A Quick Course on Health Crisis

A sign outside Olive View Medical Center proudly hails its 75th anniversary. Founded in 1920 as a tuberculosis sanitarium, it moved into new quarters in January, 1971, and was damaged beyond repair in the Sylmar quake one month later. Here in the foothills of the east San Gabriel Mountains now rises a handsome, modern, 8-year-old facility with mirrored glass reflecting blue skies.

“Here’s my card,” said Mario Sewell, reaching into his pocket. “While I still have cards.”

Gallows humor is one way to deal with stress. Sewell, an assistant administrator at Olive View, is among the survivors, so far, of the scorched-earth economics that are crippling the county’s public health system. He wasn’t among the 746 Olive View employees who received layoff notices last Friday, or among the 143 employees notified of imminent demotions. Olive View lost about a third of its staff--and this was just a fraction of cutbacks systemwide.

Meanwhile, there’s still talk of shutting this hospital down and maybe trying to sell it to an HMO. On health czar Burt Margolin’s hit list, Olive View would be the third hospital to be closed, after High Desert in the Antelope Valley and Rancho Los Amigos in Downey, and followed by Harbor-UCLA. Meanwhile, there’s hope that the Feds can bail the county out--and with President Clinton coming to town for a visit, he might bring some reelection campaign relief.

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I wanted a crash course on the county’s health care crisis, and the assignment fell to Sewell. He gave me a two-hour tour, with Olive View offering a preview of the hardships to come. The layoffs don’t take effect until Oct. 1, so Tuesday was still a typical day of business. One difference, Sewell says, is that the mood has become more solemn.

Olive View is licensed for 377 beds and has a typical patient census of about 290. The count this day was 253, in part because the hospital stopped accepting transfers as of Sept. 1, in preparation for the cuts. But at a county hospital, admissions represent just one aspect of service. Last year, Olive View had 120,000 clinic visits and handled 80,000 emergency room cases, as well as 20,000 admissions.

We walked along the second floor hallways. Here was the orthopedic clinic. It will be eliminated. Here was cardiology; its services will be cut about 30%. Eye, head and neck, Sewell said, will be eliminated. Same with dental.

We walked into a crowded room marked Clinic A, home of the comprehensive care clinic tailored for older patients. This too will be eliminated.

Mary Gonzales, a registered nurse, grew tearful telling of an encounter with a frequent visitor. “He said, ‘I just want to say goodby, because I don’t think I’ll be seeing you anymore.’ . . .

“A lot come to us and ask, ‘What’s going to become of us?’ We try to tell them we’ll try to refer them.”

Only 2% of Olive View’s patients have private insurance. Of the rest, more than 50% receive MediCal, 2% are on Medicare and about 25% are medically indigent. Mary Gonzales worries that her patients won’t be treated as well elsewhere--or that they won’t be treated at all.

Next we walked into a room that hosts a variety of clinics. On this day, at this hour, it was neurology. Now it is budgeted to handle 23 new referrals, plus an equal number of follow-ups. After Oct. 1, that will drop to 12 referrals and 12 follow-ups.

What will be lost is preventive care. “We’re going to end up seeing the sickest of the sick,” said Dr. Robert Nishimura, a member of the UCLA Medical School faculty who teaches at Olive View.

He poses this scenario: Imagine an epilepsy patient who no longer attends this clinic and falls into bad habits. Foolishly he tries to stretch his medication, taking two pills a day instead of three. A seizure lands him in the emergency room and a hospital bed--at much greater public expense.

“It’s a domino effect,” Nishimura says.

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Next stop was the emergency room--a standard ER, not a trauma center. In a lobby that contains seating for about 60, there was standing room only. It should get worse after Oct. 1. As it is, the usual wait is about two hours, but it can range up to six. The need to do triage, to prioritize cases in order of urgency, makes it hard to predict.

Next door is the psychiatric emergency room, the only such county-run facility in the north county. Protected by state law, this is one operation that wasn’t trimmed. There has to be some place for police to take people who are judged to be a danger to themselves or others, or who are gravely disabled by mental illness.

The psych ER was protected, but the psych ward wasn’t. It will be cut from 57 beds to 32, losing an adolescent ward. Private hospitals may accept MediCal transfers, but who will care for the adolescent who is poor and suffers mental illness?

The human dominoes keep falling.