Faced with a $210-million health budget shortfall and few painless options for eliminating it, members of the Los Angeles County Board of Supervisors voted Tuesday to close the county's only rehabilitation hospital and to reduce the capacity of another hospital by 100 beds.
While the 4-1 decision to close Rancho Los Amigos National Rehabilitation Center and reduce beds at County-USC Medical Center reaffirmed the board's commitment to a restructuring of the county health system that began last year, it also infuriated Rancho supporters who attended an emotional public hearing on the cuts. The vote sparked a chorus of shouts to "Keep Rancho open!" that lasted more than 10 minutes.
The board rejected a proposal by Supervisor Don Knabe to postpone the vote so the county could explore the feasibility of converting Rancho into a private, nonprofit hospital, but said there is still time to investigate that option. Knabe, whose district includes the hospital, has defended it against proposed cuts for years.
The county is currently lobbying the federal government for assistance in closing a heath department budget gap estimated at $210 million. Several supervisors said the vote to close Rancho was necessary to convince federal officials that the county is serious about cutting costs.
"We have some serious credibility problems in Washington," said Supervisor Yvonne Brathwaite Burke. "They are waiting to see if we are really going to do anything. And if we want to get the money that we need to operate this system, we have to show them that we're moving forward in some way."
Supervisor Gloria Molina had previously opposed the cuts to County-USC, which is in her district. She voted for them Tuesday, saying; "If we can't do this, the whole system will sink."
Rancho is the only hospital in the county system that provides rehabilitation services to people with severe head or spinal injuries. The 100-year-old hospital also treats stroke patients and victims of other degenerative diseases, including post-polio syndrome.
Although Rancho averages about 210 inpatients per day, thousands depend on the hospital for the outpatient services it provides, and the chamber was packed with about 500 hospital supporters, most waving "Save Rancho" signs. At least 30 people in wheelchairs lined the aisles, some using ventilators to help them breathe or electronic voice boxes to help them speak.
Ruben Rios, a 33-year-old Norwalk man, said that only Rancho has the expertise to properly treat him. A quadriplegic since he was shot 15 years ago, Rios explained that he often receives inadequate care at other hospitals on weekends, when Rancho is closed.
"I've been misdiagnosed, I've been prescribed the wrong kind of medicine, and I've gotten very sick from being treated at regular hospitals," he said. "For them to close Rancho and expect a regular hospital to treat us, it would be like sending the space shuttle to Jiffy Lube for regular maintenance."
Downey Mayor Rick Trejo emphasized Rancho's regional economic impact. Its 1,600 employees make it the city's largest employer, he said, asking the board to "exhaust every possible option" before closing it.
Those speakers were joined by doctors and advocates for the disabled, who said closing Rancho would signal a lack of political will to help the disabled.
"If an internationally renowned, national rehabilitation center of the magnitude of Rancho Los Amigos Hospital, in one of the nation's most progressive cities, is allowed to close, people will be institutionalized throughout the nation as the rehabilitation necessary to live in one's home evaporates," said Nancy Baker Kennedy, who chairs the county's Personal Assistance Services Council.
Before the vote, Department of Health Services Director Dr. Thomas Garthwaite recommended Rancho's closure and the bed reductions at County-USC Medical Center, citing a county-commissioned consultant's report that said the county could save $60 million by closing Rancho and sending its patients to other county hospitals. Those savings are important to the county as it seeks to preserve other elements of its health-care network, officials said.
Former Rancho patient Alan Toy, who now directs an independent living center, was unswayed by that estimate.
"Those [numbers] have been cooked, boiled and sauteed," Toy said.
In fact, an early draft of the consultant's report called closing Rancho "one of the most expensive options" for the county. Fred Leaf, health services' chief executive officer, said the draft's conclusion was based on faulty information.
The author of a second report that recommended the county allow Rancho to convert to a private nonprofit hospital criticized the county-commissioned report's scope. "If cutting money was the only thing I cared about, I might rely on it," said Harriet Gill. "But [the county] is still going to have to buy those services somewhere else."
Knabe said he thought the other supervisors approved the closure to spur Rancho toward self-sufficiency.
"They're playing a game of chicken," Knabe said. "I hope they're right."