Doctors Threaten Shutdown of Services : Medicine: Two top USC physicians say they will close emergency rooms unless more money is available to ease staff shortages.

Two top doctors at County-USC Medical Center have threatened to shut down emergency services next month unless more money is made available to hire moonlighting physicians to help ease staff shortages.

Dr. Gail Anderson, chairman of the department of emergency medicine, has said in a letter to hospital administrators that he may have to shut down the main emergency room’s “walk-in” clinic on July 1. Dr. Daniel Mishell, chairman of the department of obstetrics and gynecology, has threatened to close the emergency room at County-USC’s Women’s Hospital at the same time. Both have cited their inability to attract moonlighting physicians to jobs in the emergency rooms paying $35 per hour.

The letters were sent in the midst of ongoing discussions between the Los Angeles County Department of Health Services and USC over who is responsible for providing additional funds.

Jerry L. Buckingham, County-USC executive director, described the two doctors as “very powerful men” and said they are “suggesting in very strong terms that they may have to shut down July 1.”

“We’re looking for a mechanism to avert a crisis,” said Dr. Sol Bernstein, medical director of County-USC. “We’re looking for more dollars from the county.”

Asked whether the doctors actually have the power to shut down the emergency rooms, Bernstein said, “The answer is a qualified yes.” But he said he believes the doctors wrote the letters “to try to get attention” focused on what everybody now agrees is an urgent problem. As long as the doctors see that progress is being made in reaching solutions, Bernstein said he is confident they will refrain from “using their influence” to shut down the emergency rooms.

The county health department pays the university a lump sum to provide physician staffing at the medical center. Faculty doctors and physicians in training, or residents, make up the bulk of that staff.

But the contract calls for additional funding by the county to supplement the staff with moonlighting physicians when the workload demands, according to Carl A. Williams, assistant county health director for hospitals. The agreed-upon stipend for these doctors is $35 an hour. They work mostly weekend evenings, holidays and nights, Bernstein said.

During the last fiscal year, Buckingham said, the county paid about $2.5 million to moonlighting doctors working in the two emergency rooms, which handled a total of 158,000 visits.

Williams agreed that the $35 hourly fee is not competitive in today’s market. But he said that the solution to understaffing does not lie simply in increasing that fee, nor is the county obligated to do so under its contract with USC, Williams said.

Williams contends that during the course of the contract, signed 3 1/2 years ago, USC was gradually supposed to take over all responsibilities for physician staffing and eliminate the need for the moonlighters’ stipend.

“When we make changes in rates of pay, it requires us to go to the Board of Supervisors, and it has pay and precedent-setting implications countywide,” Williams said.

USC Medical School Dean Robert Tranquada said the problem is that “the hourly rate that the county is willing to pay is not enough to attract the physicians necessary to cover those (emergency) services.”

Earlier this week--unrelated to the emergency room debate--Tranquada announced his resignation as USC’s medical school dean. In an interview Wednesday, he said that he is proud of many achievements during his five-year tenure and believes the new direction in which the school is headed is “utterly critical.”

He said “a combination of things” were responsible for his resignation, “a series of changes that add up to a rather profound change in this campus.”

In his letter of resignation, Tranquada said he was stepping down at the end of this month, to make way for “new leadership” better able to deal with the “tensions” and “serious budgetary problems” spawned by USC’s ambitions plans for the medical school.

Tranquada said that one source of tension has been the medical school’s joint venture with National Medical Enterprises, which has built a private, for-profit University Hospital located near County-USC Medical Center. USC plans to staff the facility.

Tranquada said the new hospital will put the school “in a position to truly compete. There is no prospect of improving our status without this resource. But it’s not a resource that comes easily.”