Judge Bars Cuts at County-USC

A federal judge on Thursday punched another hole in Los Angeles County’s strategy for shoring up its ailing health system, issuing a tentative decision that would prevent a 100-bed cutback at the flagship County-USC Medical Center.

Saying further cuts could lead to unnecessary pain, medical complications and deaths, U.S. District Judge Florence-Marie Cooper also barred the county from closing Rancho Los Amigos National Rehabilitation Center in Downey. Cooper’s ruling on Rancho echoed her decision earlier this week in a related case.

The proposed cuts, which would save $75 million in the first year alone, are at the core of plans for closing a gaping shortfall in the county’s health care system. Cooper sided with the plaintiffs, a coalition of public interest law groups, who argued that the measures would allow the county to shirk its obligation to its neediest residents.

“This is not a case of mere ‘fear and speculation’ on the part of the plaintiffs,” Cooper wrote in a biting rebuke to county attorneys. “The record before this court bears witness to a county health system in utter chaos with respect to providing timely care to those in need.”

Although the ruling is not final, it is considered an indication of how the judge ultimately will rule in the case. A hearing on the matter is set for Monday, after which Cooper may formalize her order.

“It’s a good sign,” said Yolanda Vera, an attorney at Neighborhood Legal Services, which filed the suit in conjunction with the Legal Aid Foundation of Los Angeles and the American Civil Liberties Union.

“I think what you see is this recognition that the entire system is so fragile that it can’t afford any cuts anywhere.”

If the ruling holds, health officials said, they will have to look elsewhere for cuts -- perhaps to the network of private health clinics that serve the uninsured, or even to emergency rooms. Sixteen county clinics were closed last year to save money.

Even if the proposed closure of Rancho and cutbacks at County-USC were carried out, the health department still would face a projected $649-million shortfall in five years. If the court blocks those reductions, Health Services Director Dr. Thomas Garthwaite said this week, the shortfall would balloon to $1.1 billion by fiscal 2007-08.

Without whittling down services somewhere in the vast public health system, he and other officials said, the whole network could crumble.

“You can’t be forcing a county to deal with the uninsured without the necessary revenue,” said Supervisor Gloria Molina. “It’s very discouraging. We here on the front lines are trying to save as much of the safety net as we can. This will clearly lead to a collapse of the entire system much sooner.”

California law requires counties to provide medical care for people without health insurance, including those who do not qualify for Medi-Cal, the state’s insurance program for the poor and disabled.

Emboldened by the judge’s findings, plaintiffs’ attorneys vowed to take the county to court if it seeks to cut any programs affecting the uninsured.

“I don’t think there’s anywhere they can really cut that won’t have another impact that will violate” the law, said Elena Ackel, a senior attorney with Legal Aid Foundation of Los Angeles.

“We’re going to fight any changes. They’re going to have to find other resources to devote to this or to make it run much more efficiently.”

In her ruling, Cooper relied heavily on sworn declarations of Rancho Los Amigos patients, County-USC doctors and medical residents who described the calamity that could follow if Rancho closed and County-USC trimmed beds.

In particular, she cited the testimony of Dr. Edward Newton, interim chairman of County-USC’s emergency department, and other doctors, concluding that patients “spend long hours, if not days, in the emergency department waiting to be admitted.”

She also highlighted the claims of Newton and Dr. Kate Savage, a fourth-year orthopedic surgery resident, that overcrowding at the hospital had led to preventable deaths.

State inspectors, who visited the hospital last week after The Times wrote about those deaths, could not link them to delays in care, county officials said.

But Cooper wrote that the closing of Rancho Los Amigos and the cutbacks at County-USC would result in “dangerous delays of needed medical treatment resulting in unnecessary deaths, strokes, heart attacks, amputations, renal failure, blindness, seizures, severe pain and increased risk of infection.”

She added that the cuts would lead to the spread of infectious disease, complications from delayed rehabilitation and unnecessarily lengthy and expensive hospitalizations.

In a separate lawsuit, Cooper already had issued an order barring Rancho’s closure until the county can prove disabled Medi-Cal patients can get comparable care elsewhere. Thursday’s case involved services to the uninsured. Rancho serves more than 9,500 patients per year with serious spinal cord or brain injuries.

The county is running out of places to turn for money. The federal government has three times given infusions of cash to keep the health department solvent, but officials recently indicated that the county cannot count on more help. And California, facing its own $35-billion budget shortfall, is unlikely to step forward.

The proposed cuts, combined with a voter-approved property tax increase and some additional federal funding, would have given the county two or three years to improve efficiency and find a path to long-term financial stability.

If the judge is not going to “allow us to cut any services, then our options obviously become less and less,” Health Director Garthwaite said. He said it is highly likely the county will appeal if it loses the case.

Health care workers braced themselves for more turmoil. Among the most vulnerable to future cuts are private community clinics, which receive government money to provide basic care to uninsured residents.

In September, county supervisors approved a 25% cut in the $60-million program that subsidizes private clinics. Though they were touted just eight years ago as the cure for Los Angeles County’s troubled health-care system, the clinics now fear losing county funding altogether.

“The county suddenly needing $75 million does make me very worried,” said Mandy Johnson, executive director of the Community Clinic Assn. of Los Angeles County.