Talks Resume to End Walkout by County’s Nurses

Negotiations between Los Angeles County and striking nurses resumed shortly before midnight Thursday after a day of spreading labor unrest in the county’s sprawling public health-care system.

Meanwhile, county officials went before a night-duty Superior Court judge seeking a temporary restraining order to compel the nurses to immediately return to work. Judge Miriam Vogel was scheduled to consider the motion at a post-midnight courthouse session.

“It’s my belief that the only way to settle a strike is by negotiation, but at this point we have to have nurses tomorrow (Friday) morning,” the county’s chief administrative officer, Richard Dixon, said as lawyers for both sides prepared for the hearing.

Without the nurses, he added, “irreparable harm” will be done to patients.

But a spokeswoman for Local 660 of the Services Employees International Union, AFL-CIO, which represents the county’s 4,000 nurses, said that the union would defy a court order directing its return to work.

“We are very angry,” the spokeswoman Abby Haight said. “We are totally exhausted, and we agreed to go back to the bargaining table tonight (Thursday) at the county’s request, and now they move for this court order which is typical of their bad faith.”

These developments capped a day in which the nurses’ strike, combined with a one-day wildcat walkout by X-ray technicians, forced the virtual closure of the trauma center and the emergency room at County-USC Medical Center, largest of the county’s six public hospitals.

The medical center, which normally provides emergency care to nearly 600 patients a day, was closed to all but walk-in emergency patients Thursday morning, when 54 of the 69 radiologic technicians scheduled to work failed to report, said Richard Cordova, administrator of the General Hospital at County-USC . Emergency services had already been curtailed as a result of the nurses’ strike.

Moreover, resident physicians at the 1,445-bed medical center threatened to “shut down the hospital” this morning with an additional strike. County officials negotiated with the Joint Council of Residents and Interns late Thursday in an effort to avoid the scheduled 7 a.m. walkout.

While emergency services were closed to ambulances at County-USC, other county hospitals continued to accept some ambulance traffic, but only the most critical patients.

Nurse absenteeism held steady at about 59% during the morning shift and 65% during the afternoon shift at the the six public hospitals during the third day of the strike Thursday, county officials contended. Union spokeswoman Haight claimed that 80% of the nurses struck.

The nurses want a 19.5% pay increase over two years. The county is offering 14.5% over two years or 20% over three years.

In the radiologlic technicians’ one-day wildcat action Thursday, 79% of the 145 technicians scheduled to work at the six hospitals failed to show up for the morning shift, severely disrupting emergency services that are heavily dependent on X-ray technology.

Contract Dispute

For the radiologic technicians who walked off the job, the dispute centers on a new 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 and that their jobs are so specialized that it is difficult to replace them on short notice.

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 patient transfers are slowing, 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.

Doctors May Picket

The Joint Council of Interns and Residents, which represents about 1,500 doctors, voted Wednesday to send 800 resident physicians out of the hospitals and onto the picket lines at 7 a.m today if last-minute labor talks could not 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 USC School of Medicine and usually supervise resident physicians, could be expected to pitch in and provide patient care typically given by the residents they supervise.

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 a month, only 3% below the $2,490 a month paid 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 a 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.

Union spokeswoman Haight 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.

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.

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