How Covid Overwhelmed One L.A. Hospital in California’s Worst-Hit County

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“That is a tragedy,” Dr. Nida Qadir, co-director of the medical intensive care unit at Ronald Reagan U.C.L.A. Medical Center, said of the M.L.K. statistic. Her hospital had mortality levels “a lot lower than that,” she said, though the hospital had not publicly released the figure. A new study of patients at 168 hospitals found that about half of Covid patients on ventilators died, and survival varied widely among hospitals.

Dr. Theodore J. Iwashyna, a critical care physician at the University of Michigan, said the differences in hospital outcomes reflected a “system choice.” He and others have studied patients with complex pulmonary conditions and found that those treated at smaller hospitals with fewer resources and less experience in managing them tend to have poorer survival rates. “Big hospitals should have been accepting those patients and pulling those patients out” of M.L.K., he said.

During the Los Angeles surge, hospital mortality also rose because fewer mildly ill patients were hospitalized, said Dr. Roger J. Lewis, a professor of emergency medicine at Harbor-U.C.L.A. Medical Center who helps analyze Covid data for the county. That was likely even more the case at small hospitals like M.L.K. in areas with high rates of chronic illnesses, he said.

The medical team invited Mr. Flores’s wife to the hospital, usually closed to visitors during the pandemic. She found her husband frightened and shaking. He was not getting enough oxygen, a doctor explained, and without a ventilator he could die in two days. Mr. Flores told her he wanted to go home, then changed his mind. He was exhausted and had chest pain, he said. He would try the ventilator because he wanted to live longer for his family.

Still, his oxygen levels remained low. Doctors gave him steroids and drugs that counter blood clots. They turned him on his stomach, and even paralyzed him for periods to help the ventilator work more effectively. But nothing seemed to make a difference. Mr. Flores had “cut-and-dried Covid pulmonary failure,” Dr. Prasso said.

Some Covid patients have one last option: treatment using a machine that gives the lungs a chance to rest and, hopefully, repair. The procedure, extracorporeal membrane oxygenation, or ECMO, is typically offered only in larger hospitals to patients who meet stringent criteria.

Mr. Flores might have been a candidate for it at one point, according to Dr. Christopher Ortiz, a critical care specialist from U.C.L.A., a top-ranked hospital, who pitched in at M.L.K. But Dr. Prasso said he had stopped considering the treatment. Earlier in the pandemic, he had pushed to transfer some M.L.K. patients to hospitals providing ECMO, but finally gave up.

“We’ve never been successful,” he said. “Nobody wants their insurance.”

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