County Set to Cut 79 Doctors at King-Drew

Los Angeles County plans to cut nearly 80 doctors’ jobs at Martin Luther King Jr.-Drew Medical Center by June 30, a move that county physicians say would hurt obstetric and pediatric care in an area scarred by poverty, high rates of teen pregnancy and premature births.

The jobs are among more than 800 positions that will be eliminated throughout the public health system, with pink slips set to go out June 15. King-Drew, which county leaders say is less efficient than other public hospitals, will take the hardest hit.

The hospital has been targeted for a 16% budget cut over the next three years; 79 physician, 152 nursing and 210 administrative support positions are to be erased this month.

“King’s costs were out of whack with other hospitals,” said John Wallace, spokesman for the county’s Department of Health Services. “It wasn’t like we just went in there with a hacksaw. This was done with some sound policy goals.”

Last year, a state audit compared Los Angeles County’s six public hospitals with similar hospitals throughout California. The report found that King-Drew had a relatively high ratio of staff to patients, “indicating lower than normal productivity.” Among L.A. County hospitals, King-Drew had the highest cost per patient day. Also, like other county hospitals, King-Drew has witnessed a drop in the number of children it treats.

For the county, the cut is one of the few money-saving remedies for its health department that has not been struck down by a court. But the doctors do not intend to leave quietly. Led by their union, they are plotting a legal challenge to block cuts at an urban hospital in the historic heart of black Los Angeles. On Wednesday, dozens of doctors and other hospital employees staged a demonstration to protest the cuts.

When it opened in Willowbrook in 1972, the hospital quickly became an oasis of medical care and a source of pride among neighborhoods shattered by the Watts riots several years earlier. Nearly all of its patients were African American.

“The hospital is the core of this community,” said Dr. Ernest Smith, an African American pediatric cardiologist who, at age 70, can recall an era when some hospitals refused to promptly treat black patients.

A cloud of uncertainty now pervades the hospital, from its crowded emergency room to the hushed nursery filled with sleeping newborns. Doctors at King-Drew say the budget ax will land hardest on the hospital’s neonatal intensive care unit, along with adolescent medicine and the pediatric divisions of cardiology, neurology and surgery.

Wallace said cuts in those areas make sense because county hospitals are treating fewer children than they did a decade ago. Private hospitals now compete with the county to attract these patients because Medi-Cal and California’s Healthy Families program have expanded coverage for uninsured children.

Still, doctors at King-Drew are concerned that the health of South Los Angeles’ babies and children will suffer.

The region’s rate of teen pregnancy is about 15%, more than three times the national average. The incidence of poor prenatal care, drug abuse, premature births and low birth weights is also high. Last year, a county task force found that 38% of the newborn babies in King-Drew’s neonatal intensive care unit were judged to be in acute condition on their first day of life, compared with 22% at County-USC and Olive View medical centers and 20% at Harbor-UCLA.

Christopher Herminio Morales, born two months early at less than 2 pounds, was one of those babies. Twelve days later, he is still far too small to fit his name, a skinny, helpless infant in a miniature diaper who is kept alive by a snarl of oxygen and IV tubes.

“When I look at the other ones, they look a little plumper,” his mother, Veronica Alarcon, said. “Mine looks real small.”

Computerized heart and breathing monitors stand sentry over each crib. Nurses in yellow smocks bustle around the room, occasionally stopping at one of the incubators to check on its tiny occupant. Some of the babies are too weak to nurse, even on a bottle, so they are fed drops of milk from a syringe.

Dr. Roberta Bruni, a neonatologist who helps oversee the ward, has seen mothers give birth to babies weighing barely a pound. She has watched over dying infants born with chromosomal defects. She was there the night that a pregnant woman, shot in the head, delivered premature twins by Cesarean section. She died, but her babies lived.

Even in cold financial terms, Bruni said, the county would be foolish to cut neonatal services.

“These babies are money-makers,” Bruni said. “You know how much we bill [the state] for one day?” The answer, at least for the sickest babies who qualify for medical coverage under the California Children’s Services program, is $14,000, more than enough to pay for their care.

The cutbacks at King-Drew, which could save $30 million per year, were to be just one part of the county’s health system overhaul. Facing an estimated $1.1-billion budget deficit within five years, the health department closed 16 clinics last year and intended to slash services this month at several hospitals.

But a federal judge has at least temporarily halted the closure of Rancho Los Amigos National Rehabilitation Hospital in Downey and the removal of 100 beds at County-USC Medical Center in Los Angeles. Another lawsuit is now pending over the county’s plan to cut inpatient services at High Desert Hospital in the Antelope Valley.

Inspired by the judge’s rulings in the Rancho and County-USC cases, the doctors’ union is also considering taking the county to court.

“It appears that the county is violating their civil service rules by laying off a number of permanent employees before they lay off temporary and contract workers,” said Joe Bader of the Union of American Physicians and Dentists, which represents about 800 county doctors.

Another option, Bader said, is to bring a federal lawsuit alleging patient harm -- an argument that has found sympathy with the judge handling the Rancho and County-USC cases.

Yolanda Vera, a Neighborhood Legal Services attorney who represents uninsured patients in the other cases, said her group was willing to consider another lawsuit -- but more documentation of actual patient harm is needed first.

“At this point, we just don’t know enough about what the patient care impact will be,” Vera said. “There seems to be a lot of confusion.”