Supervisor candidates Bernard Parks, Mark Ridley-Thomas discuss healthcare issues of L.A.’s 2nd District

The Times is asking the two major candidates competing to succeed Los Angeles County Supervisor Yvonne B. Burke about some key issues in the 2nd District, which stretches from Mar Vista through South Los Angeles and into Compton and Carson.

Today, Los Angeles City Councilman Bernard C. Parks and state Sen. Mark Ridley-Thomas (D-Los Angeles) offer their solutions to healthcare issues facing the county and the district, including a growing budget deficit in the county’s Health Services Department, large numbers of uninsured patients and the failure, so far, to reopen Martin Luther King Jr.-Harbor Medical Center, formerly known as Martin Luther King Jr./Drew Medical Center, near Watts, as promised.

Between now and the June 3 election, the candidates will address other questions in this occasional series.

Question: What specific steps should be taken to get the hospital reopened, including ways to pay for and ensure quality patient care there? Is a county partnership with another entity, such as the University of California or a private healthcare provider, a desirable option?

Parks:

Last year’s closure of King-Harbor as a full-service hospital was not merely a symbolic defeat for the community. It was a stunning blow to the healthcare needs of the most medically under-served population in Los Angeles County.

While urgent care is still provided, the closure was a falling domino that dispersed patients into emergency rooms at already overcrowded hospitals elsewhere in the region. About 250 ambulance rides a month take patients from King to county emergency rooms elsewhere.

King-Harbor must be reopened as a full-service hospital at the earliest possible date under the management of a competent and accountable partner. I am not comfortable with a quickie Band-Aid-type fix, however, and I fear that may happen if we rush too quickly to accept a new management that would try to do too much too soon.

I believe in reopening King-Harbor in stages. Our first priority should be to restore it as a quality inpatient care community hospital. As that is accomplished, we can then add specialty services like trauma care, specialized surgeries and specialized critical care functions. We need to build a core of medical expertise that is solid and stands on its own merits for the long haul.

I think the collaboration of a teaching institution, preferably a UC system school, (as I proposed in my recent letter to Gov. Arnold Schwarzenegger) is important, particularly for reestablishing needed training programs and for the restoration of teaching-hospital status.

Who oversees the work of any management partner is also critical. While maintaining oversight and control of county funding, the Board of Supervisors cannot and should not be the primary interface. The county needs an independent, expert and accountable structure to do this.

The most attractive alternatives would be a county Health Authority dominated by healthcare and health management professionals sufficiently insulated from political vagaries to provide firm and dispassionate oversight, completely transparent in what it does and the way it does it.

Proposals to form such an authority have been on the table for a decade and have not advanced, but that’s no reason to discard the idea. A new idea that needs to be explored is the creation of an independently elected county surgeon general position. A new governance system with competence, transparency and accountability is mandatory for the credibility of the rebirth of MLK hospital.

Whatever we do, we must acknowledge that the current system does not work. King-Harbor was a victim of that system, and the entire healthcare delivery system of the county has suffered as a result.

The restoration of the hospital to a full-service, fully licensed facility would return federal funding lost by virtue of the loss of accreditation. The structural imbalance between costs of operation and revenue to pay those costs would remain, however, so long as the size of the uninsured population continues to grow. That imbalance is true for the entire county, where 25% of the population is uninsured, but especially true for the population served by King-Harbor, where upward of 50% of the population is uninsured.

Currently, the county pays just under 20% of the total public cost of the healthcare delivery system. State and federal funds make up the rest. As with the county, state and federal funds are constrained, and significant reductions are pending in Sacramento and Washington, D.C.

King-Harbor is symbolic of a healthcare safety net that is frayed and in danger of collapse in the county and elsewhere. More than anything else, what is needed is a system of healthcare that is universal and national, a system that will provide through equitable patient funding the resources needed to keep hospitals open and healthcare professionals willing and able to provide care.

Ridley-Thomas:

For 30 years, the people of southeast Los Angeles County knew one thing for certain – even if they had little else – they always had one thing that was critical to life-and-death. They had a medical center – in their community – where doctors and nurses would care for them when they were sick, chronically ill or seriously injured.

King/Drew Medical Center was closed because it spent the last 10 years of its life suffering from an unconscionable level of political inattention coupled with a bureaucratic disregard for patient care and safety.

It is time to restore hope to an entire community that has been underserved for more than five decades. It is time for an action plan to reopen Martin Luther King Jr.-Harbor Medical Center in Willowbrook.

We must end the unconscionable level of political inattention and bureaucratic disregard for patient care and safety that caused King-Harbor to be closed in the first place. The hospital is an integral part of a countywide system of publicly funded indigent care and emergency services. Its closure imperils the county’s healthcare safety net.

Reopening King-Harbor hospital must be moved to the top of the agenda of the Board of Supervisors, and more specifically, it must be the top priority of the supervisor of the 2nd District. It is critical that key stakeholders be brought into the process of developing a plan to reopen King-Harbor.

As chair of the state Senate Select Committee on the Los Angeles Healthcare Crisis, I convened public- and private-sector health and community leaders concerned about the continuing closure of King-Harbor and its impact on the county as a whole. These leaders will advise the committee on the development of strategic proposals to reopen the hospital.

Key steps that must be taken if King-Harbor is to be reopened successfully:

* The hospital must be structured as a public-private partnership. It must be managed and staffed with culturally competent and compassionate healthcare professionals who view patient care as their top priority. This is the only way to encourage public and private investment in this essential community health resource.

* The hospital must have an administration and governance structure that operates outside of L.A. County’s political authority and its health services bureaucracy. This will ensure the hospital has focused attention on maintaining high medical standards that exceed accreditation reviews.

* The hospital must have a governing authority that is accountable to the people it serves. It must empower residents to play a much greater role in their own healthcare and the delivery of services provided to them. It must be sensitive to the healthcare disparities that exist in its service delivery area.

The creation of this hospital public-private partnership must be undertaken in view of the public, so community residents can understand the stakes involved.

A public-private partnership to reopen King-Harbor will require the investment of time, energy and funds from the federal government, state of California, private hospital systems and nonprofit organizations. They will all have a crucial hospital financing role to play.

Q: Beyond reopening the hospital, what is your plan for improving healthcare throughout the 2nd District?

Parks:

There are several initiatives I will pursue to improve healthcare in the 2nd District. My appointee to the First 5 L.A. commission will support First 5 funding for continuous and comprehensive health insurance coverage for young children in families with incomes under 300% of the federal poverty level, support funding for programs in the district that expand and improve prenatal care, preventive care for young children, dental care, behavioral wellness screening and early mental health treatment.

Either through the First 5 program or as part of the county outpatient clinic program, I would want to see mobile units periodically stationed at locations such as malls and schools to provide diagnostic services along with immunization and low-level treatment.

A disproportionate number of below-acceptable health inspection grades are received by restaurants in the 2nd District, putting patrons at risk of food-borne illness. I would work to improve the educational aspect of the county’s restaurant inspection program to bring restaurants in the district into more consistent compliance with health standards.

As I have done on the City Council, I would support limitations on the permitting of fast-food restaurants as well as the posting of nutrition data at all restaurants. To further combat childhood obesity and diabetes, which are at epidemic levels in the district, I would also support soda and junk food bans at all schools, as is currently the practice at Los Angeles Unified School District.

A significant portion of the uninsured population in the district is homeless or living at risk of homelessness, many if not most with physical and mental health vulnerabilities. In addition to working to enhance the year-round emergency shelters program countywide and in the district, I would work to include health and mental health clinicians among the shelters’ staff.

Emphasis also needs to be given to the population in our community that are fortunate enough to have medical insurance but fail to use the prevention and ongoing monitoring that is provided. As most diseases and ailments in the 2nd District are preventable through education, exercise and routine examinations, these options are used only moderately, as general research in the medical care industry shows that 20% of the insured clients use 80% of the medical care services. That is a clear indication that they fail to use the preventive elements of their plan but wait until they are either diseased or seriously ill before seeking medical attention.

Finally, due to its location, age of housing stock, lack of a connected public transportation system and past industrial/manufacturing businesses, the 2nd District includes or is impacted by major polluters or existing pollution. (Los Angeles International Airport, Los Angeles Harbor, oil fields, brown field locations, abandoned industrial sites or parcels of land, greenhouse gases from emissions and lead-based paints to name just a few).

It is imperative that there be sensitivity to the full impact of these environmental concerns on the health of 2nd District residents, visitors and workers, with particular emphasis on children. Air, water and soil quality inspections are mandatory to provide the needed preventive and educational guidelines to all but eliminate, or at least reduce and mitigate, their impact on the health of the community.

Ridley-Thomas:

We must protect the 2nd District’s network of community health clinics and comprehensive health centers to encourage residents to seek preventive care.

We must also increase efforts to encourage residents to enroll in community wellness programs to improve their overall health status. We must also make use of high-tech methods to connect patients with nurses and physicians.

I will continue my efforts to expand school health centers in the 2nd District. I have been a major proponent of school-based health centers, because they bring health services to children where they need healthcare most.

Q: As a way to save money, county officials have proposed finding outside agencies to take over most of its outpatient clinics. What do you think of that proposal? Do you have an alternative?

Parks:

As a philosophical matter, I am not opposed to third party management and operation of the county’s outpatient clinics. The county has successfully contracted with third parties to run everything from its airports to golf courses, and there is nothing inherently sacrosanct about county employees staffing outpatient clinics.

As with other privatization and semi-privatization proposals, however, the test must be whether the service can be provided at less cost with equal or superior performance results, and the county staff has not yet made that case with respect to outpatient clinics.

The operation of outpatient clinics should not be based on a preconceived notion or theory but on an objective analysis of the most effective manner services can be delivered. A thorough investigation of multiple models should include an evaluation of all available options, from private, public-private, public, educational institution to any appropriate combination of the above.

Ridley-Thomas:

I am not in favor of having outside agencies take over most of the county’s outpatient clinics. But I am a strong believer in forming public-private partnerships that can be used to strengthen our county’s health clinic network or add resources to our network of community clinics.

Q: What steps can the county take to see that it has the money necessary to run public hospitals and clinics and to keep hospital emergency rooms open?

Parks:

Fundamentally, there is not enough local, state and federal money available individually to sustain healthcare facilities and healthcare services in the county and other major jurisdictions around the country. As the availability of care is increasingly limited, the uninsured and underinsured population is growing, and the demand for care is rising.

It is very apparent that funding must be leveraged, services co-located and coordination of services across jurisdictional lines must exist. The collective efforts of the future must replace the current fragmented and isolated efforts of today.

As I indicated earlier, the healthcare safety net is badly frayed. Ultimately, a system of universal healthcare must be implemented or the current systems will collapse, as has nearly happened at King-Harbor. Universal healthcare is the foremost domestic challenge this nation faces and the only option available to prevent implosion of the healthcare network in the county and ultimately elsewhere in the country.

The county simply does not have the resources on its own to financially underwrite the system back to a healthy condition. The county could spend all $3.6 billion of its discretionary general fund budget on healthcare and not come close to meeting the costs required to operate our public hospitals and clinics and to keep emergency rooms open.

In my judgment, there are four things that must be implemented immediately:

* Stop the state Legislature from routinely cutting Medi-Cal to balance the state’s budget (a recent 10% cut is one of many in the past years).

* Stop the implementation of the new federal Medicaid guidelines that will reduce funding in the state of California by $600 million and the County of Los Angeles by $240 million.

* The state must negotiate a better deal with the federal government on waiver/reimbursements that impact the funding of the state’s Medi-Cal program.

* Stop all unfunded state mandates.

Ridley-Thomas:

While universal healthcare coverage at the federal level is essential, I voted for three major state health reform bills – Sen. Sheila Kuehl’s single-payer bill, former Assembly Speaker Fabian Nuñez’s health reform bill and the Schwarzenegger-Nuñez health reform bill – that came before me as a member of the Legislature.

Each of these bills would have brought significantly more money into our state healthcare system and would have reduced the need for emergency room care among those who are uninsured.

In addition, after King-Harbor hospital was closed, I co-authored Senate Bill 474, which was signed into law in 2007, to create the South Los Angeles Medical Services Preservation Fund to protect $100 million annually that L.A. County would have lost.

Medi-Cal reimbursement rates have historically been among the lowest in the nation. We need to seriously consider state legislation authorizing the establishment of a County Hospital Special District that has the authority to raise funds to supplement state and federal funding for public hospitals within L.A. County.

Appropriate leadership by the Board of Supervisors and a broad campaign to reopen King-Harbor could and should be the catalyst for addressing these broader financial questions.