Nurses, Doctors Elated but Leery of Quick Fixes

From the crowded wards at County-USC Medical Center to neighborhood clinics in South-Central Los Angeles, patients, doctors and nurses celebrated the presidential bailout of the county’s troubled health care system Friday--but said their lingering anger and distrust make them wary of quick fixes.

The county’s massive medical network has been shaken so badly that even a bundle of money could not boost the sagging morale or heal the pain employees say they have felt over the past weeks.

Because of the tumult, some doctors predicted that talented, experienced employees, some of whom have already found other jobs, will continue to flee the shaky county health system. And they worried that the county will have trouble regaining employee trust and recruiting a front-line medical team to replace those who leave.

With few details of the rescue plan available, nurses and doctors remained confused, and sometimes pessimistic, about their jobs and their patients’ options.

“I think the hospital is safe, but only for the moment,” said Holly Boyd, a nurse who conducts AIDS research at the County-USC Medical Center, which has become a symbol of the county’s cash-starved health system. “This is not a permanent solution.”

Dr. Ronald L. Kaufman, the medical center’s chief of staff, agreed: “It gives us reason to hope. It doesn’t say this couldn’t happen again.”

Last Friday, in tense, emotional conferences with their supervisors, 5,200 county health workers were given notices that they would be laid off or demoted Oct. 1. The unprecedented health crisis also forced the county to announce that 34 of 45 clinics and health centers would be shut down, along with most hospital outpatient services.

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The somber mood lasted through this Friday, when President Clinton announced his rescue package. At County-USC, some jubilant nurses cheered, sang songs and snake-danced around the tent city they erected in a protest this week. Ambulance drivers passed by honking horns and waving in support.

But lingering tension and fear crept into the celebration and few were willing to proclaim total victory. Dozens of nurses continued to protest the county cuts by staging sickouts that shut down parts of the hospital. And speakers, although pleased by the bailout, remained guarded about the future and suspicious about the political climate.

Weeks of turmoil have left many health care workers shaken and embittered. The presidential bailout, while welcome, will do little to prop up the crumbling morale or console laid-off employees who feel betrayed.

Emerging from a job-hunting workshop at the H. Claude Hudson Health Center Friday, Violet Williams said no amount of presidential largess could bring back the security she felt before a pink slip landed on her desk last week. Even if she gets back her job as an urgent care nurse, she said, she is going to make sure she puts in time at a private-sector company at least a few days a week.

“I’m going to have a backup from now on,” Williams said. “I’m never going to depend on the county again.”

Echoing that distrust, union leaders Friday vowed to keep demonstrating and staging sick-outs until county supervisors come up with a detailed plan to spend the money--a plan they said must include rehiring all who lost their jobs.

All 16 of the registered nurses assigned to the County-USC operating room called in sick Friday to keep the pressure on county supervisors. The job action forced hospital officials to suspend all non-emergency and elective surgeries, spokesman Harvey Kern said.

Workers in the hospital’s family planning clinic also stayed home. And half the nurses in the pediatric division refused to report to their scheduled shifts, forcing managers and other replacement workers to fill in.

“We need to hear that the layoffs are going to stop, that there is going to be worker protection, that these members are going to have jobs Oct. 1,” said Gilbert Cedillo, the general manager of Local 660 of the Service Employees International Union, which represents nurses and other health workers.

Some patients even joined in the protest.

The threat of losing a nurse who has long cared for him alarmed 35-year-old Neal Pouliot, who is being treated for AIDS. In the high-profile AIDS clinic, four nurses were scheduled to be laid off and six others demoted and possibly transferred. Being cut off from his favorite nurse would feel “like you are taking me away from my family,” Pouliot said. “I am going to be out here until I learn that my nurse will be back.”

To underscore their resolve to keep fighting for patients like Pouliot, demonstrators at the rally held up signs saying, “The pawns are still angry.” And nurse Ghislaine N. Nash hoisted a placard warning: “These cuts won’t heal.”

Indeed, many health care workers predicted that fallout from the long-running crisis will continue to haunt the county for years.

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On a personal level, many employees said they felt tremendous stress. The County-USC staff has dealt with earthquakes, a riot and shootings in the emergency room, but many said the recent crisis--marked by the layoffs, transfers and demotions announced a week ago--was worse than anything they have ever faced.

“Everyone around here feels like they’ve been hit in the head by a 2-by-4,” Kaufman said. The system in general has also been frayed. Because of the budget uncertainty, the county hospital has lost several nurses who moved onto other jobs, Kaufman said. And he predicted that the county might have trouble finding talented replacements.

Dr. J. A. Asensio, a nationally prominent trauma surgeon who was recruited to County-USC from Philadelphia, joined the noontime rally to warn that the ongoing uncertainty might prompt many on the staff to seek new work.

Until President Clinton’s announcement, he expected the hospital to lose half its emergency-room nurses, 30% of its operating room nurses and eight critical care nurses. Those experienced nurses will probably be offered their jobs back--but might not be so willing to accept. “A lot of private institutions would love to raid our system because we have a great bunch of people who are highly qualified,” said Asensio, who had been on duty for 42 hours.

Recognizing that the crisis had soured employee morale, hospital spokesman Kern said: “We have to figure out how we are going to go about reversing this. Emotions are heavy. It is going to take a while to get over all this, even if we are over the crisis.”

Workers at some clinics were not even sure if the crisis was actually over.

Grim memos still covered bulletin boards and countertops at the H. Claude Hudson Health Center: lists of employee hot lines, reminders about outplacement counseling, explanations of budget crisis. Even the employee services center had been transformed, with a hand-scrawled sign tacked on the door announcing Career Transition Room.

With these doomsday bulletins surrounding them, employees still felt wary and anxious--and far too unsettled to celebrate.

“I have my layoff notice, and that’s what I’m going on,” said Renata Burris, a registered nurse.

Clerk Rosundra Golden, who received a layoff notice last week after seven years with the county, agreed: “Do I trust the county after what happened to me? No way. . . . It sounds good now--they’re almost saying what we want to hear--but it’s not good enough for me.”

Ironically, the bailout alarmed some nurses precisely because of its bounty.

Fearing that county supervisors would grab the money and rebuild the old system, without taking time to draft reforms, they predicted another crash just a few years down the road.

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“Sure, we’re happy, but for how long?” asked nurse Zenaida Argonza, who listened to Clinton’s speech broadcast over the public address system at the Hudson clinic. “How long can they assure our jobs?”

Looking up glumly from the newspaper, Dr. Bobby Harris fretted: “You never know how they’re going to use the money.”

Similar concerns haunted Dr. Jack Kent, a primary care doctor at an Eastside clinic who was laid off last week. Kent remains hopeful that Clinton’s rescue package will save his job. But nerves, and distrust, mute his optimism.

“We really can’t trust the politicians who ran it down to the wire and then at the last minute they bail us out,” Kent said. “We are going to have to remain vigilant.”

While they clamored for reform--such as cuts in the bureaucracy--some health care workers also called for the county to retain control over the clinics, rather than turning them over to the profit-conscious private sector.

“We do what’s necessary here. We’re not concerned about saving money at the patient’s expense, and we don’t want to see that change,” nurse Williams said.

Unsure about their jobs, nurses said they felt even more queasy about what to tell their patients. After reading about the presidential rescue plan, many relieved patients called up to make appointments--only to be told that, officially, the Hudson clinic will still close at the end of next week.

Administrators continued to send out packets explaining the closure. And doctors continued to compile patient records to turn over when the clinic shuts down.

“We’re just abandoning our patients,” nurse Connie Alamdari said. “We’re still telling them we close Oct. 1, and we say they just have to watch the news to see. We’re still at our jobs, but emotionally, we’re not. We’re disoriented.”

That disorientation came through most clearly at the nurses’ farewell picnic on the grassy lawn of the Hudson clinic. Clutching copies of a keep-smiling poem that promised, “The sun will shine again soon . . . you’ll see,” nurses rolled barbecued chicken in floppy tortillas and tried to figure out whether they should be mourning or celebrating.