Politics Bodes Ill for Aging Hospital

A 40-year-old building just outside Torrance is on the verge of becoming Los Angeles County’s latest political hot potato.

The structure houses Harbor-UCLA Medical Center, a 340-bed public hospital serving a vast uninsured population, as well as treating thousands of Angelenos who have health coverage. As a consequence of those numbers, the emergency and surgery rooms are so cramped that hospital officials say gurneys are crammed next to each other and, in one instance last year, the power went out during an operation because the wiring could not handle the electrical load from modern medical equipment.

Everyone agrees that emergency rooms and operating theaters must be rebuilt. But there are disagreements over when that $230-million renovation, already delayed for seven years, should begin. Some county supervisors say that if they do not act soon, the hospital and its patients will be at risk, while others charge that rushing the project may lead to the sort of wasteful spending that nearly pushed the county into bankruptcy in 1995.

Unable to muster sufficient votes to jump-start the long-delayed project, Supervisor Yvonne Brathwaite Burke last week agreed to wait four months while a consultant studies whether the addition should be built according to current plans or be scaled back.

The dispute highlights not only the needs of the aging hospital, but how the relationships among just five people--the county supervisors--shape the nation’s largest public health care system. At a time when the five lawmakers are unusually united in decisions ranging from the child welfare system to the county budget to leases in Marina del Rey, public hospitals remain a source of friction.

Though Los Angeles County is trying to move away from the costly hospital-based health care system that nearly led to its insolvency, hospitals remain prized, hundred-million-dollar institutions with a high level of community recognition. And because they deal with life-and-death issues that affect all reaches of society, managing the hospitals is the easiest understood, and perhaps most critical, of the many duties entrusted to supervisors in the often obscure, byzantine county bureaucracy.

Leading the push to begin the Harbor-UCLA Medical Center renovation is Burke, in whose district the facility is located. Last month, she surprised her colleagues when she moved to fast-track the project by spending $1.7 million to update the design on the new surgery and emergency rooms. Any delay, she said, would jeopardize about $80 million in state money that is available only until June 30.

“One out of three people in Los Angeles County [doesn’t] have medical insurance,” Burke said in an interview. “Those people look to us for their care. And surgery is a matter of life and death.”

But Burke’s move to fast-track the plans met opposition from three of her colleagues, who said that although it was clear new facilities were needed, the project may be too ambitious and needed careful scrutiny. The group includes, surprisingly, Supervisor Gloria Molina, who has fought bitterly against the downsizing of the hospital in her own district, County-USC Medical Center.

Molina argued that County-USC had to go through a multiyear evaluation process before the health department recommended the quake-damaged facility be rebuilt at 750 beds--only to eventually scale back its recommendation when a board majority proposed a 600-bed replacement. “We’ve put [County-USC] through a justification process,” Molina said. “The reality is, you can’t just run over the process.”

On the Harbor-UCLA issue, Molina found herself allied with Supervisor Zev Yaroslavsky, perhaps her greatest foe on County-USC. Yaroslavsky agreed that the Harbor project needs greater scrutiny, saying that the county was “at a crossroads,” turning from “an old Soviet-type system of big government, big buildings,” to one oriented toward community-based, outpatient clinics.

How these alliances developed and how a project that medical staff members say is critically needed was delayed for seven years tells a great deal about how Los Angeles County government runs and the pressures on the county’s medical system.

The story begins in the early 1990s, when the county was beginning to feel the pinch of the recession but, borrowing money from a variety of sources, still had dreams of expanding its medical system. The board compiled a list of medical projects, which was topped by rebuilding County-USC Medical Center and building a hospital in the San Gabriel Valley. Also on the list was the Harbor-UCLA remodeling.

In 1992, plans for 15 new surgery rooms were drawn up. The health department said the project could be funded for savings from a smaller County-USC, then planned to have 946 beds. Burke said she supported the downsizing of County-USC based on the assumption that it would free up money for Harbor-UCLA.

“Everyone’s sort of playing dumb right now” about the connection, Supervisor Don Knabe said in an interview earlier this month. But “I clearly understood that part of this whole process was to allow the surgical unit to be upgraded,” added Knabe, whose district borders Harbor and who supports moving the project ahead.

Four years later, all bets were off. The recession and the county’s massive spending on its public hospital system had combined to push Los Angeles to the brink of bankruptcy. Only a federal waiver of Medicare rules was able to free up $1 billion to keep the county solvent. But that bailout was contingent on Los Angeles shifting from its pricey hospital-based system to one geared toward cheaper outpatient clinics.

It was in this atmosphere that, after months of research, the board voted to scale County-USC back to 600 beds, infuriating Molina and bucking recommendations from various parts of the medical community. One surprising break was between Molina and her frequent ally Burke, who joined the rest of the five-member board voting for the smaller hospital.

Molina marshaled an unusually unified group of Eastside legislators who pushed the board to reconsider its vote. In a compromise reached last year after months of battling, the county and state are to join together to fund a new branch of County-USC in Baldwin Park. But County-USC remains a sore point among all camps at the Hall of Administration.

The rise in tax revenues due to the economic boom in California has made the fiscal crisis of the mid-’90s a distant, if still vivid memory. Over the last two years, the county has begun revisiting long-delayed capital projects.

Then, during the final board meeting in late December, Burke startled her colleagues by trying to revive the Harbor-UCLA renovation. She said it was an urgent matter to update the project to secure about $80 million in state funding that would be lost if plans were not ready by June 30. She also said that if the work wasn’t done, the hospital’s accreditation with the federal government would be jeopardized--a possibility medical officials later downplayed but said could eventually be a possibility.

But Burke’s colleagues were skeptical. The state money, they said, always could be secured later by legislation. And Supervisor Mike Antonovich reminded Burke that a similar project involving Olive View-UCLA Medical Center, a hospital in his district, had been scaled back after careful scrutiny.

Supervisors also pointed out that the last assessment of the project was in 1993, when Harbor had nearly 100 more beds and the county was still in expansion mode. The plans called for 15 operating rooms; by comparison, the new County-USC will have only 24 operating rooms although being nearly twice the size of Harbor.

“No one wants to overbuild anything,” Burke told her colleagues. “I’m not trying to build a temple. I’m just trying to take care of a hospital so it doesn’t close down.”

Last week, the health department was able to get a six-month reprieve from the state, enabling it to hire an outside consultant to assess whether the project needs to be downsized. With that breathing room, Burke agreed to postpone the matter.

In an interview, Burke said she will not make a political issue of the Harbor-UCLA situation, contrasting it with the lengthy battle over County-USC. “I’m not running for office based on whether Harbor is built,” she said.

Molina in an interview said political pressures regarding hospitals are inevitable--”there’s always been a push to politicize these decisions,” she said--but added that the Harbor issue should be guided by medical need, as she said her stance on County-USC has been.

At the hospital itself, administrator Teckla Mickoseff said that the number of patients requiring surgery is rising--although the number of patients in hospital beds countywide fell during the past decade. She said it can be difficult even getting severe cases into the intensive care unit.

“We really need this replacement,” Mickoseff said.

Mickoseff said that she thought reevaluating the scope of the project was “appropriate,” given the age of the plans. But, she added: “I would hope that if we revisit, we do that expeditiously so we can revise and move on and not wait another seven years.”