Despite Deficit, Board to Study ER Expansion

In a blunt display of the politics that undergird Los Angeles County’s ailing health system, county supervisors Tuesday moved toward expanding emergency facilities at three county hospitals even as they anticipate cutting other health services to deal with a looming $1-billion deficit.

They voted to draw up plans to expand emergency and operating rooms at Harbor-UCLA Medical Center near Torrance and study adding emergency room beds at Olive View-UCLA Medical Center in Sylmar and High Desert Hospital in the Antelope Valley. The three facilities lie in or near the districts of four of the five county supervisors, who argued that they were overwhelmed by patients and needed expansion.

Most notable was the hospital left off the list: County-USC Medical Center in Boyle Heights, the West’s largest public hospital. The supervisors have decided to downsize it to meet federal demands that they focus more on efficient outpatient care than expensive but politically popular hospitals.

That facility lies in the district of Supervisor Gloria Molina, who has tense relations with her colleagues and was the lone supervisor to object to preparing for the expansions.

Critics have long argued that the county’s six public hospitals are used more as political chits than instruments of sound medical policy.

The discussion comes as the county prepares for hundreds of millions of dollars in possible health cuts triggered by shrinking federal funds to treat the uninsured.

Supervisors had been scheduled only to authorize $1 million to draw up plans to expand the emergency and surgical rooms at Harbor-UCLA, which straddles the southern districts of two supervisors: Yvonne Brathwaite Burke and Don Knabe. For two years, the two have lobbied to expand Harbor’s emergency room--saying it is dangerously overcrowded--but have been unable to get any of the other three supervisors to support them.

On Tuesday, the supervisors from the southern half of the county joined with the two representing the northern half: Mike Antonovich and Zev Yaroslavsky. With the unannounced addition of the two northern hospitals to the list of those to be studied for expansion, all four voted to approve drawing up Harbor expansion plans.

The board is still several votes away from permanently approving the expansion. But placing Olive View and High Desert in the mix was a new step for a board that has tried to emphasize shrinking--rather than expanding--hospitals.

Yaroslavsky, one of the most vocal proponents of that approach, said the board was only seeking information and did not decide to spend any extra money.

“It was just Mike Antonovich’s and my effort to say while we’re building a new hospital in Boyle Heights and we’re expanding another in Torrance, don’t forget about these two facilities--let’s at least know what the needs are,” Yaroslavsky said after the vote. “It’s not like it’s a need for our hospitals.”

He argued that the process paralleled an earlier assessment of the needs of County-USC, which ultimately led to the controversial decision for a smaller facility.

But Molina was skeptical.

“Any kind of needs assessment . . . is going to demonstrate that there’s a huge need,” she said after the motion was unveiled. “I think it’s inappropriate for this board to be adding onto the tab when, in reality, there are discussions going on and people saying, ‘Well, we’re going to have to close one of our hospitals. We’re going to have to close some of these beds.’ ”

Molina was alluding to the dire budget situation in the county Department of Health Services, which almost dragged the county into bankruptcy in 1995 until the federal government bailed it out. But with Washington now cutting its aid to Los Angeles, the health department faces a $100-million deficit next year, which will grow to $884 million by 2005. Further federal cuts will take away an additional $120 million by 2007.

Supervisors have demanded that the department prepare plans to close those deficits, but at the same time have taken steps to expand politically popular health programs in ways that complicated efforts to bring the county budget in line.

Last year, for example, supervisors approved $12 million in anti-smoking programs against the advice of the health department.

County health officials even had proposed closing High Desert Hospital earlier this year--only to run into stiff opposition from Antonovich, who complained that the department did not consult with the community or study any alternatives. After shooting down that proposal, Antonovich helped oust the health department director, Mark Finucane.

In the midst of their moves Tuesday, supervisors continued to interview applicants to replace Finucane as head of the nation’s second-largest public health system. The board’s action on hospital emergency rooms shows the treacherous political waters that a new director will have to navigate.

Despite the suggestion Tuesday that the emergency rooms would be expanded, county officials were divided over whether they ultimately would commit to spending county money on the fraying hospital system. They said they had to approve the Harbor studies to qualify for state funding of a renovation project there that could ultimately cost $100 million.

“I don’t interpret any of the actions today as either committing to build Harbor . . . or to do anything at Olive View or anything at High Desert, but it’s a matter of adding additional information to the equation,” county Chief Administrative Officer David Janssen told the supervisors.

But Knabe replied, “I interpret it differently.” He and Burke said they did not want Olive View or High Desert projects to leap ahead of Harbor, noting that the South Bay hospital expansion has been studied since 1993.

Yaroslavsky said the studies could reveal that there is not an adequate need for expansion. “It doesn’t mean one way or the other whether it’s going to get done.”

But the motion approved by the board stated flatly that the medical facilities need expansion. “The [Olive View] emergency room must be either expanded or replaced to provide the appropriate care that our patients need, including adequate patient triage and privacy,” the joint motion indicated. Creating an emergency department in Antelope Valley would ease pressure on the area’s other hospital, which had to turn away ambulances 40% of the time last year, Antonovich and Yaroslavsky wrote.

Kathryn Barger, Antonovich’s chief of staff, said it was not her office’s intent to imply that county staff must conclude that expansions are warranted. She said Antonovich has had to push the needs of the two hospitals in his districts, especially after officials at the private Antelope Valley Hospital said they were deluged with patients who should be at a county emergency room.

“Mike’s not stupid; he knows there’s not a fountain of money out there,” Barger said. “But just like Gloria has to be responsible to her district, Zev has to be responsible to his district, we have to make sure we fulfill our responsibility to our constituents.”