Harbor-UCLA to be cited for overcrowding

I don't think the article is blaming the hospital, per say. Doesn't it say that the citation is going to the Los Angeles County Department of Health Services? Overcrowding in the ED at Harbor is a serious problem. Ask any of the residents and they will likely tell you the patients at Harbor are one of the best parts of the program. Those patients shouldn't have to wait for days to be seen. Having interviewed at many of the large county programs in the country, I can tell you that I never saw wait-times that even approached those at Harbor. I don't know what the solution to this is, but I do think we need to advocate for change.

well, the EM program there has been pushing for a new, expanded ED for years and years. Maybe the county will take this as a wake-up call and finish the new ED post-haste. Obviously, of course, there was no way this could have been foreseen

Hard24Get said:

well, the EM program there has been pushing for a new, expanded ED for years and years. Maybe the county will take this as a wake-up call and finish the new ED post-haste. Obviously, of course, there was no way this could have been foreseen

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The phrase they used in the article was "Patients are in immediate jeopardy".

Such language was used just before they closed down my facility.

They're also threatening to cut off funding from Olive View.

My own view is that LA County would love nothing better than to downsize their county health system, and consolidate everything at the new LAC-USC medical center.

GeneralVeers said:

The phrase they used in the article was "Patients are in immediate jeopardy".

Such language was used just before they closed down my facility.

They're also threatening to cut off funding from Olive View.

My own view is that LA County would love nothing better than to downsize their county health system, and consolidate everything at the new LAC-USC medical center.

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But this is so unfair! They asked for a new ED long ago and the county wouldn't approve a new facility until recently, adn they closed down Drew, which led to Harbor getting more patients. How can you cite an ED for having too many people show up, anyway? Short of driving patients elsewhere?

Hard24Get said:

But this is so unfair! They asked for a new ED long ago and the county wouldn't approve a new facility until recently, adn they closed down Drew, which led to Harbor getting more patients. How can you cite an ED for having too many people show up, anyway? Short of driving patients elsewhere?

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I was wondering the same thing. I found out that where I am the paramedics are told to redirect people to other EDs when one is 'too full.' I don't know how much better a system that is. I was wondering if they still took patients who walked in at this point (when they are diverting all ambulances) or if they tried to convince some to go to a different ED (which I hope doesn't happen).

EM2BE said:

I was wondering the same thing. I found out that where I am the paramedics are told to redirect people to other EDs when one is 'too full.' I don't know how much better a system that is. I was wondering if they still took patients who walked in at this point (when they are diverting all ambulances) or if they tried to convince some to go to a different ED (which I hope doesn't happen).

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When we'd go on divert at KDMC, we were still obligated to take walk-in patients. The walk-in patients are what kill you when your ED is already full and you're holding patients to be admitted.

The situation in LA is only going to get worse as volume increases and EDs close down. The county has done little to address the problem.

pseudoknot said:

In LA County, an ED can divert ALS ambulance patients only, for four hours at a time. If you look at the status board, you will find that half or more of EDs in a given area are often on divert status.

BLS (non-paramedic) ambulances cannot be diverted since they do not make contact with a base hospital for transport.

Walk-ins cannot be diverted because it would violate EMTALA.

I am a little surprised that Harbor and Olive View have been getting the regulatory attention they have. My guess is that there are people still fired up after the MLK closure who are looking for other targets. I do think that life will continue to be very difficult for LA's EDs and patients until more EDs start opening than are closing.

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This all makes sense. And your last paragraph seems quite accurate (from where I'm sitting).

GeneralVeers said:

My own view is that LA County would love nothing better than to downsize their county health system, and consolidate everything at the new LAC-USC medical center.

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Just curious why you think the county wants to consolidate everything at USC?

GeneralVeers said:

The phrase they used in the article was "Patients are in immediate jeopardy".

Such language was used just before they closed down my facility.

They're also threatening to cut off funding from Olive View.

My own view is that LA County would love nothing better than to downsize their county health system, and consolidate everything at the new LAC-USC medical center.

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And along those same lines...what effects (if any) can this regulatory scrutiny have on the EM programs in LA? Any viewpoints as to what this spells for LAC+USC, Harbor, etc.?

2008 EM Reviews said:

And along those same lines...what effects (if any) can this regulatory scrutiny have on the EM programs in LA? Any viewpoints as to what this spells for LAC+USC, Harbor, etc.?

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Anything would be purely speculative on my part. The only evidence I can speak to is that LA County seemed unwilling to allow any of the MLK residents to stay on at any other LA hospitals, despite the desire by the PD at LAC-USC to expand the program with some of our residents (they easily have the volume). LA County refused to continue paying our salaries at another facility, so any chance to put us at other facilities was lost. They (the supervisors) never provided an explanation as to why they wouldn't allow us to transfer and got angry when confronted by some of our attendings and residents.

The closure of MLK and the failure to expand and revamp the facilities at Harbor-UCLA in order to compensate for the demand seems telling. LA County knew the MLK closure was coming for about a year and could have made plans, however they did nothing.

Despite the relative success and good reputation enjoyed by Harbor-UCLA, I think that the LA County supervisors would not lose any sleep if the place was shut down, thus reducing their financial obligations. For people who supposedly represent the poorest districts, the supervisors have let their constituents down by failing to maintain even a basice safety net.

I asked someone about this and have a feeling the rest of those who applied this cycle will also be receiving an email that is very satisfying shortly.

Harbor-UCLA is not getting shut down or any in jeopardy of losing funding. There has been a significant increase in patient volume since King's ED closure. This has been a problem for months. IF there is any citation it will not be directed towards Harbor's patient care. The citation will be due to the extremely long waits that can be detrimental to the patients' health and the overall emergency system in LA.

I do not believe that LA County DHS or the Board of Supervisors want to see Harbor or any additional EDs close. The County is already in a huge medical crisis due to the large number of patients who are only able to receive care in the public hospital system.

Unfortunately, a tragedy sometimes has to occur for people to WAKE UP and address the issues at hand. Hopefully, we will see more money and resources channeled into the EDs, clinics, and hospitals that have been working hard to take care of the underserved in LA.

Harbor is a busy hospital in general. Most clinics have very long wait times and the hospital is filled to the brim. Harbor's ED is very busy and wait times are much longer than ideal. Whenever I walk through the waiting area, it seems like it's standing room only... The ED staff is very good, but there just isn't enough staff or room to deal with the patient load. There are plans to build a much needed new expansion with a new ED and ORs in a lot adjacent to the main building, but as many county projects, this one has been much delayed and has barely gotten off the ground.

I can't see the county trying to consolidate all services under LAC-USC. It would make no sense (Ok, so maybe they might try it ). LA is just too spread out for that... USC is just to far from Torrance or Sylmar to obviate the need for Harbor or Olive View. And its not like USC isn't busy enough as it is.

From the perspective of someone not in the health field, it's been like watching a trainwreck.

How many EDs are going to be shut down before L.A. County Public Health gets its act together? It's been like watching dominoes fall.

L.A. County is way too spread out for a centralized location. Who's going to drive into L.A. proper for emergency treatment when they live damn near in Ventura County? And how is that even remotely good response time for ambulance services, if they have to go from one end of the county to the other?

There are so many things wrong with L.A. County Public Health. Too many bureaucrats, not enough people actually qualified to run public health.

LuvbugMD said:

Harbor-UCLA is not getting shut down or any in jeopardy of losing funding. There has been a significant increase in patient volume since King's ED closure. This has been a problem for months. IF there is any citation it will not be directed towards Harbor's patient care. The citation will be due to the extremely long waits that can be detrimental to the patients' health and the overall emergency system in LA.

I do not believe that LA County DHS or the Board of Supervisors want to see Harbor or any additional EDs close. The County is already in a huge medical crisis due to the large number of patients who are only able to receive care in the public hospital system.

Unfortunately, a tragedy sometimes has to occur for people to WAKE UP and address the issues at hand. Hopefully, we will see more money and resources channeled into the EDs, clinics, and hospitals that have been working hard to take care of the underserved in LA.

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I agree that Harbor-UCLA is not under any IMMEDIATE closure threat, however MLK did not close down overnight either. It took them over 5 years to finally close down MLK, and the Supervisors did nothing to stop the closure, in fact their attitudes suggested they'd be relieved to be rid of the financial responsibility.

The Board of Supervisors is an autocratic group accountable to no one, and they are not known for making prudent decisions that represent the best interest of the people of Los Angeles. Their decisions are purely motivated by financial and political expediency. While I agree that centralization of services at LAC-USC would be disastrous for millions of people, I can see their perverse logic at work in "reducing the county's healthcare financial obligations".

pseudoknot said:

To be fair, there were serious issues with patient care at MLK for many, many years, and the only reason it wasn't closed down much earlier was a very vocal local constituency that had the ear of the Supervisors and Congress. I agree that the county's oversight is pretty lax and that they gave the residents there the shaft, but I think there was a lot of external pressure (not to mention good reasons) that led to the closure of MLK, which I don't see in the case of Harbor or Olive View.

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All true, and I'm in no way implying that the situations are the same. The fact is that MLK had correctable problems (namely lazy employees and corruption) that the Supervisors refused to correct over the 5 years they had to do so. Most of it had to do with BS racial politics.

http://www.latimes.com/news/local/la-me-harbor13feb13,1,746173.story

"Health system in crisis" sells papers in LA.

great! now I have acute on chronic matchitis. I spend weeks agonizing over my ROLM then I see these articles about how the board of supervisors might like to close two of the top programs on my list.

am I a bad person? I help elderly people cross the street and stuff like that.

maybe if they close down my residency program i'll go to law school.

Well, I talked to Hockberger the other day, and he said he'd never had a week with more meetings in his life. He was actually on shift when the guy went AWOL and was found dead, and he was basically the only person not freaking out in the ED over it. You can't keep tabs on every mysterious cocaine-or-not-cocaine abuser in your ED before they walk out and die.

But, in terms of substantive improvements, there are a couple things they're doing as "quick fixes", which address the issues they were cited for. They're adding more nurses to the triage area and contracting with an EP group to perform the initial "medical screening exam" that's required to be performed in a timely manner. This will help them become more compliant with the regulations, but doesn't necessarily decrease waiting times - especially for patients that don't have legitimate emergencies - but it should, at least, prevent events from occurring where someone dies from being inappropriately assessed up front. The other moves they're making, which should at least help a small portion with the wait times, are contracting with a private group to open up more beds; the hospital was built for 500 beds, and they operate 400 due to staffing. It seems as though it will essentially create a non-teaching service to take some of the admissions. In addition, one of the other "choke points" is when the long-call medicine team caps, and the single R2 on overnight to cover admissions for the next day's admitting teams can't work up all the patients the ED admits overnight fast enough to get them upstairs and prevent boarding. They're going to hire a hospitalist to help make sure patients have admitting orders and someone to follow them when they go upstairs to get them out of the ED. Of course, this will probably only help for a week or so until the hospital is, again, at full capacity for staffing and the limiting factor again becomes bed availablity, but, well, just keep trying one solution at a time....

2008 EM Reviews said:

Well, I talked to Hockberger the other day, and he said he'd never had a week with more meetings in his life. He was actually on shift when the guy went AWOL and was found dead, and he was basically the only person not freaking out in the ED over it. You can't keep tabs on every mysterious cocaine-or-not-cocaine abuser in your ED before they walk out and die.

But, in terms of substantive improvements, there are a couple things they're doing as "quick fixes", which address the issues they were cited for. They're adding more nurses to the triage area and contracting with an EP group to perform the initial "medical screening exam" that's required to be performed in a timely manner. This will help them become more compliant with the regulations, but doesn't necessarily decrease waiting times - especially for patients that don't have legitimate emergencies - but it should, at least, prevent events from occurring where someone dies from being inappropriately assessed up front. The other moves they're making, which should at least help a small portion with the wait times, are contracting with a private group to open up more beds; the hospital was built for 500 beds, and they operate 400 due to staffing. It seems as though it will essentially create a non-teaching service to take some of the admissions. In addition, one of the other "choke points" is when the long-call medicine team caps, and the single R2 on overnight to cover admissions for the next day's admitting teams can't work up all the patients the ED admits overnight fast enough to get them upstairs and prevent boarding. They're going to hire a hospitalist to help make sure patients have admitting orders and someone to follow them when they go upstairs to get them out of the ED. Of course, this will probably only help for a week or so until the hospital is, again, at full capacity for staffing and the limiting factor again becomes bed availablity, but, well, just keep trying one solution at a time....

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Those are all wonderful plans, but the main issue with almost every hospital is the nursing shortage. Where are they going to get these nurses from? It's easy to say "we have 100 extra beds we can open up" but in practice it's nearly impossible.

When I was at MLK the facility itself had 550 beds, however we ran about 190 due to extreme nursing shortages. Likewise the old LAC-USC facility had over 1000 beds, but usually ran about 700.

pseudoknot said:

Don't worry, I still think it will be ok and UCLA will take care of its own even if the county doesn't.

I kind of wish I'd gone to law school sometimes. I think I would have loved law school but hated being a lawyer. Hopefully the reverse is true for med school and the practice of medicine...

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The county won't take care of anyone. If Harbor closes, then those residents are screwed and will probably have to leave the state (as we did). The UCLA residents should be fine, as they'll still have their primary training site, and I'm sure UCLA can find additional hospitals to train at.

pseudoknot said:

UCLA runs the training programs at both Harbor/UCLA and Olive View. Hence my thinking that people going to either program don't need to worry too much.

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It all comes down to money. The Harbor residents are paid by the county, and the county will not pay to employ them should the hospital closed. I doubt UCLA would be willing to pick up the financial responsibility.

Hi guys,
i assume everyone got this, but for those of you who didn't the PD tried to addresss a lot of the concerns of applicants on this e-mail:


Dear Applicants,

On February 6, 2008 the Los Angeles Times published an article dealing with
Harbor-UCLA Medical Center's recent State citation for "a dangerous level of
ED overcrowding."

We completely understand that you might find the article in the LA Times
concerning. Although this sort of review by a governmental agency raises
eyebrows and legitimate concern, this is something that will finally help us
out in direct and tangible ways that we've been asking for a long time. The
reality is that this "citation" is actually a blessing in disguise for our
hospital, as it finally makes the County pay attention to our overcrowded
status and brings further solutions and resources on top of the ones that are
already coming our way to deal with it. This is NOT the same situation as
happened with Martin Luther King Hospital. We are also sure that we will be
much better off as a result of the increased resources to help offload our ED
volume.

We hope this allays some of your concerns and want to assure you that our
residency program is not in jeopardy of losing ACGME accreditation or closing
and that the LA County Department of Health Services and our hospital's
leadership are providing a coordinated response to address the citation. It
would be a shame to have something like this change your mind about Harbor.
We have no doubt that we are going to be here for a very long time doing the
things we do best... teach residents and take care of our underserved
community.

Please feel free to contact David Burbulys or Bob Hockberger (310-222-3501,
[email protected], [email protected] ) to ask any other questions you
might have.



David Burbulys, MD Robert Hockberger, MD
Residency Director, Emergency Medicine Chairman, Emergency Medicine

I'm also attaching an email below from Bob Hockberger, our Chairman, to our
residents explaining the current situation and the remedies for the
overcrowding.

___________________________________________________

EM Residents,

This morning's LA Times has an article dealing with our hospital's recent
State citation for "a dangerous level of ED overcrowding." It mentions the
patient who died after leaving our ED before his assessment was completed, but
doesn't mention that the State did not find fault with our management of the
case, just the crowded circumstances that may have contributed to his leaving.

Both DHS and our hospital's leadership are moving quickly to address the
citation, which we expect to have lifted within a relatively short period of
time. The actions that are being taken include:

1. We are going to place more nurses and attendants at triage to make sure
that all patients get triaged in a timely manner.
2. We are going to contract with a private group of emergency physicians to
place a board-certified emergency physician in a room close to triage to
perform rapid medical screening exams on all patients, help move the really
sick ones to the ED and order tests on the others so test results will be
available when the patients get to the ED later. They will also work with the
triage staff to monitor the status of waiting room patients and provide
limited treatment (ex. pain management).
3. The hospital is going to get the funding for several previously-requested
programs that will help expedite patient care (and flow out of the ED and the
hospital):
- A hospitalist program for Medicine (to admit patients around the
clock and to expedite inpatient flow and discharges)
- An expedited outpatient evaluation clinic (to help us avoid
admitting patients for that purpose)
- An inpatient unit run by Cardiology to which we will send ED
patients who need short-term treatment we now provide in the ED, like
treatment of CHF or ruling out ACS before performing treadmill tests.
- Expansion of Urgent Care to 16 hours/day every day of the year.

Some of these things will happen relatively quickly, some will take a little
time. As I mentioned previously, I believe that things will be much better,
both for our patients and for us, a few months from now after all of these new
programs have been implemented. Currently 10,000 of the 50,000 patients
triaged to the Adult ED each year leave before being seen because of long
waits. Our goal is to see all of the patients who come here seeking medical
care. These additional resources should help us come closer to accomplishing
that goal.

I will continue to keep you updated regarding our progress.

Bob

loomis said:

Hi guys,
i assume everyone got this, but for those of you who didn't the PD tried to addresss a lot of the concerns of applicants on this e-mail:

Click to expand...

I thought about posting this, but figured it would only invite more vitriol.

pseudoknot said:

BLS (non-paramedic) ambulances cannot be diverted since they do not make contact with a base hospital for transport.

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That's not 100% accurate thought. Yes, BLS units can't be officially diverted due to not making base contact and interfacility transports are exempt (same reason), but the ambulance companies still call in prior to arriving. Most ambulance companies don't want their units/EMT-Bs sitting around for 3 hours [a big F you to Presbyterian Intercommunity Hospital, by the way, for this], so they're more than willing to offer transport/attempt placement [Law 5*] at a non-impacted hospital.

THAT SAID, critical patients being transported by BLS [interfacility transports, based on ETA of medics vs transport time] will still go to the closest facility which doesn't help the situation at all.


*Laws of the House of God

pseudoknot said:

Not everywhere. In Santa Monica, for example, BLS units make no contact with hospitals whatsoever, although the fire department will usually check to see if a hospital is closed out of courtesy first.

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So BLS patients just show up unannounced? I never fully realized [I worked mostly in OC, which in and of itself is a bass ackwards system] that Southern California EMS was so screwed up. I'd argue that emergency IFT [SNF->ER, as opposed to a direct admit or visiting an outpatient service] are not always accepted prior to arrival [depends on the level of the facility and the condition of the patient. I imagine that a board and care plays by a different set of rules than a SNF].

Siggy said:

So BLS patients just show up unannounced? I never fully realized [I worked mostly in OC, which in and of itself is a bass ackwards system] that Southern California EMS was so screwed up. I'd argue that emergency IFT [SNF->ER, as opposed to a direct admit or visiting an outpatient service] are not always accepted prior to arrival [depends on the level of the facility and the condition of the patient. I imagine that a board and care plays by a different set of rules than a SNF].

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BLS just showed up unannounced at MLK. Initially when I started there we would have a base station and the ACLS would call in. L.A. County centralized their EMS base stations in 2005. Afterwards ACLS would show up without warning UNLESS the patient was coding or had some other emergent condition.

GeneralVeers said:

BLS just showed up unannounced at MLK. Initially when I started there we would have a base station and the ACLS would call in. L.A. County centralized their EMS base stations in 2005. Afterwards ACLS would show up without warning UNLESS the patient was coding or had some other emergent condition.

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In Boston they only radio in priority 1 or 2 patients. I've heard Boston EMS BLS units call up hospitals on divert and ask to come there for X, Y, or Z reason, but I would suspect they always know who's on divert (which, by the way, doesn't matter for bad traumas or codes or that sort of stuff, at least where I work...)

Siggy said:

So BLS patients just show up unannounced? I never fully realized [I worked mostly in OC, which in and of itself is a bass ackwards system] that Southern California EMS was so screwed up. I'd argue that emergency IFT [SNF->ER, as opposed to a direct admit or visiting an outpatient service] are not always accepted prior to arrival [depends on the level of the facility and the condition of the patient. I imagine that a board and care plays by a different set of rules than a SNF].

Click to expand...

I would prefer BLS and routine ALS ambulances show up unannounced. We finally eliminated non-priority radio reports. We researched it and found it tied up the triage nurses (for 2-5 minutes, yes some reports were 5 minutes long), and the triage nurses rarely, if ever, did anything to prepare for non-priority patients. Complicating the matter even more is that often times the triage nurse who took the call-in would get tied up and the other triage nurses wouldn't know anything about the patient anyway. EMT's and paramedics were still giving the same report in person to the triage nurse.

I read this thread after the AMA thread....and it may be slightly off topic... but doesn't the idea of national/government run healthcare for all sound absurd considering that LA county can not accomplish it. LA is only one (although large) city in the US. Think about it

Dr. Caveman said:

I read this thread after the AMA thread....and it may be slightly off topic... but doesn't the idea of national/government run healthcare for all sound absurd considering that LA county can not accomplish it. LA is only one (although large) city in the US. Think about it

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No, I don't think that just because LA county is having issues that it means universal health care can't be accomplished. There are plenty of COUNTRIES with universal health care. In fact, almost every developed country has universal health care. You may feel that it's not up to American standards, but that's sort of the point - it's a compromise in services given to a few so that we can provide basic services to many.

Dr. Caveman said:

I read this thread after the AMA thread....and it may be slightly off topic... but doesn't the idea of national/government run healthcare for all sound absurd considering that LA county can not accomplish it. LA is only one (although large) city in the US. Think about it

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that's why no one is proposing it. The debate now is only about supplementing insurance for those that don't have it, and ending this type of care (at least with regard to the VA)

I guess this wouldn't be an EM thread if it didn't digress...

Harbor-UCLA is not closing...It's actually expanding. They're building a new ICU and new ER and just completed a new research building on campus...

This hospital should not be closed down. Instead they should be made mandatory for every member of staff who works here to wear a clown uniform to work instead of scrubs... becuase that is exactly what they are.... clowns. That way, those of us who walk through those doors.. know what to expect... people who know absaloutly nothing about medicine at all.

Having grown up in the UK for 24 years I can tell you I disagree with socialised medicine (since I lived under it) but I can also tell those of you who work here at harbor, a UK University would not let you dumb-**** step one foot through the door...infact.. you would be laughed right out the door.

Here are some of the ridiculous (to put it lightly) comments I have heard coming from this cess pit.

"What is a partial seizure"

"The only EEG we do at the weekend is for the heart" (this dumb-ass must have been smoking crack the day she learned about EEG's) I almost said something, but did not want to embarass this fool... perhaps I should have said something, I might have saved the poor souls life who was coming in after me having a heart attack.. to shamefully get an EEG instead of an EKG

I also find it extremly offensive to be automatically de-faulted as a homeless crack addict when I walk through the doors. Perhaps given the economy they should not be so suprised to see a pretty white girl with a bachelors degree walk through the door... believe me... there are going to be more and more...just like myself.

TO be frank, there is really no excuse what-so-ever to turn up to a job in which YOU SAVE LIVES with a disgraceful lack of knowledge about your subject. Each time I have walked in here.. someone is messing up. If you are the type of person to mess up alot, please choose another job. I do not walk into my teaching room with no clue about Beethoven whilst trying to teach it.

Oh and I failed to mention this. The last time I was there (THE LAST TIME) whilst sat in the waiting area I saw a distraught woman come rushing in, whoose husband was outside in a wheel chair having a heart attack. When she asked the nurse to help her in with him, her response was "Sorry thats not my job ask security" I witnessed her ask security, only to get the same response.

May I let you in on a little information here....for those who do work here.. and those who dont. Its one thing to ignore someone who needs medical attention, but to DETER someone from it.. is .. of course... a criminal offense. Thankfully, Im already de-sensitized to this type of behaviour due to being treated under the NHS.

I could quite happily live my life knowing this place is shut down. An ice-skating ring or theme park might be better on these grounds

Total bunch of half-wits. They have become like animals themselves.

I only came to this forum to post this after finding this online, have no desire to post anything else and will probably be banned now. lol.

wtf was that...

GnatAttack said:

This hospital should not be closed down. Instead they should be made mandatory for every member of staff who works here to wear a clown uniform to work instead of scrubs... becuase that is exactly what they are.... clowns. That way, those of us who walk through those doors.. know what to expect... people who know absaloutly nothing about medicine at all.

Having grown up in the UK for 24 years I can tell you I disagree with socialised medicine (since I lived under it) but I can also tell those of you who work here at harbor, a UK University would not let you dumb-**** step one foot through the door...infact.. you would be laughed right out the door.

Here are some of the ridiculous (to put it lightly) comments I have heard coming from this cess pit.

"What is a partial seizure"

"The only EEG we do at the weekend is for the heart" (this dumb-ass must have been smoking crack the day she learned about EEG's) I almost said something, but did not want to embarass this fool... perhaps I should have said something, I might have saved the poor souls life who was coming in after me having a heart attack.. to shamefully get an EEG instead of an EKG

I also find it extremly offensive to be automatically de-faulted as a homeless crack addict when I walk through the doors. Perhaps given the economy they should not be so suprised to see a pretty white girl with a bachelors degree walk through the door... believe me... there are going to be more and more...just like myself.

TO be frank, there is really no excuse what-so-ever to turn up to a job in which YOU SAVE LIVES with a disgraceful lack of knowledge about your subject. Each time I have walked in here.. someone is messing up. If you are the type of person to mess up alot, please choose another job. I do not walk into my teaching room with no clue about Beethoven whilst trying to teach it.

Oh and I failed to mention this. The last time I was there (THE LAST TIME) whilst sat in the waiting area I saw a distraught woman come rushing in, whoose husband was outside in a wheel chair having a heart attack. When she asked the nurse to help her in with him, her response was "Sorry thats not my job ask security" I witnessed her ask security, only to get the same response.

May I let you in on a little information here....for those who do work here.. and those who dont. Its one thing to ignore someone who needs medical attention, but to DETER someone from it.. is .. of course... a criminal offense. Thankfully, Im already de-sensitized to this type of behaviour due to being treated under the NHS.

I could quite happily live my life knowing this place is shut down. An ice-skating ring or theme park might be better on these grounds

Total bunch of half-wits. They have become like animals themselves.

I only came to this forum to post this after finding this online, have no desire to post anything else and will probably be banned now. lol.

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If I saw you at MY hospital with a nonsensical rambling diatribe like you just provided, I too would diagnose you with a "bad case of the crazies" and turf you out the door as soon as possible. Harbor-UCLA is dealing with gunshot wounds, and the sickest of the sick patients. Your inane problems (and your behavior) likely just annoyed them.

Attending, huh? Now why do I have my doubts about that?

What caused her to resurrect an otherwise happily buried thread?

Take care,
Jeff

Epilepsy=not an innane problem. Glad I dont have generalized seizures otherwise I would not have been able to witness such hideous people.....I actually learned alot....

What a childish thing to say lol "Well if you were in my hospital id put you out the door" ROFL..Ill never end up in YOUR hospital you fool.

If we are going to resort to 2 year old remarks.. then here goes this..

"If you came to my music school, I would throw you out the door because well.. well .. your just.. a .. well your just ... a dick head"

LOL. Your a **** doctor, your a dick head, you will never make a good doctor..just quit your career now and save everyone the hassle of having to see your face everyday ....or kill yourself or something.. you really sound like a total waste of space.

GnatAttack said:

LOL. Your a **** doctor, your a dick head, you will never make a good doctor..just quit your career now and save everyone the hassle of having to see your face everyday ....or kill yourself or something.. you really sound like a total waste of space.

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Thank you. You have just demonstrated to everyone that you have lost. Thanks for playing! Come again!