A Tide of Layoffs and Painful Questions : County: Health workers who remain wonder what will become of patients.

By JEFF BRAZIL, HENRY CHU and TINA DAUNT

Oct. 14, 1995 12 AM PT

TIMES STAFF WRITERS

When the toddler hit by a car in “C Booth” wails in pain.

When yet another teen-ager with a fatal gunshot wound blinks for the last time.

When the old man with multiple sclerosis needs to be bathed.

In the desperate din of the emergency room at County-USC Medical Center, nurse Marsha Murray has always been comforted by the fact that she could glance across the gurney and see the faces of longtime friends and colleagues.

And then came this crisis. Or money crunch. Or whatever they’re choosing to call Los Angeles County’s worst-ever financial mess these days.

Now, Carrie Corn, voted “nurse of the year” last year by the emergency room’s residents and one of Murray’s closest friends?

Gone.

Unlike the 3,283 doctors, nurses and staff of the county’s beleaguered health care system who were told Friday that they were to be laid off or demoted by month’s end, Corn voluntarily left the job she loved because of the atmosphere of instability that has plagued the county’s clinics and hospitals in recent weeks.

Striking at the heart of the area’s largest hospitals and outpatient clinics, the county’s on-again, off-again fiscal woes climaxed Friday as pinks slips finally took effect.

As Friday the 13th approached, Corn and numerous other doctors and nurses have resigned, leaving behind thousands of doctors, nurses, custodians and clerical workers who wonder:

Now what?

What will become of the patients whose clinics have been closed? Of their laid-off colleagues? Of them?

“I’ve been here 14 years and people say I’m the lucky one,” Murray said Friday, “that at least I get to keep my job.”

But as she fielded a call from Rescue 15, who had an 80-year-old man with a broken hip, fed a sandwich to an invalid who had just been brought in and hadn’t eaten in five days, and looked over a full bench at the cardiac booth, Murray believed she was anything but lucky. “It’s like saying you’re the only one to have survived a plane crash and there are 300 dead people lying around you,” she said.

“Until it’s [Gov.] Pete Wilson lying in the C Booth, the critical care booth, or [County Chief Administrative Officer] Sally Reed, people won’t realize how tragic this is.”

500,000 Patient Visits a Year Cut

Although a $364-million federal bailout in September helped keep open the doors of the county’s health centers, community clinics and hospitals, Walter Gray, assistant director of the Department of Health Services, said the county was still forced to eliminate 500,000 patient visits a year out of 4 million.

Hit hardest are the outpatient clinics at county hospitals that treat adults with such illnesses as cancer, diabetes, hypertension and heart disease. Public health programs aimed at preventing the spread of tuberculosis and sexually transmitted diseases are also affected by the budget cuts.

The county’s health system has seen layoffs and demotions before, but “nothing ever this massive,” Gray said.

Solace in Support for One Another

Bound by their uncommon commitment to caring for the underprivileged, the nurses, doctors and support staff of the county’s crowded clinics and hospitals admit it: They had come to depend heavily on one another.

Amid the long lines of pregnant teen-agers and the young people with AIDS and the old folks with TB, they found much solace in the reassuring looks, the broad grins and even the salty tears of their companions. However, capped by Friday’s events, the recent weeks have been filled with more than the usual doses of anguish and sadness.

And it perhaps says something about the quality of the patients and their caretakers that on Friday each seemed most worried about the fate of the other: Those who lost their jobs or had abandoned them worried about what would become of their former colleagues. Those who still had their jobs worried about their patients. And the patients? Many of them were among those shedding tears, realizing that they would never again see some of the people who have treated their families for years.

At the Northeast Health Center near Boyle Heights, some of the adult patients went to the 40-year-old clinic as children and received their immunizations there. For decades, the red brick building on Marengo Street has served as a lighthouse, a haven for the area’s mostly Latino residents to get good medicine and a warm hug from the staff, many of whom have worked there a decade or longer.

Now, the clinic is one of six being privatized.

The staff of 11 public health nurses at Northeast is being transferred to the Central Health Center on Figueroa Street, where their former patients will have to go for their health problems. The thing is, the Northeast health district serves more than 90,000 people identified as poverty-stricken and there is considerable concern that they do not have the means to make the longer trip to Central. Or that they will not get word that that is where they are supposed to go from now on.

“It’s another barrier for our patients, whose priority is putting food on the table and having a roof over their head,” said public health nurse Nina Cogan, who has worked at the Northeast clinic off and on since 1968.

“This is going to affect everybody ,” said Cogan’s colleague Emily Avila. “The people we treat for TB and communicable diseases work in the food industry . . . and other industries. And if they don’t get treatment, that will facilitate the spread of communicable diseases.”

Even if the patients do end up getting the message, some wondered what sort of services they could provide with their whittled-to-the-marrow staffs.

At Martin Luther King Jr./Drew Medical Center, 27 people were laid off from a busy surgery unit in Los Angeles’ inner city.

“We are not going to be able to provide the proper level of care,” said Mary-Anne Purtill, a surgeon in her fifth year of residency in the trauma center.

“I already work 80 to 100 hours a week. What more do you want from me? What more can I give this hospital, this county, the poor people in this region? My question is, when will the rich white people feel responsible for the poor minorities? Where are all the Christians? They talk big talk and they give lots of money to their pastors, but they don’t help the people in here, the people who need it most.”

Surgeon Romeo Massoud predicted that patients needing non-emergency surgeries would have to wait months. “We already have a backlog,” he said. “Where will these people go?”

Melvin Jones, another surgeon, said: “It’s just sad. The system is broke. You talk about cutting the fat? This system is already down to skin and bones.”

Blackout Starts Day on Ominous Note

At Harbor-UCLA Medical Center, a freak electricity blackout forced the staff to begin the day on an ominous note on an afternoon in which 319 employees there received the long-dreaded word that they were being laid off.

That is a cut of nearly 9% in the 3,600-member staff at the sprawling facility near Torrance.

In addition to the layoffs, 137 employees will be demoted or transferred to another county facility--the so-called cascade, bemoaned by physicians for replacing highly trained staff members with others from different specialties who happen to have Civil Service seniority.

Dr. Julie Noble, medical director of pediatrics for the Community Health Program, said the pink slip she received last month was rescinded Friday. But the fact that the county even considered firing her boggled numerous medical center minds--she oversees the care of 1,000 children.

Still, three of the four nurses with whom Noble works directly were laid off. Although they will be replaced by other nurses, Noble laments the abrupt loss of the closeness gradually built up between care-givers and patients.

“It has been tremendously demoralizing,” she said. “Medicine is a product of relationships. As a patient, if you don’t trust the doctors and nurses, you won’t go back. There’s a lot to be said for the health benefits of those relationships.”

Bill Kingman, director of ambulatory care at the hospital, said he had tried to save employees who were a part of critical programs such as the HIV and pediatrics sections. But he could not save all of them, including the manager of the women’s breast health program.

“That’s going to be a big problem,” he said. “She was bumped because the Civil Service system did not recognize her specialty.”

As evidence of what the next crisis might be, the earliest available appointment in the cardiology clinic is mid-December.

On this day, Noble couldn’t help but recall that she began the day groping around windowless clinic rooms with a flashlight, the rooms darkened and silenced by a blown transformer. At 10 a.m., the lights went back on. But, she said, “Chaos reigned.”

So did confusion.

In Long Beach, Mel Grussing, administrator for the Coastal Cluster Health Centers, said the number of patient visits had already plummeted by two-thirds after residents there had been told weeks ago that the cluster’s seven clinics were to be closed.

Apparently, word that the clinics had been given a reprieve had been slow to spread.

Not that the cluster escaped without bad news: Sixteen people were laid off at the various facilities and others will get word of their forced departures in the next two weeks.

Early next week, Grussing and his staff will meet to lay the groundwork for how the smaller staff will handle the workload.”Right now, the people are just hanging in there, trying to figure out how Monday is going to look,” he said.

The news was no less grim in far-flung areas of Los Angeles County.

At the Mid-Valley Comprehensive Health Center in Van Nuys, the banner said brightly, “We Are Here to Serve You,” but it sagged to one side, barely staying mounted to a chain-link fence. As a symbol, it seemed terribly precise as doctors and nurses went about the business of helping patients amid the steady rain of bad news and flagging spirits at the center, which has been housed in a cluster of trailers since the Northridge earthquake.

As it did for their colleagues around the county, the day started with a bundle of letters in the center’s administrative office--letters that contained the fates of dozens of employees at clinics throughout the San Fernando Valley. Some were told that the day was their last, others given two weeks.

For those who survived the morning round, another batch of letters was due later in the afternoon, spawning an air of uncertainty that made it difficult to concentrate on the task at hand.

In the prenatal unit, the work schedule has been mapped out for the coming weeks. But spaces for names have been left blank, said nurse Socorro Salanga.

In some ways, this fiscal crisis has seemed more arduous than last year’s quake, Salanga said. “This is prolonged,” she said. “With the earthquake, you knew immediately what you got. This has been going on for how many months now?”

‘This Hospital Has Been Like My Family’

At Olive View / UCLA Medical Center in Sylmar, typing clerk supervisor Rita Nolasio broke down in sobs over her transfer, which came on top of a demotion a month ago.

“This hospital has been like my family, and this has been my house. And now it’s like they’re saying, ‘Get out of our house! Get out! Get out!’ ” said Nolasio, 50. She is the widowed mother of a 4-year-old daughter who attends kindergarten at the hospital.

By 1 p.m., Doris Hish, a 39-year veteran at the hospital who supervises patient services, fired 35 people--and still had a dozen more termination notices to give.

“These people came here for a promotion and more money. Now they’re out of a job,” said Hish, weeping.

Many of her employees attended farewell luncheons for laid-off co-workers, unaware that they themselves would be in the same position by day’s end.

“Little do they know that when they come back to work in the afternoon, they’re going to lose their jobs, too,” Hish said.

Irwin Ziment, medical director at Olive View, laid off two doctors Friday morning. One took it stoically. The other?

“The other, I would say as a clinician, was in a state of shock.”

Ziment added: “I really regret the horrible sense that America is the richest nation on earth, and yet we are seeing an erosion of society’s care for the less fortunate. Our patients might be criminals or drug addicts or sociopaths, but we see them all as humans, as patients, and even as friends. . . . We’ll all be much busier, working in a more mechanical fashion. And that makes me very unhappy.”

Some laid-off doctors, he said, have offered to come back to work as volunteers. “They’ll work for free as they sort out their future,” he said.

“That’s the kind of doctor we have here.”

Farewells and Last Meal Taken Together

With words of anger and sadness, employees at the Canoga Park Health Center had a last lunch together and bid their farewells.

If it seemed more like a funeral, it felt like one.

“Our family is being divided,” said Lucia Carpenter, head physician at the health center.

“You give your life to something for so many years just to turn around and get kicked down,” said Alise Unzueta, a 30-year county health employee, who was transferred from the clinic to Rancho Los Amigos Medical Center in Downey.

By Friday morning, Lillian P. Lee, district health officer at the Northeast Health Center, had already learned she was being transferred to the Pomona clinic. She had worked at the Northeast clinic for 15 years. Her underlings, all of whom were either laid off or headed elsewhere, gave her a card at their goodby breakfast. They were not shy in explaining that the tears flowed as fast as the coffee.

On the front, the card asked, “Wanna know how we’re going to get along without you?”

Inside, it answered: “We don’t either.”

Times staff writers J. Michael Kennedy, Terence Monmaney, Jeffrey L. Rabin, Lucille Renwick and Jon D. Markman contributed to this story.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Impact of the Layoffs

To cut its budget, the county will lay off or demote 2,656 health workers by Sunday and another 627 by Oct. 31. Major county hospitals and their outpatient clinics will be the hardest hit. Here are breakdowns by job category and location.

Layoffs and Demotions by Job Category

Professionals (includes doctors, nurses, social workers): 1,354

Clerical: 590

General Services (includes nursing attendants, food service, laundry workers, lab attendants): 588

Paraprofessionals (includes lab technicians, physician’s assistants, accounting, physical therapists, licensed vocational nurses): 283

Management and staff: 219

Craft workers: 199

Hospital Layoffs and Demotions

*--*

Temporary Employees Permanent Employees Demoted Location Released Laid Off Employees County-USC 190 440 179 Olive View/UCLA 311 188 89 Harbor-UCLA 115 204 70 King/Drew 127 143 63 Rancho Los Amigos 55 146 47 High Desert 24 78 35

Location Total County-USC 809 Olive View/UCLA 588 Harbor-UCLA 389 King/Drew 333 Rancho Los Amigos 248 High Desert 137

*--*

Layoffs and Demotions at Health Centers and Clinics

Location: Northeast Cluster (includes Downtown, parts of South-Central and east L.A. County as far as Pomona)

Temporary Employees Released: 50

Permanent Employees Laid Off: 131

Demoted Employees: 23

Total: 204

Location: San Fernando Valley

Temporary Employees Released: 28

Permanent Employees Laid Off: 23

Demoted Employees: 8