Deal to Avert Healthcare Cuts Is OKd

Los Angeles County on Tuesday agreed to a deal with patients-rights groups to keep open Rancho Los Amigos National Rehabilitation Center and to scale back planned cuts at County-USC Medical Center, settling a two-year legal battle over the county’s efforts to slash health services amid a looming financial crisis.

The Board of Supervisors voted unanimously behind closed doors to run Rancho, a renowned Downey facility that treats patients with catastrophic injuries, for at least three years while searching for a private contractor to take over the operation.

In turn, the settlement allows the county to cut 25 of County-USC’s 745 beds and make more reductions as long as the hospital can bring down the average length of patient stays. The number of beds to be cut, though, is far less than the 100 that county supervisors had approved in 2003.

The deal, which must still be considered by a federal judge, promises to remove at least temporarily the uncertainty that has hung over both hospitals and was greeted with cheers from patient advocacy groups that had sued the county.

“This is a victory for the poor, indigent patients in L.A. County who suffer from chronic health conditions and have to rely on the county healthcare system,” said Silvia Argueta, an attorney with the Legal Aid Foundation of Los Angeles.

The settlement was not immediately announced as California’s open-meeting law requires. The county had announced at 5 p.m., after the weekly board meeting, that supervisors had taken no action on the issue. But in response to a call from The Times, County Counsel Raymond G. Fortner Jr. later said that was wrong.

He said he had mistakenly believed that some details of the settlement still needed to be worked out, so he had not directed the board’s executive office to make the action public.

“But I am told that all of the significant details have been worked out, and it just remains to be signed by the plaintiffs and the county,” he said.

Supervisors voted in January 2003 to close Rancho and trim County-USC to save an estimated $75 million a year. But a federal judge barred the county from putting the plan into effect, concluding that it would illegally deprive poor and disabled residents of vital medical services.

The ruling was a blow to the county’s plan to shore up its shaky healthcare finances. Forecasts estimate that the Department of Health Services will plunge into the red by nearly $1 billion within three years.

Tuesday’s settlement, however, resolves concerns about patient care while also allowing the county to better plan for its financial future, said Miguel Santana, chief of staff to Supervisor Gloria Molina. “It’s an assurance for the community that a specific level of care is going to be provided at LA-USC and Rancho,” he said. “At the same time, it gives the county a bit of flexibility to meet the fiscal issues.”

A county source familiar with the settlement’s details said the agreement would save an estimated $61 million over four years. The county also agreed to pay attorneys who brought the suit $451,000 in legal fees.

The deal will allow the county to save money by shaving Rancho’s beds from the 207 it operated more than two years ago to 162, plaintiffs’ attorneys said.

If the hospital is privatized, the county must make certain that patients are properly transferred. Future patients who are indigent or eligible for the state’s Medi-Cal program must also be assured adequate care at an accredited hospital if the county closes or gives up ownership of the facility.

At County-USC, future cuts will be tied to attempts to make the hospital more efficient, ensuring that it will be capable of admitting 40,000 inpatients each year.

Under the agreement, the county will be able to eliminate an additional 35 beds each time the hospital reduces the average length of stay for patients by 0.3 days. Currently, patients stay an average of 6.5 days -- higher than the 5.4 days at Harbor-UCLA Medical Center. In addition, the agreement calls for the hospital to keep emergency room patients waiting for less than seven hours before being admitted to other parts of the facility.

Under the settlement, the county guaranteed 50 beds for psychiatric patients and promised to open a $12-million outpatient clinic within six months to treat sick patients who do not need treatment in the hospital’s emergency room.

Mark Rosenbaum, legal director of the American Civil Liberties Union of Southern California and an attorney on the case, praised the county for its decision to resolve the legal battle.

“The county deserves a great deal of credit for committing itself to a comprehensive healthcare system that meets its legal and moral obligations of serving the medically needy through a system that respects taxpayers,” he said.