A Matter of Life and Death : Closing County- USC may help the bottom line, but it will be a disaster for Los Angeles, medically and morally.

There was almost no chance that the little girl would survive. She’d gotten a killer strep infection, and almost every organ in her body was close to failure. She lay bloated and covered with a rash, amid a mass of tubes. Her mother and the “county docs” never left her side. Almost anywhere else, I’m convinced, she would have died. Instead, after many weeks of care from physicians who gave up their off-duty hours and nurses who regularly do their job under the most adverse conditions, she walked out of the hospital: a normal, smiling 8-year-old; a miracle of County-USC Medical Center.

There are other stories. The man and his wife were undocumented. They had saved money for her to deliver their child at a private hospital, but there was barely enough to cover the cost of the infection she got after delivery. The baby went home with him. Then the baby got sick and was soon burning with fever. The man wrapped his infant in a blanket, got on a bus and began a long odyssey from one hospital to another. None would examine the infant without remuneration. Finally he arrived at County-USC. Yes, they would care for the newborn, money or no money. The frantic father unwrapped his little bundle and placed it in the arms of the physician on call. The baby was dead.

These stories are everyday fare at County-USC, which has provided care for all who needed it for 117 years. Research that has bettered the lives of millions has been done here, and diseases have been discovered here. And now we are told that County-USC is to close. There are reasons why this will be a disaster for Beverly Hills matrons and movie stars as well as for poor kids with sickle cell disease.

In the past few years, Los Angeles has experienced a resurgence in tuberculosis. In many cases, the bacteria causing this disease have become resistant to antibiotics that stopped them in the past. And TB is but one example of the type of contagious disease against which County-USC is a strategic defense. AIDS is another. Few institutions in this county have the facilities and the specialists to deal with contagious diseases and those that do would be overwhelmed with the cost of treating the significant numbers of patients who are destitute. Communicable diseases don’t respect barriers of neighborhood and social position.

In 1977, Philadelphia’s lone public hospital closed its doors. Philadelphia is smaller than Los Angeles and does not have a vast influx of immigrants bringing exotic germs from all over the world. Yet the closure of Philadelphia General Hospital is still a problem 18 years later. The city’s Albert Einstein Medical Center, already in trouble because of fewer private patients, tripled its number of Medicaid patients. In Los Angeles, many patients aren’t even eligible for Medicaid, so private hospitals will have to bear the full cost of caring for these patients--or pass it on to paying patients.

Federal law mandates that critically ill patients be stabilized at the facility that first encounters them. They cannot be turned away, but they can be transferred to a county hospital when they are stable. Without the safety valve of the county hospital system, private hospitals would have to assume care for all indigent patients who are triaged in their emergency rooms. Many private hospitals will end up closing their emergency services to block the financial hemorrhage. You and I--taxpaying, insured native-born Americans--will have no place to go when we are hit by a car.

Industries suffer when too much attention is paid to the yearly bottom line to the exclusion of strategic investment in equipment for future competitiveness. With its training programs for hundreds of new doctors each year and its opportunities to upgrade the skills of those already in practice, County-USC is the medical equivalent of strategic industrial investment.

There is something fundamentally wrong about human beings permitting other human beings to die in the streets. And that is exactly what will happen once we dismantle our already threadbare health care safety net. County-USC is our flagship. It has served long and well and is too vital to be put in mothballs.