Hospital Dispute Raises Larger Questions

The ongoing battle over how big to build a new County-USC Medical Center, which will get its latest airing today, is developing into a face-off over the broader question of who gets to make Los Angeles County government’s most important policy decisions:

Should it be the local governing body--the Board of Supervisors?

Or, in an era in which the state is playing an increasingly dominant role in parceling out public funds, should the state Legislature have a bigger say?

The specific answers to these abstract questions are being worked out in a political arena in which the community most affected by the size of the hospital--Latinos on the Eastside--finds itself with a good reason to cheer for Sacramento.

Eastside Latinos have much more political clout there than they have in Los Angeles County government. They form a formidable leadership bloc in Sacramento that includes the speaker of the Assembly, Antonio Villaraigosa, and the president pro tem of the state Senate, Richard Polanco. By contrast, only one of the five supervisors, Gloria Molina, is Latina.

Molina said she sees nothing wrong with legislators seeking a say. Would anyone even be raising an eyebrow, she asks, if the legislators involved were Rep. Maxine Waters making a fuss about a decision affecting South Los Angeles, or Rep. Henry Waxman, on a decision affecting Westsiders?

In trying to preserve as much as they can of County-USC, Latino elected officials are fighting for an issue that has enormous symbolic, as well as practical significance. County-USC is the county’s largest public hospital and the only one east of downtown. It is the linchpin of the countywide trauma network. Its imposing granite facade is also perhaps the most important symbol of the social safety net, and of government in general, on the Eastside, where it known to some as the Great Stone Mother.

Assemblyman Gil Cedillo, a boyhood friend of the speaker and a Los Angeles Democrat whose district includes the Boyle Heights facility, is not shy about demanding more legislative influence.

To Cedillo, the supervisors’ decision to build a relatively small replacement for the antiquated, earthquake-damaged hospital, on the grounds that they may not be able to afford to operate a larger one, is shortsighted, irresponsible in light of opposition from the organized medical community--and reversible. “What infinite wisdom do they have?” he asks of the four supervisors who have so far outvoted Molina in favor of the smaller facility.

And why should they expect to have the sole say, Cedillo asks?

The state and federal governments pay most of the operating costs for the county’s health department, he notes.

“This question of local control rings a little hollow if someone else is paying the bill.”

Inability to Raise Taxes

Cedillo, who has taken the lead in recent months for a coalition of like-minded Eastside legislators, is accustomed to putting pressure on the supervisors. For years he tried to influence them as the head of the county’s largest public employee union. With his election to the Assembly last year, representing a district that sweeps through downtown and Koreatown, he has merely changed his venue.

“For me, he says, “this is a continuation of the Keep L.A. Healthy/Keep L.A. Working campaign we ran in 1995.”

That union campaign was organized in a successful effort to avoid massive firings of county employees and keep the county from closing County-USC altogether in response to an unprecedented budget shortfall.

The shortfall was largely traceable to Sacramento. Legislators there responded to their own, recession-inspired budget problems in the early 1990s by grabbing money from counties. They took control of hundreds of millions of dollars in property taxes--by some estimates $1 billion--that had long been under Los Angeles County’s control.

Cedillo recognizes that the grab, along with voter-imposed restrictions imposed on local governments’ ability to raise taxes, “remains the fundamental problem of local government.” And he intends to use that to his advantage in the case of County-USC.

In 1995, he said, the campaign he helped organize went national, reaching out to John Sweeney, the national head of Cedillo’s union who was then making a successful bid to head the AFL-CIO, the Rev. Jesse Jackson, Health and Human Services Secretary Donna Shalala and ultimately, President Clinton, who produced money for a bailout in time to help Los Angeles and his own reelection bid.

This time, the former union leader suggested, there will be a similar effort.

Sitting in the audience last week at the Board of Supervisors meeting, he remembered that he and some of his union colleagues had occasionally found it necessary to occupy legislators’ outer offices to make their points. Now that he is in an inner office himself, the struggle, as he sees it, remains the same: It is between those who believe that government exists to meet people’s needs and those who believe that government exists to “force the needs into a balanced budget.”

In terms of a County-USC replacement, needs were officially outlined in a 1996 report by USC professor of medicine and public policy Robert Tranquada. He concluded that 750 beds were necessary to replace the facility that is now operating with 860.

But last November, pleading poverty and citing the nationwide trend toward more outpatient care, the Board of Supervisors rejected Tranquada’s recommendation, which also had been embraced by the health department, doctors, hospital and community groups. Over the objection of Molina, they voted to build a hospital with only 600 beds.

Since then, a political melodrama has been unfolding that has rivaled in intensity the action on “General Hospital,” the long-running television soap opera that used County-USC as its facade.

Saying they could not live with the smaller facility, Eastside legislators pledged to withhold $140 million to $200 million in state construction funds that the county was counting on as part of its projected $800-million to $1-billion effort.

The supervisors countered with a promise to build an even smaller hospital unless the legislators let go of the funds. The legislators remained steadfast.

Hoping that the legislators would have a change of heart, the supervisors delayed pulling the trigger. They have been proceeding with design plans for both a 600-bed and 500-bed alternatives, knowing that only one will be built. To stop the waste, they have scheduled a showdown vote for today.

Because of private warnings by the head of the county health department and others that a 500-bed option is so small it would be a medical disaster, the supervisors are expected to back off from their threat and approve the 600-bed facility--hoping that a future Legislature will eventually decide to help them out, sources say.

But efforts at a broader compromise, underway as late as Monday, have foundered.

Compromise Is Rejected

In the first effort at a compromise, legislators offered to support 600 beds if they were contained in a building that could house 750 if needed. A majority of supervisors rejected that and countered with a proposal to reserve land next door to a 600-bed facility, on which a 150-bed addition could be built, if needed. Legislators dismissed that as a promise made of air.

Last week, Molina said, Supervisor Yvonne Brathwaite Burke approached her in a last-ditch attempt to broker yet another compromise.

Molina agreed to endorse a 600-bed facility--with an outpatient annex--if her colleagues would agree to a follow-up study on the need for more hospital beds.

If the study still found a need for 750 beds, the county would agree to convert the annex to an inpatient facility--or forfeit the state money it had accepted.

Legislators, Molina felt sure, would go along with that. But she said that Burke told her Monday that the rest of the supervisors would not.