Board OKs Report on Proposed Medical Center

Rebuffing requests for a delay by the new Assembly speaker, the Board of Supervisors on Tuesday approved the environmental impact report for a new County-USC Medical Center, taking another step toward rebuilding the Boyle Heights hospital at a size smaller than many Eastside residents and medical experts believe is necessary.

The replacement for the quake-damaged hospital is not scheduled for completion until 2008, but Tuesday’s vote marked a significant step forward for the controversial project. It also illuminated political pressures complicating the county’s ability to secure $1 billion in federal health funding in the coming year.

That funding, in the form of a waiver of federal Medicaid rules that allows the county to be reimbursed for non-hospital care, has been held up in a battle involving the county, state and federal governments over what each will pay. The current waiver expires June 30, and without it the county would be forced to close a $250-million deficit, possibly by cutting medical services to uninsured patients.

The federal government has been demanding that the state, with its $13-billion surplus, pay part of the waiver’s cost, but the County-USC battle has soured relations between the Legislature and the supervisors.

“I’m sure the governor and the speaker are not going to allow dollars to come into L.A. County . . . and shortchange East Los Angeles,” said Supervisor Gloria Molina, who has long fought her four colleagues’ decision to rebuild the hospital at 600, rather than 750, beds.

Assembly Speaker Bob Hertzberg (D-Sherman Oaks) wrote a letter to supervisors last week urging them to put off approving the environmental impact report, which must be completed before construction can begin. Hertzberg wrote that he had created a special Assembly committee to consider the looming health care crisis in Los Angeles County and urged that “we put aside our differences and come together in support of one plan.”

That request was echoed by Assemblywoman Gloria Romero (D-Los Angeles), who chairs the new committee and attended Tuesday’s meeting in an unsuccessful attempt to persuade the board to delay the project.

Supervisors were taciturn as they approved the environmental report on a 4-1 vote. “There has been a continuing dialogue going on with the state,” said Supervisor Don Knabe, who has negotiated with numerous legislators about the hospital during the last several years.

Knabe also pointed out that supervisors in 2002 will decide whether demand is such that a 150-bed annex should be built in Boyle Heights.

When the board decided to downsize County-USC, it did so amid the near-collapse of its health system in 1995. Since then, the county has been trying to shift from expensive hospitals to cheaper outpatient care. Supervisors and their health staff have argued that any patients who are turned away from a smaller County-USC could be sent to the county’s other hospitals, which are increasingly empty.

Molina challenged those contentions Tuesday with an array of charts and statistics, which she said showed “a tremendous elimination of health services on the Eastside” if the hospital was closed. Based on

the number of patients in County-USC beds today, there would be 189 patients who could not get treated in a 600-bed facility, she said.

Additionally, she said the county had planned to deal with patient overflow by contracting with private hospitals to care for uninsured county patients. But that effort has proved futile so far, she said.

“I present facts every time,” she said after the meeting. “They present no facts whatsoever.”

Director of Health Services Mark Finucane, who initially supported a 750-bed hospital but eventually lowered his recommendation, said he expects that by 2008, when the new medical center is completed, the county will find a way to contract for the care of those patients.

Also on Tuesday, supervisors were briefed in executive session about negotiations between their health officials and federal officials over the waiver’s future. The board went into closed session under a portion of the government code allowing them to discuss anticipated litigation outside public view.

County Counsel Lloyd W. Pellman said that was because the county could be sued if the waiver is not renewed and it must terminate contracts with private clinics. He could not identify a specific individual or organization that has threatened to sue the county.

Terry Francke, executive director of the California First Amendment Coalition, said that such an act appeared to violate the state’s public meetings law, which he said states “that if they cannot point to a particular threat by a particular person to the county, then any closed session is premature.”