Los Angeles County supervisors scrambled Tuesday to fix an array of problems in their health system, moving to ease overcrowding in the County-USC psychiatric emergency room and train more nurses to provide specialized medical care.
The actions came in response to Times articles describing dangerous delays in critical care at County-USC Medical Center, including the deaths of three patient after prolonged waits for dialysis.
A county grand jury also weighed in on the hospital this week, warning that its psychiatric emergency room is unsafe to patients and staff. The ER, which was built to accommodate eight patients but normally holds 20 or more, is so cramped that some patients are treated insensitively or left dangerously unsupervised, doctors and nurses say.
The solution to that crisis, which has bedeviled hospital officials at least a year, appears simple: opening up 39 vacant beds in another county hospital for patients backed up in County-USC's psychiatric emergency room. On a motion by Supervisor Mike Antonovich, the board told its health staff to determine how much that would cost and report back in two weeks.
The board also approved spending $2.5 million to retrain county workers in nursing specialties. Although such nurses are in short supply across the county, a power struggle between the board and the county's largest union had stalled the use of this money until now.
Health officials will tell the board in two weeks precisely how it will be spent.
The supervisors also launched a two-month study of their entire $2.4-billion-a-year health department to find any other deficiencies in emergency care like those The Times described at County-USC.
In this county, with more uninsured residents than anywhere else in the nation, the public health system has long struggled to achieve solvency and efficiency. On Tuesday, supervisors lashed out at everyone--bureaucrats, unions and one another--as obstacles to reform.
"We have a critical problem," Supervisor Zev Yaroslavsky said. "We see it plastered on the front page of the paper, and we knew it was there before it was plastered on the front page of the paper."
Supervisor Yvonne Brathwaite Burke asked health officials for reports on when services are curtailed because of staffing shortages. At County-USC, beds and operating rooms are often closed to patients because there aren't enough nurses to staff them.
"We don't have any idea how many more people become seriously ill or maybe even die" from nursing shortages, Burke said.
"I really look forward to that report," Molina said. "It is the one that is going to tell us there are deficiencies in every single area."
"All these issues," she concluded, "are going to require real dollars."
The flurry of motions constituted amendments to Molina's initial proposal to beef up the county's nursing recruitment and retention. Until she paid a surprise visit and ordered changes earlier this year, it took a minimum of six weeks to hire a nurse at County-USC.
Several supervisors denounced the former administrator of County-USC, Roberto Rodriguez, and their own former health director, Mark Finucane. Both men resigned in March and stepped down Saturday, though Finucane continues to work as a county consultant.
Molina was incredulous that vacant beds that could be used for patients bottlenecked in County-USC's psychiatric emergency room exist elsewhere in the county's massive health system.
"That [County-USC] is getting these patients when there are empty beds in other hospitals is unbelievable," she said.
Antonovich led Finucane's temporary replacement, Fred Leaf, through a careful series of questions about whether Rodriguez had adequately considered easing the overcrowding by using the empty beds at Olive View Medical Center in Sylmar.
"The director at the time doesn't appear to have evaluated alternatives," Leaf told Antonovich. "This is a fairly basic management responsibility and I agree with you, the manager at the time should have addressed this."
In interviews last month, County-USC administrators said using vacant beds at Olive View was one way to ease overcrowding in their psychiatric emergency room, but noted that it would require board action.
The board lashed out at county health officials in general, whom they have long accused of moving too slowly to correct inefficiencies. "Why can't the bureaucracy on its own meet the needs" of patients? Antonovich asked.
"Why does it take micromanaging or replacing the head of the department?"
Yaroslavsky also blamed the Service Employees International Union, Local 660, which has been quarreling with supervisors over who will control $40 million in retraining funds the county got last year. The union, which lobbied hard for the money, wants to have an equal say in its expenditure. Supervisors have balked at that.
After complaints from the union about the delay in freeing up the money, Yaroslavsky proposed spending the $2.5 million the county can immediately use on training nurses to work in intensive care or dialysis units--two areas that have been subject to deadly delays. He challenged the union to let Leaf draw up a plan.
"I have no objection as long as labor is a full and equal partner," said Kathy Ochoa of Local 660.
An angry Yaroslavsky accused the union of delay. "I suppose if Local 660 kicks up enough of a fuss, Mr. Leaf will say he needs another two weeks--and maybe in that time someone else will die in the dialysis unit at County-USC," he said.
Ochoa later said she saw no problem with Yaroslavsky's proposal.
Molina, who has often battled with Yaroslavsky over the health system, said he was being unfair to the union. As for the blame, she said, "there's enough to go around for every single one of us."