County Should Look for a Merger, Not a Miracle

The Los Angeles County Board of Supervisors seems unable to decide how to blunt the disaster facing its Department of Health Services. As one union representative recently put it, “There seems to be no operating plan for the future between total disaster and business as usual.”

Here’s what’s at stake. In November, the county’s health department, faced with a skyrocketing deficit, authorized a drastic plan to close an outlying hospital and 11 major clinics. All inpatient services at two of its remaining four major full-service hospitals would be cut. Also to be shuttered and sold was Rancho Los Amigos, the blue-ribbon National Rehabilitation Center whose like probably doesn’t exist anywhere in the western United States. The board voted last week to close it.

The major hospital closings, however, were put on hold. The remainder of the shutdowns was accomplished at much risk to the well-being of many of the county’s 800,000 indigent patients. In the meantime, the county’s voters passed a new property-tax measure -- itself a phenomenal event in the 25th year of the Jarvis age -- that will provide $168 million a year to keep trauma centers open. According to the latest figures, Measure B and the year-end cuts brought the health department’s deficit down to $250 million. The hope stopped there.

But not the delusion. County officials have been clinging ever since to the belief that another miracle can save the bedeviled health-care system. Perhaps the state, or even the Bush administration, might come forth and mitigate the pain. But Gov. Gray Davis’ spending plan struggles to close more than $30 billion in red ink, while President Bush’s deficit has grown to seven times that. Even if our president belonged to the Socialist Party, instead of the Republican, you wonder what he could do to solve L.A. County’s health service crisis.

The only county executive who seems to grasp the full gravity of the situation is health department chief Thomas Garthwaite, the former Veterans Affairs official who is doing his best to streamline the system while cutting it back.

He wrote the Board of Supervisors after B’s passage that the county still had to close Olive View’s and Harbor-UCLA’s inpatient facilities, among other drastic cuts.

Despite his warning, county Supervisor Zev Yaroslavsky recently told reporters that, thanks to B, the complete Olive View and Harbor hospitals can stay open indefinitely. Yet each of these big hospitals costs more than $100 million a year to keep open. And B’s $168 million has to be split among all 13 L.A. County trauma centers -- mainly the four run by the county. Even if Washington came through with a one-time grant of $150 million, unless hundreds of doctors, interns and nurses volunteer to work free, the county’s full-service hospital system is living on borrowed time -- and not much of that.

Dr. Ilena J. Blicker, past president of the Los Angeles County Medical Assn., says the effects of these closures “will affect everyone. It will create a major shortage of hospital beds ... for all medical patients.” Meanwhile, the county leaders’ inert health-system strategy looks as if it’s running on empty. On Tuesday, they’re going to have to do better.

That’s when hearings begin on what the system’s real future will permit -- and what it has to close down. So here’s a suggestion.

Instead of closing Harbor-UCLA -- by all accounts the best hospital in the system -- combine it with the nearest county hospital. That’s Martin Luther King Jr/Drew Medical Center, by all accounts the worst.

About 10 miles apart, the two benefit vastly different environs. Harbor-UCLA near middle-class Torrance -- 18,000 bed patients annually -- serves the beach cities and Carson, as well as low-income, unincorporated county areas nearby. King-Drew, which has about 12,000 bed patients a year in a similar-size facility, serves Watts, South-Central, Compton and other areas noted for poverty and crime.

Garthwaite says its location is why King is being saved and Harbor closed. King’s area has a higher proportion of the indigent and underserved among its overwhelmingly Latino patient population. But its professional reputation is unfortunately studded with horror stories, rising from costly county settlements, that suggest bad institutional management: The woman who contracted AIDS because the blood she received in a transfusion was HIV-positive and had been set aside for quarantine. The patient with the gunshot wound to his knee who died after the hospital’s trauma staff spent six hours trying to find a vascular surgeon before giving up and transferring him to another hospital. Then there was Sheriff’s Deputy Nelson Yamamoto, who died, allegedly, because of poor care received during bullet-wound surgery in 1992.

Such tragedies can occur at any big public hospital, yet close observers of King note that its leadership shirked responsibility for such patient deaths and often failed to institute remedial measures.

King-Drew has its own medical school, one of the three associated with county hospitals. But Charles Drew University -- founded (as was the medical center) in the wake of the 1965 Watts riots, when African Americans felt they were denied admission to most medical colleges -- also has fallen on hard times. In recent years, its all-important internal medicine department had the lowest rating in the continental United States.

Again, the problem seems to be weak leadership. Many of the teaching doctors work at King-Drew and have lucrative private practices. Lack of oversight of all their activities seems a chronic problem. Harbor has a teaching hospital that’s affiliated with UCLA Medical School, though, where many Drew University students already attend classes. Making Drew a division of UCLA would elevate both its leadership and its status at minimum inconvenience to the student population.

As a hospital, Harbor-UCLA has had the highest ratings in the county system, which includes King, Olive View and County-USC Medical Center. Its management is tough and efficient. Despite this, both Harbor and King are, in the words of one observer, “maxed out.” As many as 123 patients were recently waiting for treatment at the Harbor emergency room. Use of King facilities is similarly heavy. Closure of either would create huge obstacles to adequate health care among tens of thousands of poor and uninsured people.

But if there must be a closure -- and absent a miracle, a closure there must be -- let’s make the most of it. King has a newer, bigger plant and a better location. Harbor’s got the best people. Combining them isn’t going to solve the county’s problem of how adequately to accommodate an underserved patient population on reduced resources. As Yaroslavsky is wont to say, only the creation of a federal health plan can do that.

But it could give us a more efficient hospital than either the current King or Harbor medical centers. That’s probably the best the Department of Health Services can do right now. But it is doable. And all those uninsured clients deserve no less.