It’s 11 AM on the Monday after Thanksgiving. Our 29-bed Emergency Department at MLK Community Hospital in South LA has already seen more than 200 patients.
To handle the volume, we have our triage tent set up. Then there’s a row of about a dozen chairs that stretch out the door and wind around the tent. All the chairs are full of the sick and their caretakers.
One of these patients is 71-year-old Antonia*.
“My sister’s eye is swelling,” says her brother Juan*, 68. “She can’t see, and she’s starting to lose balance. I’m afraid she’s going to fall down and get hurt more.”
He brought Antonia to MLK because of our hospital’s reputation for short wait times and excellent service. “MLK is great,” he says. “Another sister of mine came here and the way they treated her was wonderful.”
Juan made an appointment at an outpatient center for his sister a month ago. She still hasn’t been seen.
Antonia can’t wait any longer. “Right now we’re really concerned she’s losing her ability to walk,” her brother says. So here they are at the MLK emergency department.
Antonia’s story is not unique. Many patients waiting in line have a similar one.
Nearby, Leticia* waits with her two young daughters. All three have been coughing for a week and Leticia’s chest is starting to hurt. “It feels like something worse than a cold because it’s been hanging on for so long,” she says. “It’s hard to get a doctor’s appointment so we came here.”
So it continues down the line of waiting patients: this patient has flu symptoms, another has fever, another is coming for follow-up care for a wound. Much of this could be handled in the outpatient setting by a family doctor. But Medi-Cal doesn’t pay primary care doctors enough to work in places like South LA, so we have a shortage. MLK’s emergency department becomes the provider of first and last resort.
Lack of accessible care places unbearable stressors on hospitals like ours. Before this day is through, our small emergency department will see a record-breaking 447 people. Annually, we are on track to see triple the volume our emergency department was built to handle. As the holiday season continues and more people travel to gather with their loved ones, the volume looks unlikely to let up.
Researchers at Yale University who study emergency department crowding conclude that it puts patient safety at risk. They also emphasize that this is not a hospital management issue but an indication that resources are overwhelmed. We know already that these stressors are pushing health care providers to our breaking point, none more so than those of us who serve localities which rely on emergency departments to fill gaps in primary and specialty providers.
This isn’t just happening in South LA. Emergency departments across the nation are experiencing record capacity challenges because of COVID, the seasonal flu, and respiratory syncytial virus (RSV), which largely affects children. Some are calling this triple threat a “tridemic”.
It’s the last thing South LA needs. California lost at least 97,000 of its residents to COVID, a disproportionate percentage of those from communities of color. More than 32,000 children in California lost a primary caregiver. Many family breadwinners died, leaving low-income families in dire financial straits on top of the pain of losing a loved one.
The COVID crisis made healthcare a legislative priority, the current “tridemic” should be one as well. MLK’s overcrowded hospital is just one more indicator of how broken our healthcare system is, especially in areas more reliant on Medi-Cal. Legislators—a third of them newly minted—should take this lesson with them to Sacramento.
California faces a budget deficit of $25 billion in 2023. We may see cuts to many essential services. But here in South LA, and in safety-net hospitals throughout the state, we need to hold the line.
This is where the need is most dire. People already can’t find a doctor in South LA — what if they can’t find a hospital? Cuts cause hospitals, especially safety-net hospitals, to close. Without a local hospital, our patients face a hard choice: Find a larger, more monied hospital far away, or delay care. Too many do the latter, with disastrous results. Untreated disease is why amputation is our hospital’s number one procedure.
There is another way.
Let’s prioritize funding for community and rural hospitals, and community-based providers in underserved places like South LA, so that our most vulnerable residents get better support. Our most overcrowded emergency departments will be able to meet demand. People will be able to get care locally and without significant delays. Lives will be saved.
We have to push toward a future of better health outcomes in California. At this time of epic need, healthcare for the most vulnerable is not where California should cut its budget. The solutions are clear: invest in our community health systems and support our health care workers. We’re going in the right direction. This holiday season “tridemic” has proven that we can’t stop now.
*Names have been changed for patients’ privacy.
