As striking Los Angeles County nurses reluctantly began returning to work Friday under court order, scores of angry doctors, some wearing green scrub clothes and stethoscopes, walked out of the giant Los Angeles County-USC Medical Center and set up picket lines outside.
The troubled county health system, trying to resume normal operations with the return of the nurses, was also hit by a one-day walkout of pharmacists that shut down outlets for medicine in some hospitals and forced supervisors to run the pharmacies in others.
In addition, all routine laboratory work was suspended Friday at the county's Martin Luther King Jr./Drew Medical Center in South-Central Los Angeles when 26 of the facility's 38 lab technicians failed to report to work in an apparently related walkout.
The resident doctors at County-USC Medical Center were striking over an issue separate from that of the nurses. They presented an incongruous scene as they marched--about 60 at a time--waving picket signs and chanting:
"Two, four, six, eight, make the county negotiate! Eight, six, four, two, make the county talk to you!"
Periodically, a doctor's beeper would go off and the physician would drop his picket sign and run into the hospital to attend to a patient.
"The strange part of this," said Dr. Donald Tschirhart, 28, "is that after all of these years of education, you think as a white-collar Republican that 'strike' is a nasty word. and yet here I am on the other side of the line."
The Joint Council of Teamsters No. 42 said earlier in the week that its drivers would not cross the doctors' picket line for hospital deliveries. Some deliveries were made, however.
The effect of the strike was uncertain and even the number of participants was in doubt.
Mark Segal, director of the Joint Council of Interns and Residents, which represents the doctors, estimated that "80% to 90% of the residents are participating in the work stoppage but everybody is periodically going into the hospital to check on their patients."
But a spokesman for the 1,445-bed County-USC Medical Center said that only 65 of the 557 residents and interns scheduled to work Friday morning failed to report.
Residents are doctors who have graduated from medical school and are receiving four years of training under the supervision of senior hospital physicians. Interns are first-year residents. The senior physicians actually have responsibility for the patients under care.
'Contracting Out' at Issue
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 County-USC Medical Center. The county wants the right in a new contract to continue the practice of "contracting out" for physician care. But the doctors argue that the practice will kill their union and downgrade patient care.
Residents at Martin Luther King Jr./Drew Medical Center and at Harbor-UCLA Medical Center in Torrance voted Thursday night not to join the strike, partly because residents at those facilities have not been placed on the USC payroll arrangement.
The thousands of striking county nurses, who walked off the job Tuesday, slowly began returning to work Friday morning. County officials reported an overall absentee rate of 26% for the morning shift Friday--down drastically from the overall 60% absentee figure reported during the strike. But at the Martin Luther King Jr./Drew Medical Center, where absences sometimes hit 85% during the three-day strike, more than 40% of the nurses were still out Friday morning. For the afternoon shift at King, absenteeism dropped to 27%.
Union representatives said they were surprised by the back-to-work order served on them early Friday during a bargaining session requested by county management. Bargaining resumed shortly before midnight on Thursday but nurses had vowed to continue the walkout during the talks.
Decide to Comply
Backing away from an earlier statement that such a court order would be ignored, nurses and union representatives decided to comply.
"We didn't want to put the nurses in a position of getting arrested on the picket line," said Abby Haight, spokeswoman for the Service Employees International Union, AFL-CIO, Local 660, which represents the 4,000 nurses.
But the nurses did not return quietly.
"The striking registered nurses of L.A. County have brought the county to its knees," said a statement issued by the nurses' bargaining committee. "Because of our power, the county has obtained a court injunction which has temporarily ordered us back to work. We will continue our fight."
A hearing for a preliminary injunction against the strike is set for Feb. 10.
Nurses and county labor negotiators were scheduled to resume talks this morning. The parties are not bargaining face-to-face but instead are using a state mediator who relays proposals and counterproposals back and forth between the parties in separate rooms.
Nurses are seeking a 19.5% pay raise over two years. The county has offered 14.5% for two years or 20% for three years. According to the union, salaries for county nurses and supervising nurses range from $24,936 to $34,536 annually.
With some hospital pharmacies closed by the pharmacists' walkout, health officials said that indigent patients in need of medication are being referred to drugstores under contract to the county.
But some patients were confused and frustrated Friday morning as they attempted to have prescriptions filled.
"I don't understand this," said Herminia Garcia, who had received a prescription from a doctor at County-USC. "Why is the pharmacy closed? They sent me there for my prescription, but there's nobody else to help me."
"I think this is lousy. A lot of people need their medicine," said Ray Blunt, 33, an unemployed resident of South-Central Los Angeles who came to the hospital for treatment of the flu but was unable to get a prescription filled.
The pharmacists staged the one-day walkout partly in sympathy with the nurses and partly because they have been offered only 2% pay increases by the county, according to Olphelia McFadden, general manager of Local 434 of the SEIU.
The medical technologists who walked out of the King Medical Center acted out of "frustration" with their contract talks with the county, according to Henry Walton, a negotiator for SEIU Local 660.
Despite such continuing labor problems, county officials seemed cautiously optimistic Friday at the close of a chaotic week.
'Much Better Today'
"Things are much, much better today," said Irv Cohen, assistant director of the Department of Health Services. Cohen said the patient census throughout the hospital system, which normally runs at 3,000 or more, was down by 30%.
Some outpatient clinics that severely curtailed services during the strike were partially reopened for service.
But emergency rooms and trauma centers continued to divert ambulances to private hospitals. Cohen said that with the emergency rooms closed, the workload at County-USC was manageable. He said about 75% of the nurses there had reported back to work on the day shift and the percentage rose to 89% for the shift that began at 3 p.m.
The radiologic technicians who struck Thursday were back on the job.
Health officials discontinued their efforts to transfer patients to private hospitals, but most were still refusing to accept new admissions, Cohen said. Only Rancho Los Amigos Hospital, the nationally known rehabilitation center in Downey, opened its doors to new patients Friday.
Times staff writers Claire Spiegel and Ted Vollmer contributed to this story.