Services, Patient Load Cut to Cope With Nurses’ Strike

As a strike by nurses at Los Angeles County’s public hospitals and health clinics extended to a second day Wednesday, county officials continued to cope precariously by cutting services and reducing the patient load by about 20%.

Richard Cordova, administrator of the giant County-USC Medical Center, said the number of patients there had been reduced to 1,095 Wednesday from 1,335 Sunday night but he added, “We cannot continue to work this way.”

Increasingly, private hospitals in the area began to feel the sting of the strike as indigent patients, who would normally go to public hospitals, sought care in private facilities.

Hospital Fears

David Langness, an executive at the Hospital Council of Southern California, which represents most private hospitals in the area, said, “Our health-care system here in Los Angeles has become so interdependent--the county and the private sector--that any disaster now like a flu epidemic, an earthquake or a spate of injuries caused by freeway crashes or gang violence would simply swamp the system.”

In a development that could further disrupt operations at County-USC, resident and intern physicians there voted late Wednesday to strike, beginning Friday. Other county hospitals and medical centers are not yet involved.

The 800 interns and residents at County-USC have been without a contract since last September, according to Christopher Ho, a member of the executive board of the Joint Council of Interns and Residents, which represents 1,500 physicians.

At a meeting Wednesday night, the doctors voted 136 to 33 in favor of a walkout.

Unlike the striking nurses, the doctors are not seeking wage increases, Ho said. They are concerned with the county policy of “out-contracting,” a system of hiring personnel that “eliminates collective-bargaining agreements and all benefits associated with that.”

The contracting plan would destroy the doctors’ union and subject them to working unusually long shifts of 40 hours or more, thereby harming patient care, a spokesman for the doctors’ union said.

Don DeMoro, executive director of the council, said the union will keep “a skeleton crew in the facility to ensure no patients are endangered.” But he predicted the hospital will be shut down when doctors join striking nurses.

“We may very well expand” the strike to other county hospitals, DeMoro said.

The county reported 58% absenteeism among nurses Wednesday throughout the county health system, which includes six hospitals and scores of outpatient clinics.

According to the county, strongest support for the strike was at the 200-bed Olive View Hospital in the San Fernando Valley, where 80% of the nurses failed to report to work. At the largest hospitals, 1,454-bed County-USC Medical Center, 553-bed Harbor-UCLA Medical Center in Torrance and 350-bed Martin Luther King Jr./Drew Medical Center, absenteeism among nurses was 59%, 67% and 75%, respectively.

At 106-bed High Desert Hospital in Lancaster, four of the 16 nurses scheduled to work did not report. At Rancho Los Amigos Medical Center, the nationally known rehabilitation facility in Downey, 34% of the nurses did not report to work, according to the county.

Abby Haight, spokeswoman for the 4,000 county nurses who are members of Local 660 of the Service Employees International Union, AFL-CIO, declared, “We’re ready to stay out as long as necessary.”

Union officials accused the county of underestimating the number of nurses on strike. Sharon Grimpe, general manager of Local 660, said 80% of the nurses were absent Wednesday from County-USC Medical Center, 90% at King and 80% at Harbor-UCLA Medical Center.

County negotiators appeared unwilling to budge from their latest offer of a 14.5% pay hike over two years or 20% over three years. The union is seeking a 19.5% pay raise over two years, plus increased staffing and improved working conditions. Nurses say they are paid 22% less than their counterparts in privately owned hospitals.

According to the union, salaries for county nurses and supervising nurses range from $24,936 to $34,536 per year.

Cordova said his aides have been trying to transfer patients who are covered by Medi-Cal from County-USC to private hospitals, but that is a tedious process that requires not only finding a hospital willing to accept a patient, but a doctor willing to care for the patient. It also involves transferring laboratory work and medical records.

With the occupancy rate at the county’s 78 private hospitals hovering at about 60%, there is no shortage of private beds. The problem is that the hospitals typically do not employ enough nurses and support staff to take care of the patients who would fill these beds. In addition, some doctors would prefer not to treat Medi-Cal patients because the payment rate is not as high as that of privately insured patients.

Nevertheless, about 150 patients had been transferred out of the six public hospitals to private hospitals by Wednesday afternoon, said Irv Cohen, assistant director of the Department of Health Services.

In addition to receiving these new patients, the private hospitals are struggling with a growing backlog of indigent patients who would ordinarily be transferred into the public hospitals because they cannot pay their bills. Because of the strike, the county is refusing to accept these patients, Cohen said. They total about 50 patients a day throughout the county.

Besides feeling the impact on their patient wards, the hospitals are feeling the crunch in their emergency rooms, said Deanne La Rue, spokeswoman for the Hospital Council of Southern California. With the emergency rooms and trauma centers at the public hospitals accepting only the most critical patients, more ambulances than usual are being diverted to private hospitals.

Temporary Closings

They became so overburdened Tuesday night that about 35 emergency rooms closed temporarily, said Virginia Hastings, head of emergency services at the health department.

Because of restricted access to the county’s emergency rooms and trauma centers, the Los Angeles Fire Department is stationing a helicopter at the Civic Center so that the sick and disabled can be ferried quickly to private hospitals in outlying parts of the county.

“It’s chaos,” said Fred Hurtado, president of the United Paramedics of Los Angeles Union. “The system cannot cope with the everyday load. The nurses strike has exacerbated an already incredible situation.”

County officials said their moves to consolidate patient wards, postpone elective surgery and cancel outpatient clinics has not significantly jeopardized patient care. But there were scattered reports by doctors of troublesome medical situations that occurred during the first night of the strike Tuesday.

At Harbor-UCLA Medical Center, Dr. Tom Pearls said the hospital’s coronary-care unit had to be closed for lack of nursing staff. Five patients who needed the unit’s special care had to be transferred to another unit that lacked the necessary monitors.

Some truck drivers have refused to cross nurses’ picket lines to make deliveries at county health facilities. The nurses, however, do not have strike sanction from the Los Angeles County Federation of Labor, AFL-CIO, as erroneously reported by The Times Wednesday.

Some nurses on the picket lines wrestled with the ethical questions raised by the strike.

Alice Pope, 42, a nurse practitioner who has worked for the county for 18 years, said, “We really want to give quality care, and we haven’t had that chance. . . . We’re adamant about what were doing. We want to help these people, not harm them. And that’s why we gave the county five days notice (of the strike). Our goal is to give quality health care.”

Times staff writers Bill Boyarsky, Gerald Faris and John Hurst contributed to this article.