Sylmar Hospital Faces Threat of Budget Cuts

The last time a major earthquake struck, Olive View Medical Center was reduced to a pile of steel and mortar. It took tens of millions of dollars and years of political jockeying to turn it back into a modern, state-of-the art institution.

Eighteen years later, physicians, nurses and administrators are predicting another temblor might shake the Sylmar institution. This “financial earthquake,” they say, would be nearly as devastating as nature’s.

The hospital, warned Dr. Milton Greenblatt, chief of psychiatry, “could really become a kind of ghost.”

The alarm was sounded in May when Los Angeles County’s chief administrative office recommended a series of cost-cutting moves at Olive View and other county health facilities. Officials proposed slashing $17 million from Olive View’s $52-million budget for the coming year in anticipation of lean state appropriations for health care.

Supervisors’ Deliberations

Olive View’s fate ultimately rests with the County Board of Supervisors, which will begin deliberations on the 1989-90 budget Wednesday. The board could approve the budget by week’s end, but Olive View’s future might not be settled until next month when the county knows exactly how much revenue it will receive from the state. The missing link in the fiscal picture is the amount of health-care money the county will be apportioned through Proposition 99, the cigarette tax initiative.

Unlike the county’s other three teaching hospitals, Olive View has been singled out for a dramatic reorganization that would threaten its survival, hospital officials say. The sweeping changes would greatly reduce the array and quality of health care and would force most patients to travel to county hospitals in Watts, Torrance or East Los Angeles for treatment, Olive View officials predict.

Douglas Bagley, Olive View’s administrator, estimated that the cuts would force the hospital, which is relied upon by the area’s poor, to turn away thousands of people annually. The facility would have about 93,500 fewer contacts with patients each year, Bagley estimated.

Olive View, which depends upon the UCLA Medical School for its in-house medical faculty and resident physicians, would also lose its affiliation with the university, Bagley said. With severe cutbacks in various medical departments, the hospital could no longer sustain its 14 residency programs, he said. As a result, the hospital would lose 91 residents and 60 full-time physicians--most of whom belong to the UCLA faculty. The nursing staff would also be decimated, the hospital’s nursing director said.

“I think what you would end up with is a second-rate facility,” said Dr. Kenneth Shine, dean of UCLA’s medical school. “It would be going back to the Dark Ages in which county hospitals functioned.”

‘Mad Hatter’s Tea Party’

“It’s clear that the CAO’s budget was poured out of a Mad Hatter’s tea party,” said Dr. Irwin Ziment, the hospital’s chief of medicine, who vowed to quit if the reorganization occurs. “It is a brew of immense illogicality.”

While acknowledging that the proposed cuts are regrettable, officials in the chief administrative office said the changes offer some advantages.

Under the plan, most of the 104 beds used by surgical, cancer and cardiac patients, as well as other severely ill patients, would be relinquished to expand the overloaded maternity ward and to create a nursing home within the hospital. Also, the office wants to shrink the capacity of the psychiatric ward, the numerous outpatient clinics and the emergency room at the 270-bed facility.

Administrative office officials argue that shifting bed usage would relieve pressure on the maternity ward, which has been far more popular than hospital planners expected. The medical center, which operates the busiest maternity ward in the San Fernando Valley, is routinely shattering birth records on a monthly and even daily basis. When the hospital opened in 1987, the county projected that it would handle 3,200 births annually. But hospital physicians expect to deliver 6,000 babies this year.

In addition, the reorganization would enable the hospital to provide nursing-home beds for the county’s impoverished elderly, said Carol Kindler, assistant chief of the administrative office’s state and federal programs division. Elderly people remain patients at each county hospital because no empty nursing-home beds are available in the community, she said. Last spring, the county found 173 such elderly people in its hospitals.

The county could also pocket $3.4 million annually from the arrangement because fewer staff members would be needed to care for nursing-home patients, Kindler said.

The proposals would not jeopardize the quality of care, even though some patients would have to travel elsewhere in the county to see a physician, Kindler said.

Supervisor Mike Antonovich opposes a huge reorganization of Olive View, said Kathryn Barger, his health deputy. Antonovich’s staff is working to forge a compromise if the county falls short of adequately funding all health services, she said.

Impossible Cuts

“Some of those cuts are just impossible to make,” Barger said. “It’s easy to put them on paper, but to implement them would be detrimental to services at Olive View.”

Carl Williams, the county’s assistant director of hospitals, predicted that not all the drastic curtailments will be implemented. “In the meantime,” he said, “the ‘what-if’ scenarios get a lot of people anxious, including myself.”

Dr. George Mikhail, head of the hospital’s obstetrics and gynecology department, said no one is more opposed to revamping Olive View than he, even though his department would supposedly benefit. Although his department needs more beds, more space and more doctors, the plan to bail out the maternity ward is misguided, Mikhail said.

The 34 additional beds slated for the maternity ward would not relieve the logjam, he said. The extra beds are intended for women who have delivered, not for women who are in the labor and delivery rooms, where there is the greatest need for more space, he said.

And the reduced capacity of other medical specialties would affect the obstetrics and gynecology department, he said. Because many poor women receive little or no prenatal care, they are more likely to have medical problems that require a radiologist, a kidney or heart specialist, or some other specialized physician, he said.

“To think it can function in a vacuum is not right,” Mikhail said of the maternity ward.

Specialties Affected

Because only 28 of 104 beds would remain in the medical and surgery wards after the proposed reorganization, the hospital would not be able to handle enough patients to sustain its about 50 medical specialties, ranging from cardiology to general surgery to endocrinology, agreed the hospital’s medical department heads, who are UCLA faculty members.

“We would have a calamity on our hands with residents with nothing to do,” said Dr. Jesse Thompson, chief of surgery.

A national accrediting body probably would pull its endorsement of the residency programs at Olive View, forcing the resident physicians to leave, hospital officials said. And it would be difficult to find replacements since most doctors are attracted to the institution because it is a teaching facility, they said.

The medical center would also lose many nurses who were drawn by the hospital’s academic atmosphere, said Marianne Z. Kainz, director of nursing. Many would find jobs at private hospitals that offer much higher salaries. She estimated that the hospital would experience a permanent 15% to 20% vacancy rate in its nursing staff.

The nursing shortage would be further aggravated by the inevitable pullout of several area nursing schools, which provide student nurses, Kainz added.

Ultimately, it would be the patients who suffer most, the hospital’s medical staff agreed. It would be difficult for the county hospital network, which is already overloaded, to absorb thousands of sick residents from the San Fernando and Santa Clarita valleys, they said.

“With the system as full as it is, they would not be cared for as well,” said Dr. S. Douglas Frasier, chief of pediatrics, who worries about the children he would no longer be able to treat. “I think infant mortality would go up in the county.”