‘Chaos’ in O.C. Health Care Seen if UCI Center Closes : Hospitals: Care for trauma, indigent and burn patients would be among casualties, experts say.

At the main hospital entrance, gold and pink poppies bloom in the sun. Across the way, near the Lifeflight helicopter pad, workmen are laying beams for an $18-million psychiatric hospital and putting the finishing touches on an $11.5-million cancer center.

Inside, nurses care for high-risk babies in the neonatology ward while emergency-room doctors work feverishly to save the life of a mangled traffic victim or a gunshot victim. And at a nearby clinic, couples from London and New York await their turn for pioneering surgery that can give men long considered sterile a chance to father a child.

This is UCI Medical Center, Orange County’s biggest, most prestigious and most controversial hospital. Controversial because, year after year, this hospital has cared for most of Orange County’s poor, leading to large financial losses and giving rise to its image as the “county hospital.”

Actually, the 493-bed medical center has not been owned by the county since July, 1976, when the Board of Supervisors sold the complex to the University of California for $5.5 million. But 15 years later, the UC regents are threatening to close the hospital if the county and state do not contribute more to the care of the indigent.

As area hospitals drop out of the Medi-Cal program, UCI Medical Center finds itself serving an increasing number of uninsured patients. Last year, the hospital treated 10,000 indigent patients and, as a result, produced a $10.9-million deficit.

“We simply can’t keep funding what is truly a county hospital,” complained regents Chairman Roy T. Brophy. “It’s not the job of the UC system to take education funds and use them to pay for indigent medical care.”

Local officials said the regents are asking $3 million from the county this fiscal year and $7 million from the state to cover the deficit and keep the hospital in business. County supervisors recently directed their staff to find the money, and county Health Care Agency Director Tom Uram said he is “optimistic” the problem can be resolved. “UCI Medical Center is a very valuable commodity, and we need to continue its existence,” he said.

For all the losses, the medical center doesn’t fit the bleak image of a county hospital. In the past five years, state officials have spent $40 million on remodeling and building new labs and attractive outpatient clinics.

Capital improvements aside, this 33-acre medical complex offers some of the most sophisticated medical care in Orange County--a level of care that belies its image as a county hospital and, therefore in the minds of many, a facility of last resort.

Orange County’s most sophisticated trauma center is here. Also here: the county’s only burn center, top-level neonatal units for the sickest babies and a regional Poison Control Center that directs emergency treatment for child-poisonings and drug overdoses in five counties.

In addition, 379 medical students are being trained here and an additional 642 doctors are on fellowships or performing residencies--training in specialties like neonatal medicine, emergency medicine, surgery, pediatrics.

If the hospital closes, Dr. Walter Henry, dean of UCI’s medical school, insists that he can still run a fine medical school by contracting for medical training with nearby hospitals.

But the medical center “plays such a pivotal role” in Orange County’s health care that its closure “would be a very challenging problem for the community. . . . We certainly hope that is not going to be necessary.”

Other health experts warned of disaster if the medical center should close.

David Langness, a vice president with the Hospital Council of Southern California, predicted “chaos”--perhaps even “the total demise of Orange County’s health-care system as we know it today,” if the hospital closed.

Other hospitals would be flooded with indigent patients, Langness said, and burn or trauma patients would have to travel farther to get care. “It’s the same thing that happens now if you are unfortunate enough to get a severe burn in Los Angeles County,” he said. “With only 12 burn beds, patients must be flown to Las Vegas, Northern California, Texas. If UCI closes, the county will begin to suffer some of the same problems as Los Angeles County.”

Emergency Care

It was another busy day in Orange County’s busiest emergency room. By late afternoon nearly every plastic chair in the sparsely furnished waiting room was filled.

Among the 50 people waiting to see a doctor: an elderly woman with a sprained ankle, a man with stomach pain and a scared young man whose pregnant girlfriend was rushed to the examining room four hours earlier with heavy bleeding.

It was taking too long for his girlfriend to come out, groused 21-year-old Augustine Martinez. Still, the Placentia landscape worker said, if you have little money and no health insurance, UCI is a good place to come. “It’s one of the best hospitals in Orange County.”

Indeed, UCI’s emergency room is the most comprehensive in Orange County.

On its 70-member staff are nurses, technicians and doctors who are specialists in emergency medicine. Its doctors can call on UCI experts in limb reattachment and plastic surgery, a burn unit, toxicologists at the hospital’s regional Poison Control Center or the Lifeflight helicopter that can ferry premature babies or traffic victims to the hospital. At other local hospitals, specialists in anesthesiology, general surgery, pediatrics and neurosurgery may be on call, but at UCI they are in the hospital 24 hours a day.

For all the manpower, emergency room doctors say they rush from one case to the next with little time for breaks. UCI typically handles 110 emergency cases a day--from minor colds and sprains to life-threatening heart attacks and internal bleeding.

UCI also operates one of four trauma centers serving the county. UCI’s trauma center doctors also handle an average of six trauma cases a day--such as gunshot wounds, head injuries, traffic accident victims--a volume twice that of Orange County’s other trauma centers.

For all the problems, neither patients nor emergency room staff can believe that the hospital will close. “If it closed, the people would be in big, big trouble,” said Martinez. “Especially the people who can’t afford” to pay for medical care.

Added Dr. Gregg A. Pane, assistant director of emergency medicine: “It cannot close. It will not close.” This hospital “is the Charles Atlas that holds up the world” of health care in Orange County.

The Personal Touch

They call it “the tower.”

But this five-story, $14.3-million addition to the main UCI hospital building was more than just a new addition nine years ago. It was a first step toward remodeling the entire medical complex. And, in a hospital flooded with uninsured patients, the tower’s 110 beds--all in private or semiprivate rooms--were built to attract patients with private insurance.

To be sure, these sparsely furnished rooms would never be mistaken for a suite at the Ritz-Carlton. Painted shades of mauve, they still look like hospital rooms, with linoleum floors, an armchair or two, and, in semiprivate rooms, a curtain between beds.

But the tower has amenities all its own. Volunteers from the hospital auxiliary push an “art cart” into its rooms, inviting long-term patients to select a painting for their walls.

Another touch: two “concierges” are assigned to small English writing desks in the tower’s waiting rooms. They run errands for patients, families and staff--booking rental cars or hotel rooms for visitors, buying presents for patients’ friends and on weekday afternoons, “we bring ‘round a tea cart, with refreshments for all patients,” said veteran concierge Judy Dufort-Van Voorhis.

Other times, Dufort-Van Voorhis said, the concierge is a counselor--holding hands, comforting patients or families. And when a patient dies, she pens a condolence note to the family from the UCI staff. Tower patients and their relatives say they appreciate these efforts. “When you’re scared green and there’s no one to help and you’re stuck here from out of town . . . (the concierges) are your moral support,” said Doris Simmons, a Patagonia, Ariz., ranch owner whose husband spent three months at UCI.

For all the tower’s amenities, its occupancy rate reportedly dipped from 90% several months ago to 50% in late February, hospital sources said. Hospital spokeswoman Elaine Beno countered that occupancy had dropped only slightly, from 90.1% in 1989-90 to 83.8% from July, 1990, to date. Upscale touches aside, “we’re still the university hospital with the highest percentage of indigent patients in the country,” said a longtime UCI doctor who sees patients in the tower, and some private patients won’t go to a hospital with so many indigent patients.

“They have these tours of the tower for all the fashionable ladies,” the doctor said. “But a lot of them still end up going to Hoag” Hospital in Newport Beach.

Baby Care

In a neonatal nursery, nurse Susan Gallitto sat in a rocking chair, gently feeding a 3-pound baby breast milk from a straw. The girl was three months premature. As the bright-eyed child studiedGallitto’s face, the nurse cuddled her small patient and smiled. “She’s pretty responsive,” she said. “She’s doing good.”

With warming lamps and tiny respirators, 150 neonatal nurses and 26 doctors care for about 1,300 preemies a year, some born here, some transferred from nearby hospitals.

Three neonatal nurseries care for these smallest of babies at charges that start at $2,000 a day. In neonatal intensive care, up to 25 plastic incubators hold the sickest of preemies, their bodies wired with monitors tracking heart rate, respiration, blood pressure. Though other hospitals have neonatal units, only UCI and Children’s Hospital of Orange County in Orange have the equipment and staff to meet state criteria for this most intense level of neonatal care.

A 25-bed intermediate nursery takes care of healthier preemies. And an innovative “petite suite” handles six to 10 of the hospital’s tiniest babies. These are 1- to 2-pound babies, no longer critically ill, who are thought to recover more quickly in their own closely monitored unit.

Directing neonatal and perinatal care is Dr. Louis Gluck, 68, a white-haired physician and medical legend who is considered the father of modern neonatal medicine. Thirty-one years ago, at Yale University, he started the world’s first intensive care unit for newborns, developing its miniaturized equipment and setting standards for care.

After seven years at UCI, Gluck boasts that his neonatal division is “the best in the world.” Fifteen of his staff neonatologists have contracts to run neonatal units at six other hospitals in Orange, Los Angeles and Riverside counties.

Gluck continues to direct care here--visiting babies and instructing six doctors on fellowships. Neonatology is not cookbook science, where “you do A, B, C,” he said. “I want my people to learn to individualize, to assess a baby.”

Gluck doubts that the medical center, with all its resources, can close. But if it did? “Mortality among infants could go up,” he warned. “The standard of care would go down.”

He offered a suggestion to prevent that: “This is a heavy shopping county. It wouldn’t kill the county to put a half-cent tax” on retail sales to support the medical center.

Cancer Research

Why does a mole become cancerous? Can large doses of a substance found in carrots, beta carotene, prevent cancer--or help cure it?

These are a few of the problems that Dr. Frank L. Meyskens, director of UCI’s 10-year-old Clinical Cancer Center, has been researching lately.

From an aging bungalow behind UCI’s hospital, the 45-year-old oncologist supervises $10 million of basic cancer research, $5 million more of clinical research and two outpatient clinics that see nearly 1,000 new cancer patients a year.

In addition, Meyskens, who is world-renowned in “chemo-prevention” of cancer, oversees 19 faculty members and 14 post-graduate fellows on more than 100 clinical trials, testing new drugs on patients whose cancer hasn’t responded to conventional means. Although Orange County boasts several cancer centers, only UCI’s has been accepted into the American Assn. of Cancer Institutes, a New York-based group with strict research and teaching requirements.

At the cancer center, Meyskens says his doctors take a multidisciplinary approach to cancer. UCI’s patients “are seen as much as possible by a multitude of physicians.” A UCI breast cancer patient will see a surgical oncologist and a radiation oncologist as well as plastic surgeon, he said.

Meyskens and his colleagues, now scattered around the hospital complex and on the Irvine campus, are looking forward to new quarters--a four-story, $11.4-million center near the hospital entrance that could open by late fall. But he is shocked at suggestions that the project could stop dead, that the hospital might close.

“It would be quite surprising if a major metropolitan area such as Orange County, that wishes to be excellent, would not have a medical center,” Meyskens said. There are many solutions short of closing the hospital, he added, such as closing the emergency room, pulling out of the county’s indigent services program or quitting Medi-Cal.

Fertility Clinic

“The laboratory is crazy today,” Dr. Ricardo Asch says.

Wearing blue surgical scrubs, the 43-year-old infertility specialist was taking a break from a series of innovative surgeries at his Center for Reproductive Health.

All week, Asch explained, he and a St. Louis colleague, Dr. Sherman J. Silber, were performing a string of operations on two dozen couples that might enable men considered sterile to father a child.

Asch, Silber and three other infertility experts announced their technique last December in the New England Journal of Medicine. The method, which allows men born without a vas deferens, or sperm duct, to become fathers, requires several surgeries--first on the man to aspirate sperm from the testes, then surgery on the woman to retrieve eggs. Sperm and eggs are then mixed in a test tube and implanted in the woman’s Fallopian tubes, where fertilization can occur.

Last year’s results were promising: Ten of 32 couples treated achieved a pregnancy. So last week, hoping to improve their odds, Asch and Silber were trying again. Couples from throughout the world descended on his center, located in one of UCI’s new outpatient pavilions, hoping to conceive a child.

“Once I found out what my condition was, this was our best hope in having our children,” explained a 32-year-old New York banker who, with his wife, was giving the $20,000 operations a second try.

Operations for infertile couples were the latest in a host of fertility techniques Asch and three other center doctors used to treat 1,000 center patients last year. Among the methods: in vitro (test tube) fertilization and a technique called GIFT (for gammete intra-Fallopian transfer), which Asch invented 16 years ago while at the University of Texas.

Still, Asch is looking for something better. “All these procedures require surgery,” he said. So now, in his new 6,000-square-foot clinic and lab, he is developing a new technique “without any surgery at all.”

Asch is horrified at the idea that the medical center might close.

If it did, “I wouldn’t stay here. I would go to another academic university,” he said, insisting he needs the medical library and the collaboration with other university physicians and students to advance his work.

His career aside, Asch said the biggest losers if the medical center closed would be Orange County’s poor. “If they do not get (medical care) here, where are they going to get it?”