Worried that the county's medical safety net may still unravel and unleash a flood of uninsured patients on them, top executives of private hospitals in the San Fernando and Santa Clarita valleys said Tuesday they want a prominent voice in how the nation's second-largest public health system is reformed.
Meanwhile, county supervisors approved health czar Burt Margolin's recommendation that county clinics in Canoga Park and Valencia be turned over to the Northeast Valley Health Corp., a nonprofit, government-funded organization that provides medical attention to the poor at 10 clinics.
Meeting at Holy Cross Medical Center, officials of at least six hospitals from West Hills to Valencia agreed that the county's $2.1-billion public health system needs profound restructuring if its ongoing budget crisis is to be resolved.
"The county is going to continue to have long-term problems, and changes are going to need to be made," said Dr. Keith Richman, a Pacoima internist who heads the group, which is bidding to take over six county clinics and a comprehensive health center in the San Fernando and Santa Clarita valleys that were targeted for closure by county supervisors last month.
The Valley facilities are part of a countywide network of six comprehensive centers and 39 neighborhood clinics. County health officials have proposed trimming the facilities' budgets but keeping them all open in the wake of $364-million federal bailout announced last week by President Clinton.
But even as the hospital executives were meeting Tuesday, county supervisors were wrestling with deep cuts that must be made in their vast health-care system, which despite the federal rescue package faces a large budget deficit.
Private hospital officials have watched the unfolding county health crisis with alarm, fearing a collapse of the county network would deluge private hospitals with non-paying patients, undermining them financially and forcing closure of their emergency rooms.
"People like us are left to pick up the pieces," said Dan J. Brothman, president and chief executive officer of West Hills Regional Medical Center. "The safety net is falling apart right now."
The hospital executives, noting that managed care has forced them to downsize their own facilities in recent years, applauded Margolin's drive to place more emphasis on outpatient care while moving away from more expensive hospital-based care in the county system.
They also endorsed Margolin's recommendation to create a county Health Authority composed of medical experts independent of the county Health Services Department. The authority would oversee implementation of broad health policies approved by county supervisors.
Cathy Fickes, chief executive officer of Mission Community Hospital, said a health authority would help ensure that San Fernando Valley hospital officials are heard in county decision-making on health issues. She complained that while executives of private hospitals in Downtown Los Angeles and elsewhere in the region have the ear of county health bureaucrats, Valley hospital officials are treated like "we're kind of [in] a lost land out here."
Several members of the hospital group also complained that they have heard little or nothing from Margolin about the status of their proposal to assume management of county public health facilities.
Private hospitals, physician groups and other medical providers last month submitted dozens of bids to take over the county's 39 neighborhood clinics. The privatization effort is a key element in Margolin's strategy of overhauling the system to extend care to more of the county's 2.6 million uninsured residents for the same amount of money.
Margolin's top aide, Jonathan Freedman, said Northeast Valley Health Corp. was selected to operate the Canoga Park and Valencia clinics because county evaluators had determined that it was capable of providing high-quality care to the poor and was financially stable.
The nonprofit corporation, funded mostly by the state and federal governments, provides prenatal care, family planning services, testing for tuberculosis and the AIDS virus and other medical care. Its clients include those covered by Medi-Cal, the state's insurance program for the needy, and those without health insurance, who pay on a sliding scale.
Freedman said the Valley hospital group was not among "top bidders" that county officials are negotiating clinic contracts with. But he added that no bidders have yet been rejected, since officials may want to deal with them if they cannot reach agreement with higher-ranked bidders.
Times staff writer Timothy Williams contributed to this story.
* LAYOFFS DELAYED: Supervisors postpone furloughs until Oct. 15. A1