Uncertain Prognosis

The last two years have not been kind to High Desert Hospital. It has been racked by a series of scandals. The Board of Supervisors, citing poor management, ordered that its top administrator resign. The facility narrowly avoided closure during the county’s budget crisis last year.

Now, the future of the 35-year-old hospital is again in doubt.

Los Angeles County, still trying to cut costs by reshaping its health-care delivery system, is attempting to persuade private groups to operate High Desert so it can discontinue paying the $8.3-million annual county cost of operating the hospital.

The county has pledged to stop funding the hospital by July 1.

Although no one knows what will happen, few in the Antelope Valley believe privatization is a good thing for the facility, which employs 567 people in the recession-battered area.

In fact, some fear that there will be no serious bidders, High Desert will close, and its poor patients--about 40% of whom have no health insurance and no means to pay for their care--will be forced to fend for themselves.

That, supporters of High Desert say, would be a disaster, mainly because the hospital is the only one that serves the poor in a fast-growing area with a population of 400,000.

Also, the area that High Desert serves makes up nearly half the county’s land mass--an area about the size of Rhode Island. The Antelope Valley is isolated from the rest of the county by desert and a freeway that is nearly impassible during winter storms.

“We’ve always felt neglected up here in the Antelope Valley, and High Desert is a symbol,” said Palmdale Mayor Jim Ledford. “You could close a clinic down in Los Angeles and you could utilize another one close by. But if you close High Desert, well, we don’t have anything else.”

If the facility is closed, the shock waves are expected to radiate throughout the Antelope Valley and beyond. Emergency rooms will be filled with poor patients who need basic care but have nowhere else to go. Unemployment rolls will rise. One of the older institutions in the sprawling modern suburbs of the Antelope Valley will be gone.

Last month, the Los Angeles County Department of Health Services contacted 79 health-care organizations about taking over services at the hospital. The groups have until Nov. 6 to respond.

Even the most optimistic are guarded about the prospects for an easy transition.

“My guess is that the whole facility is going to be a tough sell because of its location and the competition from other hospitals,” said Mel Grussing, High Desert Hospital’s administrator. “We are not internationally known like [county hospitals] Rancho Los Amigos or County-USC. We are a small hospital out here in the Antelope Valley.”

Making the task more difficult, county officials say they will not entertain proposals that do not include provisions for caring for the poor--a requirement that will probably be a hard sell in the private sector.

“The community has made it clear that they want the indigent cared for, no matter what happens to High Desert,” said Kathryn Barger, health deputy to Supervisor Mike Antonovich, who represents the area. “You’ve got to have a financial incentive to entice the private sector. . . . The question is how do you dangle the carrot?”

So nine months before High Desert is scheduled to be privatized, nervous employees go about their jobs, politicians vow to save the hospital, and the area’s private hospitals fear that they will slip into insolvency if forced to care for patients who can’t afford to pay.

High Desert’s crisis began two years ago when the county Department of Health Services spent about $600 million more than it actually had.

Forced to cut services, the County Board of Supervisors voted to privatize High Desert and Rancho Los Amigos hospitals.

Employees suspect that High Desert was chosen in part because of several management embarrassments: The hospital was penalized by the state for mishandling radiation, and it had kept on staff a physician who had been charged with sexual battery.

The investigation concluded that High Desert officials were guilty of “questionable decisions, lack of timely action and poor judgment” and should be removed. Administrator Roy Fleischman retired.

High Desert’s fate was sealed when the Clinton administration granted the county a $364-million bailout last year, which compelled the health department to continue to move away from expensive inpatient care toward cheaper outpatient services.

High Desert, like the remote valley it serves, had humble beginnings: In 1961, the hospital opened next to the county’s now-closed Mira Loma jail to care for inmates suffering from tuberculosis.

But in the intervening 3 1/2 decades, the once pastoral desert valley has become one of the fastest-growing regions in the U.S.

During the 1990s, Lancaster has grown by 22.5% to 119,186 people and neighboring Palmdale by 47% to 103,423. Palmdale was the second-fastest-growing city in the nation during that time, while Lancaster placed sixth.

But the area, which has a poverty rate of about 8.5%, is underserved medically, political and health officials say.

Even after deep budget cuts left only 76 of its 170 beds available, the hospital admitted 1,350 patients during the 1995-96 fiscal year and handled 58,932 outpatient visits.

And in March, Desert Palms Community Hospital closed, leaving the Antelope Valley with three hospitals instead of four, and two emergency rooms instead of three. It also left Palmdale with the unenviable distinction of being the largest city in the state to lack a hospital.

Of the three remaining hospitals, only High Desert cares for those who can’t afford to pay and who lack health insurance. There is no emergency room at the hospital, but there is an intensive care unit, as well as long-term beds for the elderly and victims of severe head injuries.

While Antelope Valley Hospital Medical Center and Lancaster Community Hospital treat uninsured patients in their emergency rooms--as the law requires them to do--once the patients are stabilized, they are often transferred to High Desert.

Still, county officials consider Antelope Valley Hospital Medical Center a natural partner to High Desert. The hospitals have had a sometimes antagonistic relationship dating back several years, usually focused on the struggle to care for Medi-Cal patients.

Health officials say Antelope Valley Hospital Medical Center has little choice but to enter the High Desert sweepstakes: If it does nothing, it faces the risk of being required to care for indigents anyway, but if it makes a successful proposal, it will be able to control a measure of its own destiny.

After losing about $5 million in 1994-95, Antelope Valley Hospital Medical Center has righted itself, and in 1995-96, it earned $4 million. The hospital is planning to increase the size of its emergency room from 17 to 26 beds and open a 99-bed skilled-nursing facility by the end of 1997.

Antelope Valley Hospital Medical Center officials say they are studying their options.

Meanwhile, High Desert is pursuing its own plans without waiting for the private facility.

First, officials have been negotiating for several months with a Philadelphia-based health-care provider to take over the hospital’s rehabilitative unit, though the talks have bogged down lately because of legal concerns on the part of the county counsel’s office.

The hospital might also consider treating tuberculosis patients again--this time illegal immigrants held at Mira Loma jail. The deal hinges in part upon whether the Immigration and Naturalization Service leases the county jail in the near future.

Other options include serving the Antelope Valley’s large population of veterans by providing care at a veterans home planned to be built nearby.

Grussing, the High Desert administrator, knows that the options that have presented themselves so far contain no panacea. When asked about the hospital’s selling points, the optimistic Grussing talks about the employees and the quality of care.

“I can’t offer a hospital full of private patients, or even patients that can pay anything,” he said. “But what we do have is an excellent, excellent staff.”