• printer friendly
• mail this article
• iPod format
• digg

By Gil Hopenstandand Patrick KerkstraSummer Bruin Staff

Emilia Galan's mother-in-law owes a great deal to County-USC hospital. The uninsured North Hollywood resident underwent surgery there Wednesday ­ a procedure which she could not have afforded at another hospital.

"It's hard to think what I would do," said Galan of where her ill relative would receive care if the hospital closed. "It's going to be a big problem."

Galan's quandary is one suddenly shared by thousands of Angelenos.

On June 26, Sally Reed, Los Angeles county's chief administrative officer, released her proposal to rid the county of its monstrous $1.2 billion debt. The announcement included one particularly harsh prescription: the closing of County-USC hospital, the nation's largest health care facility west of the Mississippi, and the abrupt elimination of 9,000 health care jobs.

The highly anticipated decision will be made in the week of July 24, when the five person Board of Supervisors votes on the issue. The fate of patients, county employees, surrounding hospitals and the financial health of the county itself, are all riding on the vote.

Los Angeles area residents may be hit hardest by the loss of County-USC's trauma center, one of the busiest in the nation. It provides more than 28 percent of trauma care in the county and receives an average of 650 emergency room visits a day.

The hospital's reputation as one of the nation's finest trauma centers has added to the shock of Reed's plan.

"County-USC runs one of the best trauma centers in the country. If you're seriously hurt in an accident or an act of violence, there's probably no better place to be taken than County-USC," said Richard Brown, UCLA professor of public health.

"That's an irreplaceable asset," he continued.

The hospital's closure will put added strain on other area medical centers ­ including UCLA ­ which together will be forced to handle displaced emergency, government-insured and uninsured patients. One expert described closing the facility as "catastrophic.

"I say catastrophic because if the trauma center were closed, I just don't see how any other hospital around can handle the trauma load," Brown said.

Michael Cousineau, associate director of public programs for UCLA's center for health policy agreed.

"I've heard anecdotally that people laugh at the idea of successfully diverting the trauma cases," Cousineau said. "Thirty percent of the trauma in the entire county is being handled by that facility. To consider diverting that elsewhere, from my thumbnail sketch of the situation, I just don't think it's possible."

Betty Robertson's son is currently a trauma patient at County-USC. Also uninsured, the hospital is treating his critical condition.

"I don't know if he could survive somewhere else," she said quietly.

Officials at County-USC acknowledged that the burden of their closure on other hospitals would be "tremendous.

"Should USC close, we would be rerouting trauma patients to other centers," said Virginia Price-Hastings, director of emergency medical service agency at County-USC. "I suspect the trauma system would collapse. There would be too many patients for the remaining hospitals."

Price-Hastings could not predict how many additional people UCLA would potentially be forced to help.

"What we anticipate is that there would be a domino effect. The closest hospital would fill up and the patients would be sent to the next and the next. While UCLA is not in the direct line of fire, it will be affected by the ripple effect," Price-Hastings explained.

"We're geographically far from them so the effect would not be as huge as others," agreed Marshall Morgan, director of UCLA's emergency medical center.

Still, Morgan and others speculated that UCLA would see increases in the trauma load and in the number of uninsured people seeking care.

"(The workload) would increase greatly," said radiologist Albert Gonzalez. "It would be similar to when Saint Johns closed due to the (Northridge) quake. When Saint Johns came back up, volume went back down."

Another cost-cutting option before the supervisors is to maintain County-USC but close some of the county's other five smaller hospitals. This plan would instead call for the satellite hospitals to push their patients onto County-USC.

Officials say significant sums could be saved by closing care centers such as Olive View and Harbor hospitals, both operated by UCLA. But their closure would limit patient access to the regional hospitals, again displacing thousands.

"That maneuver would have a much greater effect on our volume," Morgan said. "The geography is such that Olive View services the (San Fernando) Valley and Torrance services the harbor. We're kind of between them. There aren't many big hospitals between us so more of that volume would come to us in that scenario. Either way it won't be good."

Luckily, UCLA's interests run parallel to the plans of decision-maker Reed.

"The USC medical center would be the better choice because the condition of the building is such that it requires replacement, which would be a $1 billion project which we obviously can't fund," Reed told The Bruin.

With more uninsured patients potentially seeking care at UCLA, officials will be forced to decide how to treat them. UCLA's current policy is to move most uninsured patients to County-USC for government-paid treatment.

"We wouldn't be able to transfer them; the next option if USC is closed is can we transfer to another county hospital ­ UCLA would have to take that financial responsibility," said Morgan, adding that the county has recently been moving "to ultimately abdicate the responsibility of the uninsured."

That additional "financial responsibility" on area hospitals is coming at a time of state budget woes and widespread cost-cutting efforts. There is doubt whether they can afford to pay for all the uninsured people in Los Angeles County.

Closing County-USC and sending its thousands of uninsured patients elsewhere will have human, financial and political consequences that are difficult to quantify. The topic is a sure catalyst for community discontent and debate.

An initial burst of fierce anger and emotion greeted the proposal. After only one day, 1,500 protesters gathered at the hospital to protest its potential closure.

But despite the obvious dangers and consequences of shutting the hospital's doors, financial reality is forcing county officials to seriously consider taking the highly unpopular plunge.

The closure of County-USC would save about $350 million, Reed said, and is the single largest cut in an ambitious proposal to eliminate nearly 20 percent of the county's public jobs.

"We have a shortfall in federal funds of $655 million," she said. "In order to make up those kinds of reductions, we have to close a major part of our hospital structure."

When asked what the consequences of not closing County-USC were, Reed responded, "It would jeopardize public-safety programs, the already strapped park system and welfare ­ all would be in grave jeopardy."

The cutbacks are designed to help plug the $1.2 billion deficit in this year's county budget. The enormous deficit has its roots in the 1970s, when Proposition 13 passed, limiting property taxes and severely draining counties of needed resources. For years, the state supplemented the loss, but recent statewide budget crunches have forced Sacramento to stop that practice.

"The state has been the one who substantially got us into this problem," said Joel Bellman, press deputy for county supervisor Zev Yaroslavsky.

"In enacting Proposition 13, they stripped us of our most important revenue sources and shackled us from raising those funds in the future."

Talk is circulating in county and health care circles of emergency help from state and federal sources. Although some are hopeful, some seem skeptical that the politically motivated Gov. Pete Wilson will chose to bail out Los Angeles' health care system.

"I think the governor is more concerned with winning votes from the Republican right wing across the country then he is with pleasing Los Angeles."

"Right now the prospects for any assistance from the state are pretty bleak," Brown said.

The likely consequence of the closure is a mere shifting of the uninsured patients and the financial burden they represent to smaller, surrounding medical institutions.

Los Angeles has an abnormally high proportion of uninsured individuals, Brown said. One out of every three non-elderly Angelenos does not have health insurance, and the county built its extensive hospital system in response to that problem.

But just as the county's fortunes have declined, the number of uninsured in Los Angeles has only increased. The ailments of the uninsured will not disappear ­ but will be moved to places less prepared to handle the costs of treating them. Those additional costs are unlikely to be paid for by the debt-ridden county.

"If the county is looking for ways to cut expenses, it's not going to do it by closing and then paying a lot of money to private hospitals to take care of uninsured patients," Brown said.

An additional concern is that patients will wait longer before bothering to go to a far-away hospital, worsening their condition, and in the long run increasing the costs of their treatment.

"County-USC sees the patients that are the worst off now. They often don't go in until they're damn near dead already," said UCLA cardiothoracic surgeon Garland Hodges.

"If those patients don't have a nearby hospital to go to, they're likely to wait even longer," Hodges added.

Some fear that by waiting so long, the problem will eventually develop until it becomes critical, forcing the patient to visit the emergency room.

"If County-USC shuts down, there is simply no way these hospitals can absorb that volume of emergency patients and remain financially viable," Brown warned.

Reed also acknowledged that the financial impact of closing County-USC was likely to strain other medical centers.

"It's going to mean that (other area hospitals) will see more unsponsored patients, and that's one of the things that they have not been able to handle easily in recent years," Reed said.

UCLA is historically one of those institutions with a low rate of uninsured patients, and thus one of the most ill-equipped to handle a dramatic increase in treating uninsured patients.

"(UCLA) may see a real spillover or domino effect in emergency room care, which would leave a lot of uninsured patients on our doorstep," Brown said.

The uninsured patients who may fill UCLA's waiting rooms present a real quandary to the hospital ­ a paradox that's facing the county on a much larger scale: how to balance responsibility with reality.

"There is some serious soul searching as to ... how much of the health care burden (UCLA) would have to pick up," said David Hayes-Bautista, director of the Center for the Study on Latino Health.

He said "UCLA doesn't have that obligation legally," explaining that the state constitution calls for each county to provide last-resort medical services.

A vote on whether to close the hospital will be brought before the five county board members later this month. Zev Yaroslavsky, the newest county supervisor and a UCLA alumnus, is considered by some to be the swing vote between the Democratic and Republican camps.

"Gloria (Molina) and Yvonne (Brathwaite-Burke) are supporting current service levels at all costs. Mike (Antonovich) and Deane (Dana), the Republicans on the board, are perceived as less supportive of those services and more willing to cut them," Yaroslavsky's press deputy said.

"Zev, being new to the board and having a foot in both camps ... is perceived as someone who could go either way," Bellman continued, describing the board members' positions as "fluid."

The proposal before the supervisors to close County-USC is shedding light on the human toll of budget cuts. But regardless of how they vote this month, critical services will soon be denied to people who need them most.

"I understand where the county is coming from," said Daniel Cardenas, a County-USC hospital obstetrician, "but at the same time we're talking about people's health and lives."

L.A. health care on the edge

Southland's largest hospital may close to save county $350 million

Photos by Justin Warren/DB

Comments

Post a comment