L.A. County Defends Its Health Care for the Poor

County health officials Friday denied as “misleading” and “flawed” recent charges by the Legal Aid Foundation of Los Angeles that health care for the poor is dangerously substandard in public hospitals and clinics.

Health Director Robert Gates, in a memo to the Board of Supervisors, attacked the foundation’s report, charging that it “provides an unnecessarily harsh overview of the county’s health care system.”

“Insofar as it lacks scientific objectivity, it cannot be relied upon as a basis for major health policy decisions,” Gates said.

The authors of the report, meanwhile, said they stand by their conclusions and chided Gates for adopting a “circling-the-wagons” attitude in his response.

Warned of Needless Deaths

The Legal Aid findings, first reported in The Times on June 26, quoted more than 50 county physicians, nurses and health workers as saying that care offered to the poor at the county’s six hospitals and 47 health centers is substandard. Among the conclusions was that needless deaths may occur in hospital emergency rooms due to long waits or misdiagnosis of patient ailments.

Although rejecting the foundation study’s overall assessment, Gates in his reply agreed that some of the identified county health care problems do exist. But in most instances Gates disputed that the consequences were as dire as charged.

For instance, Gates acknowledged that demand for prenatal care is high, that patients may have to wait lengthy periods for appointments to health clinics and for mammographies and that certain state-of-the-art equipment is not available at all facilities. But he said that priorities are made depending on need and that patients receive immediate treatment when it is ordered by an attending physician.

Gates also confirmed a Martin Luther King Jr. Hospital nurse’s observation that “patients wait in the (emergency room) 24-48 hours for a bed on the ward,” but he said a delay of that duration could occur only if the patient needed to be moved to a specially equipped bed.

The Legal Aid Foundation report was prepared by public health consultant Geraldine Dallek and by E. Richard Brown, an associate professor at the UCLA School of Public Health. In his reply, Gates relied on reports from his staff of physicians and administrators.

To most of the allegations made in the Dallek and Brown study, Gates said the conclusions were either based on faulty analysis, incomplete data or on statements taken out of context. He said his staff conducted an independent inquiry into the allegations, including interviews of some of the same people quoted in the Legal Aid report.

“We conclude the Dallek and Brown report appears to be primarily a highly selective compendium of ‘worst case’ anecdotal remarks regarding isolated experiences of medical and professional staff in a department that delivers over 1 million inpatient days of care and over 1.2 million outpatient visits annually,” Gates said. He added that a departmental survey of patients conducted earlier this year indicated a “very high degree of satisfaction.”

Dallek and Brown, in a joint statement, said they had not read Gates’ response, but based on excerpts read to them, they feel that their original conclusions are accurate.

“To deny that these problems exist does a grave disservice to the poor of Los Angeles who are dependent on county hospitals and health centers, to county health and hospital employees and to the people of Los Angeles,” their statement said. “The Los Angeles County health care system is severely underfunded, understaffed, underbedded and underequipped.

“Rather than circling the wagons and attacking all criticism, the county would do better to honestly address the issues of access and quality of care and devote greater effort to obtaining adequate funding from the governor and the Legislature to deal with these issues.”