NEWS ANALYSIS : County-USC in Web of Bitter Social Dispute

When it opened more than half a century ago, County-USC Medical Center was known simply as the General Hospital, and it occupied prime real estate on what most Americans regarded as the main street to social progress.

It was 1932 and America was in the mood for a New Deal; the boom years for great institutions of public service were about to begin. And, from the start, County General was among the greatest.

Over time, the political neighborhood changed. The streets around County-USC got meaner, money became dearer and the hearts of the people whose taxes pay the bills hardened along with their own economic prospects.

Today, County-USC stands at the intersection of some of Los Angeles County’s most bitter social controversies--the future of publicly funded social services, the impact of immigration and control of local tax revenues. As the Board of Supervisors weighs Chief Administrative Officer Sally Reed’s proposal to stave off a looming bankruptcy by closing the hospital altogether, there is little sentiment for shutting it down, but a clear recognition that the terms of debate have changed fundamentally.

“I won’t agree to close a major medical facility in central Los Angeles,” said county Supervisor Zev Yaroslavsky, one of the board’s three liberal Democratic members. “But I do concede that Sally Reed’s proposals reflect the depth of the structural fiscal problems that this county faces.

“County-USC needs to be replaced with something on a smaller scale that fully serves the needs of the community without propping up a bloated health department bureaucracy, which is bleeding this county dry.”

But to Father Greg Boyle, who runs a jobs program out of East Los Angeles’ Dolores Mission, the county’s poorest Catholic parish, the consequences of County-USC’s closure are “unimaginable for this community.”

“People just can’t conjure up an alternative to County-USC,” Boyle said. “It’s all they have here. There is no other health care.”

In fact, the implications of Reed’s proposed budget rather neatly delineate the new realities of local government not only in Los Angeles, but also across the state and nation. The first of these push the funding of social services onto the jurisdictions of last resort. Thus, Reed’s proposed budget makes deep cuts in health programs, which largely are mandated by the state and federal governments, while applying a much lighter hand to the courts and law enforcement agencies, which are primarily a county responsibility.

This fiscal evolution also dovetails with the essential paradox of Los Angeles politics: Officials are elected by one community--largely white and the more affluent minority--to govern another community--younger, poorer and overwhelmingly nonwhite. The older, white voters repeatedly have expressed their preference for low taxes and social spending, well-financed law enforcement and a growing suspicion of immigrants.

Reed’s hard-nosed budget proposal essentially endorses those political priorities, although on purely fiscal grounds.

Any proposal that involves County-USC must deal not only with the reality of the service it provides to a population generally bereft of other health care, but also with the hospital’s symbolic importance to a community where the sense of alienation from government looms large. In an area where there are few visible public services, County-USC’s monumental buildings are a dominant physical and emotional landmark.

“In this neighborhood many people have no private transportation,” Boyle said. “They look up and see those buildings and they know they have somewhere to go, if they need help. The truth is that for many of our people there just isn’t anywhere else.”

Rep. Xavier Becerra (D-Los Angeles) called the medical center one of the Eastside’s emotional foundations. “It’s just been here for so long,” said Becerra, who addressed a protest rally Monday at the medical center.

“For the people who live here today,” Becerra said, “this hospital is the bedrock of their health care system. [But] it stands for something more than just a hospital. It’s a real symbol of life. People are born there. People will die there. And many more will continue to live because of the care they receive there. We just can’t bear to lose it.”

Aurora Castillo, president of the 200-member Mothers of East L.A., said the medical center is a Eastside symbol that the community will fight to keep.

“They think it’s easy to come into East L.A. and close down a medical center that’s important to all of us,” she said. “Well, we’re going to show them it isn’t.”

If adopted, Reed’s proposal would close down the hospital--probably in September--along with four regional health centers. In all, the jobs of 12,600 Department of Health Services workers would be eliminated in Reed’s budget, most of them at County-USC, which employs 9,000. That represents fully two-thirds of the 18,255 county jobs she would like to eliminate. By contrast, she proposes cutting only 1,132 jobs from the Sheriff’s Department, the public defender, district attorney and Superior Court combined.

Reed, in her budget message, acknowledged to the Board of Supervisors that the medical center “has long been the heart of the county’s health care system.” But she said that if the big hospital stays open, it would jeopardize the survival of four of the county’s six other hospitals and make balancing the budget much more difficult.

Reed stressed County-USC’s physical limitations. She pointed out that the sprawling facility--whose square footage is larger then that of the Pentagon--cannot meet numerous modern-day health and safety codes, and is inefficient to operate.

Noting that plans were underway to replace it at a cost of $1.3 billion, money the county would be hard pressed to come up with, Reed said closing the big hospital made the most sense to her.

There are no contingency plans, but Reed said she thought private hospitals could absorb much of the patient load, a point hotly disputed by County-USC officials.

In Southern California, a private hospital has been closing once every six weeks on average over the last four years, mostly because they cannot keep enough patients in their beds.

The county Department of Health Services has always resisted the idea, arguing that private hospitals simply could not absorb all its patients, duplicate its trauma system, or take care of its indigent patients--those without any kind of insurance, even Medi-Cal.

About 40% of the patients at County-USC have no ability to pay.

“This is not a plan. What it is is a crisis,” said Jim Lott, a vice president with the Healthcare Assn. of Southern California, which represents 230 public and private hospitals. “This is not a solution. This is simply saying we can’t afford it, we are going to walk away from the problem. That is irresponsible.”

County-USC Chief of Staff Ronald Kaufman said that more than 70% of the hospital’s 60,000 admissions each year come through the emergency room, meaning they are seriously ill.

“Private hospitals may have empty beds, but they are not the right kind of beds,” Kaufman said. “The patients we would be sending out would be acute care and trauma patients. It is a naive statement to say there is the capacity to absorb our patients.”

Past efforts to cut county health services have failed in large part because of the immense political and legal power of the hospital workers.

“We won’t go gently,” vowed Steve Weingarten, spokesman for the Service Employees’ International Union (SEIU), who estimates his union represents 10,000 of the 12,600 workers whose jobs would be lost. “I’m not going to negotiate which branch of the tree they hang us from.”

Weingarten said County-USC, which serves an overwhelmingly Latino, largely immigrant community, made an inviting target. Asked if it represented a continuation of the kind of anti-immigrant politics that fueled the Proposition 187 campaign last year, he noted, as did Reed, that virtually every county health facility serves a large proportion of Latinos.

“I don’t think its motivation is ‘let’s get the Mexicans,”’ he said. But he also said that ever since Proposition 187 passed last year, “everything in California has that [immigrant bashing] tone to it. We’ve seen a real ugliness spread around that movement.”

In the first of what likely are to be numerous protests over Reed’s proposal, an estimated 1,500 people gathered Monday on the main steps of the County-USC Medical Center in Boyle Heights at a rally organized by the union. Patients from the hospital, community residents, priests and health workers held placards, listened to speeches that criticized Reed and demanded that the hospital be kept open.

Jesse Perez, 24, one of the patients, watched the demonstration with his wife, Virginia.

“If this hospital was closed, I’d be dead now,” said Perez, who works in a truck wash in East Los Angeles. Perez said he was cut and required 18 stitches in his left arm when he defended his wife from an assault Friday night.

“The first thing they do when they have budget problems is to come into the minority community and start closing down hospitals,” Perez complained. “There are six hospitals in the county. Why don’t they close one in a white community? A lot of it has to do with racism. We already had Proposition 187 and now this.”

Yaroslavsky argues that the problems that set the current crisis in motion go back to another contentious state ballot measure--Prop. 13. He argues that since the passage of that initiative, the county has become increasingly dependent on Sacramento’s rebate of local property tax revenues to fund essential human services.

The supervisor notes that $1 billion in such funds that the state withheld this year to solve its own budgetary problems essentially would wipe out the county’s deficit.

“The diabolic thing about this crisis,” he said Monday, “is that it may pit one Angeleno against another when we ought to be standing shoulder-to-shoulder and marching on Sacramento to make the state live up to its responsibilities.”

Times staff writer John M. Glionna contributed to this story.