County OKs Hospital Cuts

Los Angeles County supervisors voted 4 to 1 Tuesday to begin closure of Rancho Los Amigos National Rehabilitation Center in Downey, a renowned specialty hospital for victims of stroke and traumatic injury.

Struggling to close a massive health-care deficit, the supervisors also voted to reduce the size of the county’s flagship hospital, County-USC Medical Center, from 745 beds to 695.

But as expected, the board delayed action for three weeks on whether to end inpatient and emergency services at Harbor-UCLA and Olive View-UCLA medical centers.

Supervisors said they were awaiting the outcome of a ballot initiative next week that would raise property taxes to fund trauma and emergency care. They also are hoping to secure more money in negotiations with state and federal officials.

The decision to close Rancho blindsided its advocates and employees, who said they learned of the impending vote late Monday and did not have time to rally a defense.

Rancho Los Amigos, built in 1888, offers highly specialized services that are not available at other county facilities. The hospital has 207 beds and a staff of more than 1,400. It treated 2,600 inpatients and 8,700 outpatients last year -- stroke and diabetes patients as well as those with spinal cord and head injuries.

Rancho Los Amigos officials had hoped the hospital would be able to operate under an independent hospital authority to be established by the state Legislature. But the Department of Health Services determined that the hospital could not be financially viable, even with a planned county subsidy of $14.7 million annually.

With the closing, the health department predicts that it will save $58.6 million next year and then $65 million to $70 million annually. The closure of 50 beds at County-USC would save $16.1 million per year.

Dr. Dan Lammertse, president of the American Spinal Injury Assn., said county officials are wrong if they believe they will save money by closing a rehabilitation center. The cost will merely shift to acute-care hospitals and emergency rooms.

“The public,” he said, “has the wool pulled over its eyes.”

Rancho Chief Executive Consuelo Diaz and other Rancho Los Amigos officials had argued that before voting on the hospital’s fate, the county should hire consultants familiar with rehabilitation hospital management to determine whether the hospital could sustain itself. That was not done.

The Board of Supervisors did agree Tuesday to hire an independent consultant to examine the health department’s fiscal analysis of the hospital and make a report within 45 days. If the numbers hold up, supervisors would hold another hearing in January to finalize the hospital’s closure, planned for June.

Insured patients will be all right, Diaz said after the vote, because they can be treated in private hospitals. But many uninsured patients won’t get the rehabilitation services they need and will spend long periods of time at acute-care hospitals, she said.

Not everyone is persuaded, however, that Rancho Los Amigos ultimately will close. Once before, in the mid-1990s, the county made plans to privatize the hospital, then backed down.

“We’ve seen this before -- when they tried to sell the hospital in 1995,” said Gail Reeves, a member of Las Floristas, a charitable organization whose volunteers have raised millions of dollars for children’s care at the hospital over the years. “I’m waiting to see what’s going to happen.”

Supervisor Don Knabe, whose district includes the hospital, was the lone vote against Tuesday’s cuts, saying the proposal was made too hastily and without enough information. Knabe said hospital supporters didn’t have enough time to make their case to save the hospital, which he called “very, very unfair.”

Supervisor Gloria Molina criticized Knabe for voting against the health cuts, saying it undermines the board’s unanimous voice in trying economic times. The county faces a projected deficit of $500 million to $750 million in three years.

“I’m just very, very disappointed,” Molina said of Knabe’s opposition. “None of us want to make these decisions.... I think it’s the beginning of painful decisions all around.”

In an earlier round of cuts in June, the supervisors voted to close 11 health centers and four school-based clinics. They also agreed to convert High Desert Hospital in the Antelope Valley into an outpatient clinic next year, and trim public health spending by about 10%.

For the most part, speakers at Tuesday’s public hearing praised the board for delaying its vote on Harbor and Olive View. Harbor has created a powerful community coalition seeking to head off any cuts to the hospital.

Long Beach Mayor Beverly O’Neill said Harbor is important to the 2.2 million residents in the South Bay. Because of the hospital’s proximity to Los Angeles International Airport and the Port of Los Angeles, it must be available in case of a major disaster.

“As the need is increasing, it is ludicrous to think that cutting back on a life-or-death facility is an answer,” O’Neill said. “To close this would be absolutely having blood on our hands.”

Hospital industry officials said the closure of Harbor or Olive View would have a domino effect on the county’s private hospitals, which would quickly be overwhelmed.

“Bottom line: There isn’t any elasticity left in the system to absorb any of the cuts that you make,” said Jim Lott, executive vice president of the Healthcare Assn. of Southern California, a hospital trade group.

Most supervisors said Tuesday that they are prepared to vote Nov. 19 to close Harbor and Olive View --two of the county’s four full-service public hospitals -- if more money is not forthcoming.

“I question whether or not we can avoid bankruptcy of the county if we keep going” without making changes,” said Yvonne Brathwaite Burke.

Supervisor Mike Antonovich agreed. “We need to reform the system. We need to have fiscal responsibility and accountability.”

The vast majority of speakers pinned their hope on Measure B, a parcel tax on next Tuesday’s ballot that would raise $168 million annually for the county’s emergency and trauma-care network.

If approved, the tax would cost the owner of an average-sized property about $42 per year.

“It’s critical, make no mistake about it,” Supervisor Zev Yaroslavsky said.

At a rally on the steps of the county Hall of Administration, several speakers implored the crowd to push for passage of the parcel tax.

“Measure B is the most important thing on the ballot in L.A.,” state Sen. Richard Alarcon (D-Sylmar) said.

Former Los Angeles Police Chief Bernard C. Parks weighed in as well.

“It’s of no value to have a first-class paramedic service and not have a trauma center to take people to,” he said.