Latino Leaders Demand Larger Hospital, Warn of Bailout Woes

A coalition of Latino officeholders demanded Wednesday that Los Angeles County supervisors reverse their plans to dramatically downsize County-USC Medical Center or face the lawmakers’ opposition to the county’s efforts to renew a federal bailout of its massive public health care system.

The group, led by Assembly Speaker Antonio Villaraigosa and Supervisor Gloria Molina, made clear at a legislative hearing in Los Angeles that it will ratchet up the political pressure on the supervisors to break years of gridlock over the size of a new County-USC hospital.

Villaraigosa (D-Los Angeles) said lawmakers may have to subpoena county supervisors and state and federal health officials to resolve the County--USC deadlock. “I can tell you this issue is not going to go away until the county comes to the table,” he said.

Unwilling to accept the county’s plans for a 600-bed replacement hospital, Molina vowed to press federal officials to consider the hospital issue before deciding whether to approve a five-year extension of the federal bailout that saved the county health care system from collapse in 1995.

Molina said “the community is going to be robbed of essential services” unless the county builds a 750-bed hospital in Boyle Heights or opens a smaller satellite hospital in the San Gabriel Valley.

Without hundreds of millions of dollars in federal assistance, Molina said the county’s health system will sink again. “We don’t have the ability to keep this system alive,” she said.

Villaraigosa and more than half a dozen of his legislative colleagues insisted that plans for a 600-bed County-USC are totally inadequate in a county with the largest number of residents in the nation who lack health insurance. “We don’t believe that meets the needs of the future of this county,” he said.

Offering an olive branch to the four supervisors who favor the smaller hospital, Villaraigosa said the Legislature is prepared to provide funds to help build and operate a larger facility.

But in the political environment of Sacramento and Washington, where there are no guarantees of long-term funding, such an offer is viewed skeptically by those who are ultimately responsible for running the county’s health care system.

Supervisor Yvonne Brathwaite Burke said in an interview that the 600-bed hospital would be the largest built in the country in the past 15 years. “The reality is we are doing what is consistent with every other place in the United States,” she said.

Burke said the county is relying on projections that show a continuing decline in the number of hospital beds that will be needed as the county attempts to build up its outpatient clinics and health centers. The expansion of outpatient services and the downsizing of far more costly inpatient care was the cornerstone of the 1995 federal bailout that avoided drastic cuts in the county’s health care system.

The supervisor said the rift with the Latino lawmakers is a result of the hospital becoming “a political issue that no one wants to give on.” She noted that some lawmakers are running for office on a promise of 750 beds. Indeed, Villaraigosa can use the hospital issue in his race for mayor of Los Angeles against a potential rival, Supervisor Zev Yaroslavsky.

In an interview, Yaroslavsky said the supervisors made “a gut-wrenching decision” on downsizing County-USC based on the changes that are taking place in health care. “It is commonly accepted that the number of hospital beds is diminishing. Hospitals are closing,” he said. “We have empty hospital beds in our system.”

The supervisor said the greatest need is for more primary care at community clinics. “The perpetuation of this political debate is not serving the needs of the uninsured.” He criticized state lawmakers for refusing to help the county build the new hospital while providing financial assistance to private hospitals needing seismic upgrades.

Board of Supervisors Chairman Don Knabe could not be reached for comment. Spokesman John Wallace said the supervisor welcomes a dialogue with Sacramento on the hospital issue. “By no means is the door closed. The supervisor is continuing to have discussions . . . with members in Sacramento. We are closer now than we were a year ago, so he is still optimistic that a compromise can be reached.”

Assemblyman Martin Gallegos (D-Baldwin Park), who chaired the hearing, said a solution must be found. “There is a train wreck approaching,” he said. “If we draw a line in the sand and paint ourselves in a corner,” the county will again face a health care crisis.

Against a barrage of criticism, county Health Services Director Mark Finucane sought to defend the decision of the four supervisors that a new County-USC will have 600 beds. He said opening a satellite hospital in the San Gabriel Valley is “a better idea than building 750 beds” in Boyle Heights. Building a 60 to 80-bed hospital in the San Gabriel Valley “makes better sense than adding beds to the medical center complex,” he said.

UCLA health care expert E. Richard Brown said 2.8 million county residents lack health insurance. Despite a stronger economy, he said, the uninsured population continues to grow by 20,000 people a month because many employers do not provide health insurance, especially in Los Angeles.

Dr. Robert Tranquada, former dean of the USC Medical School, said all but one of the studies done on the size of a new hospital concluded that more than 700 beds are needed. He said the uninsured population is growing much more rapidly in the core area of Los Angeles than the rest of the county.

Lark Galloway-Gilliam, executive director of Community Health Councils, said the struggle over County-USC--the linchpin in the county’s network of trauma centers--has to be settled. “Our politics are getting in the way of our moral obligation” to provide health care, she said.