The Last Resort

Thursday was a day like any other at the Los Angeles County-USC Medical Center. Twenty-three babies were born, and one patient died. It was hot, and so windows were thrown open in the wards where patients sleep five to a room. At County-USC, this is called air conditioning. Neonatal specialists kept close watch through incubator glass on a tiny, wriggling red form, a premature baby who weighed less than a pound. Trauma surgeons checked on a 15-year-old boy who had suffered 15 bullet wounds, a victim of mistaken identity.

One bullet had run straight through his heart. Twice it had stopped beating. They brought it back both times, and now here he was, hands behind his head, jauntily sharing his story. He remembered how the gunman had emptied two magazines into him. He remembered seeing blood spurt from his chest. At that point, he had blacked out.

“I thought,” he said, “I had died.”

“You did,” a doctor deadpanned.

A fresh crop of interns had joined the staff this day. The newcomers tried not to appear too wide-eyed as they toured an emergency room filled, as always, with the retching, moaning everyday casualties of the metropolis. A young man with his face shot full of holes. A pregnant woman, her body crumpled from a car wreck. An old man, gray and gaunt, whose chest X-ray revealed something nasty. This one had been transferred from another hospital, one with no taste for treating an old man with what looked like cancer and, more on point, without health insurance. This, too, constituted everyday business at County-USC.

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It sits just east of the Golden State Freeway, a sprawl of medical facilities dominated by the landmark General Hospital. A decade ago, I spent a few months there, gathering material for a newspaper series. The experience changed the way I thought--not only about the medical center--but also about Los Angeles. This is a city that can have trouble finding reasons to love itself, a city with many miseries and a mean streak. The County-USC Medical Center was something different.

Here was a place, supported by the people of Los Angeles, where improbably expert care was dispensed wholesale to the destitute, a “hospital of last resort” for patients no one else would take. I watched, amazed, as they streamed in every day, hordes of them, arriving by taxi or buses, in ambulances or on foot, limping, bleeding, dilating and, sometimes, dying. This was, to put it simply, a good place.

The center since has gone through some changes. The Northridge quake knocked out several buildings, forcing makeshift consolidations. A gunman’s assault on triage doctors has brought heightened security, driving out panhandlers who once charmed the hallways. The faces of the doctors and nurses have changed, although certain values survive. “No one,” one doctor once told me, “comes here to get rich.” Mainly they come to learn their trade. Some move on to finer facilities, but others become hooked on the medical center and its needy hordes.

These were the ones Thursday who, three days after the fact, still were flabbergasted that L.A. County’s top bureaucrat, one Sally Reed, had proposed closing County-USC. “Inconceivable,” said Dr. Jeffrey Johnson, voicing what seemed to be the word for the day. He was standing beside the crib of a baby born with AIDS. The mother had been informed of her own infection in a letter from a private clinic, which also suggested it might be a “good idea” to take her troubles to County-USC, and thanks anyway for the business.

“Where,” Johnson asked, “will children like this go? What other hospital will take a case like this?”

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His questions went straight at Reed’s notion that private hospitals can step forward to close gaps caused by the County-USC closure. This is a dangerous fiction. These same hospitals every day shunt to the medical center--”dump” is the trade term--patients who either carry no insurance or, because of medical complications, wouldn’t pencil out. “They pick the cherries,” one doctor said bluntly, “and send us the pits.”

Who, medical center doctors, nurses and patients alike demanded to know Thursday, will take the AIDS patients, run the tuberculosis clinics, deliver the high-risk babies, treat the 30% of the population without medical insurance? Who will save this one-pound baby, that 15-year-old shot through the heart?

They tended to focus on Reed, a $175,000-a-year newcomer who doubtless receives her medical care elsewhere: How could she fail to foresee the potential consequences of her proposal? Maybe Reed deserved more credit, though, for prescience. She did, after all, request full funding for one county facility located on the County-USC site. It’s the one that houses the coroner.