> ## Content Index > Fetch the complete content index at: https://www.smdp.com/llms.txt > Use this file to discover other available public pages before exploring further. # ER ward faces its own crisis: bed shortage - URL: https://www.smdp.com/er-ward-faces-its-own-crisis-bed-shortage/ - Published: 2003-04-08T15:00:00.000Z - Updated: 2026-10-23T02:03:09.000Z - Author: Carolyn Sackariason - Tags: Health, Santa Monica, #archive-import *Community hospitals need more space, patient facilities* With an average of 70 patients rolling into Saint John’s Health Care Center emergency room every day, doctors have to stay on their toes to keep the revolving door open. The biggest challenge physicians face in today’s emergency ward is finding a place for patients. On a recent afternoon — a typical day in the emergency room at Saint John’s — there were more patients than beds. Two patients were waiting for space in the hospital’s intensive care unit, while others were waiting for a regular hospital bed and many others were lying in cots in the ER’s hallway waiting for a private stall. “There are not enough hospital beds in Santa Monica to serve the community,” said Dr. Russ Kino, medical director of the Saint John’s emergency room. “We need more space, more beds. We are pressed for beds in the city.” Saint John’s Health Center is currently building new facilities that will provide for more beds, but it will be some time before they are ready. The $325 million project is part of a rebuilding plan as a result of damage the hospital sustained in the 1994 Northridge earthquake. Saint John’s currently has 229 beds, but that will be increased to 301 after the new buildings open. More importantly, the hospital’s new facilities will have better support services to accommodate patients and their needs, said Bob Klein, vice president of Saint John’s Hospital and Center Foundation, which is the fundraising arm of the hospital. The multi-year project will provide a new imaging center, additional outpatient services and improved critical care and ICU facilities, among a host of other amenities. Saint John’s runs between 75 to 80 percent capacity on average, which leaves little room for administrators to juggle patients around when an influx of new people are admitted. 4CF,“When you are running 80 percent, you have a full ship,” Klein said. “We anticipate once we complete this (project) we should be able to handle the capacity better.” For Dr. Kino, who oversees the ER, the bed shortage is an added stress on an already stressful environment. It’s a constant juggling act for the two doctors on duty, two physician’s assistants and more than a half dozen nurses working during a shift. Tracking patients and their medical needs can get confusing when the ER is hit with a crowd. It gets even more busy on the weekends, when the ER sees about 100 people a day. Dr. Kino said about 75 percent of the patients can be treated at home or by a physician outside of the ER once they leave. The other 25 percent are admitted to the hospital. A large erasable board hangs on the ER wall that tracks patients, their condition, their medical care assessment, which doctor is assigned to them and, more importantly, if they are waiting for a bed somewhere in the hospital. Doctors and nurses refer to the board constantly and use it as their primary tool in managing the ER. ER nurse Lorraine Baumann updates the board sometimes by the minute, as the fast-paced environment can change in a matter of moments. Doctors refer to the board to keep track of which patients they are responsible for, as well as to keep up to speed with the ER’s capacity and where their colleagues may need support. “It’s like a freeway, when one person breaks down in a lane, it creates a log jam,” Dr. Kino said. Dr. Kino, who handled about seven patients in a span of a few hours, also serves as support for ER personnel who need additional help. With patients lined up against the walls waiting for treatment and a bed, others can be heard behind the curtains screaming in pain, moaning in discomfort or venting about their frustrations of being in the ER. At the beginning of his shift, Dr. Kino was first greeted with a small crisis while trying to diagnose an 84-year-old New Hampshire man who came in dazed and confused. An elderly woman across the hall is screaming, “Nurse, nurse, nurse, goddammit!” Dr. Kino rushes to her bed to find out she needs to be repositioned. He asks a nurse to help, but she informs him she’s trying to move another patient out of the hallway. He assists the nurse so she can reposition the distraught woman. After the first crisis of many for the day is addressed, Dr. Kino diagnoses the New Hampshire man as having a minor stroke based on his prior medical history. “In five minutes, five years, you could have a full-blown stroke,” Dr. Kino tells his patient. “You’ve had four or five episodes and you’ve been lucky to recover from it.” But the man, who was visiting his daughter in Santa Monica, was reluctant not only to be admitted into the hospital, but to receive any treatment at all. “I’ve gotta take care of my wife,” the patient told Dr. Kino. “I’m probably the healthiest 84-year-old you’ve ever seen.” Dr. Kino, who possesses a calm bedside manner and a thick Australian accent, convinced the man to at least let a neurologist come to the ER to check him out. Dr. Kino asks the patient to sign a release form, but against his medical advice. The patient is then transferred into the hallway and waits an hour and a half for the neurologist to show up. 341,“If he doesn’t want to stay, we’ll bring the mountain to Mohammed, so to speak,” Dr. Kino said. As the doctor who is in charge of the ER for the eight-to 12-hour shifts, Dr. Kino gets pulled in several directions and juggles many requests and patients. One minute he’s looking at an X-ray of a patient’s lungs to help a physician’s assistant with a pneumonia and then he’s taking a call from another patient’s primary care physician to discuss treatment. “You walk miles every day,” he said. “Sometimes you hold going to the bathroom for hours.” Next, Dr. Kino helps an 81-year-old man who suffers from dementia sitting on a cot in the hallway. His tongue is gushing blood and no one really knows what’s wrong with him. Dr. Kino sticks a thick piece of gauze in the man’s mouth and realizes he has a substantial gash on his tongue. The patient is moved to a relatively new section of the ER, called “Fast Track.” “It segregates the sick patients from the walking well,” Dr. Kino said. “People with minor cases get slowed down and pushed to the back of the line because the sickest get treated first. Fast Track gets the minor cases in and out quickly.” Emergency rooms treat patients based on the severity of their sickness, not on who arrived first. So a patient who sprained his ankle could be sitting in the ER for hours while other patients who are sicker than him keep coming through the door. “(Fast Track) is more efficient and is a way to keep the stream of patients more manageable,” Dr. Kino said. On the way to his next patient, a woman in the hallway asks him, “When are they going to move me?” Dr. Kino glances at the board and tells her no beds are available in the hospital at the moment, but to be patient. He then goes to evaluate a 64-old-woman suffering from tightness in her chest. After a brief conversation with her regular physician and several questions of the patient, Dr. Kino suggests that the woman be admitted to the hospital. However, it appears she is more concerned about whether she can still go on a planned cruise later in the month than her unstable angina condition. As Dr. Kino talks with his patient, a woman down the hall is heard screaming, “I can’t take this anymore!” Dr. Kino remains focused and convinces his patient that she should be admitted and examined by a cardiologist. A man who was shot in the head 10 years ago and is bound by a wheelchair, sat in Saint John’s ER hallway awaiting treatment because he had fallen out of his chair. Dr. Kino was able to report to him after an hour that his X-rays had checked out and he was able to go home. But as Dr. Kino was informing his patient of the developments, the patient interrupted him and said, “Excuse me, I’m going to the bathroom.” Dr. Kino looked down and realized the man was urinating through a catheter from his bed in the hallway. He gave a smile and said, “OK, I’ll be back in a minute.” It took another hour for ER personnel to find the man’s wheelchair so he could go home. As Dr. Kino went to check on the 81-year-old with the tongue laceration and dementia, a physician’s assistant asked him to check on another patient in Fast Track. He was a retired cop, weighed 340 pounds and suffered from a damaged tendon in his knee joint. But, in this case, the man was more concerned about what prescription he was going get and if he could be admitted to the hospital than he was about his injury. “How about Percocet?” asked the patient, who already had a shot of morphine. After a lengthy discussion with the patient’s primary physician about his history and fondness for narcotics, Dr. Kino sent the man home with a special-sized brace, a pain killer much less potent than the one he’d requested and arranged for a home nurse to come to him. Dr. Kino said he occasionally runs into patients who ask for stronger narcotics than they need. He said he’s always hesitant in prescribing narcotics, particularly when the patient exudes such a strong desire for them. Finding out as much as possible about a patient is key to Saint John’s ER treatment. Dr. Kino, along with the other ER doctors, spend a lot of time on the phone with various physicians to talk about their patient’s history, treatment and follow-up care. “The standard of care is extremely high here,” Dr. Kino said. “Most communities don’t have that tight follow-up. We spend a lot of time communicating with their doctors.” ![](https://storage.ghost.io/c/55/9f/559f9abc-8372-4a2e-8c2d-27386da4e363/content/images/2026/10/040803-02_02.jpg) Nurse Lorraine Baumann updates the patient board in the ER ward at Saint John’s Health Care Center one recent afternoon. (Photo: Carolyn Sackariason/Daily Press) ![](https://storage.ghost.io/c/55/9f/559f9abc-8372-4a2e-8c2d-27386da4e363/content/images/2026/10/040803-02_03.jpg) Dr. (Photo: Carolyn Sackariason/Daily Press) *Originally published in the Santa Monica Daily Press print edition on April 8, 2003.* [Read the original PDF.](https://s3.us-east-1.amazonaws.com/smdp%5Fbackissues/040803.pdf?ref=smdp.com)