CITY TIMES COVER STORY : Tough Medicine : County-USC Medical Center Is Growing to Meet the Needs of the Poor, But There Is a Cost: a Broken Neighborhood, Uprooted Families

Al Juarez, 52, cruises through the streets of Marengo Terrace, but the neighborhood he sees is one that is no longer there.

Marengo Heights Elementary School.

St. Camillus Catholic Church.

And Brittania Street, which used to run north from Marengo Street and lined with homes up the hill.

The memories are there, but much of Juarez’s neighborhood is long gone, eroded bit by bit as County-USC Medical Center has grown to meet the needs of the county’s poor.

An outpatient clinic stands where the homes on Brittania Street once stood. The USC University Hospital has replaced the church. The Francisco Bravo Medical Magnet High School is where Marengo Heights Elementary School used to be.

In the coming months, Juarez, his family and more than 200 other households and businesses on Cummings, Chicago, Charlotte and Marengo streets--and possibly Cornwell Street--will witness the final transformation of their neighborhood. All will be demolished to make way for a single, streamlined 2.1-million-square-foot county hospital to replace four of the medical center’s hospitals, including outdated General Hospital and two outpatient clinics.

The new six- to 15-story hospital is expected to save the county $49 million a year in operational costs, with improved--but less costly--security, the consolidation of some services and elimination of others. The $1.1-billion construction project is expected to be completed in 2002.

Without the replacement of the 40- to 60-year-old hospitals, federal and state regulators, citing safety reasons, have threatened to close the medical center, a place of last resort for millions of the county’s uninsured and poor. Half of County-USC’s patients are covered by Medi-Cal and an additional 32% have no insurance coverage whatsoever, according to 1993 figures. With 80,000 admissions a year, 75% of which are emergencies, it is the busiest hospital in the nation.

The decision to uproot several hundred residents to build a state-of-the-art hospital, County Supervisor Gloria Molina said, was seen as plausible when the “greater good” of providing medical care for the county’s poor was considered.

Javier Moreno and his wife, Maria Lourdes, and their two children have lived in the area for 11 years, the last four in the home they rent on Charlotte Street. Although they love their neighborhood with its nearby park and quiet streets, they said they understand the importance of the project.

“It’s not good to have to move,” said Moreno, 37, a supervisor at a North Hollywood manufacturing company, “but if it’s good for the community, then it’s worth the sacrifice we have to make.”

But Juarez, who was born at General Hospital and works with a federal jobs training program, sees it differently. His family, which moved to Cummings Street in 1950, has fought all along the way to preserve as much of their neighborhood as they could.

“Minority communities are divested of their right to live in the city,” he said. “Their rights are sacrificed in the process of doing something for the ‘greater good’ of the community. When you start busting up a neighborhood, a lot of things start happening . . . graffiti, cars broken into, absentee landlords.”

Juarez’s 72-year-old mother, Amparo, has seen tremendous changes over the years in Marengo Terrace and has raised five children in the process. Her son, Manuel, worked as a volunteer at County-USC’s trauma center when he was a teen-ager and is now a doctor at Loma Linda Hospital. Six people spanning three generations now live in the house and a duplex on the lot.

“It was a real neighborhood,” she said as she sat in a recliner in the family den. “We had a shoe shop and a bank and we had houses all along Marengo. Little by little, things just started falling apart.”

Through the years, the Juarez family and their neighbors have fought plans to change Marengo Terrace and met with some success. When the county hospital wanted to build a wall at the edge of their properties about 28 years ago, they defeated it. And about 35 years ago they were able to save Hazard Park when officials planned to build a veterans hospital.

“We just banded together and brought in the news and television. We raised a lot of protest,” Amparo Juarez said.

But County-USC appears to have won this battle.

Officials hope to begin county appraisals of properties by July 1, setting the stage for negotiations and buyouts, relocation and demolition. Construction of an eight-story parking structure south of Marengo Street will be the groundbreaking project. The houses and businesses on Cummings Street will be the first to go.

The county has promised assistance to those who will be displaced, up to $22,500 for homeowners, in addition to their property’s fair market value, and a flat payment of 48 months of rental payments for those who have leased property.

The prospect of moving has been difficult for many, particularly the elderly. And it has been especially painful to those who moved here after being displaced by other construction projects.

“I looked for nine months before I settled on this house,” said Lorenzo Canales, who moved to Cummings Street in 1953 after being forced out of Chavez Ravine to make way for the construction of Dodger Stadium. His lot and three homes now hold four generations of his family.

Esther Troncoso grew up on Cummings Street, was married in St. Camillus Church and bought a house up the street from her mother, Francisca Flores. She now fears that the family will not be able to find homes as close as they are now. “It’s very strange seeing the changes,” Troncoso said.

Yet, Moreno and other renters say the county’s offer will give them an opportunity to buy their first home.

“It will help us with a down payment for a house,” he said. “Otherwise, we would not be able to come up with the down payment,”

Feelings are just as mixed in the business community, where the county has promised fair market value and relocation help.

“Sometimes it’s not fair, but what am I going to do?” asked Jenny Shin, who has owned the Burger King at Cummings and Marengo streets for nine years. The restaurant will be razed to make way for the widening of Marengo and the entrance to the new hospital.

“I’m trying my best to take care of the business,” said Shin, who wants to relocate nearby to keep the customers she has served over the years. “I’m the only one that’s a property owner; the other (business people) are renters,” she said. “They’re happy because business is bad and they’re going to be bought out by the county.”

Sharon Lowe, an attorney with the Legal Aid Foundation of Los Angeles who has been helping Marengo Terrace residents through the county process, said developers and government agencies have to think hard again before cutting into a neighborhood. After Chavez Ravine, freeway projects and now the replacement of County-USC Medical Center, displacing neighborhoods has become such an expensive proposition--$35 million in this case--that it will not be so easy in the future.

“Communities cannot be sacrificed in the name of progress,” Lowe said. “We have to believe in preserving the Eastside communities and other communities all throughout the inner city and let (government officials) know how expensive it’s going to be. We have to drive that home with the politicians, who when they think of 200 families, ‘it’s no big deal.’ ”

Architect William Roger of Romigh Roger Rusk, a Los Angeles architectural firm that designed the new hospital, said he and other planners studied several alternatives to displacing the neighborhood, but the prohibitive cost of demolishing General Hospital and the disruption it would cause to patient care forced the county’s decision to go into the neighborhood.

Plans call for the new hospital to be placed at Marengo and Cummings streets, where the outpatient and AIDS clinics and a parking structure now stand. A flat, handicapped-accessible parking lot for 400 vehicles will be built at the site of the 15-acre Marengo Terrace neighborhood, as well as entrances for outpatient, inpatient and emergency services, and an education and conference center.

“We were planning to build the hospital without having to go into the neighborhood until we realized the (1992 Americans With Disabilities Act) required this lot,” said Frank Villalobos, president of Barrio Planners Inc., an Eastside architectural firm and consultant on the project.

The new hospital will have far fewer public entrances--only four to six--and an improved security system complete with door metal detectors, thereby reducing the medical center’s $10-million annual security budget by an undetermined amount. General Hospital alone has 33 entrances, where ambulances, supplies, family members and outpatients arrive. After a gunman shot and wounded three doctors last year in the emergency room, a private security company was hired, and visitors are routinely screened for weapons.

General Hospital was completed in 1932, before safety codes required fire sprinklers and outside exits. Stairwells, which would be used in an evacuation, empty into the building instead. And because it does not meet fire codes, the hospital must spend $2.3 million annually on a fire watch team whose members go on rounds to check for fire and safety hazards.

General Hospital was designed with five-bed wards and no private rooms or waiting rooms. Wires are strewn across each ward to hold up curtains for patient privacy. Fans for ventilation can be found hooked up by extension cords in hallways and rooms because there is no air conditioning. Oxygen tanks sit in corridors because the facility has no piped-in oxygen. In some departments, doctors and nurses examine X-rays on viewing screens in the hallways because there is nowhere else to do the job.

Employees say the new building will not only be a plus for them, but will also increase patients’ comfort and improve care.

Roxane Raffin Chan, a clinical nurse manager in pulmonary, bronchoscopy and rheumatology, described time-wasting and ex-hausting measures to track down patients at various clinics on the 72-acre campus. And, she said, patients are forced to endure inconveniences while not in the best of health.

“Yes, we have to run around from building to building to building, but the patients are on stretchers and they’re having to go from building to building,” Raffin Chan said. “We have to call county transport if they have to get tests done and they’re sick. It would be wonderful to get all the tests done in one place.”

General Hospital also is desperately lacking in privacy for patients and their families, which the new facility will seek to rectify by providing private and double rooms.

Recently, Raffin Chan said, a dying woman in a ward with four other patients delivered a fetus in front of her family, who had no idea she was pregnant. The family’s trauma became a public display in the ward--and the other patients had to share the experience with them.

“A curtain doesn’t cut it,” Raffin Chan said. “From what I see, we have the high-tech, state-of-the-art equipment, the knowledge and the caring. The only thing we don’t have is an adequate place to put it.”

Ray Hernandez, a former custodian who has roamed the corridors of General Hospital for the last two years as part of the fire watch team, has become familiar with the old building in ways he never imagined. He said he frequently has to move stretchers or oxygen tanks that could block access to firefighters.

“I figure, back in the ‘30s, they never would have imagined that this place would grow the way it did,” Hernandez said.

The new hospital will have 946 beds, fewer than the current 1,450, and this has raised concerns that it will actually provide fewer services to the community. But Edward L. Martinez, the medical center’s executive director, defends the reduction in beds by pointing out that there will be a more efficient use of beds in the new hospital and that more illnesses and injuries will be handled on an outpatient basis.

“The concentration will be on high acuity (the most intensive), intense and high-tech services,” he said. “A higher proportion will be (intensive-care unit) beds. Now, 8% to 9% are ICU. That will be 25% in the new facility. Our level of care will essentially remain the same. Those beds we will be eliminating will be contracted out to the community clinics, which handle low-acuity, low-maintenance beds.”

“When you look at the kind of role that County-USC plays, as far as its regional responsibilities to meet the health care needs of the poor, of those who have no other access to health care, it’s very significant,” said Supervisor Molina.

So crucial, she said, that displacing the families and business owners in Marengo Terrace has to be done. Otherwise, she said, the care delivered to the poor at the hospital would have stopped, an even greater disaster.

“We have no choice because the population of need is not going away,” Molina said. “There is no other option for people who need health care in this community but to rebuild the facility and get it done as soon as possible.”

For Al Juarez, who was born at General Hospital, the sadness of moving from his childhood home is mixed with a feeling of helplessness.

“It’s just an example of poor people being pushed out and the compensation isn’t enough to replace your home. Raggedy as it is, a lot of people think (this neighborhood) is home.”