County Seeks Compromise on Cutbacks at Hospitals

Boxed in by a federal judge who refused to allow Los Angeles County to slash health services, the Board of Supervisors is now looking to cut a deal.

County lawyers are pursuing a settlement with public interest groups that sued over plans to close Rancho Los Amigos National Rehabilitation Center and eliminate 100 beds at County-USC Medical Center, according to attorneys involved in the closed-door negotiations. A deal could yield a slimmed-down Rancho, with 150 beds rather than the 207 it now has, and perhaps some bed reductions at County-USC.

“The Board of Supervisors has directed [county lawyers] to put all resources possible into settling this case,” said Barbara Frankel, an attorney with Neighborhood Legal Services who represents uninsured patients who rely on the county hospitals. “The sooner, the better, because it’s a dollars-and-cents issue for them.”

The board had voted in January to close Rancho and trim beds at County-USC, calling it a painful but essential move that would save at least $75 million a year. Advocates for poor and uninsured patients sued the county over the planned cuts, but county leaders stuck to their cost-cutting strategy.

Los Angeles County was deep into its closure plan for Rancho -- the hospital had even begun turning away patients -- when U.S. District Judge Florence-Marie Cooper issued her April ruling, throwing the preparations into disarray. She blocked the shutdown until the county could prove that Medi-Cal patients who used Rancho would receive comparable and timely care elsewhere.

Two weeks later, Cooper issued a ruling in a related case that barred any bed cuts at County-USC. The county has appealed both decisions.

County officials were reluctant to say much about the settlement talks.

“I don’t want to be settling this through the newspaper,” said Leela Kapur, assistant county counsel. “I want to be settling this with them.”

Supervisor Zev Yaroslavsky, one of the most vocal critics of the judge’s rulings, also declined to comment.

Interviews with plaintiffs’ attorneys and health officials suggest that both sides are moving toward a compromise that would maintain Rancho’s core mission of treating catastrophic injuries, including spinal cord and head trauma. But the hospital may shed units that treat liver problems, diabetic amputations and inflammation of the limbs and heart.

Reducing Rancho’s operations could save the county an estimated $40 million a year, said Dr. Thomas Garthwaite, director of the county Department of Health Services.

As is often the case these days in the cash-squeezed county, much of the debate turns on money.

Garthwaite said that hashing out a legal deal with patient advocates “isn’t antagonistic, except that we don’t see how to make the budget stretch any further.”

“We believe we need to limit the size of our system to the size of our budget. They believe that they have to advocate for the citizens and patients to have the most access to care. I think they’re trying to find the right answers, as we are,” he said.

Eventually, the county hopes to attract a nonprofit hospital to take over Rancho, an idea detailed in an April report by the nonprofit California Community Foundation.

The outlook for reductions at County-USC is less clear, according to those involved in the negotiations.

One possibility is to expand hours at ambulatory care clinics, so that people with diabetes, asthma, heart disease and other chronic conditions could be stabilized before they wind up in an emergency room.

That would help relieve crowding in county hospitals, which in turn might mean that patient advocates would accept a small reduction in beds.

Others insist that any cuts there would be intolerable. Dr. Brian Johnston, an emergency room physician at White Memorial Medical Center, a private hospital near County-USC, said county leaders must put patient care first.

“In the long run, they need a system based on the medical needs of the population,” he said, “not based upon a fixed budget.”