Wounded System Still Stands

Perhaps the greatest achievement of the Los Angeles County health-care system in 2002 was avoiding complete collapse.

Core programs such as emergency and trauma care remained intact as voters endorsed a property tax increase that will yield $168 million annually.

But the county’s reprieve came at a cost to its poorest residents, who saw 16 health centers closed and cutbacks at dozens of private clinics. More than 455,000 patient visits were eliminated and about 100,000 patients were affected.

With the state struggling to close a deficit of nearly $35 billion and the federal government insisting that it won’t grant another bailout, the county health department may face another year on a financial precipice.

“It’s kind of like hanging around in the hut, waiting for the avalanche to hit -- and hoping that it doesn’t come,” said Yolanda Vera, senior health policy attorney with Neighborhood Legal Services of Los Angeles County, which advocates for indigent patients.

Some people already feel the pain.

Gary Mayer, an uninsured 41-year-old diabetic, used to seek care at the county’s Azusa Health Center, less than 2 1/2 miles from his home, until the clinic closed in September. Now he travels 11 miles to the El Monte Health Center, or 22 miles to the Los Angeles County-USC Medical Center, for doctor visits and prescription refills.

Walk-in patients at El Monte often wait four hours to be seen by a doctor or nurse, said Mayer, who has had eye and foot complications from diabetes. The wait for prescriptions also can take hours.

“You sit there all day long,” Mayer said. “You have to go real early in the morning just to see the doctor.... If they have too many people, they’ll tell me to come back.”

Things may deteriorate. The Board of Supervisors is poised to close the county’s two hospitals without emergency rooms: High Desert Hospital in the Antelope Valley and Rancho Los Amigos National Rehabilitation Center in Downey.

Claudia Noyola, a patient resource worker at Rancho, said she is concerned about her job and about where disabled patients will find care if the decision to close the hospital stands. Rancho, which is nationally known for its innovative treatments, sees about 9,500 people each year for a variety of catastrophic injuries and ailments, including stroke and diabetes, liver problems and spinal cord and head injuries.

“I’m a single mother and I have to feed my child, so yes, it worries me,” said Noyola, 26, of Downey. “There has to be better ways for them to find money than just closing this place.”

But the cuts could have been much worse. In the summer, county officials proposed closing the emergency rooms and inpatient services at two of the four full-service public hospitals -- Harbor-UCLA and Olive View-UCLA medical centers -- if new money weren’t found.

County voters gave the facilities a reprieve on election day, voting to raise property taxes to fund emergency and trauma care.

The tax initiative, called Measure B, got more votes than any person or issue on the county ballot. It will raise taxes by 3 cents for every square foot of residential and commercial development, or about $45 for a 1,500-square-foot home.

“The most painful decisions have been at least put off temporarily, if not permanently,” said Linda Rosenstock, dean of UCLA’s School of Public Health. “For that, I think we can credit the public’s concern about their own access to emergency services.”

Even with the new property taxes, conservative projections indicate that the county faces a health deficit of at least $210 million within three years. Discussions are continuing with state and federal officials on how to bridge the gap.

A top federal health official, Tom Scully, has said repeatedly the government does not plan to bail out the county, but it does want to help the county navigate its budget crisis without slashing patient care.

In the private sector as well, hospitals struggled in 2002. Tenet Healthcare Corp. closed St. Luke Medical Center in Pasadena, leaving the city with only one full-service hospital.

The same company announced plans to close Daniel Freeman Marina Hospital, citing financial problems. But a coalition of community activists fought Tenet’s decision. And the state attorney general’s office, which oversees the sale of nonprofit hospitals to for-profit companies, successfully petitioned a Superior Court judge to halt the closing temporarily because Tenet had not lived up to the terms of its purchase deal. To date, the hospital remains open.

Financial troubles extended to three San Fernando Valley hospitals whose operators filed for bankruptcy protection recently after a lender didn’t deliver funding. Granada Hills Community Hospital, Pacifica Hospital of the Valley and Pine Grove Hospital remain open as they reorganize their debts.

In addition to budget problems, many hospitals had other challenges: preparing for a possible bioterrorism attack, alleviating emergency room congestion and implementing state regulations that set minimum ratios of nurses to patients.

Nurses unions, appealing to members’ dismay over cutbacks and tight staffing, made huge gains in organizing drives in Southern California. Earlier this month, the California Nurses Assn. won its campaign to organize 1,500 registered nurses at Cedars-Sinai Medical Center, the largest private hospital in the West.

The hospital is challenging the results.

The same union also won its first contract this month for 1,300 nurses at Long Beach Memorial Medical Center.

Though possibly worst in Los Angeles County, the looming financial crisis in health care was a major theme statewide.

To lighten demand for services, Gov. Gray Davis in May proposed raising the income limit for families to qualify for Medi-Cal, increasing required paperwork, and cutting dental, chiropractic and other so-called optional benefits.

The Legislature rejected those cuts, but did allow the governor to delay the expansion of the much-touted Healthy Families program to include working poor parents.

The state’s budget problems worsened though, and the governor has proposed many of the same cuts again.

State officials estimate that about 500,000 people would be pared from the Medi-Cal rolls -- either for failing to fill out paperwork or for not meeting new income limits.

The governor’s latest proposals would pare $167.5 million from the general fund’s $11-billion budget for Medi-Cal, which covers 6.4 million indigent, elderly and disabled adults and children.

Health advocate Anthony Wright described the cuts as a “full assault on the health-care system.”