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County medical crisis deepens
Los Angeles County's profoundly troubled public healthcare system fell into further crisis Thursday when its embattled director abruptly quit, and negotiations with a private entity to reopen King-Harbor hospital fell apart.
Dr. Bruce A. Chernof, whose relationship with the Board of Supervisors had grown acrimonious, told officials his exit was unrelated to the failed negotiations over Martin Luther King Jr.-Harbor Hospital.
He leaves as the county Department of Health Services faces a projected budget shortfall of $750 million over the next two years and undertakes the knotty task of moving County-USC Medical Center from its Depression-era facility to a new, smaller complex.
"Look, there is never a good time to lose a health director," said Supervisor Zev Yaroslavsky, "and this is as bad as any. I think it's the toughest job in the county without a doubt -- perhaps the most difficult job in public service in California -- because he is asked to run a department that is constantly in the red. It has a lot of problems."
The county operates the second-largest publicly funded healthcare system in the nation, with an annual budget exceeding $3.3 billion, three general hospitals and a network of clinics that together treat about 700,000 patients a year, most of them uninsured.
County officials have been under increasing pressure since the August 2007 closing of King-Harbor (previously known as King/Drew) in Willowbrook left neighboring communities without a public hospital.
Chernof had been promoted to the top department job in 2006 after a series of directors left with short tenures. He had a mandate to save the hospital, which had been plagued for years by serious problems, including mistakes that led to patients' deaths.
When the hospital closed after failing a federal inspection that would have cost it much of its funding, county officials said they would seek a private operator to reopen it within 12 to 18 months. If that did not happen, Chernof said then, the county might attempt to reopen the hospital itself.
Officials and community activists were heartened by recent news that a small for-profit hospital in Long Beach was in negotiations to reopen King-Harbor. But some healthcare experts expressed skepticism that the 184-bed Pacific Hospital of Long Beach was too small and inexperienced to run such a complicated and financially pressured large public hospital.
On Thursday, county officials confirmed that Pacific had withdrawn from talks but did not disclose the reason. Community activists who have long lobbied for reopening King-Harbor as a full-service teaching hospital were neither surprised nor disappointed by the plan's collapse.
Bringing in a small, private hospital to run a complex county facility was like "dropping a VW engine into a Rolls-Royce," said Ted Watkins, founder of the Watts Labor Community Action Committee.
Nor would they miss Chernof, who was widely viewed as rebuffing community involvement in health services plans.
"This was ill-fated from the beginning," Watkins said, "and the county really needs to circle back around and encourage a community-participatory process."
Chernof could not be reached for comment Thursday.
With Pacific pulling out, the county is essentially back to square one in finding a King-Harbor replacement.
The county's chief executive, William T. Fujioka, worked throughout the day to restart the talks with Pacific Hospital, with no apparent success.
Supervisor Yvonne B. Burke, who represents the district that includes King hospital, was predicting as recently as two weeks ago that it would reopen with 77 beds by February.
"I'm eager to find out if there is anything that can be done to bring them back to the table," Burke said Thursday. "At this point, I have no reason to think that there is anything that can be done."
Burke said the healthcare situation in her district "is very, very dire and critical. It has reached crisis proportions."
Based on a variety of health indicators, the South Los Angeles area remains among the most disadvantaged communities in the nation. More people die of lung cancer, stroke, diabetes and heart disease there than in any other place in L.A. County.
Yaroslavsky said he hoped that Pacific Hospital's withdrawal was not a negotiating tactic. "I hope that Pacific is not trying to put the county in the position where the county has to make any deal Pacific is willing to make."
Yaroslavsky said negotiations were still in the early stages when they broke apart, and it was still unclear whether Pacific Hospital would have agreed to sufficiently care for the uninsured or been willing to reach an agreement with the union representing county health workers -- two points that he said were essential.
"The only thing worse than not having a hospital there is having a new hospital there that will not pass muster or will not serve the needs of the community," Yaroslavsky said.
Supervisor Don Knabe, whose close friendship with the family that owns Pacific Hospital was reported in The Times on Monday, declined to respond to a phone call seeking comment on the pullout.
In a brief interview Wednesday, Pacific owner Faustino Bernadett said, "We are trying to help the community. The negative press has not given us confidence in moving forward."
Bernadett said the most crucial sticking point with the county, however, was that "the county has to define what size hospital is appropriate for the community. Once that is decided, that will give us confidence to move forward or not move forward."
Bernadett declined to specify whether the county pushed for a bigger or smaller facility than was proposed by Pacific. According to Pacific's proposal, King-Harbor would have reopened next year with 77 beds initially, far fewer than the 400 beds once available at the Willowbrook site
On Thursday, Pacific Hospital President Clark Todd declined to elaborate, saying the county had asked him not to talk about it.
The county has long had a hard time keeping health services chiefs. Officials have a history of publicly browbeating them and second-guessing their actions to try to right the beleaguered system.
When Chernof departs -- at a still-uncertain date -- he will also leave the new County-USC Medical Center unfinished. It was initially projected to open in 2007, but heavy rains early on delayed construction and pushed the date back a year. County-USC officials then hoped to open the facility in June, but recently pushed it back to September or October.
Chernof's departure is not likely to delay it further, according to project director Carolyn Rhee. "We have a whole infrastructure over here to execute the move," she said. "Our planning is pretty detailed."
Major decisions about the hospital's configuration, however, remain unfinished.
Supervisor Gloria Molina, whose district includes the hospital, said she is still grappling with how to resolve the tug of war at County-USC over the number of pediatric beds and other issues.
"I don't know how that's going to be resolved," she said. "I'm very concerned."
At times, Molina and fellow supervisors' frustration over County-USC and other issues has boiled over during public tongue-lashings directed at Chernof, especially after state inspectors said patients at Harbor-UCLA Medical Center were in "immediate jeopardy" because of an overcrowded emergency room.
Supervisors repeatedly complained that health officials provided few answers to their questions. And when reports were produced, supervisors complained they were confusing and inaccurate.
"I really don't understand any of what you were talking to me about," Molina told Chernof at a February meeting, after a back-and-forth about average wait times at emergency rooms. "It should not be that difficult, and you don't need to make it that complicated."
One week later, after a report came out of Chernof's office detailing plans to close several public health clinics around the county, supervisors again came down heavily on the health director.
Nevertheless, Molina, Yaroslavsky, Burke and the chief of staff for Supervisor Mike Antonovich all expressed admiration and support for Chernof and surprise at his departure in interviews Thursday.
Times staff writer Charles Ornstein contributed to this report.
(BEGIN TEXT OF INFOBOX)
Key events in Dr. Bruce A. Chernof's time as Los Angeles County health services chief:
May 2006: Chernof is promoted to head the $3.3-billion health services system after serving as interim director for almost six months; his top assignment is to save the long-troubled Martin Luther King Jr./Drew Medical Center in Willowbrook.
May 2007: Edith Isabel Rodriguez, 43, dies after visiting the hospital because of abdominal pain; she collapses on the floor of the emergency room lobby and writhes in agony as hospital employees ignore her.
August 2007: King/Drew fails a critical federal inspection and shuts down.
February 2008: State inspectors say Harbor-UCLA's overcrowded emergency room is placing patients in "immediate jeopardy."
February 2008: Chernof proposes shutting down 11 of the county's 12 public medical clinics as a cost-cutting measure and finding private operators to provide the services; county supervisors tell him to find other ways to save money.
March 2008: The county enters talks with a small private facility, Pacific Hospital of Long Beach, to reopen King/Drew, since renamed King-Harbor. Negotiations collapsed Thursday.
Thursday: Chernof resigns and accepts a position as chief executive of a new nonprofit foundation.
-- Jean-Paul Renaud