Testimony on Behalf of LA Best Babies Network at the Beilenson Hearing on the Proposed Downsizing of the LA County Martin Luther King Jr./Drew Medical Center, before the LA County Board of Supervisors.
Testimony by Carolina Reyes, M.D., executive director of LA Best Babies Network, and visiting associate professor at the Keck School of Medicine of the University of Southern California, on behalf of LA Best Babies Network, before the Los Angeles County Board of Supervisors,
November 6, 2006.
Testimony Submitted to the
Beilenson Hearing on King Drew Medical Center
Carolina Reyes, MD
Hearing date: November 6, 2006
I, Carolina Reyes, M.D., declare and state as follows:
The following facts are within my personal knowledge and if called as a witness I could and would testify competently thereto.
1. I am a physician licensed in the State of California. I received my medical degree from Harvard Medical School in 1988. I am board certified in Obstetrics and Gynecology and board certified in Maternal-Fetal Medicine.
2. I completed my residency and fellowship training at the Keck School of Medicine at the University of Southern California in the Department of Obstetrics and Gynecology at Los Angeles County Women’s and Children’s Hospital. I am currently a Visiting Associate Professor at the Keck School of Medicine.
3. I am Executive Director of the LA Best Babies Network, dedicated to achieving healthy pregnancies and births.
4. I have reviewed the Beilenson notice posted by the Los Angeles Department of Health Services indicating that the County intends to decrease in-patient hospital services at martin Luther King Hospital. I have also reviewed the description of the Metrocare Plan contained in the October 17, 2006 letter from the Director of the Los Angeles County Department of Health Services to the Los Angeles County Board of Supervisors. The Metrocare Implementation Plan proposes as presented to the Los Angeles County Board of Supervisors on October 17, 2006, recommends the transfer of the Obstetrical, Neonatal Intensive Care Unit services to Harbor UCLA Medical Center
by November 30th and expanding the KDMC OB/GYN clinic into the current Women’s Health Center. The plan recommends downsizing the KDMC facility to 75 inpatient beds effective November 30th and to 42 beds effective March 1, 2007.
5. The impact of the downsizing of KDMC on the residents of SPA 6 and the County as a whole is staggering. I am especially concerned with the potential impact of decreasing services in a geographical region where health disparities match statistics in third world countries. King Drew Medical Center addresses the health care needs in an area that faces some of the greatest health care disparities in Los Angeles County.
- 21,118 births in SPA 6 in 2004. The highest density of any region in Los Angeles.
- Infant mortality in SPA 6 (2003): 145 (6.5/1000 live births)
- Although only 2.5% of births in SPA 6 were born at KDMC in 2004, there is a disproportionate share of high-risk moms and babies.
- According the DHS, 23% of the babies born at KDMC in 2004 were under 2500 grams or premature;
- KDMC has the highest rate of extremely premature babies (62/1000)
- SPA-6 has the highest rates of chronic morbidity.
6. SPA 6 has the highest maternal mortality rate in Los Angeles County. This is over 10 times the Healthy People 2010 goal.6. Providing care to complicated pregnancies and critically ill neonates requires specialized units, specialized physicians, nurse specialists and support systems able to provide intense immediate quality services. Over the year, tremendous strides have been made in survival rates and quality of life for some of the most vulnerable newborns, especially the extremely low birthweight. This has been a result of providing immediate quality services. This type of specialized care will not be easily accessible as proposed in the Metrocare plan.
7. As a perinatologist, I am especially concerned with the potential impact on the most vulnerable, the extremely premature babies, whose quality of life is determined by immediate care in the first hours of life. King Drew Medical Center has the largest capacity for neonatal intensive care services in the county with a state of the art facility. This is appropriate since this facility has the largest volume of the smallest most vulnerable babies in the county. According to the DHS,
about 23% of the births at KDMC are admitted to the NICU. Moreover, in 2005, King Drew Medical Center admitted 37 babies born extremely low birthweight (weighing under 1000 grams) requiring immediate neonatal intensive care services in order to have a chance at survival. No other hospital in the county matches the rate of extremely low birthweight babies. With the closure of the 43 licensed neonatal beds at King Drew Medical Center, the current volume of extremely low birthweight babies requiring immediate neonatal intensive specialized care at KDMC has the potential to far exceed the capability of the proposed Metrocare plan. At present, most hospitals with level III NICU services in neighboring hospitals are operating at capacity. Harbor UCLA has about 9 additional licensed beds.
8. Increasing the number of extremely low birthweight babies translates into more acute care, longer lengths of stay, therefore occupying NICU beds for longer periods and reducing the number of available beds. Will the Metrocare plan have the capacity to be able to accommodate the need for NICU services and provide quality care to the largest volume of very low birthweight babies in the County? Metrocare will not only need to optimize the current capacity of the NICU adding neonatal specialists and support, but will need to develop a county wide plan for transfer of neonatal patients requiring less intense care in order to accommodate the demand for services.
9. The rate of obstetrical patients with maternal morbidity at KDMC is unmatched in the County. The Metrocare Plan will need support to recruit appropriate specialized care with additional maternal-fetal specialists, anesthesiologists, neonatologists, etc.
10. Will the Women’s Health clinic plan to provide prenatal services? If so, given the level of patient acuity in SPA 6, the prenatal care services in OB services will still require high-risk obstetric specialists to assist in the management of prenatal care patients. With the higher level of maternal morbidity in this region, averting risk in the prenatal period is central to providing quality care.
11. In my experience with obstetrical services in a County facility, patients would rather wait to be attended than to have to drive outside of their community for needed services. Given that Harbor UCLA is 10 miles, it is likely that families would much rather wait or seek care at neighboring hospitals. This is likely to further strain the neighboring hospitals and further risk a domino effect of closures of emergency room services.
12. According to the DHS, about 23% do not own a vehicle. Providing transportation services from King Drew Medical Center to Harbor ULCA is a necessary component to the MetroCare Plan. But as we know, illness and a woman in labor do not operate on a schedule. Easily accessible round-the-clock transportation, although essential, will not be a sufficient plan. Providing needed care in the community where families reside should be the goal.
13. Currently, neighboring clinics in SPA-6 have seen a rise in demand for services. Given the anticipated overflow of patients to surrounding public-private partnership (PPP) clinics is there a plan in place to allocate additional support to the PPP clinics to accommodate the increase in volume?
14. In addition, the safety net system with Los Angeles County is largely strained and faces significant challenges to providing medically necessary care to the County’s large publicly insured population. While the Metrocare Plan may be the most expedient plan under urgent circumstances we should not accept this plan as the final solution. We need a commitment to long-term planning to meet the needs this community deserves.
Thank you,
Carolina Reyes, MD |
