until two more patients died under similar circumstances, at which point a new medical director arranged for County-USC nurses to respond to emergencies "around the clock." In addition, several other incidents point to "dangerous delays" that often surface at County-USC:

• In April, a patient "bled to death" in the emergency room when "specialists in stopping internal bleeding" did not arrive in time to save him.
• In one case, a man waited a "record" 84 hours in the emergency room before receiving medical attention.
• In January, the hospital waited 16 hours before performing a "standard brain scan on a man with a head injury."

Gridlock at the ER
A second Times story today examines delays at County-USC's emergency room, where "[d]octors say long waits and other roadblocks are increasingly jeopardizing patients at [the] hospital," which has "one of the busiest ERs in the nation" (Riccardi/Rohrlich, Los Angeles Times, 6/26).