Sickout by Night Nurses Continues at County-USC

For the second consecutive day, night-shift nurses staged a sickout at Los Angeles County-USC Medical Center’s neonatal intensive care unit in an apparent protest over understaffing and unsafe working conditions, hospital administrators said Sunday.

Seven of eight night-shift nurses called in sick for the 7 p.m. shift, said Women’s Hospital Administrator Connie Diaz.

“We’re down to 20 babies now,” said Diaz. “We have enough nurses either staying over (from the day shift) or coming in to care for those babies.”

Day-shift nurses reported to work Sunday. But the first night-shift sickout Saturday forced officials to transfer 12 of 37 babies in the unit to private hospitals, Diaz said. The condition of the infants--all critically ill and confined to incubators--was unavailable Sunday.

“They’re all very tiny and very sick,” Diaz said. “Normally, it’s not a good idea to move them. . . . But there wasn’t a whole lot of choice.”

All eight nurses scheduled to work from 7 p.m. Saturday to 7 a.m. Sunday called in sick, requiring administrators in the country’s busiest labor ward to scramble for replacements. Some outside nurses were called in to assist day-shift nurses who stayed late to pitch in, Diaz said.

“It’s not too good,” said attending physician Ramanathan Rangasami, noting the staff was stretched thin.

Before Sunday evening’s action by the nurses, Diaz was optimistic that the night shift would return to work.

“These are outstanding nurses and they really love those babies,” Diaz said. “They are very dedicated people and if this is a planned thing, I’m sure it’s reflecting their concern for the ongoing care of the babies.”

Diaz said hospital administrators were hoping to meet with the nurses today.

“They haven’t asked for a meeting,” she said. “But since they called in sick, we’ll have to wait until they come back to work for a meeting.”

Irving Cohen, director of administration and finance for the county Department of Health Services, said he was disturbed by the nurses’ tactics.

“We have a crisis because the delivery rate in L. A. County is skyrocketing,” said Cohen, whose agency funds County-USC. “If this is their way of showing compassion . . . we’re not quite pleased.”

A woman who identified herself as one of the absent nurses, but said she did not want to reveal her name for fear of losing her job, said state standards require at least one nurse to every two neonatal ICU babies. County-USC, with its huge obstetric caseload, at times has a ratio of one nurse to four babies, she said.

“We’ve asked that the number of babies be kept down to a load we can endure,” the woman said. “The nurses are very, very concerned about the babies’ welfare.”

But Diaz said the state allows different nursing ratios depending on how ill the infants are, and that a 4-1 ratio is acceptable for less critically ill babies. Most of the infants in the unit on Saturday, however, required the more intensive 2-1 ratio, she said.

Even under normal conditions, one or two of the infants may be transferred to a private hospital every day because there are not enough nurses to care for them. Most of the babies are covered by Medi-Cal, so the parents usually are not affected by the move to more expensive private facilities, Diaz said. She said she did not expect the county to be billed, either.

The labor ward at Women’s Hospital last year delivered about one of every 200 infants born in the United States, making it the country’s busiest facility. It is equipped to handle about 45 births daily, with a maximum of about 15,000 each year. But the hospital has not delivered fewer than 16,000 babies since 1982 and, since July, has averaged about 55 a day.

To dramatize what they termed “battlefront obstetrics,” staff doctors last December threatened to make public a videotape that included scenes of more than a dozen women in labor crowded in halls.

Compounding the problem, the hospital receives a large percentage of high-risk patients that private facilities are unwilling to care for, Diaz said. Nearly 85% of the women are Latino, most of whom are immigrants, indigent and without adequate prenatal care.

When their children are born prematurely, ill or with congenital defects, they are placed in the neonatal intensive care unit. The ICU is licensed to handle 48 babies, but because of staffing shortages rarely accepts more than 30 or 35, Diaz said.

“I think I am in sympathy with the problem,” Rangasami said. “This has been ignored for a long time.”

Three years ago, half of the staff nurses at County-USC’s Women’s Hospital joined nurses at county hospitals in a two-day sickout to protest pay and working conditions.

Last August, the County Board of Supervisors cut $7.6 million from the county’s health services budget, with County-USC taking the brunt of it. A Superior Court judge has ordered the cuts restored, but supervisors have not agreed on how to come up with the money.

Times staff writer Edward J. Boyer contributed to this story.