As Los Angeles County supervisors made a rare unified plea for financial help Monday, emergency room nurses at County-USC Medical Center staged a sickout to protest their pending layoffs--briefly forcing the nation's largest public hospital to close its emergency room and trauma unit to ambulances.
The sickout forced dispatchers to divert some patients to other hospitals during the three-hour closure, although the emergency room remained open to walk-in patients.
Hospital and paramedic officials could not immediately estimate how many people were affected, but most reported that the impact on other nearby emergency rooms appeared relatively light. One gunshot victim died at White Memorial Medical Center, which does not have a trauma unit, and the hospital's chief of staff speculated that such a specialized facility might have helped saved the man's life.
After a highly unusual joint press conference, held on a rooftop patio of the Hall of Administration, the chairwoman of the Board of Supervisors sharply criticized the nurses for the job action, in which 14 of 18 emergency room nurses called in sick Monday morning. Twelve of 13 nurses failed to appear for the afternoon shift starting at 3 p.m.
"It was an irresponsible act," Supervisor Gloria Molina said.
During the three-hour closure, paramedics were told to take patients to other hospitals, including White Memorial, Cedars-Sinai Medical Center and another county facility, Martin Luther King Jr./Drew Medical Center, said County USC Medical Center spokesman Harvey Kern.
In the morning, County-USC was placed on "internal disaster" mode, prompting the activation of the hospital's emergency command post, where officials monitored the facility's activities throughout the day to see if any more nursing shifts would be understaffed.
Some of the nurses who stayed through their night shift to cover for the nurses engaging in the sickout said those who stayed home were not to blame for any deaths or injuries. "They're doing everything they can to keep this place together," said nurse Lauri Heller. "They are not here because they care very deeply about these patients. They don't want to see this happening on a permanent basis."
Although some members of the Board of Supervisors criticized the nurses for their absence, they also said they will act swiftly--perhaps today at their weekly board meeting--to reverse a Health Services Department decision to lay off more than 300 specially trained emergency room nurses countywide. The nurses, a bulwark of the trauma network, were among 5,200 health workers given pink slips or demotions Friday.
The five supervisors directed county Chief Administrative Officer Sally Reed to immediately rehire between 300 and 400 emergency, operating room and intensive care unit personnel after being informed the layoffs would cripple county hospitals.
The supervisors' main theme at the press conference, however, was the increasingly urgent need for state and federal assistance as an Oct. 1 deadline for severe cuts in county health services nears.
"We have no [cash] reserves," said Supervisor Deane Dana. "We have no money available."
Molina said she is trying to meet privately with President Clinton later this week in Los Angeles in hopes of persuading him to break free $178 million the county wants the federal government to provide for health care.
In addition, the supervisors called on Gov. Pete Wilson to bring state lawmakers back for a special legislative session so they can approve additional aid for the county. Supervisors said they were dismayed by the state Legislature's decision not to provide more than $100 million in relief from state-mandated programs, by giving the county the power to reduce General Relief payments to the poor and cut mental health services.
All five supervisors also signed a letter to the governor requesting the special session to approve four pieces of legislation that the county wants passed to help balance its deeply troubled budget.
"These state actions represent the minimum that the county needs in order to prevent a major meltdown of our budget in 1995-96," the supervisors wrote.
"We respectfully request your help in allowing the Legislature to spend more time addressing the needs of the state's most populous county. . . . If not, we intend to immediately begin the process of making further reductions in the county budget, which will have severe adverse impacts on the people of this county."
But so far, Wilson is not budging on the supervisors' request for a special Legislative session, citing lack of consensus among Los Angeles County leaders and local legislators.
Despite the county's bleak financial situation, four of the five supervisors said they will reject $100 million of the $150 million from the Metropolitan Transportation Authority approved by the Legislature late Friday. Because the $100 million is in the form of a five-year loan from the MTA, the supervisors said that to accept the money would represent more of the kind of borrowing that has gotten them into trouble in the first place.
Dana said the county already has mortgaged Marina del Rey and numerous county buildings and cannot continue to borrow to pay operating expenses.
"We have to know how we're going to pay it back," he said.
As Molina pursues a private audience with President Clinton, county health czar Burt Margolin planned to be in Washington today to meet with top federal health officials in an eleventh-hour effort to get a commitment for the $178 million in health care money. "The state, the county and the federal government have got to get the job done," he said in an interview. "Otherwise, the impact on Los Angeles County will be catastrophic."
Margolin said the county must receive a definitive yes or no answer from the federal government by the end of this week, or the supervisors will have no choice but to consider closing one or more county hospitals. He previously has recommended closing four of the six hospitals--all except for County-USC and Martin Luther King Jr./Drew Medical Center--if additional funding is not received.
As the county intensified its push for more funding, unionized doctors, nurses and other health employees vowed to turn out at the supervisors' meeting today by the thousands.
"We need a massive show of force," said Alejandro Stephens, president of the Service Employees International Union, Local 660, which represents half of the county's 85,000-plus workers. "We need to be in the supervisors' faces . . . to make sure these cuts do not go through."
Gilbert Cedillo, general manager of Local 660, said the efforts by nurses at County-USC to bring the health crisis to the attention of the public was good. He said he thought the nurses were "very careful about it" not to jeopardize patient care.
Even if the trauma nurses do get a reprieve and some health cuts are averted, union leaders, doctors and nurses continued to predict disaster if six health centers and 28 community clinics close and 75% of hospital outpatient services are eliminated, as planned Oct. 1 unless there is a bailout.
"We're putting Los Angeles County on the high wire, and pulling out the safety net at the same time," said County-USC emergency room Dr. William Mallon. "And the people of L.A. are not acrobats. They are going to fall to their deaths."
The scene at the County-USC emergency room Monday morning was fairly calm. Because nursing supervisors and specially trained staff from other parts of the hospital filled in and night nurses stayed overtime to fill in, the sprawling trauma unit at the Boyle Heights hospital was only closed to new patients for less than three hours, doctors said.
By 9 a.m., the trauma unit was nearly empty. Monday mornings, Dr. Dennis Chan said, are traditionally slow times. The adjacent emergency room was calm, but full of people waiting to be seen for minor injuries that did not need immediate care.
"It's calm now," said one Los Angeles city Fire Department emergency medical technician, Cesar Garcia. "But it was a crazy house here last night."
The impact of the looming cutbacks, many county health officials said, was illustrated in dramatic fashion early Monday when an ambulance carrying a man suffering from gunshot wounds was diverted from County-USC and sent to nearby White Memorial Medical Center.
Like most private hospitals, White Memorial near Downtown Los Angeles lacks a trauma center. Hospital officials at both facilities said the as-yet unidentified man would have had a far better chance of surviving had he gone to County-USC, with its staff of ready-and-waiting emergency surgeons and nurses.
"We're not sure" we could have saved him, said County-USC emergency room doctor Diku P. Mandavia, "but we would have been far more capable of handling this injury. One hour [of trauma unit closure], one death."
Dr. Brian Johnston, chief of staff at White Memorial, said the man died at about 7 a.m. from gunshot wounds. "Should this man have gone to a trauma center? Unequivocally yes," said Johnston. "This is a direct consequence not of the nurses walking out but of all the nurses being fired because of the cuts in the health care system."
Johnston was one of many doctors who told the Board of Supervisors months ago that deaths would be inevitable if the board put in place proposed cuts to the health care system that they ultimately adopted.
He said the area's few trauma centers and other emergency rooms will be overwhelmed due to clinic closures. He said that even people with medical insurance will not be immune if they need trauma care after car accidents, shootings and other life-threatening injuries.
Chan, head doctor in County-USC's trauma center, said the specially trained nurses are an integral part of any trauma team because they can treat shooting and car accident victims without waiting critical seconds for a doctor to tell them what to do. "I need nurses who are not afraid to get dirty, to fight wars, to get blood all over them," Chan said. "I don't need clinic nurses" like the ones the county has proposed transferring to trauma units because they had enough seniority to avoid layoffs.
Times staff writers Dave Lesher and Max Vanzi contributed to this story.