JEFFREY KAYE: On an ordinary night in a Los Angeles hospital emergency room...
HEALTH CARE WORKER: Okay, very good. Do you know where you are now?
JEFFREY KAYE: ...Overworked doctors and nurses tend to the evening's casualties.
PATIENT: Get me up.
HEALTH CARE WORKER: Not yet. You can't get up yet, okay?
JEFFREY KAYE: Among them, victims of accidents, heart attacks, and stabbings.
HEALTH CARE WORKER: So you're having pain right over the stab wound?
PATIENT: Right by the stab wound.
HEALTH CARE WORKER: Okay. Let's look at your lungs, okay?
JEFFREY KAYE: As the ER fills up, patients with less serious problems can wait six hours or more. Increasingly, patients are using overburdened emergency services for routine medical care, as LA County slashes health care spending and shuts clinics. Dr. Daniel Higgins directs emergency services at a South Los Angeles hospital.
DR. DANIEL HIGGINS, St. Francis Medical Center: We've been at 120% capacity all year. We're seeing patients waiting in the waiting rooms for prolonged periods of time. We've seen patients waiting in the halls because we can't find ICU beds, because they're not enough nurses, or the beds are actually full. We have too many people in the hospital. It's a disaster.
HEALTH CARE WORKER: Can you move both legs?
JEFFREY KAYE: LA's fragile network of public and private facilities, available to all patients regardless of ability to pay, has long been stretched thin. But now, it's being stretched to the breaking point. The county recently closed down most of its once-bustling health care centers; 11 of 18 public clinics have been shut down to save money. Patients once seen here must either go elsewhere or go untreated. Now many in the largest public health care system in the nation are grappling with the consequences of the cuts, which will be far-reaching, and for some could be fatal.
DR. PAUL HUA, Imperial Heights Health Clinic: There is going to be more people dying in the ER if you don't give them preventive care, definitely. There will be people dying out in the streets.
JEFFREY KAYE: One of the elected county supervisors responsible for the cuts agrees with the dire predictions.
ZEV YAROSLAVSKY, LA County Supervisor: This is a decision about life and death.
JEFFREY KAYE: But Zev Yaroslavsky, a liberal Democrat, says without cutbacks, the county would go bankrupt.
ZEV YAROSLAVSKY: For me to have to close a clinic is alien to every bone in my body. It is as foreign as foreign can be. But if we don't do that, then the consequences to our clientele could be even more draconian: Closures of hospitals, closures of trauma center, emergency rooms, and clinics in hospitals.
JEFFREY KAYE: At the heart of the problem is the huge and growing population without health care insurance. They make up the bulk of the county's patients. 31% of LA's non-elderly residents-- two and a half million people-- have no coverage. That's a number greater than the population of Miami-Dade County. With federal assistance shrinking, LA County is facing a looming health budget deficit amounting to three-quarters of a billion dollars over the next three years.
ZEV YAROSLAVSKY: So when we talk about our situation here in LA, it doesn't begin to have any rivals anywhere in the country, any comparables. There isn't a county in the United States... in fact, most states in the United States don't begin to compare to the demand for service from our public health service that we have here in Los Angeles.
JEFFREY KAYE: The demand is highest in LA's poorest neighborhoods, such as South Los Angeles. Here, poverty and illness are intertwined. Its residents, nearly all Black and Latino, have the county's highest mortality rates for heart disease, cancer, stroke, and diabetes. Violent crime is another health threat. The area has among the highest murder and shooting rates in the county. Since the 1950s, many south LA Residents sought treatment at the Imperial Heights Clinic. Last year the clinic reported 38,000 patient visits. But on October 1, it closed its doors to patients, a victim of the budget cuts. As doctors planned to transfer patients and their own practices to the remaining county facilities, staff boxed up files and tore up old records.
DR. KARLON JOHNSON, Imperial heights Health Clinic: Well, I think it is kind of devastating, especially for the poor people. There are a lot of old people in this community. They are not able actually to catch the bus. They don't have cars. And so it's going to be devastating for those people.
JEFFREY KAYE: Imperial Heights was just one link in the delicate health care chain. Five miles away, another link, the Hubert Humphrey Medical Center-- one of the few LA public clinics staying open-- braced for an onslaught of new patients who would make the trip there. Every day, a line of people seeking care forms just after dawn. This was Charles Thierry's second day in line. Suffering from back pain, he is one of the patients transferred here from imperial heights.
CHARLES THIERRY: I came here yesterday. I left. There was too many people. There was just too many people.
JEFFREY KAYE: How long did you wait before you went back?
CHARLES THIERRY: About two hours. The lobby was full, and they had people all on the outside.
JEFFREY KAYE: You just gave up?
CHARLES THIERRY: I just gave up.
JEFFREY KAYE: And now you're trying again.
CHARLES THIERRY: Well, yeah. I'm in a lot of pain, and so I need the service. I've got to come back.
JEFFREY KAYE: Do you have insurance?
CHARLES THEIRRY: No, I don't have no type of insurance. Otherwise, I wouldn't be here fighting these lines.
JEFFREY KAYE: When the doors opened, Thierry joined the rush for treatment into a clinic where the cuts will translate into longer waits and delays in each of the services, from blood testing to patient checkups, to the busy pharmacy. Navel Chikwande brought his mother Elizabeth to get a refill on her blood pressure prescription.
JEFFREY KAYE: How long can you stay here?
NAVEL CHIKWANDE: About three hours.
JEFFREY KAYE: Three hours? And if you don't get seen in three hours, will you have to leave?
NAVEL CHIKWANDE: Yes. We have to go back to work.
JEFFREY KAYE: As patients put off preventive care, the stress builds on emergency services, both private and public, the final links in the health care chain. Dr. Higgins is with Saint Francis Medical Center.
DR. DANIEL HIGGINS: I took care of a patient the other day that came in that had a major bleed in the head, major bleeding into the brain, was in a coma, was on life support. And I asked the family, "she's hypertensive now. Does she have a history of hypertension?" They said, "yes, she's always had hypertension." I said, "well, why didn't she get any care?" "Well, she couldn't get into any county facilities, because the waits are months at a time, and she had no money, had no insurance." So rather than paying ten dollars a month for hypertensive medicine for this lady, we're going to pay tens of thousands and hundreds of thousands of dollars for her terminal care, as she suffers on a respirator and dies eventually.
JEFFREY KAYE: While the poor are feeling the brunt of the closures, county officials and health care professionals emphasize that everyone, rich and poor, insured and uninsured, could be affected by the cutbacks. Veteran nurse Ida Carvins is nursing director at the Hubert Humphrey Medical Center.
IDA CARVINS, Hubert Humphrey Medical Center: Say, for instance, I'm a diabetic. I don't have my medication. I drive the 405 just like you. I can go into a low blood sugar attack, and take you out and a few other people. If you're talking about communicable diseases, you talk about these people have active TB, you talk about these people being exposed to shingella, salmonella, and all the other good stuff that can make you have the runs. These people are working in your restaurants.
JEFFREY KAYE: But county officials are planning an even deeper round of cuts, which includes closing emergency rooms at two major hospitals which would be turned into clinics.
ZEV YAROSLAVSKY: Your insurance will be worth as much as a thousand shares of Enron stock if we have to close the trauma network of LA County. You can wave your insurance card all you want, but if you can't redeem it anywhere, you're up the creek. That's what we are facing. That's what everybody is facing.
JEFFREY KAYE: During past health care crises, Washington provided hundreds of millions of dollars in relief to LA County. Local officials have been in closed-door meetings with federal authorities to appeal for more government assistance, but the Bush Administration, which declined our requests for an interview, has said there will be no bailout. County Supervisor Yaroslavsky warns LA is a symbol of a national crisis.
ZEV YAROSLAVSKY: We are ground zero for the national health care debate. All of the problems and vicissitudes of our national health care system--or lack of one--start right here in Los Angeles County. This is where we have the most uninsured of any jurisdiction in the country. This is where we have the financial crisis that threatens to bring down the system.
JEFFREY KAYE: As they plead with Washington for federal dollars, LA officials are also asking county voters to pass a November ballot measure to increase property taxes. That would boost funding for emergency and trauma care services, but even if the measure passes, there's little hope that closed clinics will reopen.