Fight Over Hospital Plan Escalates

In back rooms and boardrooms, a game of high-stakes political chicken is escalating between the county’s five elected supervisors and a powerful coalition of Los Angeles-based state lawmakers over what kind of hospital should replace the gargantuan County-USC Medical Center.

And like most contests of brinkmanship, no one knows for sure whether one side or the other will blink, or whether they will collide in a dramatic pileup that could have ramifications for millions of Angelenos--especially poor and uninsured Latinos on the Eastside.

The underlying issue is simple: How big a medical center should be built to replace what is arguably the largest public hospital in the world, as well as the linchpin for the public health system in the largely Latino Eastside and the county’s overall trauma network.

But the politics are dizzyingly complicated.

After years of hand-wringing, study and debate, four of the county supervisors voted against their Eastside colleague Gloria Molina last November and approved a new 600-bed facility to stand next to the aging and earthquake-damaged hospital in Boyle Heights.

They said they couldn’t afford to build anything larger, despite dire predictions by medical experts of the sick and dying being turned away and ambulances diverted. At the moment, County-USC is serving more than 800 patients, so building a 600-bed hospital and trauma center to replace it could leave scores of sick and injured without a local hospital at which to seek treatment.

Nevertheless, the supervisors said not only that they could not afford a larger hospital, but also that they didn’t want one, since the federal government was providing them with hundreds of millions of dollars to transform their hospital-heavy health system into one emphasizing preventive care in community clinics. The supervisors said they believe a 600-bed hospital will fill the need in the future as they beef up other parts of the health care system.

The vote angered a coalition of mostly Latino state lawmakers and Latino Caucus members who had sided with Molina. Among them were some powerful figures, including Assembly Speaker Antonio Villaraigosa and state Sens. Richard Polanco and Hilda Solis.

The Democratic coalition threatened to withhold state funds for the county if it did not reverse course and approve a 750-bed facility, which they said is the absolute minimum number of beds needed to provide the poor and indigent of the Eastside with even a threadbare safety net.

This week, as they continue deliberations over the state budget in Sacramento, the coalition is making good on that threat. It has made it clear that if the supervisors don’t build the bigger medical center, they won’t get about $130 million in critically needed state construction funds to build any size hospital.

Larger Threat From Capitol

And there has been a larger, mostly implied, threat as well: The coalition is becoming extremely powerful in Sacramento, especially with Villaraigosa’s meteoric rise to the top Assembly post. And if the supervisors don’t play ball, they’re being told that the coalition’s clout can, and will, be used to punish the nation’s largest county, which depends on the state for hundreds of millions of dollars for local health, welfare and public safety programs.

Publicly, coalition members won’t say that. Instead, they say they only want to use their influence to help the county get the state and federal funds it would need to build the bigger hospital and better serve their own constituents.

But the hints of retaliation are not always subtle. Said first-term assemblyman and coalition member Gilbert Cedillo, “I will say that it is important for the county of Los Angeles to have a good working relationship with Sacramento and particularly the Los Angeles delegation.”

The county supervisors aren’t pleased, suggesting that the threats, veiled or otherwise, amount to political blackmail. At the same time, the supervisors aren’t above a little threatening of their own.

On Tuesday, after hours of debate and often rancorous exchanges with Molina, the board settled on a route that will cost taxpayers more money in the short run but could leave them better prepared for the future, and at the same time turn the tables on their Sacramento counterparts. They voted 4 to 1 not only to proceed with spending as much as $46 million on architectural plans for the 600-bed facility, but also to draw up blueprints for a 500-bed facility, even though proceeding with both plans will cost the county about $400,000 a month.

The exact amount of money the coalition is threatening to withhold changes virtually day by day, depending on a complex mixture of state funding formulas and health-care reimbursement rates. But the supervisors have decided that 500 beds is the most they could build without it.

Although no one said it, the supervisors’ message to the coalition was clear: If you don’t give us the money, we’ll just build the smaller hospital and let you explain to all of your constituents why you withheld the money.

Even as they did that, the supervisors stressed the importance of continuing to work with the coalition. But Supervisor Zev Yaroslavsky, who represents the Westside and parts of the San Fernando Valley, said he wouldn’t vote for a 750-bed facility. And Supervisor Mike Antonovich said he would love to build the 500-bed hospital and funnel the savings into beefing up law enforcement.

A 750-bed hospital would cost the county more than $1 billion, compared with $818 million for the 600-bed facility. And the last thing the county wants to do, Antonovich said, is build a “Taj Mahal” that it cannot afford to staff and operate, especially after the embarrassing spectacle of having to leave the new Twin Towers jail shuttered for a year in 1996 because there was no money to run it.

“If the state wants a 750- or 800-bed hospital,” Antonovich said, “then let them pay for it.”

Last week, the supervisors offered a compromise--a pledge to build a 150-bed hospital annex in the future if the main 600-bed hospital can’t handle the load.

That was shot down by coalition members, who demanded to know in a letter why the county wouldn’t accept their peace offering, which was to have the county build a 750-bed hospital “shell” but only staff it initially for 600 beds.

“To date, there has not been an explanation provided as to why this proposal is not feasible,” said the July 6 letter, signed by 14 coalition members.

Coalition Members Feel Betrayed

Sen. Hilda Solis (D-El Monte), whose constituents are served by the hospital, said that she and other coalition members helped provide the county with emergency funding during its fiscal crisis in 1995, and that they feel betrayed by the county’s refusal to budge on the issue.

The coalition members, Solis said, aren’t the ones playing games.

“We are not the ones who put a motion on the floor saying if we don’t get the money, we’ll go down to 500 [beds],” Solis said, noting that even the board’s own experts, including Health Services Director Mark Finucane, initially recommended a 750-bed facility.

“We fought for them tooth and nail” in recent years, Solis said of the supervisors, “and now they are coming up to me with something that is just not rational. I’ve got to think about the constituents that I represent.”

For his part, Finucane now says he supports a 600-bed hospital, especially since the latest configuration calls for an enlarged emergency room and trauma center, and a plan to divert non-critically injured patients to private hospitals under public/private partnerships. Moreover, a plan to add several smaller, comprehensive health care centers will meet the county’s needs, he says.

The coalition isn’t buying it, and says Finucane is only siding with the supervisors because they can fire him at will. At last Tuesday’s board meeting, Molina agreed, echoing the concerns of more than a dozen community activists who also pleaded with the supervisors to vote for a bigger hospital.

“It is a dramatic shortfall in beds, and that’s why there is no one here testifying that you’re [going] in the right direction,” Molina said, adding that the hospital’s current census is about 860 patients. “This is the beginning of the breakdown of the only safety net we have ever had.”

Molina has insisted all along that the county will have to pay for the medical care of the indigent one way or another, and that treating them at a new County-USC is better, and cheaper, than contracting for beds at private, for-profit hospitals. She told her colleagues that their refusal to compromise on bed number is “a dastardly decision . . . and an irresponsible decision.”

As for the coalition that is siding with Molina, she said: “The Legislature is taking a stand. I applaud them for their effort. They have to.”