Judge Orders Striking Nurses Back to Work

Eighteen hours after they walked off the job, striking Los Angeles county nurses Tuesday were ordered back to work by a Superior Court judge, who said the labor dispute had created “an imminent threat to the health and safety of the public.”

County Health Director Robert Gates said he expects most of the nurses to be back on the job by today. Richard Dixon, the county’s chief administrative officer, added that the county has requested state mediation to help reach a new contract.

Judge William Huss issued the temporary restraining order at 5:05 p.m. after hearing 90 minutes of testimony from county health officials about widespread disruption of medical care at the county’s six public hospitals and 47 neighborhood clinics.

Nurses did not immediately respond to the order, however. Gilbert Cedillo, general manager of Local 660, Service Employees International Union, representing the 4,500 nurses, said late Tuesday he had not seen a copy of the temporary restraining order, and that neither he nor the nurses are obligated to obey it without seeing it.

He said nurses will meet at 11 a.m. today at Patriotic Hall in downtown Los Angeles to determine their response.

Local 660 leaders emphasized that they are “escalating” collective bargaining issues with the county, announcing that 3,000 Department of Public Works employees will go out on strike today.

In addition, 5,000 eligibility workers and supervisors in the Department of Public Social Services notified the county that they are “terminating their contract,” a Local 660 spokesman said.

Still, as word of the back-to-work order spread Tuesday night, private hospitals breathed a “huge sigh of relief,” according to David Langness, spokesman for the Hospital Council of Southern California. Many private facilities had assigned extra staff to their emergency rooms in anticipation of swarms of patients turned away from county medical facilities.

Even as the court hearing was in progress Tuesday, county officials were receiving updates on what they testified was a rapidly deteriorating situation, with critically needed emergency rooms closed and hospital wards crippled by staff shortages.

In a deposition, Ed Foley, administrator of Harbor-UCLA, said 29 operations had to be canceled Tuesday, including three on cancer patients and one on a child with a broken arm.

The strike began at 11 p.m. Monday and intensified Tuesday, with half the morning shift failing to report to work at the hospitals and health clinics relied upon by hundreds of thousands of mostly poor patients. County officials swiftly closed the hospitals’ emergency rooms to ambulances and began discharging patients or transferring them to private hospitals.

The county neighborhood clinics curtailed services sharply, relying on skeleton staffs to reschedule patient appointments. At El Monte Comprehensive Health Center, only two of eight regular clinics were open, according to Barbara Lee, a center administrator.

At the Compton Health Center, Maria Gomez, 18, was told that her baby, who had an eye infection, could not be seen. “I don’t feel good about it because my baby is sick,” Gomez said.

Dr. Lionel Cone, at a San Fernando Valley clinic, said he was having to turn away sick children. “We are not able to provide for them,” he said.

Cedars-Sinai Medical Center and UCLA Medical Center on the Westside and Huntington Memorial Hospital in Pasadena expanded their trauma service areas to compensate for the shutdown of the trauma units at Martin Luther King Jr./Drew Medical Center, County-USC Medical Center and Harbor-UCLA Medical Center. Those hospitals account for 50% of the trauma beds countywide.

The nurse shortage was complicated by a one-day walkout by unionized therapists, laboratory technologists and clerical workers also dissatisfied with county contract offers.

Outpatient clinics were closed and elective surgical procedures postponed. Ambulances were diverted to other hospitals, and patients showing up on their own in emergency rooms were handed flyers warning of long waits for care.

At Women’s Hospital, a part of the County-USC complex, 50% of the nurses working in maternity units did not show up Tuesday morning, spokesman Harvey Kern said.

But union workers disputed that, asserting that the shortages were as high as 100% in some areas of the hospital.

Infants in the neonatal intensive care unit were discharged and others were transferred to nearby private hospitals, reducing the census there from 41 to 33 by about noon on Tuesday.

At King/Drew, where union officials said as many as 75% of the nurses on some units honored the picket lines, patients waited 10 to 12 hours in the emergency room for treatment. There were delays in getting blood tests and medication.

Roberta Scott, a public health nurse at the North Hollywood Health Center who picketed County-USC on Tuesday, complained about the quality of patient care. She said clinics are normally so crowded that patients needing checkups six weeks after giving birth can’t get appointments for three months.

Several nurses said working conditions were so bad--with too few nurses or dangerously long waits for care--that they feared their professional licenses were in jeopardy.

“The county is trying to make us look like a bunch of money-grubbers out here,” said Bill Stuehler, an emergency room nurse on the picket line at Harbor. “But that’s not the case at all. We’ve been working under unbearable conditions for years.”

But the dispute primarily has centered around what nurses said were pay and fringe benefit disparities between county and private-sector nurses. The county contends the pay is equivalent for nurses at public and private hospitals. Wage and fringe benefit disparities, the nurses and union officials said, have hampered efforts to fill 1,059 nursing vacancies currently at hospitals and health clinics.

The county has offered a 5.5% pay raise now, with 7% more next year. On a two-year contract, the union is seeking a 10% wage hike now and 7% next year. The nurses’ contract expired Sept. 30.

Safe working conditions were a frequently voiced concern, even among nurses who refused to join the strike. Stanley Partin, a nurse in the surgical intensive care unit at County-USC, said he thought the county’s wage package was “really quite good,” but security issues had not been adequately addressed.

An expensive card-key system, for example, was installed at the sprawling Boyle Heights hospital, which has many separate buildings and entrances. But Partin said the system is hardly used.

“There are doors open all the time,” he said.

Indeed, the ability to go in and out of County-USC easily was bizarrely illustrated at midnight Monday when, against the backdrop of chanting pickets and security guards poised to escort non-striking workers, a dazed and barefoot patient in pajama pants and skimpy gown wandered toward the main gate. An alert security officer, driving up the entrance ramp, wheeled his car around to block the patient’s path. After a brief chat, he gently turned the patient back up the driveway and walked him into the building.

Also contributing to this story were Times staff writers Michael Connelly, Kenneth J. Garcia, David Haldane, Denise Hamilton, Anthony Millican, John Mitchell, Janny Scott and Claire Spiegel.

Nurses: The Numbers

This shows how many county nurses were scheduled for work and how many failed to report for duty.

MONDAY AT 11 P.M. TUESDAY AT 7 A.M. Scheduled Absent Scheduled Absent County-USC 268 30 520 214 M.L.King Jr./Drew 63 18 92 50 Olive View 60 11 168 79 Harbor-UCLA 166 43 215 133 Rancho Los Amigos 105 31 166 98 High Desert 4 3 28 21 Public health clinics 0 0 508 305

TUESDAY AT 3 P.M. Scheduled Absent County-USC 301 83 M.L.King Jr./Drew 67 15 Olive View 30 21 Harbor-UCLA 136 86 Rancho Los Amigos 85 61 High Desert 11 7 Public health clinics 15 1

SOURCE: Los Angeles County Department of Public Health Services

The Strike at a Glance

The union: 4,500 nurses are represented by Local 660, Service Employees International Union.

Honoring the strike: Some of the county’s 10,000 unionized clerical and laboratory workers were expected to stay out.

Hospitals affected: County-USC Medical Center, Harbor-UCLA Medical Center, Martin Luther King Jr./Drew Medical Center, Olive View Medical Center, Rancho Los Amigos Medical Center and High Desert Hospital.

Issues: Staffing levels, salary, health benefits and safety issues.

The nursing shortage: 1,059 budgeted county nursing vacancies. The county gas hired 600 nurses in the last 18 months, but 200 others have left.

Safety issues: Nurses say there is inadequate security at the hospitals and they fear, among other things, gang violence. The county says it has taken steps to make working conditions safe.

The county pay offer: 5.5% increase now, 7% increase next year. Or a three-year contract providing a salary increase of 18% plus 2% in fringe benefits.

The union position: 10% increase now, 7% next year, with increased health benefits to all Local 660 members.

Current pay: Veteran county nurses typically earn $41,376 a year. The Hospital Council of Southern California found a 6.5% pay disparity between private hospitals and government hospitals.