The scheduled fall opening of a 600-bed replacement for the aging Los Angeles County-USC Medical Center has rekindled a dispute over whether the new hospital will be too small. What few people seem to realize is how much the county has already downsized the old one.
The massive Boyle Heights landmark, on daily average, staffed 617 beds in 2007, according to data reported to the Office of Statewide Health Planning and Development. Up to about 2003, it had staffed about 750 beds, or more.
It's not unusual for hospitals to operate fewer beds than the number allowed on their licenses, especially older hospitals. County-USC opened in 1933 with 1,400 beds.
Still, the cutbacks in recent years -- around the time the county started to downsize, and ultimately close, its troubled Martin Luther King Jr.-Drew Medical Center in Willowbrook -- have alarmed patient advocates.
The double loss has strained some already financially shaky private hospitals. And as devastating as the loss of a county hospital was for South Los Angeles, the cutbacks at County-USC could have more far-reaching effects, said Barbara Siegel, an attorney with Neighborhood Legal Services. As the hospital's bed count has gone down, more ambulances are diverted to other hospitals, she said.
"If you take that into consideration, the downsizing of County-USC potentially has a greater impact on the availability of care than the closure of all the beds at Martin Luther King hospital," she said.
In 2003, Siegel's and other patient advocacy groups sued to stop County-USC from eliminating 100 of the 745 beds then in operation.
The Board of Supervisors, which had been trying to head off a budget deficit in its health department, settled the lawsuit in 2005.
It agreed to cut just 25 beds, with further reductions tied to certain conditions, such as reducing patients' length of stay to turn over beds more quickly and keeping emergency room boarding times under seven hours.
County-USC has since dropped to 671 budgeted beds, and county officials said last month that it intended to cut 70 more in the current facility.
(For the nonbureaucrat, bed counts can be a mystery. The county defines a "budgeted bed" as one that is funded in that year's health department budget, but the number of beds staffed with the required ratio of nurses -- and thus actually in use -- may be lower.)
County officials said the hospital had been able to cut beds without violating the settlement by discharging patients more speedily.
"It's a smaller hospital, but we're able to see the same volume as 2003," said Rene Seidel, director of board relations for the county supervisors.
The groups that sued in 2003 disagree that the hospital has met all the conditions. By their account, County-USC should have at minimum 685 budgeted beds and should make a better effort to staff them.
A recent study by the Hospital Assn. of California found that all private hospitals with emergency rooms have seen increases in patients without insurance; critics say the increase is caused by the shrinkage in county beds.
To Rob Fuller, chief operating officer at Downey Regional Medical Center, it doesn't matter if the increase in indigent patients at private hospitals is coming from the loss of beds at King-Harbor or at County-USC or just an increase in the number of patients without insurance.
"A bed is a bed, and wherever you lose one, the impact is felt," he said.
California, with two hospital beds per 1,000 people, falls below the national average of three per 1,000. South Los Angeles County, where Fuller's hospital is, has less than one bed per 1,000 residents.
If hospitals don't have enough beds, patients have to travel farther to receive care. That in turn means longer ambulance runs and fewer ambulances available to pick up the next sick patient.
"And that is the point I don't think many people comprehend," Fuller said. "County-USC's downsizing -- like any reduction of hospital infrastructure in the area -- hurts everyone, not just the Medi-Cal patient who might otherwise seek services at County-USC."