Layoffs of VA Hospital Doctors Begin; Critics Predict ‘Lethal Crisis’

In a move that has outraged physicians, administrators at the Veterans Affairs Medical Center in West Los Angeles on Wednesday began notifying 29 of its 211 doctors that they will lose their jobs by August as part of cutbacks at veterans hospitals nationwide.

The cuts--which officials say could eventually affect as many as 300 staffers at the facility--follow similar layoffs last month at the Long Beach Veterans Memorial Medical Center, where 22 physicians, some of them part-timers, lost their jobs.

VA officials say the layoffs are part of a national reorganization plan and compensates for overstaffing at the two hospitals, reflects a prolonged national shift to outpatient care and will not affect the level of patient care.

But physicians--contending that doctor-patient ratios at the two hospitals are not seriously out of line with the national average--said Wednesday the layoffs are the unkindest of medical cuts and could result in a “lethal crisis” for the medical centers.

“Unfortunately, this is only the beginning--they’re just getting started,” said Dr. Robert Kaplan, president of the Long Beach VA Physician and Dentist Assn. “And patient care is going to suffer as a result.”

The cutbacks are part of a reorganization of veterans health care administration over the past 2 1/2 years, in which staff positions have been reduced by more than 21,000 and acute-care beds by more than 14,000 nationwide.

“We are reorganizing the way we provide health care. We are no longer a hospital-based system. We are an integrated network . . . [with] hospitals and outpatient clinics working like a consortium,” said Linda Stalvey, a spokeswoman at the Department of Veterans Affairs, in a recent interview.

The reorganization, she said, seeks to eliminate duplicated services and allocate resources based on the number of patients served.

Overall, the local region, which encompasses centers in Southern California and Nevada, received a 2% budget increase this year, Stalvey said, but the VA hospitals in Long Beach and West Los Angeles have been forced to cut back.

West Los Angeles hospital spokesman Dave Bayard said the number of patient beds--a measure of how much acute care is available in a hospital--has decreased from 1,204 in 1980 to 771 this year. The average length of stay for patients has dropped 50% in recent years, he said.

“A decade ago, just 10% of surgeries were done outpatient,” Bayard said. “Now that number is up to 70%. All of this calls for fewer doctors.”

Bayard said affected physicians were being contacted Wednesday to schedule individual meetings with the facility’s chief medical officer. He said the projected target date for the layoffs at the Westside facility is Aug. 29.

He said the goal was to cut $10 million from the facility’s $291-million annual operating costs. In addition to its 211 doctors, some of whom work part-time, the hospital employs 580 registered nurses and 484 other nursing staffers.

Long Beach officials are looking to cut $15 million in operating costs. Kaplan said doctors there received 30-day layoff notices in mid-June and departed during the past weekend.

Neither facility could estimate the number of nurses that will be cut in the coming months. Bayard said the physicians would be pared from specialties across the board, from cardiology to pathology.

Veterans groups on Wednesday said the effects of the cuts at centers nationwide will depend on what kind of doctors are laid off.

“Laying off doctors who have some specialty that is not easily found elsewhere is bad news,” said David Gorman, executive director of Disabled American Veterans in Washington.

“But if you’re simply reducing the work force, that may not be a bad thing for patients. Because you can probably hire three registered nurses or physician assistants for the same amount of salary dollars as one doctor and treat two or three times as many patients. And that would be good news”

Last week, a judge refused to issue a temporary restraining order to stop the Long Beach layoffs, and lawyers for the doctors say they are unsure what move they will make next.

“The issue of patient care is raised by this lawsuit,” contended the doctors’ attorney, Andrea L. Cook. “And the loss of 21 physicians has a profound effect on a hospital. The VA hospital in Long Beach has lost some of its best and brightest physicians through this move.”

Kaplan said the wholesale loss of doctors may have an adverse effect on hospital budgets through the loss of research grants and other funding sources brought in by individual doctors.

“There will be longer waits and slower access to special things and basic primary services as well,” he said.

Kaplan also predicted that lab work and tests will have to be done on a contract basis in some cases, which could disrupt the doctor-patient relationship.

“This is not like a business where you can make widgets in a more efficient way,” he said. “Doctors see patients one at a time. There’s only so much you can do.”

Times staff writer Julie Marquis contributed to this story.