County Studies Deep Cutbacks in Health Care : Budget: Department’s options include closing General Hospital or King/Drew Medical Center. Director cites the threatened shift of state taxes, but some critics say officials are crying wolf.

In the face of looming state cutbacks, the county Department of Health Services has proposed a set of eight options that would drastically cut health care for the poor, including one that calls for the shutdown of the county’s famed General Hospital, one of the nation’s busiest medical facilities.

Another proposal to county budget writers would close Martin Luther King Jr./Drew Medical Center, the well-known hospital built in the aftermath of the Watts riots, and still others suggest closing or sharply curtailing the services at other key hospitals and health centers in the county’s public health delivery system.

Health Services Director Robert C. Gates, who was responsible for the budget documents, conceded in an interview that closing one or more of the hospitals is unthinkable, but insisted that the size of threatened state budget cutbacks is so large that his financial experts had few options other than to suggest closing hospitals.

Under the various scenarios laid out by Gates’ financial advisers and obtained by The Times, 5,000 to 12,000 physicians, nurses and other health workers could be laid off and 600,000 to 2 million patient visits a year would be eliminated. Health officials say that if the Draconian cuts go through, it would force many sick people out of the system, intensify the progression of their diseases, and lead directly to premature death or disability.

County administrators have been known over the years to predict doomsday scenarios at budget time in an effort to influence various governors and Legislatures. Some local health officials, while acknowledging that the county faces severe budgetary pressures, say they refuse to believe that the Board of Supervisors would ever take the step of closing a large public hospital, particularly General Hospital, the centerpiece of the County-USC Medical Center and an Eastside landmark.

But observers say that never before have health department officials gone as far as they are going in suggesting hospital closings and sharp curtailments in health services.

“We’re taking it very seriously,” said David Langness, spokesman for the Hospital Council of Southern California.

The proposals were developed to assist Acting Chief Administrative Officer Harry L. Hufford prepare his annual budget for all county agencies. His budget will be released Friday and will include one or a combination of more than one of the scenarios. Ultimately any budget actions would have to be approved by the five-member Board of Supervisors.

The budget documents were drawn up as the result of Hufford’s warnings that Gov. Pete Wilson’s proposal to shift $2.6 billion in property tax revenues away from the state’s counties would leave Los Angeles County with a $1.2-billion shortfall. He said the Department of Health Services’ share of the shortfall would be $390 million.

Gates initially said that his agency could meet a $390-million cut by keeping General Hospital open while closing five of the six large county hospitals: the Harbor/UCLA Medical Center, Olive View-UCLA Medical Center, Martin Luther King Jr./Drew Medical Center, Rancho Los Amigos and High Desert Hospital.

But budget documents obtained by The Times suggest a more piecemeal approach and lay out the possibility of keeping the five hospitals open while closing General Hospital, the centerpiece in the Eastside’s four-hospital County-USC Medical Center complex. The complex also includes pediatric, psychiatric and women’s hospitals, and they are not presently being targeted, although many observers say their futures would be in jeopardy if General Hospital were to close.

Key supervisors and other county officials so far have not been willing to go on the record as saying they favor closing one hospital over another. They say they don’t want to comment until they learn how well the county will fare in the state budget.

Although the scenario envisioning the closing of General Hospital would save money by eliminating thousands of days that patients spend in the hospital, other scenarios would achieve the steepest cuts by suggesting cutbacks in outpatient and emergency room visits.

One county health official said outpatient visits, including patients who show up at emergency rooms, are being targeted because the state reimburses the county its costs at a rate of only about 25 cents on the dollar.

One of the eight Health Services proposals said closing General Hospital would trim $192 million from the county budget at the cost of shutting off all but the most acute health care to as many as 600,000 people a year and laying off 6,000 doctors, nurses and other hospital workers.

To some, closing General Hospital makes a certain amount of sense because plans are already under way to close the facility, the oldest in the county network, and replace it with a $1-billion mega-hospital by 2000. The hospital does not have modern fire protection or air conditioning, and it lacks many other modern medical necessities, such as piped-in oxygen.

The plans to raze and rebuild the hospital call for its patients to be farmed out to a number of central Los Angeles hospitals during the construction period.

“As long as they are going to do it anyway, why not now as long as we can figure out some way to avoid the pain of the people it will displace?” Langness said.

Some remain strongly skeptical that General Hospital or King/Drew will ever be closed.

Dr. Joseph P. Van Der Meulen, vice president of health services for USC, which has been affiliated with the hospital since 1885 and uses the facility as its medical school’s primary teaching hospital, said, “I think that it is extremely unlikely that they would close down the County-USC Medical Center, given its size and importance to the community.”

Van Der Meulen warned that if the doomsday scenarios are a budget ploy, they could backfire by frightening patients and hurting the morale of the hospital’s employees.

Harvey Kern, a spokesman for the hospital, said morale already is low after a series of earlier budget reductions, a hiring freeze that has been in effect for two years, and an early retirement program that cost the hospital some of its most experienced administrators.

“Last year there were over 200,000 emergency room visits here, plus another 400,000 outpatient. If we were to go out of business, where would these people go?” Kern asked.

Dr. Reed V. Tuckson, the president of the Charles R. Drew University of Medicine and Science in South-Central Los Angeles, said he does not believe the possibility of closing King/Drew Medical Center should be taken seriously.

“It would be an unmitigated disaster,” Tuckson said. “It is an inconceivable idea. The reality is that people will not be seen, and they will die.”

Prognosis for Health Care The following are the options outlined in internal Department of Health Services budget documents. Option 1: Close General Hospital JOBS AND SERVICES LOST: 5,500 jobs and about 600,000 emergency room treatments, outpatient visits and hospital admissions annually. SAVINGS: $192 million Option 2: Close Harbor/UCLA and Rancho Los Amigos medical centers and Hudson Comprehensive Health Center JOBS AND SERVICES LOST: 5,500 jobs, 1.7 million patient visits annually. SAVINGS: $183 million Option 3: Eliminate 20% of outpatient services at all county health facilities. JOBS AND SERVICES LOST: Estimates not available. SAVINGS: $196.5 million Option 4: Eliminate all non-emergency room outpatient visits at all hospitals; close Hudson, Humphrey and Roybal comprehensive health centers. JOBS AND SERVICES LOST: 3,650 jobs, 1.7 million patient visits annually. SAVINGS: $187 million Option 5: Close Martin Luther King Jr./ Drew, Rancho Los Amigos and Olive View/UCLA medical centers. JOBS AND SERVICES LOST: 7,200 jobs, 927,000 patient visits annually. SAVINGS: $204 million Option 6: Close Harbor/UCLA and Rancho Los Amigos medical centers and High Desert Hospital. JOBS AND SERVICES LOST: 5,900 jobs, 876,000 patient visits annually. SAVINGS: $172 million Option 7: Close Harbor/UCLA, Martin Luther King Jr./Drew, Rancho Los Amigos and Olive View-UCLA medical centers, High Desert Hospital; Roybal and Humphrey health centers. JOBS AND SERVICES LOST: 11,800 jobs, 2 million patient visits annually. SAVINGS: $323 million Option 8: Close General and High Desert hospitals, Harbor/UCLA and Rancho Los Amigos medicalcenters and Humphrey Comprehensive Health Center. JOBS AND SERVICES LOST: 12,135 jobs, 1.9 million patient visits annually. SAVINGS: $329 million