Hospital could lose 250 resident jobs

As county health officials lobby Washington to extend crucial, about-to-expire federal funding for Martin Luther King Jr.-Harbor Hospital, they also face the possibility of permanently losing 250 medical resident slots.

County leaders and local health authorities say that could badly damage the region’s healthcare system, a side effect of the continuing debate over the hospital’s fate and the county’s efforts to convince the federal government that it is turning around the long-troubled facility. Unless officials in Washington grant the extension, federal funding for the hospital -- and the residency slots -- will disappear at the end of the month.

“This is a fundamental and a critical issue for the healthcare [system] of Los Angeles,” county health chief Dr. Bruce Chernof told supervisors during Tuesday’s meeting. Citing shortages of medical specialists, he described the potential elimination of the resident positions as a “terrible loss to the entire delivery system in Los Angeles County, both public and private.”

The 250 at-risk positions, historically filled by medical students assigned to the hospital, are about 15% of the 1,700 medical resident positions countywide, Chernof said. And nearly half of all physicians in hospitals across the county were trained in county residency programs, Chernof said.

The county is in the midst of drastically reducing services at MLK-Harbor after the medical center flunked a crucial inspection last fall, jeopardizing $200 million in federal funding, nearly half the hospital’s budget. Health officials cut the hospital’s specialty services, severed ties with the affiliated medical school, reduced bed capacity and put the facility under the management of another county hospital, Harbor/UCLA Medical Center near Torrance.

To give the county time to revamp MLK-Harbor, the federal government agreed to extend its funding through March 31. Chernof has asked for another extension, through Aug. 15, to complete the transformation and comply with federal standards.

Supervisor Zev Yaroslavsky, who led the board’s discussion on the residents, said elimination of the training slots would be “lunacy.”

The vast majority of physicians tend to stay in the communities they train in, according to health experts.

Placing residents “in an environment that sees no county-type patients, that doesn’t address the indigent” will limit their experience treating medically underserved patients, said Dr. Neil Parker, senior associate dean for student affairs in graduate medical education at UCLA’s David Geffen School of Medicine. “That’s part of the education.”

Ten emergency rooms across the county have shut down in recent years, although one reopened. The closures further limited patients’ options and strained the remaining facilities.

Potential loss of the resident slots “is not just a local issue,” said Supervisor Yvonne Brathwaite Burke, indicating that a doctor shortage could spread across the state.

Congress capped the number of federally funded medical residents nationwide in 1997. Although some unused slots were redistributed under a one-time federal provision in 2003, the federal Centers for Medicare and Medicaid Services creates positions only in limited circumstances. New teaching hospitals are eligible for new resident slots, as are new programs in rural hospitals. The positions are tied to Medicare funding.

Technically, MLK-Harbor could apply to have its resident slots reinstated but would need approval from federal officials and a medical education accrediting group, according to the Medicare agency. Nationwide, more than 106,000 accredited residency positions were filled this school year, according to the Accreditation Council for Graduate Medical Education. Not all medical residents receive federal funding, however.

As the county awaits a decision on continued federal support, Chernof said he makes weekly phone calls to update state and federal officials on the hospital’s progress. Officials have been lobbying the governor and the California congressional delegation, seeking support for MLK-Harbor.

Federal regulators have requested additional details on the downsizing and are determining the legality of a second extension -- this one worth $60 million, Chernof said.

“We’ve made so much progress at this point,” he said, that denying “a 4 1/2 -month extension, given the months and months and months of work ... doesn’t make sense to me.”

Without the extension, the county Department of Health Services would be forced to come up with $60 million on its own, or close MLK-Harbor, Chernof said.

“To say we’re at crunch time is an understatement,” Yaroslavsky said.

susannah.rosenblatt@latimes.com