LOS ANGELES -- The Saturday morning calm at Catalina Island Health's two-bed emergency room was broken just before noon, when two tourists with arm injuries burst in within minutes of one another.

Praveen Biln, the registered nurse on duty in the ER, kicked into gear checking vital signs on the first arrival, a woman in her 50s who broke a bone in her elbow when she fell while roller skating at the Catalina Casino.

Minutes later, 8-year-old Carter Olsen hobbled in with his worried mother after hurting his arm in a fall. An X-ray ultimately revealed it wasn't fractured.

"Can I ask you a silly question: Did you hit your head? Can you turn your neck?" Biln asked him to be sure he wasn't hurt anywhere else. Carter, of Newport Beach, told the nurse that he had not, and that he could. "Awesome," Biln told him. "You're doing so good."

As the only full-time medical provider on the island, Catalina Island Health is a vital resource for approximately 4,000 residents and 1 million annual visitors. But Tim Kielpinski, the hospital's CEO, says it was "in dire straits" and on the brink of having to shut its doors last year before it received an emergency multimillion-dollar bailout from the county.

"We just had six days of cash on hand in June of 2025," he said Saturday evening at a fundraiser for the hospital. "Six days," he added, "before we would have faced impossible decisions."

Its financial picture has improved somewhat since that nadir, but Catalina Island Health remains one of several hospitals across Los Angeles County that are struggling to stay open in the face of strong financial headwinds. Inflation has soared since the COVID-19 pandemic, government reimbursement for Medi-Cal patients and the uninsured often doesn't cover costs, and providers say they frequently have difficulties obtaining full payment from insurers.

Compounding the issue is the fact that many providers will lose millions of dollars of annual federal funding beginning in 2027 as a result of Medicaid changes ushered in by last year's One Big Beautiful Bill Act, or HR1.

Recent county efforts to help struggling hospitals such as Catalina Island Health and Martin Luther King Jr. Community Hospital in Willowbrook will bring some relief. In June, county voters approved Measure ER, which imposes a half-cent sales tax estimated to bring in $1 billion a year to help cash-strapped hospitals, clinics and Planned Parenthood services.

And on Tuesday, the L.A. County Board of Supervisors unanimously voted to approve a motion to hire a consultant to reevaluate how it allocates funds collected via a property tax instituted by Measure B, a 2002 ballot initiative. The original measure stated that the funds are to be used to support trauma centers, emergency medical services and bioterrorism response, but in practice, the money has mainly gone to hospitals with trauma centers.

Some hospitals that provide emergency medical services but not trauma care, including Catalina Island Health and MLK hospital, are pushing for the county to help them by providing recurring disbursements of Measure B funds.

Paul Young, chief of advocacy and public policy at the Hospital Association of Southern California, which has not taken a stance on Measure B, addressed the stark situation facing many of its member hospitals and health systems across L.A. County during the Tuesday meeting.

"Hospital finances are an amalgam of calculus and Jenga," he told the board, adding that, "we're cognizant of the fact that hospitals are struggling in this day, and that struggle will increase with the impacts of HR1 impacting us in 2027."

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Anyone who needs medical care on Catalina Island has two options: stop in at Catalina Island Health in Avalon or take a ferry, helicopter or airplane back to the mainland.

It's a system that has worked for decades, but it may be in peril, as the 12-bed private nonprofit hospital's leaders are concerned it won't be able to survive its current financial challenges.

It received a lifeline in April 2025, when the county announced that it would be disbursing the hospital $3 million collected via Measure B, which brought in about $427 million in fiscal year 2025. Today, with the help of that initial $3 million, plus the first half of another $3 million of Measure B funds that the county decided to disburse to the hospital, Catalina Island Health has 45 days of cash on hand. Kielpinski said that's the most in at least a decade.

But because the payments are essentially one-off bailouts, the hospital can't rely on those funds going forward. Meanwhile, as of June 2025 — a month before the first Measure B payment — Catalina Island Health was operating in the red, with about $24 million of net patient revenue and expenses of about $25.5 million, the CEO said.

"At the moment we don't need any help with operations because of Measure B and other governmental support," Kielpinski said. "But that could easily fall off, and then we'd be back in the same situation unless we can make up the costs otherwise."

He said the hospital is "trying to turn it around from all the levers possible," such as renegotiating contracts with insurers, trimming costs and advocating for more government funding.

If those efforts are unsuccessful, personnel from the Avalon Fire Department and Los Angeles County's Baywatch would be able to provide some level of emergency medical treatment while patients await transportation across the Catalina Channel. But they do not have access to some of the equipment the hospital has, or the ability to provide some of the services it provides, such as CT scans and sedated intubation. That would mean worse health outcomes for some patients.

Catalina residents' day-to-day lives would also be impacted, as they would have to purchase pricey ferry tickets and travel to the mainland for even basic medical care.

A commonly held stereotype about Catalina Island is that it's home to only the wealthy — people who can afford sailboats and vacation homes. But the island's economy is propped up by lower-income workers, many of whom work multiple jobs and live with several other people in small homes there to make ends meet, said Jessica Flores, Catalina Island Health's director of clinic operations and patient experience.

And many of them have chronic conditions, such as heart disease or diabetes, so they visit Catalina Island Health frequently, she added. If the hospital, which is an affiliate of UCI Health, closed, they might be left with no choice but to move off the island, which could leave businesses scrambling for workers and harm the tourism industry that fuels the island's economy.

"They're the people who are keeping these businesses running and everything, and they live here year-round," Flores said. "They can get their care here. When their blood sugar drops, we have the necessary components to make sure that they can get back to work, that they can get back to their lives. If we weren't here, would those people be able to stay?"

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The impacts of Catalina Island Health closing would also extend beyond the island.

The hospital sees about 2,500 emergency patients annually. Catalina Island Health estimates that about 1,500 of them would have to be flown by helicopter to mainland hospitals for treatment if there was no longer an emergency room on the island.

Currently, approximately 250 emergency patients are transported from Catalina by helicopter each year, according to Kielpinski. About 200 of those flights are handled by Mercy Air, a for-profit service that flies patients and bills their insurers for the costs.

But Mercy Air doesn't fly patients who are treated by Baywatch, which would be the entity requesting Medevac flights for essentially all of the emergency patients who would need to be taken to hospitals on the mainland if Catalina Island Health closes, Kielpinski said.

Those patients are typically flown by L.A. County Fire Department helicopters, at a rate of about $13,000 per flight hour. That equates to an estimate of nearly $20 million of new expenses for county taxpayers annually.

Jose Ramirez, a shuttle driver for a hotel near Catalina Island Health in Avalon, has lived in Catalina for 47 years. He remembers the gorgeous views from the helicopter that flew him to a mainland hospital in L.A. County after he injured his leg in a bicycle accident on the island. But he also recalls the $25,000 bill he was stuck with for the portion of the cost of the flight that his insurance didn't cover.

If Catalina Island Health were to close, Ramirez said, he and his family would have to travel to Long Beach or L.A. for all of their medical care.

"We don't have any other doctors here," he said Sunday afternoon. "We've got lots of people here, so we've got to have a good hospital with good doctors."

That won't be possible for much longer unless Catalina Island Health is able to solve another existential problem. Construction of its current building across from the Catalina Island Golf Course finished in 1960. The hospital is not up to state earthquake code, so it has until January 2032 to complete construction of a new building to replace the existing one.

The plans for a new facility have been drawn up and hospital leaders are confident construction will be wrapped by the deadline. The new building would feature two additional beds and the capacity to perform additional services such as infusion therapy for cancer, mammography and colonoscopies.

Catalina Island Health just needs to pony up $30 million to secure the $145-million low-interest loan it anticipates receiving from the USDA to fund the $175-million project.

On Saturday evening, Kielpinski spoke about the importance of replacing the existing building during a swanky fundraiser overlooking the water at Descanso Beach Club in Avalon. After the dozens of well-heeled guests in attendance tucked into New York strip steaks and carrot cake, Kielpinski called on them to open their wallets and donate.

"We need you to partner with us," he said. "We can't do it without you."

The event was a smashing success, he said afterward, bringing in a record $5.1 million — up from $1.1 million at last year's annual fundraiser — via donations and silent auction purchases. But the hospital still needs to raise another $18 million in the next 18 months if it hopes to serve the next generation of Catalina residents and revelers.

"When someone you love needs this hospital, will it be here?" Kielpinski asked the attendees as the sun set over Descanso Bay.

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