Out in the Cold, and Getting Sicker and Sicker : Health Care: Our county hospitals have been brought to near collapse by a series of state administrations that simply decided to fund more politically attractive programs.

Anyone who pays attention to news in Los Angeles or who provides or seeks care at a county hospital is conscious of a crisis within this system.

The problem is not lack of caring but lack of money. County health care has been short of funds since its inception, but the shortage reached crisis stage in the last decade, as Proposition 13 reduced overall funds and decisions on spending priorities were transferred to the governor’s office.

Some perspective is needed to give context to the grave and significant recent events within the Los Angeles County Department of Health Services and its hospitals, from overloaded trauma facilities to the difficulties at Martin Luther King-Drew Medical Center.

Three themes have been present throughout the history of the nearly 140 years of Los Angeles County’s public hospitals: a state mandate that places the responsibility for the funding of indigent health care on the county; constant under-funding of this county function; and recurrent but ineffective public outcry about a situation that has never been satisfactorily resolved.

In 1852, the state Legislature decreed that indigent health care would be the financial and administrative responsibility of individual counties, a decree later incorporated into the state constitution. In 1875, a county grand jury filed a report that read as follows: “We find some of the wards not kept as clean as they ought to be. Neither did there seem to be attendants enough to attend to those who were very sick.” Sounds familiar.

It is also important to realize that this approach to caring for the indigent sick was devised at a time when the population of Los Angeles County was less than 15,000, and the entire state had a population of no more than 350,000.

Today, the hospitals of the County of Los Angeles include the 2,045-bed Los Angeles County/USC Medical Center (the busiest acute-care hospital in the nation), 553-bed Harbor/UCLA Medical Center, 480-bed Martin Luther King Hospital, 323-bed Olive View Medical Center, 735-bed Rancho Los Amigos Hospital and 173-bed High Desert Hospital.

All of these hospitals, with the exception of High Desert, are major affiliates of the three medical schools in Los Angeles. Together they provide 1,110,000 days of hospital care and nearly 1,410,000 outpatient visits annually. Last year at the Women’s Hospital of the County/USC Medical Center, more than 17,000 babies were born--representing one out of every 200 births in the entire United States.

These hospitals are the only glue holding together the crumbling trauma and emergency care system of the county. In addition, Harbor/UCLA, County/USC and Rancho Los Amigos are recognized around the world for their leading research work.

The most recent public outcry regarding the problems of the county hospitals has focused on Martin Luther King Hospital and building code deficiencies at the County/USC Medical Center. It is high time for the real source of these problems to be identified and corrected.

The predictions that preceded the passage of Proposition 13 are being realized. The essential assets of our county’s health-care system have been neglected and are even more grossly under-funded than before. In fiscal year 1981, the proportion of the Los Angeles County budget allocated to the county hospitals was 16.8%. In the past fiscal year that proportion had fallen to 8%, a mind-boggling decline of more than 50%.

Fairness requires recognition that the capping of property tax revenues by Proposition 13 has led to severe strains on the resources of the county. Under those circumstances the only place the county hospitals could turn was the state budget.

Perhaps the saddest part of the already wrenching story of the financing of the county hospitals over the past 10 years has been the virtual total neglect of their needs by a series of state administrations that simply decided to fund more politically attractive programs.

We have seen drastic cuts in mental-health and family-planning funds, the crumbling of our already antiquated buildings, the refusal of the state to fund payments to private hospitals that would keep open their trauma centers and prevent inundation of county facilities. We have seen the cynical substitution of Proposition 99 dollars in place of state dollars already designated for county hospitals.

These decisions are not difficult to understand. The clients of the county hospitals are poor and unorganized and carry no political clout. Roads, police, courts and commercial development--all of which command powerful political constituencies and extensive lobbying efforts--have been the winners in the funding battles. The county hospitals and the poor who seek care in them are once again left out in the cold.

These hospitals are staffed, for the most part, by loyal, hard-working and dedicated professionals whose cries for adequate support of their overwhelming task have been summarily neglected.

Amid these conditions, the medical staffs provide a level of sophisticated care to the indigent population that is a model for the rest of the country. For all of us, regardless of social and economic considerations, they provide critical trauma and emergency care. Put simply, they are irreplaceable resources for our community. But despite the often heroic efforts of doctors, nurses, interns, technicians and specialists, it is the patients who do the real suffering.

That is no longer consistent with what can be tolerated in a community as dynamic as Los Angeles County. The leadership for these critical changes must come from both the Board of Supervisors and the governor’s office, and the whole community must become involved in bringing these changes about.