Compromise Near in County-USC Stalemate

Signaling a probable end to one of the state’s most heated political battles, the county Board of Supervisors has coalesced around a plan to open a new public hospital in the San Gabriel Valley community of Baldwin Park, while rebuilding County-USC Medical Center in East Los Angeles on a smaller scale than some lawmakers wanted.

The precise size of the new facility has not been determined, because negotiations are ongoing between the board and influential Eastside lawmakers in Sacramento. Those legislators held up payments to the county in an attempt to force the construction of a 750-bed County-USC rather than the 600-bed facility settled on by the county.

But the board’s offer to build the Baldwin Park facility has broken a three-year stalemate over the issue and, what is most significant, is supported by Supervisor Gloria Molina, who has fought ferociously with her four colleagues over their decision to rebuild County-USC with 600 beds.

“This opportunity to build a San Gabriel Valley hospital is a really good one,” said Molina, who proposed the compromise. “That’s what it’s all about anyway. It’s not about building beds; it’s about how do we serve the community.”

Supervisor Zev Yaroslavsky, who has been one of the strongest advocates of keeping County-USC at 600 beds, said: “I think everybody is supportive of the concept of a small satellite hospital in the San Gabriel Valley. It’s an idea that has merit, and it’s worth pursuing to see if it would serve the needs of the county.”

The proposal has vast ramifications. It could rearrange the geography of health care in the Los Angeles region by creating a county hospital in an underserved area; it is 30 miles from Pomona to County-USC, the nearest public hospital that treats the uninsured. Opponents of the 600-bed Eastside hospital plan charged that it would offer too few beds to meet the region’s medical needs.

The potential deal also could heal rifts that have kept millions of dollars from Los Angeles County’s coffers, burned up countless hours of public debate and sparked back-room political battles.

“I think we might be able to work this out,” said Assembly Speaker Antonio Villaraigosa (D-Los Angeles), who has been negotiating with Board of Supervisors Chairman Don Knabe. “There’s an understanding that a hospital in the San Gabriel Valley could be a win-win.”

Even those still skeptical of the proposal, such as Assemblyman Gil Cedillo (D-Los Angeles), said they hoped the battle ends soon. “We should be solving this matter and moving on to other issues that confront the county and this region,” Cedillo said.

Still, he added that he believed the number of beds between the two facilities must total 750--a number still being debated. “Every study has indicated the need for 750 beds,” he said. “I wouldn’t be supportive of 25 less.”

Before the agreement is sealed, the two sides must agree not only on the two hospitals’ sizes, but also on how to fund construction. If, as expected, the plan requires state money, it would have to be approved by Gov. Gray Davis.

“If we can nail down the specifics on the numbers and funding, I think this is something that could happen in the near future,” said Assemblyman Martin Gallegos (D-Baldwin Park), who represents the area where the new hospital would be located. “The community has grown out here in east Los Angeles County, and there’s such an underserved population that it just makes common sense to have a facility out here.”

Call From Real Estate Agent Led to Action

The board has been quietly negotiating with Sacramento lawmakers for months to try and settle the hospital feud. Molina said the Baldwin Park solution appeared just recently, when a real estate agent called her trying to sell the defunct Baldwin Park Community Hospital. Knabe then began negotiations with the Eastside lawmakers, represented by Villaraigosa, who since becoming speaker has held back somewhat from the ongoing struggle between Latino lawmakers and the board.

Molina said she is willing to pay for the property with her office’s discretionary funds. The price has been put at about $3 million.

The first formal offer came June 25, when Knabe proposed that the county build a hospital on the site of the Baldwin Park Community Hospital that would function as an “east campus” of County-USC.

Knabe’s proposed facility would contain 60 beds and cost $37 million annually to operate and cover debt service from construction costs. In return, he proposed that the state release more than $100 million in construction funds it held last year after the four-member majority of the board decided to rebuild a smaller County-USC.

On Thursday, Villaraigosa proposed a 125-bed facility, saying medical experts agreed that was the minimum size needed to meet the needs of the community. He said the state was willing to fund the $12 million difference between the two proposed facilities.

Supervisors and other county officials have been extremely hesitant to comment publicly for fear of souring negotiations, but privately they have been very hopeful.

“This has really been a thorn in everyone’s side,” one supervisor’s aide said. “It’s really been something to get this to where it is.”

The battle over County-USC has transformed arcane disagreements about medical policy into rallying cries for an all-out political war.

Medical experts and Molina protested the board’s 4-1 decision, formally reached last summer but in the works for almost a year, to rebuild it to a 600-bed facility. They warned that a facility of that size--a third smaller than the current Boyle Heights hospital--would not adequately serve Los Angeles County’s growing uninsured.

Supervisors countered that the county had ample empty hospital beds elsewhere in its sprawling health system and that it had been directed by the federal government to shift from a costly hospital-heavy system to one based on preventive care in outpatient clinics. Reliance on expensive hospitals contributed to the county’s near-bankruptcy in 1995.

But Molina, in whose district County-USC sits, would not budge. She argued against the decision in countless meetings, once accusing her colleagues of racism, for which she swiftly apologized. Her insistence alienated her from her board colleagues.

Molina also helped rally an unusually united coalition of Latino legislators to pressure her colleagues to build a 750-bed facility. The lawmakers held up the construction money, but the board would not change its mind. The legislators introduced a bill to force the county to spend its settlement from a lawsuit against the tobacco industry. They wrote into this year’s budget a provision withholding $7 million in health funds unless the county builds a bigger hospital.

Gov. Davis excised the last proposal from the budget last month, but he warned legislators and the county that he hoped the issue was solved by the time he drew up next year’s budget. By then, Knabe had already begun negotiations with Sacramento.

The moves toward compromise are startling because both sides for months have refused to shift from their numbers, with proponents of a 600-bed facility insisting that a larger one would be too costly and advocates of a 750-bed hospital saying anything smaller would not meet existing medical needs.

Even those involved in the battle privately admitted the fight has become as much about egos as public policy.

Sources close to the board--which had maintained that more hospital beds were too expensive and were unneeded--suggested that the smaller Baldwin Park facility would be cheaper to operate than an enlarged County-USC. Under the board’s original plan, patients who could not be seen at a downsized County-USC would be treated by private sector contractors, something that would be eliminated by the San Gabriel Valley facility.

Yaroslavsky said the state’s possible contribution could take care of financial concerns.

“If the state will help pay for the construction and operation, then we don’t have a financing issue. That’s something that needs to be worked out.”

Molina said new studies show a total of about 715 beds may be adequate and that she has always said she was interested in meeting medical, rather than numerical, targets.

“I don’t think I’m backing off my position,” she said. “What I’m saying is it’s fulfilling the need.”

She noted that neither side will get exactly what it initially sought.

“Everyone’s got to give a little,” she said.