Nursing Dispute Worsens at County-USC Hospital

A yearlong labor dispute between nurses and management at Los Angeles County-USC Medical Center has escalated in recent days, with county officials accusing nurses of endangering lives by refusing to treat some patients.

County officials said Tuesday that they were investigating several incidents over the last few days in which nurses refused patient assignments at the urging of union representatives who showed up at the medical wards to support the nurses.

In three cases, the confrontation became so tense that managers called police, who ejected the union representatives from the patient areas.

“They’re disrupting patient care by their actions,” said Ray Fortner, the county’s interim counsel, whom the Board of Supervisors directed Tuesday to take the union to court over the matter.

Union officials said that the nurses took the defiant stand because they already had too many patients and that taking any more would have been irresponsible.

The dispute is the latest problem for the county’s struggling health system, which is grappling with the loss of several emergency rooms as well as continuing pressures to reform the troubled Martin Luther King Jr./Drew Medical Center in Willowbrook.

Union officials said the problem at County-USC and other county-run hospitals was an insufficiency of nurses to safely care for patients.

“There have been atrocious staffing levels for some time” at county hospitals, said Nick Builder of the Service Employees International Union Local 660, which represents the nurses. “People are no longer willing to be patient.”

A state law that took effect in January imposed strict nurse-to-patient ratios. But the union said the county hospitals had not been abiding by those rules.

“The county needs to hire 1,200 more nurses,” said union spokesman Mark Tarnawsky. “In the past few months, they’ve been losing more nurses than they’re hiring.”

John Wallace, a spokesman for the county Department of Health Services, said he could not say whether the county had hewed to the ratio, but he insisted that officials were doing their best, given the great number of patients.

“We do try to comply with nurse-to-patient ratios,” Wallace said. “We do have significant nurse vacancies, and these are really the result of the nationwide nursing shortage that is particularly acute in California.”

Nurses at the county’s five hospitals have been working without a contract since Sept. 30, 2003. In July, the county won a restraining order to halt sickouts by nurses protesting the lack of a contract.

But citing the recent dispute at County-USC, the Board of Supervisors voted in closed session Tuesday to go back to court, hoping to show a judge that the union violated the restraining order.

“We believe there has been an escalation of activity that needs to be brought to the attention of the court, and we will be publicly filing papers in the next day or two,” said interim county counsel Fortner.

He would not provide details about the incidents but confirmed that the county was investigating a union representative’s alleged drunken appearance at the hospital Monday night and the disruption it reportedly caused.

Mario Valenzuela, who identified himself as that representative, said he had had a beer while watching a movie with a friend earlier that evening but strongly denied he was intoxicated.

“Was I drunk or not professional? No way,” he said. “We have a right at all times to represent our members when discipline is involved.”

Union officials said that the incidents went back about a week and a half and that the following occurrences came during shift changes:

* On Sept. 25, a nurse manager in the medical surgery ward asked three registered nurses to take seven patients, while state law sets the maximum at six. The nurse manager also asked a licensed vocational nurse, who is not supposed to care for patients on her own, to pick up the extras. They all refused and called union representatives. County police officers showed up and escorted the representatives out of the area.

* On Sept. 26, in the behavioral medicine ward, a nurse refused to take on more than six patients. After heated discussions, management officials called county police, who escorted the union representatives to another area. The nurse felt sick and left, union officials said.

* On Saturday, a registered nurse in the medical surgery ward was asked to take on additional patients. She refused and called three union representatives. County police showed up again.

* About midnight Monday, a manager asked a nurse to take on eight patients in the medical surgery ward. She refused and was threatened with suspension. A union representative showed up and a nurse was brought in from another ward. No police were called.

The problems at County-USC come as the county health system is reeling in other areas. The county-run King/Drew has been dogged by a series of lapses in patient care, including several that contributed to patient deaths, according to regulators.

Adding to the problems, hospital accreditation officials have ordered the private university that trains doctors at King/Drew to close three of its programs, including surgery.

Moreover, the county’s emergency care system has been hit as several private hospitals have closed. Since the 1980s, 18 emergency rooms in the county have shut down.

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Times staff writer Sue Fox contributed to this report.