Health Czar Says County Could Lose 4 Hospitals

Underscoring the gravity of Los Angeles County’s fiscal crisis, health czar Burt Margolin on Tuesday recommended closing four of six county hospitals, including Olive View Medical Center and Harbor/UCLA Medical Center, unless Sacramento and Washington immediately come to the county’s rescue.

Going far beyond his original plan to shut most of the county’s health centers and community clinics, Margolin told the Board of Supervisors that the hospital closures also may be necessary.

Margolin minced no words in describing the potential impact of closing down the two major hospitals plus High Desert Hospital in Lancaster and Rancho Los Amigos Medical Center in Downey. “It is absolutely disastrous for the safety net in this county,” he said. “It is not a rational closing process. It is a disaster response.”

Under Margolin’s recommendation, County-USC Medical Center and Martin Luther King Jr./Drew Medical Center would be the only hospitals left in the county’s once vast health system.

Closing Olive View, the only county hospital in the San Fernando Valley, and High Desert, the only county facility in the Antelope Valley, would leave the entire northern part of the county without a public hospital.

Margolin emphasized that he made his recommendations reluctantly and that they would become reality only under the worst-case scenario. His report to the board said the hospital closures should be considered only as a last resort if funding to maintain the county’s safety net for the poor and those lacking health insurance cannot be found.

“If we got into this meltdown mode,” Margolin said, it would be the end result of “a catastrophic reduction in funding for health care.”

To take effect, Margolin’s recommendations must be adopted by the board, which would present extreme political risks for supervisors, especially those whose districts would be left without a public hospital.

The supervisors delayed any immediate action on Margolin’s proposal until Sept. 19 at the earliest, after the state Legislature finishes its work for the year. Although the legislative session is rapidly drawing to a close, the board is still hoping that Sacramento will provide the state’s most populous county with additional financial assistance to avert the hospital closures.

The supervisors also are counting on the federal government to approve a waiver of federal regulations to permit the county to divert some health care dollars from the treatment of hospital patients to outpatient services.

The prospect of additional aid from Sacramento is uncertain; the federal waiver is considered likelier, but final approval may not come in time to help the county.

In the meantime, Margolin’s recommendation for up to $96.1 million in additional cuts to the already ravaged health care system is expected to trigger protests from patients, employees, and private hospitals alike.

Depending on available dollars, Margolin’s proposal would close the hospitals in descending order: Rancho Los Amigos, High Desert, Olive View and Harbor/UCLA.

“It’s horrific in terms of patient care,” said attorney Beth Osthimer of San Fernando Valley Neighborhood Legal Services. “We have to convince the state and feds that this is real. This is life and death. We’re not joking here. This is not business as usual. This is not crying wolf.”

Osthimer is the lead attorney in a class-action suit filed last month in federal court challenging the county’s plans to close all six comprehensive health centers as well as 28 community clinics, and to make drastic reductions in outpatient services at county hospitals.

Politically, the recommendations put forth by Margolin may be in critical condition from the start. At least two supervisors, Deane Dana and Mike Antonovich, will not vote for the closures, which will hit their districts hard. “I was shocked,” Dana said. “I don’t agree with it. We’re not going to close our most modern hospitals.”

Olive View is the newest of the county hospitals, rebuilt after its predecessor became one of the enduring symbols of the 1971 Sylmar earthquake’s deadly destruction.

In making his case, Margolin argued that the county must maintain the two core hospitals that provide the backbone of the county’s emergency trauma network and also serve the greatest concentration of residents who are poor or lack health insurance.

Jim Lott, senior vice president of HealthCare Assn. of Southern California, which represents private hospitals, agreed that maintaining Martin Luther King and County-USC is “absolutely vital to the emergency services system of L.A. County.”

But Lott disagreed with the approach of closing health centers and clinics, saying that threatens to flood private emergency rooms with patients denied care by the county.

“There is enough capacity in the private sector to be able to absorb a great deal of the care being provided by county hospitals for inpatient services,” he said. “But the outpatient cuts do nothing but threaten the emergency rooms.”

Kenneth Tiratira, a spokesman for Harbor/UCLA Medical Center, said the hospital annually sees about 100,000 people in its emergency room.

“Any cuts to our system are going to be very tragic,” he said.

A coalition of faculty members at Harbor-UCLA on Tuesday announced an intensive effort to find alternatives to deeper cuts in the county’s health system.

At St. Mary Medical Center in Long Beach, already bracing for a deluge of patients from the closure of another major county facility, the Long Beach Comprehensive Health Center, Margolin’s proposal was not well received.

“It would be adding insult to injury,” said Greg Harrison, a St. Mary’s spokesman. “The closure of the health center, five blocks away, was bad enough, but we were counting on Harbor for its emergency room and specialty care services. . . . If Harbor closes, [all county health services in the area] would be taken away. It is very frustrating.”

On Tuesday, Olive View’s administrator, Melinda Anderson, said during the last several months a series of rumors that Olive View might close has taken a heavy toll on the hospital staff’s morale.

“A lot of the staff is concerned,” she said, “and it is primarily about who is going to take care of the patients.”

Anderson said she hopes that the Sylmar hospital can avoid closing or being privatized.

At High Desert Hospital, rumors also have taken a toll on the hospital’s staff. Earlier this year, first the county’s health department and then the county’s health crisis task force recommended that the hospital be closed. But the supervisors granted a reprieve.

“We can only try to remain positive,” said Jerry Harris, the hospital’s associate administrator. “Hopefully, something good will happen.”

Harris said morale problems have grown as the hospital has survived one brush with closure after another. “The problem is people tend to panic,” he said. “Naturally, everyone is concerned.”

At Olive View on Tuesday, James Marshall of North Hollywood was waiting to be seen for a possible hernia. Marshall--who is unemployed and has no health insurance--said the results would be devastating to San Fernando Valley patients if the hospital closed. “It would have a large effect on this area because a lot of poor people go through here every day.”

Jorge Covarrubias was at the hospital with his wife, Maria, and their 1-year old son to get help for Maria’s ear infection.

Closing the hospital, he said, probably would force many of the poor and uninsured into private hospital waiting rooms, which could drive up costs for everyone. “This is a basic service,” he said. “In the end, if you don’t prevent the problems, you are going to have to fix them anyway.”

Times staff writers Frank B. Williams and Douglas P. Shuit contributed to this story.