Cuts in Patient Services Barred at King Hospital

A Superior Court judge barred Los Angeles County Wednesday from cutting patient services at Martin Luther King Jr./Drew Medical Center, raising yet another roadblock in the county’s quest to trim health-care costs.

In a carefully worded temporary restraining order, Judge David P. Yaffe allowed county officials to proceed with plans to eliminate about 400 jobs at King/Drew by July 1. But he drew the line at reductions in patient care.

The ruling gave both sides room to claim victory in what probably will be an ongoing court battle.

County lawyers insisted that slicing jobs won’t affect patient care because, they said, the hospital is overstaffed. The doctors’ union that filed the lawsuit that brought the matter to court took the opposite view, arguing that dismantling part of the physician and nursing staff would undeniably hurt patients.

“When last I checked, if you have a doctor that sees a certain number of patients and you eliminate that doctor ... you affect patient care,” said Robert Newman, an attorney representing the Union of American Physicians and Dentists.

The judge’s order sets the stage for doctors to force the county back into court each time they suspect that patient care is suffering. Yaffe clearly did not relish that prospect.

“I’m reluctant to issue this order, because I can see that it’s going to embroil [county lawyers] in the minutiae of running this hospital,” he said.

“I can see all kinds of arguments coming downstream” about whether the hospital has jeopardized patient care. “I don’t look forward to that at all,” Yaffe said.

The judge’s decision marked the third time in recent months that a court has blocked part of the county’s plan to restructure its troubled health department.

In April, a federal judge halted the closure of Rancho Los Amigos National Rehabilitation Center until the county can prove that Medi-Cal patients will receive comparable care elsewhere. Two weeks later, the same judge prohibited the county from eliminating 100 beds at County-USC Medical Center. The county has appealed both decisions.

In the latest case, doctors took the county to task over a procedural issue: its failure to give public notice or hold hearings on the proposed cuts at King/Drew and at six comprehensive health-care centers.

The Beilenson Act, part of the state’s health and safety code, requires counties to hold public hearings before reducing health services.

County officials maintain that no Beilenson hearing was necessary because the staff cuts at King/Drew will not reduce services; they will merely slim down an inefficient hospital with excess employees, they assert. Still, county lawyers resisted a court order holding them to that promise.

“Although it is the county’s position that none of the proposed reductions will affect patient services ... we can’t truly tell” what will happen until the jobs are cut, said Principal Deputy County Counsel Anita Lee.

The debate over King/Drew’s staffing levels has been smoldering for more than a year. On one side is Dr. Thomas Garthwaite, director of the county’s Department of Health Services, who cites no less than five state, county and consultant reports that conclude that King/Drew is less efficient than other county hospitals.

On the other side are hundreds of doctors, nurses and patients who call the urban hospital a miracle worker that treats patients who are poorer and sicker than those at the county’s other medical centers.

At the Board of Supervisors’ meeting Tuesday, more than 100 people protested the staff layoffs and transfers at King/Drew, a Willowbrook hospital that has long been a source of pride in the local black community.

“That hospital has removed many a bullet from somebody’s child, shot in the streets of L.A. County,” Gladys Russell, a Compton resident, told the board.

As protesters leaped to their feet to cheer Russell on, Garthwaite sat quietly in a back room outside the board chambers, holding a thick stack of reports outlining King/Drew’s costs.

He showed a reporter a chart indicating that the birthrate at the hospital had plunged over the last decade, from 8,550 births in 1990 to 1,017 in 2002. “We have to align the staff to the workload,” he said.

The dispute probably will deepen with Yaffe’s ruling. The restraining order will expire July 15, at which point the parties will return to court.

As she left the courtroom, Lee called Yaffe’s decision “a fine thing” and said the county intends to proceed with its planned layoffs.

“These cuts will make the hospital run leaner and meaner,” she said.

Dr. Louis Simpson, meanwhile, called the ruling “a victory for the people.” The longtime King/Drew psychiatrist said the county’s cuts would eliminate eight out of 11 psychiatrists and dozens of other specialists.

“All we have to do is show one reduction that’s going to hurt patient care,” Simpson said.

And then, attorney Newman said, county officials “are going to be in serious trouble.”