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A wave of hospital closures in California is causing major disruptions for patients, staff, and communities, and the prognosis is grim for a quick recovery in an industry paying an increased share of the bill for the uninsured and poor.

Seven hospitals have either shut down or are about to close their doors – the latest casualty being the 229-bed Robert F. Kennedy Medical Center in Hawthorne – and several other hospitals are reportedly teetering financially and may call it quits.

In Los Angeles County, six emergency departments serving a total of more than 100,000 people have closed during the last year, putting a strain on the 78 remaining EDs that already have a high ambulance diversion rate because of overcrowding and the need to stay within a mandated nurse-to-patient ratio of 1:4.

“The bottom line for all the closures has been a two- to threefold increase in the number of uninsured patients receiving care at the hospitals,” says Jim Lott, spokesman for the Hospital Association of Southern California. “That’s the issue.”

Lott says the latest closure of RFK, which has lost $53 million since January 2002, removes another ED serving 24,000 patients annually from the county’s emergency system. He says the community impact of its Dec. 31 closure is still uncertain and predicts at least one more hospital will close before the end of the year.

“We still don’t know how RFK’s closing will affect nearby hospitals, but we do know they can’t absorb many more patients,” Lott says. RFK says it also came under financial pressure from two unfunded state mandates – the nurse staffing ratio law and seismic upgrading requirements.

Regardless of the circumstances, removing life support from a hospital can have unforeseen ramifications. The closure of 80-year-old San Jose Medical Center Dec. 9, for example, could leave Santa Clara County with only two trauma centers and the inability to assist serious accident victims from three surrounding counties that count on the service.

The closure also will shut down an ED that treats 32,000 patients annually and displace some 900 employees, about 450 of whom will lose their jobs. The hospital, owned by Hospital Corp. of America, is working to help place workers at two other HCA hospitals in the county, says medical center spokeswoman Lesley Kelsay.

The downtown San Jose facility was scheduled to be phased out in three years and the Sept. 8 announcement giving state regulators the required 90-day notice of closure came as a jolt to the staff and community.

“It’s a blow to everybody,” says community activist Rosylin Dean, a member of a coalition of 80 San Jose groups working to ease the effects of what it thought was a three-year winding-down period. An immediate impact will be on seniors living in housing projects who could walk to the hospital for services, she says.

Dean says a $50,000 study on the impact of the medical center’s 2007 closure is due Nov. 1 and now will be compromised by the early shutdown. One suggestion is for the funding of a 24-hour urgent care center in the downtown area.

While some 300 nurses are directly affected by the medical center’s closing, California Nurses Association field representative Patty Lasky says their option to “bump” by seniority at the other HCA hospitals puts the jobs of some 674 RNs in uncertainty.

Lasky also says area residents will lose a pediatric ICU, a rehab facility for stroke victims, and a skilled nursing facility – services not available at HCA-owned Regional Medical Center San Jose 2.4 miles to the east.