New Layoffs Approved at 3 County Hospitals

Keeping a promise to the federal government to shrink Los Angeles County’s hospital-heavy health system, the Board of Supervisors on Tuesday unanimously approved a new round of layoffs at three county hospitals that will cost about 400 health workers their jobs early next month.

A day after hearing impassioned pleas not to scale back health services at Rancho Los Amigos, County-USC and Olive View/UCLA Medical Centers, the supervisors said they had no choice but to reduce staffing because of a decline in the number of patients.

But the board halted for the time being a plan to eliminate more than 90% of the outpatient services at Rancho Los Amigos, the nationally renowned rehabilitation hospital in Downey. The county is negotiating with three private medical groups to turn over the entire hospital to a private operator.

The layoffs--the most extensive since more than 2,500 health workers lost their jobs last fall--are the latest stage in a five-year effort to move the nation’s second-largest health system away from its emphasis on expensive hospital treatment to less costly treatment at community clinics.

The supervisors decided to go forward with the Oct. 7 layoffs despite strenuous objections from the county’s biggest union.

Annelle Grajeda, acting general manager of Local 660 of the Service Employees International Union, said she was very disappointed with the board’s action. “Whenever you talk about layoffs, it has a great deal of personal impact” on our members and “on the patients that we care for.”

Union leaders had urged the board to delay any decision until after the state’s voters decide the fate of a November ballot measure that would maintain the top income tax brackets for wealthiest Californians. The county would receive substantial new revenues if the measure passes.

The supervisors, however, were unwilling to delay the inevitable. Health Services Director Mark Finucane told the board members that if they “begin to back away at all” from commitments made to the federal government, the county’s credibility will be jeopardized.

The Clinton administration, which rescued the health system from collapse last summer with a $364-million bailout, has promised an additional $172 million to help stabilize and restructure the vast network of hospitals, health centers and community clinics.

Finucane reminded the board that under terms of a five-year waiver of federal Medicaid regulations, the county has until the middle of 2000 to reduce the number of hospital beds by one-third and increase the number of outpatient visits at community clinics by 50%. “Five years is around the corner, when you’re talking about a system this big,” he said.

With patient counts down at three of the six county hospitals because of heightened competition for Medi-Cal patients and fewer births, health officials and the supervisors said they were left with no alternative but to reduce staffing accordingly.

“Don’t put us in the position where you push us to go back on our own word,” Supervisor Yvonne Brathwaite Burke told union leaders.

And in a pointed response to union suggestions, Finucane said any effort to postpone the layoffs would push the department’s budget further out of balance and set the stage for a $200-million deficit in the 1997-98 fiscal year. “We have to live within the means at our disposal,” he said.

Unless alternative assignments can be found, the Department of Health Services estimates that 95 permanent or temporary health workers at County-USC Medical Center, the nation’s busiest public hospital, and 37 at Olive View/UCLA Medical Center will lose their jobs next month.

The number of layoffs at Rancho Los Amigos will not be known until later this week after the supervisors decided to forgo temporarily the cuts in outpatient services. However, the department’s human resources director, Alan Knauss, said about 300 employees at Rancho Los Amigos will lose their jobs.

Before the board voted, Supervisor Gloria Molina questioned the wisdom of the county’s plan, approved last summer, to privatize the hospital. The supervisors heard five hours of testimony Monday from patients, medical staff and union leaders about the need to preserve Rancho Los Amigos and its broad array of rehabilitation services.

Molina said the privatization plan is “not as pretty . . . as was painted to us a year and a half ago. . . . What alarms me is we have made a commitment and we have to fulfill that commitment.”

Molina wondered how the county is going to restructure the health system and “maintain its commitment to the people we serve.”

But there was a sense that there is no alternative but to continue to downsize the hospital system and remake the health system.

Supervisor Zev Yaroslavsky said the whole restructuring plan is fraught with risk. “It is a big gamble, but we have no choice.”

Board Chairman Mike Antonovich said he supports Finucane’s efforts to privatize Rancho Los Amigos and speed up the process of privatizing another county facility, High Desert Hospital in the Antelope Valley.

There was a palpable sense of concern about what the county health system may look like when the process of restructuring is complete.

“To dismantle a health system like this is a very, very difficult and depressing task,” Burke said.