X-Ray Workers Join Nurse Strike; Doctors May Walk

Labor unrest in Los Angeles County’s sprawling public health care system spread Thursday as X-ray technicians walked out in support of hundreds of striking nurses, and resident physicians at the 1,445-bed County-USC Medical Center threatened to “shut down the hospital” by staging their own strike this morning.

In a severe curtailment of emergency service, the County-USC trauma center and emergency room, which typically treat almost 600 patients a day, was closed Thursday to all ambulance traffic. Officials decided to close the trauma center in the morning when 54 of the 69 radiologic technicians scheduled to work failed to report, said Richard Cordova, General Hospital administrator. Emergency services had already been curtailed as a result of the nurses strike.

Other county hospitals continued to accept some ambulance traffic, but turned aside all but the most critical patients.

Nurse absenteeism held steady at about 59% at the six public hospitals during the third day of the strike Thursday, county officials said. Abby Haight, spokeswoman for Local 660 of the Service Employees International Union, AFL-CIO, which represents 4,000 county nurses, claimed 80% of the nurses boycotted.

For the radiologic technicians who walked off the job Thursday, the dispute centers on a contract negotiated with the county by Local 434 of the Service Employees International Union. The contract provides an 8.5% wage increase over two years.

Cordova said the technicians operate ultrasound machines and X-ray equipment that are critical to emergency departments. Their jobs are so specialized that it is difficult to replace them on short notice, Cohen said.

Hospital administrators attempted to cope with the shortage of nurses and technicians by assigning double or triple shifts to the staff members still on duty, and by continuing to shrink their patient load by transferring patients to private facilities, refusing most new entrants and postponing elective surgery. Most outpatient clinics also remained closed, except for critical services like chemotherapy.

Patients were discharged early, with new mothers at the Women’s Hospital at County-USC Medical Center leaving 12 hours after birth in many cases. Many patients who were sick but in stable condition continued to be transferred to private hospitals. But assistant health director Irv Cohen said that patient transfers are slowing down indicating that local private hospitals may be reaching capacity. So, he said, county hospital administrators are eyeing beds as far away as Kern County and San Diego. “We’ll go as far as necessary,” he said.

Cordova said that the danger ahead is that only the most critically ill patients will be left at county hospitals--those with AIDS, with severe burns, and with acute respiratory problems, for example.

“These are the patients in the greatest jeopardy,” he said.

The situation could worsen today. The Joint Council of Interns and Residents, which represents about 1,500 doctors, voted to send 800 resident physicians out of the hospitals and onto the picket lines at 7 a.m today if last-minute labor talks cannot break deadlocked negotiations.

Mark Segal, a director of the Joint Council, said a big walkout by residents would “effectively shut down the hospital.”

“If they go out, it will be an out-and-out crisis,” Cohen acknowledged.

But Robert Gates, director of the county’s Department of Health Services, said that if the residents strike, “We would have an increasingly critical situation . . . but it does not mean we would have to close a hospital.”

Dr. Sol Bernstein, medical director at County-USC Medical Center, said the 300 “attending physicians,” who are mostly faculty members at the University of Southern California School of Medicine, will pitch in and provide hands-on patient care typically given by the residents they supervise.

“The only thing they are probably not as good at as the residents is working long hours and staying up in the middle of the night,” Bernstein said.

Residents are doctors who have graduated from medical school and are receiving four years of training in a hospital under the supervision of senior physicians. Interns are first-year residents.

Gates and Elliott Marcus, the county’s chief negotiator, held a morning press conference and challenged union claims that nurses who work for the county are paid far less than those who work for private hospitals.

The county figures, based on data collected by the Hospital Council of Southern California, indicate that staff nurses in county hospitals are paid an average of $2,422 per month, only 3% below the $2,490 per month paid to their counterparts at private facilities.

County officials also used the figures to argue that the last salary proposal offered by the county would put the striking nurses’ wages at $2,532 per month, putting them at a higher rate than the private sector.

“It will put the county nurses consistently over the salary for 75% of the nurses in the community,” Marcus said.

But Marcus’ assertion, said David Langness, spokesman for the Hospital Council of Southern California--the trade association for both private and public hospitals--is based on the premise that salaries for private hospital nurses would remain static, while in reality such wages have been climbing.

Moreover, union officials accused the county of misrepresenting there wage disparity by ignoring salaries paid by certain large private hospitals.

Abby Haight of Local 660, Service Employees International Union, said the county’s own surveys showed that at Centinela Hospital Medical Center a nurse can earn as much as $3,700 a month; at Cedars Sinai Medical Center, $2,773 a month; at Brotman Medical Center $3,400 a month; at Glendale Adventist Hospital $3,243; and at Daniel Freeman Memorial Hospital $2,684 a month.

“We need to see an increase to bring county nurses in competition right away,” Haight said. “What’s most disturbing is that Mr. Marcus is stonewalling the strike and again not taking the nurses seriously.”

The dispute involving resident physicians centers on a move by the county last summer to contract with USC to pay and manage the latest group of first-year residents hired at the hospital. The county wants the right in a new contract to continue this practice of “contracting out” for physician care.

The burgeoning labor problems have raised fears that the health care system will be overwhelmed.

County-USC medical director Bernstein said closure of the County-USC trauma center has shifted “a significant percentage of the burden” to the trauma centers at private hospitals.

Cohen said the trauma system in Los Angeles County “is walking a tightrope anyway” and that with the county unable to shoulder what is usually 45% of the burden, “Who’s to say who’s falling between the cracks, but it’s an extremely precarious position.”

At the trauma center of the Cedars-Sinai Medical Center, Ronald Wise, director of public relations, said that if the strike continues, “Things have got to get worse.”

Wise said that before the strike the trauma center was frequently filled and unable to take patients because of an overload caused by the closure of other such centers.

“The physicians are up to their elbows in patients now,” he said.

The effect of the strike was evident in the shooting of Los Angeles County Sheriff’s Deputy Cornelius J. Healy, who was scaling a brick wall Wednesday night in search of an assault suspect when another deputy at the scene accidentally shot him twice with a shotgun, authorities said.

Healy was rushed to County-USC Medical Center where he was stabilized and then transferred by helicopter about 2 a.m. to Huntington Memorial Hospital in Pasadena for surgery.

“He needed surgery--they didn’t do that and they transferred him here,” said Kay Murphy, spokeswoman for Huntington Memorial.

Murphy also said that Healy’s condition was upgraded late Thursday afternoon from critical to serious.

Murphy said that her hospital was “at a very high capacity now” and would consider potential transfers from County-USC Medical Center on a “one-by-one basis.”

“I think this will become a bigger issue in the next few days and we will be watching it very closely,” said Michelle Barker, spokeswoman for California Medical Center in Los Angeles, which Thursday accepted 12 transfer patients after “reassigning personal to accommodate them.”

Contributing to this story were Times staff writers Gerald Faris, Paul Feldman, John Hurst, Louis Sahagun, Ronald B. Taylor and Ted Vollmer.