The closure of Century City Hospital this year has only worsened a scarcity of beds on the Westside, where orthopedic surgeons say some patients must wait months for hip replacements and other elective surgery.

Yet over the hill in the San Fernando Valley, news of the planned shutdown of Northridge Hospital Medical Center? Sherman Way campus hardly registered among the area? medical practitioners, given a surplus of beds.

A half-dozen hospital closures were announced this year among L.A.? 79 acute care facilities. But because the region, the nation? second-largest hospital market, is really an agglomeration of distinct submarkets, some areas are getting hit far worse than others.

Besides the Westside, South Central and the Antelope Valley are tight. But in the South Bay, the San Fernando Valley and the San Gabriel Valley, beds are usually plentiful, although they can be scarce at times.

?hat goes on in the East San Gabriel Valley is not necessarily going to have a direct and immediate impact on what is going on in Santa Clarita or the South Bay,?said Jim Lott, executive vice president of the Hospital Association of Southern California.

Each submarket? ability to absorb patients is dependent on the number of hospitals and their ability to reach required staffing levels.

Demand for services, driven by factors such as wealth, poverty and age, also make up part of the equation. The availability of general medical-surgical beds is often submarket specific, while specialized beds, such as for mental health, operate as part of a larger countywide marketplace.

In the growing Santa Clarita Valley, for example, the only hospital serving the area hasn? yet approached capacity. ?e have a younger, healthier and wealthier community, which makes our situation better,?said Andie Bogdan, director of planning and marketing for Henry Mayo Newhall Memorial Hospital in Valencia.

Heavy demand


On the Westside, things couldn? be more different.

Cedars-Sinai Medical Center, one of the county? largest and busiest hospitals, often has an occupancy rate of up to 90 percent ?far higher than 75 percent to 80 percent rate that is considered desirable given the logistics of moving patients in and out of rooms.

Dr. Brad Penenberg, a Beverly Hills orthopedic surgeon who has access to operating rooms for two full days during the week, said it takes six to eight weeks for patients seeking hip and knee replacements to get on the schedule. ?f there was more surgical time I could make use of it,?he said.

Still, Penenberg has it better than orthopedic surgeons with less extensive staff privileges, whose patients sometimes wait months. Rather than wait, some surgeons will send patients to him.

Institutions with national name recognition, such as Cedars or UCLA Medical Center, always have more demand than run-of-the-mill hospitals. But other facilities, like Brotman Medical Center, also are busy.

?he Westside is probably one of the busiest hospital markets in the country. The census of most hospitals there is full or close to full most days,?said David Langness, a spokesman for Tenet Healthcare Corp., which owns Brotman.

The reasons for crowding are different in South Central Los Angeles, where there are fewer hospitals. Adding to the shortage: the L.A. County Board of Supervisors plans to close the trauma unit of the troubled Martin Luther King Jr./Drew Medical Center.

One nearby trauma unit is in Lynwood at St. Francis Medical Center. Last week, St. Francis reached 77 percent occupancy, which would normally be considered a healthy level. But because of the way the state requires hospitals to calculate occupancy rates, the number did not account for the 36 newborns in the maternity ward. And like many other hospitals, St. Francis often has difficulty finding staff, especially registered nurses who operate under strict nurse-to-patient ratios.

That means the hospital? 36-bed intensive care unit was close to capacity despite having 28 patients. The hospital only had enough staff on hand to operate 31 beds ?one accident away from overflowing.

?e have definitely seen an increase in inpatients,?said Carol Lee Thorpe, the hospital? vice president of community services. ?nd if your non-elective surgery numbers increase dramatically, that affects your ability to maintain elective or scheduled surgeries.?br>

In the Antelope Valley, the one private hospital remaining does not accept patients whose care is primarily funded by Medi-Cal, the government health care program for the poor. So the burden falls to the public Antelope Valley Hospital, which has the second busiest emergency room in Southern California, serving 100,000 patients annually. Last week, it was running at 74 percent capacity, a figure an administrator called unusually low.

Mixed bag


In the San Fernando Valley, the market is less tight, although the Valley? size and population give it submarkets of its own.

Competition from Valley Presbyterian Hospital in Van Nuys, for example, may have been a reason that Catholic Healthcare West, the San Francisco-based non-profit system, decided to shut down Northridge Hospital? Sherman Way campus.

Officials at Valley Presbyterian say they should easily handle the additional volume once Northridge Hospital closes, especially when a new patient tower opening shortly expands its capacity to 380 beds from 290. (The hospital had to build the tower to meet new seismic safety standards.)

By contrast, the closure last year of Granada Hills Community Hospital has put a strain on Providence Holy Cross Medical Center in nearby Mission Hills, which in August had 91 percent of its 251 beds on average filled.

?ight now we are in discussions with our architect about expanding,?said Dan Boyle, marketing and public relations officer for Providence Holy Cross. ? year ago we had to go to 24/7 with our operating rooms, so basically there have been very few delays as far as elective surgeries.?br>

The South Bay also is a mixed bag.

Several hospitals in the area have readily available bed space, but the largest hospital, Long Beach Memorial Medical Center, generally operates at 80 percent capacity, and emergency room patients often wait as long as 12 hours to be admitted.

?t? tight for us because we are the largest facility. Most of the hospitals in our area don? provide the services we do,?said Byron Schweigert, chief executive of Long Beach Memorial Medical Center, which has 741 beds, including its pediatric hospital, and offers advanced cardiac and neurological services.

In the San Gabriel Valley, overcrowding traditionally has not been a problem. But officials of several major hospitals say that has begun to change with the closures of Santa Teresita Hospital in Duarte this year and St. Luke Medical Center in Pasadena two years ago. Another factor: San Gabriel Valley Medical Center in San Gabriel canceled its Medi-Cal contract, sending poor patients to other facilities.

The increased patient load has hit Huntington Memorial Hospital in Pasadena, as well as Citrus Valley Health Partners, which operates Citrus Valley Medical Center campuses in West Covina and Covina. In those facilities, occupancy rates have sometimes extended beyond 80 percent.

?y chairman of the board is an orthopedist and he could not find a bed (for a patient) for two days,?said Health Partners chief executive Jim Yoshioka.