County Budget, Hospital Closure

* Re “Don’t Risk Health to Balance Books,” Commentary, June 22:

What is truly needed to help restructure health care in Los Angeles County is the bitter pill called “downsizing.” Discussions of closure of Los Angeles County-USC Medical Center are political rhetoric at best. The Health Crisis Task Force should begin work immediately on reallocating the intensity of service delivered at County-USC Medical Center.

As Robert Tranquada stated, cases such as AIDS and burn service most definitely should stay at the medical center. Trauma cases are somewhat more complex, but could safely be redistributed, keeping only the most severely injured and critically sick at the county facilities and retaining a smaller portion of routine trauma cases.

A new order of the day should be implemented so that the majority of routine cases (appendicitis, elective surgery, pneumonia, etc.) would be handled by the private sector. The county would retain a much smaller portion of these cases to meet the training requirements of a newly restructured, smaller residency training program. The scope and breadth of the new county hospital will have to be seriously re-evaluated. If the County Department of Health Services is seriously going to stay in the hospital business, then as this new, consolidated hospital becomes operational, a redistribution and focusing of specific services at each county hospital will have to be implemented.

ROBERT A. BELTRAN, Member

Los Angeles County-USC Medical

Center Replacement Advisory Council

* The Venice Family Clinic provides free health care to over 11,000 people who have no health insurance. However, without the support and backup of county medical centers such as County-USC, Harbor-UCLA and Olive View to refer our patients to for breast cancer treatment, heart surgery and diseases requiring hospitalization, surgery and specialty care, the Venice Family Clinic could not function.

We are one of more than 70 community clinics located in neighborhoods throughout Los Angeles County. Although we are considered “safety net” providers, the county health care system is our backup--our “safety net.”

The county health care system has been underfunded for years. With California having the lowest Medicaid reimbursement rate in the country, it was inevitable that our health care system turned into a giant flow of red ink. There are many innovative ways to continue to ensure that Los Angeles County provides health care services to everyone--dismantling the entire system is not one of them.

ELIZABETH BENSON FORER

Executive Director

Venice Family Clinic

* Isn’t it enough that we have people sleeping in the streets? Must they die there, too?

C. PARKES

Los Angeles

* So Los Angeles County is over a thousand million “overdrawn” for the coming fiscal year. Zev Yaroslavsky blames it on implementation, 17 years ago, of Prop. 13 (a tiresome and false old saw if ever there was one!) and Gloria Molina blames it on anything other than Prop. 187 . . . ad nauseam. How does one stinking county--no matter how largely populated--get into such a mess? It sure isn’t 1978’s Prop. 13. It sure isn’t the state diverting funds. But the failure to implement Prop. 187 just may have a stronger bearing than we thought.

It’s time to take this out of the courts, and make the decision which needs to be made now: Do we continue to close the emergency rooms, libraries, prisons, etc., or do we begin by closing the borders?

BARRY COOK

Newhall

* Re “County Chief Delivers Dire Budget Proposal,” June 18: Supervisor Yvonne Brathwaite Burke’s comments regarding the county’s fiscal crisis are troubling. Apparently, the county has run a budget deficit for years, masking and exacerbating the problem with borrowing and other short-term fixes. Instead of addressing root operational issues, Burke urges more short-term borrowing. She states that the “reality of how you run a business is if your cash flow is low, you borrow.” Under the circumstances, the statement evidences a disturbing lack of business sense.

As a bankruptcy lawyer, I have observed many financially distressed businesses. Borrowing in times of low cash flow may make sense if a business has sound operations and a reasonable expectation of increased cash flow in the future. Borrowing as substitute for cash flow without addressing basic operational problems and with no reasonable expectation of increased cash flow is a sure recipe for disaster. Sadly, Burke is right that many businesses do just that. I see them every day in bankruptcy court.

PAUL S. ARROW

Los Angeles