Virus Is ‘Great Leveler’ for 2 Very Different Los Angeles Hospitals


LOS ANGELES — One is a top-ranked research hospital in West Los Angeles, with buildings named after Steven Spielberg and Barbra Streisand. Its hallways are hung with works by Picasso, Miro and Warhol, part of a 4,000-piece collection of donated art. Hollywood celebrities and royalty vie to recover in its first-come, first-served luxury suites.

The other is a community hospital in South Los Angeles, surrounded by fast-food chains, liquor stores and discount shops. It, too, is a state-of-the-art institution, albeit one with far more limited resources, serving one of Los Angeles’s most vulnerable communities, home to the working poor and the uninsured as well as homeless tent encampments, where a significant portion of the population has underlying chronic health conditions.

But the coronavirus pandemic is testing both Cedars-Sinai Medical Center and Martin Luther King Jr. Community Hospital in ways never seen before. At one level, there is a growing fear that the crisis could lay bare longstanding inequities in the nation’s health care system that could ultimately make the virus more deadly in Los Angeles’s poorest communities. At M.L.K., doctors worry especially that they will be shortchanged by a system that allocates more supplies to larger trauma centers like Cedars-Sinai.

At the same time, the distinctions between the two hospitals are fading fast, as confirmed coronavirus cases in Los Angeles top 3,000 and both institutions brace for conditions they fear will overwhelm them. Neither has the equipment it says it needs to defend itself or its patients. In both places, doctors are already grappling with ethical dilemmas, putting off even needed surgeries in order to clear beds, and, as they digest the news in harder-hit places like New York and Italy, they are contemplating the even tougher life-or-death choices they fear are coming.

In many respects, they say, the virus is the great leveler.

“It doesn’t matter who you are or where you come from — this isn’t a matter of wealth,” said one Cedars-Sinai emergency room doctor, who was not authorized by the hospital to speak publicly. “This isn’t brain surgery. It’s just logistics and supplies.”

In normal times, 20 miles of interminable gridlock separate Cedars-Sinai and M.L.K. But these days, a stay-at-home order has made Los Angeles feel small. Its infamous traffic has disappeared, replaced by an eerie sense of calm.

As health care workers here track the horror unfolding in New York City, where hospitals are overwhelmed with patients and deaths are increasing, they are girding for a similar surge to hit Los Angeles.

“I was asked by a reporter today, ‘Is Los Angeles the next New York?’” Mayor Eric Garcetti of Los Angeles said last week. “And I said, ‘Sure, in the same way that New York is now the next Italy, and Italy was the next Iran, and Iran was the next China, and no matter where you live, you are the next.’”

Los Angeles County had 3,011 confirmed cases as of Tuesday, and 54 deaths, but testing is so limited that officials say they do not have a handle on how many people are actually infected, even as they believe social distancing measures have probably slowed the spread.

When a surge arrives, Los Angeles County emergency management officials say they plan to spread patients out among all the county’s acute care hospitals, meaning that where you live may not necessarily dictate where you end up. No one requiring hospitalization for Covid-19 will be turned away based on lack of insurance or inability to pay, state and federal officials have said.

Cedars-Sinai, a top research hospital, has in recent days developed its own in-house testing, and can get same-day results. M.L.K., with fewer resources, hasn’t been able to move as fast on in-house testing, and still relies on commercial labs.

As one of Los Angeles County’s largest hospitals, Cedars-Sinai, with its Level I trauma center and 886 beds, will most likely bear much of the brunt, both in terms of numbers and severity of cases.

Already, doctors there are seeing an uptick. The number of confirmed or suspected coronavirus patients at Cedars-Sinai has grown from about 50 on March 17 to about 115 as of Tuesday morning, according to a hospital official who requested anonymity because the hospital’s policy is to not release those numbers.

M.L.K., which has 131 beds, has seen only a handful of cases so far. But it faces its own set of challenges.

So far, most of Los Angeles’s positive coronavirus tests have come from wealthy communities like Brentwood, Melrose and West Hollywood, closer to Cedars-Sinai than M.L.K. Public health officials have speculated that is because many residents there have both the wherewithal to travel overseas — possibly contracting the virus that way — as well as easier access to testing.

But doctors at M.L.K. worry that no one knows how deep the virus has spread within their community’s vulnerable population. That is because tests are scarce and the county is reserving them for the sickest patients and health care workers. It is all the more concerning because many in South Los Angeles suffer from underlying conditions like diabetes and heart disease that could lead to higher death rates when the virus hits hard.

“The bigger story is the people who are vulnerable because they haven’t gotten medical care all along,” said Dr. Elaine Batchlor, the chief executive of M.L.K. “These are the same people who are preparing food in fast-food restaurants, taking care of people in day care centers.”

Even when patients are hospitalized, the basic treatment for the coronavirus is fairly straightforward. Some need fluids and oxygen and a fever addressed, while the more severe cases may need to be sedated, ventilated and fed through a tube.

Dr. Peter Chen, the head of pulmonary and critical care medicine at Cedars-Sinai, said his team has been conducting drills to accomplish those tasks as efficiently as possible and be able to handle more patients. But, he added, for “the majority of people, it’s not rocket science.”

“They have a single organ failure — their lungs,” he said. “We manage the lungs until the lungs hopefully calm down. That’s it. It’s pretty much supportive.”

The challenge comes in getting the supplies needed to treat patients with the highly infectious virus. Like hospitals across the country, Cedars-Sinai and M.L.K. are scouring for masks, gowns and ventilators.

There, Cedars-Sinai has some advantages over its counterpart: It will get a greater portion of the emergency government supplies coming down the pike because of an allocation formula that favors it and the 12 other hospitals in the county designated as trauma or disaster relief centers. Cedars-Sinai has also been able to tap into donations from private sources, like Goldman Sachs, which recently delivered a supply of masks.

Still, Dr. Chen said the hospital was “barely scraping by,” with staff members forced to reuse masks for an entire shift in order to conserve them, as are their colleagues at M.L.K. As for ventilators, the shortage is dire enough that Cedars-Sinai is considering whether other machines, such as a BiPap, which assists breathing, could be safely modified for coronavirus patients.

“My biggest fear is that we run out of protection for our staff,” Dr. Chen said. “We’re physicians — we took the Hippocratic oath. We will run into a room even if we are out of masks, but what happens if I get infected, now I can’t take care of 20 other people whose lives I could possibly save.”

At M.L.K., doctors and nurses are spending their off-hours calling up every plumber, electrician and contractor they know, pleading with them to donate masks. The hospital has 16 ventilators right now, and has put in an order for four more. Doctors say they could possibly operate up to 40, although they worry about having enough trained staff to operate them.

Dr. Oscar Casillas, the medical director of M.L.K.’s emergency department, sees the county’s system of distributing emergency supplies as fundamentally unfair. M.L.K., he said, had a disproportionate 112,000 emergency visits last year, compared with 91,000 at Cedars-Sinai, a reflection of how many people in South Los Angeles rely on the emergency room because they lack basic primary care. One of the most common surgeries at M.L.K. is amputation because of complications from diabetes.

“Our story explains how different it is in this community than anywhere else in L.A.,” Dr. Casillas said. “There just isn’t enough primary care in this area to support the population.”

Some doctors rotate between several hospitals, including M.L.K., where they arrive for shifts and tell colleagues that bigger hospitals have a better supply of protective equipment, and that can breed resentment.

“There are some of these hospitals right around us like U.C.L.A. and Cedars, and those folks are getting those supplies, and so the physicians come here and say, ‘Why aren’t you guys wearing this?’” said Jorge Gonzalez, the nurse manager in the emergency department at M.L.K. “And it’s scaring our staff, because they are seeing right in front of their faces the differences and the disparities.”

Despite Cedars-Sinai’s reputation as the “hospital to the stars,” that shorthand frame of rich versus poor belies a more complex picture.

The community Cedars-Sinai serves is significantly more prosperous, with a median household income of about $70,000, than the one served by M.L.K., where it is $37,000. But Cedars-Sinai is also the No. 1 recipient of Medicare patients in the state, and a top provider to Medicaid patients. A recent policy change also makes it the most generous nonprofit in the state in terms of free and discounted charity care.

Like hospitals across the country, Cedars and M.L.K. are working to identify any usable space to isolate non-coronavirus patients from those they suspect are infected. Both hospitals set up outdoor intake tents; and a 1,000-bed military hospital ship that just docked at the port of Los Angeles should help free up hospitals by treating non-coronavirus patients.

And to prepare for the coming surge of those carrying the virus, both are doing their best to clear beds, sending patients home or delaying surgeries they normally would not.

Dr. Richard V. Riggs, Cedar-Sinai’s chief medical officer, said that at first, only elective surgeries were postponed, but as the urgency has mounted, the hospital has also begun postponing cancer surgeries that oncologists say can wait until after May, when the peak is expected to hit.

But at M.L.K. clearing beds is complicated, because many of the patients do not have doctors in the community who can handle follow-up care.

“At least in Beverly Hills, when they send a patient home they have a doctor they know is going to take care of the person,” said Dr. Batchlor. “In our community there is just a huge deficit.”

And, they worry, they may be sending people home to living arrangements, such as homeless shelters or group homes, where social distancing is difficult, if not impossible.

“We’re feeling the pressure to clear the decks yet we feel that in a good majority of our patients if we clear the decks we actually could be creating more of a surge later on,” said Alaine Schauer, senior director of critical care at M.L.K.

But if their challenges are slightly different, their fears are much the same. One doctor doing coronavirus triage at Cedars-Sinai went home last week and, after stepping into the foyer to strip out of scrubs and bleaching the area, reread the Hippocratic oath.

“There is a ramped-up anxiety that I don’t think I’ve ever seen before,” Dr. Casillas said. “Everyone is trying to do the best they can in an unprecedented situation.”



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