County-USC hospital moves into its new home

Today is the first of a two-day move in which County-USC Medical Center is transferring its patients into its new facility. The building has 220 fewer beds than the current medical center. Hospital administrators say the new system will work just fine, but some doctors have their doubts. KPCC's Patricia Nazario stopped by a recent mock move. Staff members and first responders simulated the move six times before the big day. During this mock move, nursing assistant Maricela Diaz played a critically-ill patient being transported.

[Sound of patient being moved]

Patricia Nazario: Hospital administrators, nurses, and emergency first responders have practiced moving patients six different times.

["Ready? 1, 2, 3." (click)]

Person 1: Jackie, how are you feeling?
Jackie Rodil: I'm feeling good.

Nazario: Jackie Rodil is a registered nurse who normally helps treat kids in the pediatric ward. For this exercise, she plays one who's very sick. The RN has hoses and machines attached to her.

And as'll happen during the real move, her team of caregivers loads her gurney into the back for an ambulance for the short trip to Los Angeles County USC's new medical building.

["We're ready? Everybody ready? All right!" (ambulance doors slam)]

Nazario: Back inside the old hospital:

Cynthia Stotts: Command center, over. Come in. It's Dr. Stotts, over.

Nazario: Dr. Cynthia Stotts uses a walkie-talkie to coordinate all the moving parts of the mock move. She'll be executing the same steps during the real McCoy as staff and volunteers sweep through 50 wards and relocate 500 patients.

Stotts: As in any good organized military operation, you only get to have one general. So, that's my role.

Nazario: Stotts says, on moving day, hospital administrators'll use many military strategies. They'll also have volunteers from several military operations, including an Air Force Reserve Unit from Riverside County.

Stotts: They currently move patients from Iraq to Germany as their professional duties.

Nazario: Regional health care providers hope such professional precision carries over into the new billion dollar facility's day-to-day operations. It has 224 fewer acute-care beds than the current county facility.

It'll operate at near full-capacity from the moment its doors open. In order for the medical facility to succeed, chronically-ill patients need to stop using the emergency room for problems, including colds, minor cuts, and an upset stomach.

Monica Manrique: I have more incentives for you.

Nazario: At a recent meeting, Monica Manrique gives Javier Acosta a pill box and a plastic bag filled with toiletries. She's a care manager with the "Camino de Salud" or "Healthy Road Program." It's how USC County officials are hoping to get patients plugged into community clinics.

Javier Acosta: I'm up to my weight.

Nazario: Fourty-four-year-old Acosta is battling several major health problems, including liver cancer, cirrhosis of the liver, and the blood-borne infectious disease Hepatitis C.

Acosta: I got caught up at an early age with gangs, in the drug scene and the alcohol scene.

Nazario: Acosta says he was born and raised near Long Beach. He says he dropped out of high school in the ninth grade and has spent most of his adult life working construction jobs.

He's never had health insurance and has never been the type to take a doctor's advice. Over the last two years, Acosta says he's checked himself into Southern California emergency rooms many times.

Acosta: Probably a good... seven. Throwing up a lot of blood. Couldn't eat. To just get medicated, get rid of shakes just so my stomach would be able to hold down food. I would use it as a little drug-recovery time because of the medication.

Nazario: Acosta's been clean and sober and plugged into the Camino de Salud program for about seven months. He says he also hasn't been back to an ER. But he goes to a neighborhood clinic for regular checkups, thanks to his case worker.

Acosta: Now she's got me taking responsibility to where I'm calling up the doctor and pharmacies, try to keep my appointments.

Nazario: These are the kinds of results Camino de Salud hopes to multiply, eventually, with dozens of clinics around L.A. County's most utilized hospital.

Allen Miller: And one in every neighborhood where patients live, so every patient could get a primary care home that has care coordinated with the medical center.

Nazario: That's Allen Miller. USC County administrators brought him on board about five years ago to help alleviate pressure from its emergency room, in anticipation of the big move. Miller says he quickly realized the health care system in general was so broken, he had to do more than show patients how to jump through the hoops.

Miller: It's kinda like saying to a person, well take that road over there, then take a right and left, except what you haven't told them is that as they're going down the road the bridge is out, so you have to swing through the river. Then there's potholes over here, by the way there's three other forks in the road, but you didn't tell them which one to take.

Nazario: To minimize that confusion, Miller says, he came up with the idea of connecting community clinics with County USC Hospital. He says they've also started connecting chronic patients in an effort to ease the high demand on County USC's specialty clinics.

Miller: We've been doing it a year and a half, two years with cardiology and rheumatology. Those are the two that've been going for a while.

Christine Evelyn: These are patients a primary care physician is not capable of caring for.

Nazario: Doctor Christine Evelyn says she she's never heard of the Camino de Salud program. She's a retired rheumatologist and longtime volunteer at USC's Rheumatology Outpatient Clinic. Evelyn says specialty clinics at County USC are so backed up, doctors can't seeing patients in a timely manner, as professional boards recommend.

Evelyn: ... whether it's internal medicine, rheumatory, oncology, cardio, ophthalmology. I mean ophthalmology clinic, it was a year wait to get in and see the doctor.

We had a patient the other day, a lady with recurrent urinary tract infections. She probably has some problem in her bladder. She's just been on and off antibiotics. Her appointment to the Urology Clinic is June 2009.

Nazario: Evelyn says the only way that we can get something done quickly...

Evelyn: ... is to bring the patient into the hospital. What's gonna happen when we have fewer hospital beds? We got a memo: Don't order any more echo-cardiograms. That's the study of the heart. The next appointment is June, 2009.

Nazario: Evelyn says County USC officials should have improved outpatient care before they decreased the number of hospital beds. She's worried her mostly Hispanic, Spanish-speaking patient roster is not getting the quality care they need. USC County Hospital officials say they also want to deliver top-notch care.

As hospital staff members and volunteers move patients into the new facility, hospital officials are confident the "Camino de Salud" or "Healthy Road Program" will eventually close that gap. So far the network includes 35 community clinics around L.A. Hospital; officials hope to expand the number of sites to a hundred.