Rebuilding Too Small Is a Mistake

On Tuesday, the Los Angeles County Board of Supervisors is scheduled to decide how many beds the planned new County-USC Medical Center should have. I believe the board would be wrong to consider building anything less than 750 beds--which is 100 beds less than the capacity of the existing Boyle Heights hospital and trauma center, which was damaged beyond repair in the 1994 Northridge earthquake.

Last November, the supervisors voted 4 to 1 to build a 600-bed facility, saying the county can’t afford any more and, in any case, it is shifting to a health care system that emphasizes outpatient care. But the fact is that County-USC is a critical facility for the people of this county, providing emergency, trauma care and other vital services, some of which are not available anywhere else. To decrease its capacity now, when service needs are growing, is foolish and short-sighted.

At the urging of a majority of the L.A. County Board of Supervisors, Gov. Pete Wilson recently vetoed a bill that would have provided $267 million in funding for a proposed replacement hospital because the board did not want to bend to the Legislature’s demand that it build a 750-bed facility. That was a mistake.

Although many people believe County-USC is there only for the poor, it actually provides vital services for all residents. Its specially trained trauma team of doctors, nurses and other health care professionals are available to treat anyone in its 20-minute trauma catchment area, no matter where they live, whether they have insurance or how much money they have. The hospital treats nearly a quarter of a million people in its emergency room yearly. It treats more trauma patients that any other center in the county.

County-USC Medical Center also is unique in that it is equipped to provide certain critical specialty services that are simply not available in the private sector. It has a specialized medical staff and equipment and can perform unique medical procedures in the fields of neurology, hematology, oncology, dermatology and diabetes. Many patients are sent to County-USC by hospitals in the private sector, which cannot provide these critical services.

In addition, thousands of babies in high-risk pregnancies are delivered at the hospital’s Women and Children’s Hospital each year--more than at any other facility in the county. The hospital’s Neonatal Intensive Care Unit provides after-care to infants with serious medical conditions.

The hospital also operates the largest of three burn centers in L.A. County, providing 45% of the county’s burn care. Health care professionals at the hospital treat half the HIV/AIDS patients and half the sickle cell patients in the county.

The argument that other, private hospitals will accept the overflow from a smaller facility is wishful thinking. Yes, other hospitals will take some of the facility’s indigent population, but only if the county agrees to pay a higher rate per patient than they have ever approved in the past.

The plan for 750 beds is the fiscally responsible plan. To build a smaller hospital now, with the promise to add on later, is foolish. Nor can we count on contracting out for services, since there are additional costs associated with this for both inpatient and outpatient care.

We must provide for the needs of all of us who live or work in Southern California, and may be sent to County-USC Medical Center. The experts--the Healthcare Assn. of Southern California, the L.A. County Medical Assn. and leading independent consultants--agree that the county needs a 750-bed hospital at minimum. A 600-bed hospital would reduce services beyond all reason.