Panel Urges ‘Czar’ for County Health System : Finances: Task force says closing County-USC would create ‘irreversible damage.’ It urges shutting 30 of 45 treatment centers and clinics instead.

The blue-ribbon panel looking into Los Angeles County’s health financing crisis sent a strongly worded final report to the County Board of Supervisors on Monday, calling for appointment of a “health czar” and asserting that closure of County-USC Medical Center would create “irreversible damage.”

The report, approved unanimously by the five-member Health Crisis Task Force, argues that as an alternative to closing the medical center, the Board of Supervisors should close all but 15 of the 45 county regional health centers and community clinics.

Even at that, the report said, the private sector and other county hospitals could absorb only about half the patient load of the clinics, leaving 1.4 million patient visits unaccounted for, meaning tens of thousands of low-income patients would go without care.

To cushion the blow, and possibly head off what it called the “devastating” impact of closing the clinics and health centers, the report asks that the Board of Supervisors delay implementing the plan until Oct. 1 to allow time to seek federal and state approval of a county plan to reorganize the health system.

Task force members also hope that private health care providers will step up and offer alternatives to closure that would require some investment on their part. Talks already are under way by California Medical Center in Downtown Los Angeles to take over management of one or two comprehensive health centers in South-Central Los Angeles.

Panel members clearly offered up the plan to close the clinics as a stopgap measure.

“If the county were to permanently eliminate the curtailed services under consideration, it would endanger all members of the population, create conditions of great societal unrest and potentially lead to a public health emergency,” the report said.

County officials got a boost Monday when four top-level federal officials held a series of meetings with supervisors and task force members in the Hall of Administration.

Supervisor Yvonne Brathwaite Burke said the county was seeking $300 million in federal and state aid to help offset the $655-million funding shortfall in county health services and soften the blow of budget cuts.

“We are trying to work something out,” she told reporters. “If we don’t work something out, we are either going to see the [County-USC Medical Center] close or the rest of our health system shut down.”

The call for creation of a health services “czar,” which the task force members believe is needed to guide the health care system through a rocky period that will require massive changes, was met coolly by Burke.

“I don’t know that we need a ‘czar,’ ” she said. Noting that the Board of Supervisors is seeking a replacement for Robert C. Gates, the director of the Department of Health Services who was pressured to resign by the board, Burke said, “We just need a new leader of a department, [someone] who can manage what is the second-largest [health agency] in the nation and what is probably the most complex in the world.”

Most of the task force’s recommendations came as no surprise. In addition to calling for closure of the health centers, the task force recommended turning over Rancho Los Amigos Medical Center to private management and downsizing High Desert Hospital in Lancaster to a walk-in facility with no inpatient beds.

The task force also recommended that the number of county hospital administrators be reduced by half.

“There is a need to do business in a fundamentally different way,” said Jane Pisano, a USC administrator and a panel member.

Task force Chairman Burt Margolin called the plan sent to the Board of Supervisors “a damage control strategy” designed to save the county health system.

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He criticized a proposal made by County Chief Executive Officer Sally Reed to shut down the giant County-USC Medical Center as “a plan that manages a meltdown” of the county health system.

The report said that Reed’s proposal to shut down the big hospital, which accounts for 27% of all the trauma care in the county, would “almost certainly destroy” the trauma system.

“Its loss would put so much pressure on the remaining elements that the entire system would collapse,” the report said. It added that Reed’s recommendation “also failed to acknowledge the vital role [the medical center] plays in providing care for the uninsured in this geographic portion of the community with the largest unmet need in the county.”

In response, Reed said, “Every [county] hospital, as its primary mission, serves those who have no place to go.”

Referring to estimates by engineers and others that the hospital is so old it will require replacement at a cost of more than $1 billion, she said, “If the medical center did not require a $1.2-billion capital investment, and if it didn’t cost $350 million a year to operate--as much as four other hospitals--it would not have been my recommendation.”

The report is advisory only. The Board of Supervisors is expected to act on it this week.

Times staff writer Jeffrey L. Rabin contributed to this story.