REPORT TO
LOS ANGELES EMERGENCY MEDICAL SERVICES COMMISSION
IMPACT OF PROPOSED CLOSURE
OF
DANIEL FREEMAN MARINA HOSPITAL
Submitted by:
Community Health Councils, Inc.
July 17, 2002
CONCLUSIONS AND RECOMMENDATION
Based upon the following analysis, Community Health Councils, Inc urges the
Emergency Medical Services to recommend to the Los Angeles County Board of Supervisors
that Daniel Freeman
Hospital emergency room remain open
to mitigate the impact on emergency services capacity within the service area.
A CLOSER LOOK AT THE CONTRIBUTION OF
DANIEL FREEMAN
MARINA HOSPITAL
The following information is provided to the Los Angeles Emergency Medical
Services Commission in response to the proposed closure of Daniel
Freeman Marina
Hospital. The analysis examines
the closure in the context of not only the surrounding community but also the
changing economic environment and threats within the health care industry.
Daniel Freeman
Marina Hospital
is one of two hospitals formally owned by the Sisters of Carondolet for more
than 20 years and sold to Tenet Healthcare Corporation on December
7, 2002. The notice for the closure of the emergency room and hospital
by Tenet came within less than six months following the takeover. While the
smallest of the four hospitals owned by Tenet in the immediate area, the Marina
facility has served a critical role in the overall emergency and safety net
system for area residents.
Daniel Freeman Marina (DFM) provided in excess of 19,000 emergency visits in
2000. This represented 13% of the emergency room visits in the primary and secondary
service area. The basic Emergency Department provides visits primarily to local
Medicare patients, to non-affluent Venice
residents, and for psychiatric emergency services. The ER serves substantial
urgent care needs within its service area. Most inpatient acute care at Marina
is associated with emergency room utilizations, cardiology, neurology, and general
Medicaid admissions. The emergency room at DFM is the only facility in the
community’s primary service area.
The Primary Service Area for DFM includes the cities of Marina del
Rey, Venice, Mar Vista, Culver
City, LAX, and Playa del Rey. In 1999, there were 170,431
residents in the PSA for DFM. The Marina PSA has shown significant growth
of Latinos, a decline in the white population, and more households living in
poverty. The SSA population for Marina
also has a large growing Latino population and the number of households living
in poverty has gone up 34% since 1990. In Marina del
Rey, 54% of the population is age 40 and over, as the community ages health
care utilization increases.
Private insurance and Medicare cover the large majority of residents in Marina’s
PSA. Medi-Cal 4%, Medicare 17%, Private 9%, Self pay
21%, other 6%.
A CLOSER LOOK AT COMMUNITY CAPACTY
A.
Service Area
The primary and secondary service areas for Marina
Hospital are defined based upon the
number of discharges and emergency room visits by zip code of the patients.
The zip code designation and hospitals serving residents from the two service
areas are as reported in the November 1, 2001 Health Impact Report completed
by the Lewin Group for the Attorney General, area as follows:
Primary and Secondary Service Area
Designation and Providers
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Primary Service Area
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Secondary Service Area
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Zip codes
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90292, 90291, 90066, 90230, 90045, 90283
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Total of 21 – nine of the immediately surrounding zip codes include:
90245, 90304, 90301, 90302, 90056, 90232, 90034, 90405, 90064
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Cities/Area Designation
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Marina del Rey, Venice
Mar Vista, LAX, Culver City,
Playa del Rey
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El Segundo, Lennox, Inglewood, Baldwin Hills, Culver City, Cheviot Hills,
Santa Monica, West Los Angeles
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Hospitals located within
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DF Marina Hospital
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St. Johns, Santa Monica UCLA,
DF Memorial, Centinela, Robert F. Kennedy
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While residents in the immediate surrounding area of
the hospital utilize other hospitals for acute inpatient care, many rely on
the Basic ER at DFM for emergency services. Daniel Freeman Marina provides
56% of the emergency visits within the six primary zip codes and 18% within
the secondary area. However, over one-forth of the emergency room visits are
for individuals residing outside of the Marina’s
primary or secondary service areas. [1]
Daniel Freeman
Emergency Visits by Service Area
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Service Area
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%
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Primary Service Area (PSA)
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56%
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Secondary Service Area (SSA)
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18%
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Other Areas
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26%
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Total
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100%
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The proposed plan reroutes the paramedic runs to Santa
Monica, St. Johns
and Brotman hospitals. Two factors limit the feasibility of this recommendation;
access and capacity.
B. Accessibility:
Both Santa Monica and St.
Johns are located within the northern region of the service
area. Both facilities are located within less than a mile of each other and
within a highly congested residential and commercial area. While within 5 miles
of DFM, the actual transport time is impeded by the amount of traffic within
the surrounding community. If Marina closed, residents in the primary service
area will need to travel to hospitals located in the secondary service area
or elsewhere for emergency services, which would be anywhere from 13 to 19 minutes
travel time.
Accessibility is also measured by wait times and the
hours of 911diversion. Data from the EMS department
on Hospital Diversion to 9-1-1
Traffic due to emergency room saturation indicates a growing strain on the paramedic
and emergency room system within the service areas. The total number of
hours for diversion by the hospitals within a five mile radius of Daniel Freeman
has increased from 1,777 hours to 3,285 or an increase of more than 240%
between 1997 and 2001 as noted below. Based upon the 2002 data through May,
the diversion rate is projected to increase by an additional 30%. This translates
into longer wait times which now stand between 2-3 hours on average in the services
area.
Hours of Hospital Diversions to 911 Traffic
due to Emergency Room Saturation
|
Hospital
|
1997
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2000
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2001
|
2002* (Jan-May)
|
2002 Projected
|
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DF Marina
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85
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1,380
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1,269
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889
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2,134
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Brotman
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636
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1,139
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1,018
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560
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1,344
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St. Johns
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744
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1,036
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3,056
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1,129
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2,710
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Santa Monica
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312
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104
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695
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707
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1,697
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Total
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1,777
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3,659
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6,038
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3,285
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7,884
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Source: EMS Diversion Report on 9-1-1
Receiving Hospitals within a 10 Mile Radius of Daniel Freeman
Marina Hospital
from 1997 to May 2002.
The charts below highlight the trend by hospital over the last five years:
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DIVERSION TRENDS BY HOSPITAL
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Source: EMS Diversion Report on 9-1-1 Receiving Hospitals within a 10
Mile Radius of Daniel Freeman Marina Hospital from 1997 to May 2002.
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C. Capacity:
While a major consideration for the EMS, paramedic runs
only account for 17 % of the emergency room visits at DFM. As indicated by
the primary service area zip codes, the closure of the Marina
emergency room will result in the shifting of emergency room foot traffic to
hospitals other than three originally planned by the EMS.
The 48% of the patients that have historically utilized the Marina
facility and live outside the primary service area will need to rely upon those
hospitals in closer proximity to their place of residence than simply the three
designated by EMS. As reflected in the table below,
three of the five surrounding hospitals have insufficient capacity to absorb
the displacement that will occur with the closure of the DFM emergency room.
EMERGENCY ROOM CAPACITY WITHIN
DANIEL FREEMAN MARINA’S
SERVICE AREA
| |
DF Marina
|
Brotman
|
Santa Monica UCLA1
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St. Johns
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DF Memorial
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Centinela
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Distance from DF Marina (miles)
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0
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4.6
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4.8
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5.2
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7.4
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7.5
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ER Visits2
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19,960
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21,599
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21,083
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24,969
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40,626
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34,284
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Treatment Stations2
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8
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11
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18
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15
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16
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18
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Approx Capacity3
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16,000
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22,000
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36,000
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30,000
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32,000
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36,000
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Remaining Capacity
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0
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401
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14,917
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5,031
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0
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1,716
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1L.A. County EMS Impact Analysis of Surrounding Facility, 2000 data
2OSPHD, Hospital Annual Utilization Data Profile, 2000
3Note: capacity based on calculation of 2,000 visits per station
Capacity can also be measured by the changes in the level of service available
to the community. Based upon the following tables, the number of emergency
room stations, visits and by extension, hospital beds, is significantly impacted
by the closure of DF Marina. The number of ER Treatment stations declines for
the combined populations in the PSA and SSA from .10 to .09 per 1,000 persons,
or 33% below the county average. In addition, the number of ER visits within
the secondary service areas increases from 187.65 visits per 1,000 to 213.63
following the closure.
ER TREATMENT/VISITS/HOSPITAL BEDS RATE PER 1,000 POPULATION (1999)1
| |
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California2
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.15
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274.72
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2.33
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Los Angeles County2
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.13
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269.75
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2.65
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Prior to Closure
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PSA
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.05
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117.11
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.97
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.11
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187.65
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2.58
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Combined SS after closure
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.09
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213.63
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2.11
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1Note: Rates calculated by dividing ER Treatment Stations, Visits, Hospital Beds
by total population in each area.
2Perspectives in Health Care, CA Office of Statewide Health Planning & Development,
June 2002.
Emerging Threats
In calculating the impact of the closure on the community, it is imperative
that the EMS commission examine and factor in the dynamic
changes and threats within the larger community context. This includes the
continued and aggressive development that is occurring within the PSA and trends
within the health care industry.
The Los Angeles City Planning Department has projected a 30% growth rate on
the Westside within the next 15 years. Of immediate threat is the rapid development
within the Lincoln Corridor. A number of projects have been implemented both
residential and commercial. With the commercial development comes a population
that has previously been under counted in the analysis of the demand on the
emergency system. The immediate projections are as follows:
Primary Service Area Population: Daniel Freeman Marina
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1999 Population1
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PSA Population Total
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170,431
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SSA Population Total
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768,138
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PSA & SSA Total Population
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938,569
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Other Contributing Factors2
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Playa Vista development
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30,000
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Workforce of Major Employers in
Marina del Rey
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4,939
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Greater Venice-Marina area (30% growth
rate)
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16,500
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Total Population
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990,008
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1Source: Health Impact Study, Lewin Group. LAC
DHS Office of Planning, US Census Bureau, Population Estimation and Projections
System, LAC Urban Research Division.
2Southern California Association of Governments & the Los Angeles Planning
Dept., Growth projections for over the next 15 years.
In addition to growing population demands, other factors impacting the capacity
and strain on the emergency system include:
- Growing nursing shortage – the increased nursing shortage threatens not
only available bed, but also the staffing capacity and therefore access to
emergency room services.
- Los Angeles County Health Department Financial Crisis – the county is facing
in excess of $700 million shortfall. This will result in the closure of
11 clinics by October and possible downsizing of the current county hospital
network. The loss of access will result in an increase burden on the remaining
emergency system and the possible loss of additional private hospital based
emergency room services.
- Hospital Seismic Requirements – state law requires hospitals to begin meeting
the seismic standards beginning by 2005. Many hospitals will either be forced
to close or undergo significant construction. St. Johns
and Santa Monica hospitals have
plans with some construction underway to rebuild significant portions of
their facilities. This will result in a reduced capacity and/or disruption
in services for an unknown period
- Hospital closures – the vast majority of hospitals are experiencing significant
financial crisis. The recent changes in federal regulation and the state
budget shortfall have prompted the closure of hospitals throughout the region.