'The Separate and Unequal Health System' Highlighted By COVID-19
A South Los Angeles hospital has long provided for an underserved community where private insurance is scarce and chronic illnesses can flourish. And then came a devastating coronavirus surge.
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Los Angeles hospitals are being pushed to the brink. In the most populous county in the U.S., 1 in 3 people has been infected with COVID-19. Thousands have died. At the center of this surge is a community hospital in South Los Angeles that is serving the most vulnerable hit hardest by this pandemic. NPR's Leila Fadel goes inside that hospital and reports the outsized impact is the result of health care inequities that have been around a long time.
LEILA FADEL, BYLINE: Inside one of several triage tents in front of the Martin Luther King Jr. Community Hospital in Willowbrook - it's an unincorporated part of South LA near Compton and Watts - heart rate monitors beep as COVID-19 patients are cared for while they wait for space inside.
UNIDENTIFIED PERSON #1: (Speaking Spanish).
FADEL: In the emergency department, patients lay in beds that line the halls. An older woman says in Spanish, please, no. She's confused, alone. Nurses calm her. Some patients wait for rooms. Others are treated right in the halls.
RYAN MCGARRY: So we're living through a surge on a surge on a surge.
FADEL: That's Dr. Ryan McGarry. He's watching entire families come in with severe symptoms of COVID-19.
MCGARRY: And sometimes one lives, and one doesn't, you know? And that's brutal.
FADEL: He compares this moment to battlefield medicine.
MCGARRY: We're surrounded here by multiple tents and tubes and lines and, you know, effectively temporary structures to handle, you know, overflow on overflow.
FADEL: This is a crisis, but this nonprofit, safety net hospital has always served more than it was built to, since the day the gleaming facility opened in 2015 to replace its predecessor, shut down in 2007 over deadly conditions.
ELAINE BATCHLOR: We've been seeing, you know, a bit of a public health crisis in this community for the past five years.
FADEL: That's Dr. Elaine Batchlor, the CEO in her office upstairs. The public health crisis - an epidemic of chronic illnesses - heart disease, pulmonary disease, kidney disease, diabetes at much higher rates, as well as higher mortality rates. Here, she's working to get through this crisis, but also using it to highlight the need to bring the same quality of care to this underserved, largely Black and Latino community that, she says, more affluent communities get.
BATCHLOR: This is where the essential workers live. These are the people that are stocking the grocery stores, driving our buses, cleaning up after the rest of us. And they are continuing to be exposed to COVID on the job.
FADEL: Add the dense housing where multiple generations of families live together, the poverty, the secondary health conditions plus COVID, and it's an explosion of people getting sicker and dying more often.
BATCHLOR: Our small hospital now has more COVID patients than hospitals that are three to four times larger.
FADEL: From this office, she wrote to the governor on Christmas Eve asking for help. The state sent three National Guard Medical Strike Teams, travel nurses, respiratory therapists. She also made a plea for fundamental change.
BATCHLOR: We have a separate and unequal system of funding, and we see the results here.
FADEL: COVID preyed on the inequities. The majority of patients that come into this hospital are on public health insurance. That pays a supplemental amount for inpatient care and makes hospitals sustainable. But that's only if a patient is so sick they have to be admitted. Meanwhile, public health insurance pays a fraction of what private insurance does for outpatient care, and that includes the emergency room that's triaging below her office.
BATCHLOR: They're in our emergency department a lot because they don't have adequate access to care in the community, and we are paying for it.
FADEL: They show up because there's a shortage of 1,200 doctors in South LA. Primary care doctors, specialists don't set up where they can't make money.
BATCHLOR: You know, we've created a tiered financing system for health care with commercial at the top and Medicaid and uninsured at the bottom. And we need to change that, you know, because that's where many of our Black and brown communities are.
FADEL: The most common procedures at her hospital are completely preventable diabetic amputations and wounds. And the irony is...
BATCHLOR: We're getting paid adequately to amputate someone's leg, but we're not getting paid adequately to prevent that leg from being amputated.
FADEL: So this small hospital leans heavily on philanthropy to bridge the gap and show what's possible. It's why it can pay nurses and doctors competitive salaries and bring in cutting-edge technology. But Batchlor says, it's not sustainable without changes to the way health care is funded. On the fifth floor, the temporary ICU is inundated.
After New Year's, the staff relocated it and converted half this floor to treat more patients. Every room is doubled up. All but four of the patients on this floor are on ventilators, many on dialysis, and most came in with secondary conditions that make COVID a much more severe disease. Bigger hospitals threw money at travel nurses. This community hospital turned to the state.
MARIA ARECHIGA: We were hit really hard, so tough is, like, an understatement. It's been - it's been horrible.
FADEL: That's the ICU charge nurse Maria Arechiga. She grew up in Compton.
ARECHIGA: I know the community. So potentially, you know, this could be any of my family.
FADEL: On top of supervising nursing staff, tending to patients, she finds herself translating for doctors because so many of the sick are Latino and Spanish speakers.
ARECHIGA: I have to sit there - or one of the nurses that speak English and Spanish - with a straight face and tell them, your family member is going to die.
(SOUNDBITE OF ZIPPER ZIPPING)
FADEL: Plastic tarps with zippers hang in the doorways to convert regular hospital rooms into makeshift negative pressure rooms to keep the airborne virus particles out of the hallways.
ARECHIGA: I feel like this time around, people are coming sicker, and they unfortunately die quicker.
FADEL: As if on cue, Arechiga has to run off. An alarm is sounding - a patient crashing, their organs failing.
ARECHIGA: Give me another crash cart.
UNIDENTIFIED PERSON #2: I'm getting - I'm trying to get bunnied (ph) in here.
FADEL: She hands supplies through the unzipped tarp to doctors and nurses frantically trying to resuscitate a patient in the room. They're in bunny suits, masks and face shields. Then the patient in the neighboring bed goes into cardiac arrest. They call a code blue, a medical emergency.
UNIDENTIFIED PERSON #3: Code blue, five north, room 508...
FADEL: Two people arrive with more protective gear, and more nurses and doctors suit up and go in to help get a pulse back.
UNIDENTIFIED PERSON #4: Let's do a pulse check.
UNIDENTIFIED PERSON #5: A has a pulse.
UNIDENTIFIED PERSON #4: A has a pulse?
FADEL: There is practiced calm in the urgency. The staff work in tandem. And then Dr. Jason Prasso exits, walks away on the phone and comes back.
JASON PRASSO: One patient, unfortunately, did not make it. And I think, realistically speaking, the second patient, while we did get her back, is probably not going to make it either. And so I just want the families to have an opportunity to, you know, spend some time with them.
FADEL: Behind him, Maria Arechiga, with the help of other nurses, rolls the bed with the man's body out of the room and into another for privacy when the family arrives. Despite all they've learned, Prasso says the virus has proven difficult to manage.
PRASSO: There isn't a whole lot that I can offer besides supportive care as an ICU doctor in trying to prevent them from getting worse. And all too often, that isn't enough. It hurts as a doctor to say that. But a lot of times, there's not a lot I can do for patients who have COVID.
UNIDENTIFIED PERSON #3: May I have your attention, please? Code blue, five north, room 501B.
FADEL: Prasso rushes off - another cardiac arrest. By the end of this shift, five people are dead - four Latino, one African American - a bad day, a familiar day.
Leila Fadel, NPR News, Los Angeles.
(SOUNDBITE OF THE TIDES' "WINTER SNOW") Transcript provided by NPR, Copyright NPR.