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LOS ANGELES TIMES INTERVIEW : Ronald Kaufman : Ensuring L.A.'s Public Health Through County--USC Hospital

December 17, 1995|DONNA MUNGEN | Donna Mungen is a contributor to National Public Radio's "All Things Considered" and was nominated for a Cable ACE award for an A&E documentary

County-USC is the foundation for the entire health-care delivery system. If it didn't exist, emergency services for this region would be markedly under-served. This will be a difficult period because there will be ethical considerations on the part of physicians such as, 'How can we ethically turn away patients?' I've been in talks with private hospitals, to see how we can better deliver care for the region. A lot of hospitals view our survival as essential to their well-being.

County-USC Medical Center, a white, Art Deco structure, is perched on a hill just east of downtown. But few Angelenos whizzing by on the Golden State Freeway realize how important this hospital is to their personal well-being.

One of only 11 trauma centers in Los Angeles County, the medical center is an important nexus for two-thirds of county residents. Located in the most densely populated section of the city, the hospital provides 24-hour emergency service and secondary medical care to indigent residents. By doing so, it offers an insurance policy for the entire city by assuring that uninsured patients do not jeopardize the medical capacity of surrounding private hospitals.

As one of the nation's largest public hospitals, each year County-USC's medical staff delivers 10,000 babies, moves 250,000 patients through its emergency room, treats almost half the city's AIDS sufferers and juggles the needs of 5,000 daily visitors to its out-patient clinics. In spite of its importance to the city, County-USC's name has repeatedly surfaced on the hospital closure list--most recently during the embittered budget battle. Though saved from the chopping block by a last-minute federal bailout, the hospital is still endangered. The chief of its medical staff, Dr. Ronald L. Kaufman, must navigate in a world of declining resources, while maintaining the same level of medical service.

Groundbreaking for a smaller facility is scheduled for next year, but now Kaufman must address the medical needs of 800,000 patients annually, marshaling the skills of his 450 full-time faculty physicians; 900 interns and post-graduate residents and 1,500 other physicians. Any faulty decisions could have a domino effect.

Kaufman grew up in the Pico district, where his parents rebuilt their lives after escaping Nazi concentration camps. Kaufman received his medical degree from UC Irvine, and did his rheumatology residency at County-USC, followed by a 12-year stint at Rancho Los Amigos Medical Center. He has been with County-USC since 1989.

Trim and toned, Kaufman's fast-paced gait around the 72-acre medical hub belies his 50 years, but his acquired wisdom surfaces as he excitedly explains the integration of the various facilities. The sloping knoll is also home to USC's medical school, the Doheny Eye Institute, the Norris Cancer Hospital and several other satellite research centers. His friendly relationship with all segments of his medical clan is readily apparent as he walks around; and as a first-generation Angeleno, Kaufman is comfortable with a multiethnic patient population often neglected by mainstream medicine.

The father of two daughters, Kaufman lives in Pasadena with his wife, Barbara, a Yoga teacher. Like other healers, Kaufman has taken to heart the inscription above the hospital's entrance: "The doctors of the staff give their services without charge in order that no citizens of the county shall be deprived of health or life for lack of such care and services."

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Question: Who do you primarily serve?

Answer: Our biggest population are people needing emergency care. We are the largest provider for emergencies and trauma services in the region and the busiest emergency room in the country.

The patients seeking ongoing care come to us for two reasons. They may not have insurance coverage, so they are referred to us as indigent. They are welcomed here and we have an obligation to take care of them. The other group includes those who have insurance but are seeking our expertise and specialty services.

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Q: What do you consider to be the area you serve?

A: If you draw a circle around us, within a 15-mile radius, approximately 6 million people--or, 60% of the entire population of L.A. County lives within those boundaries. Outside of that area, few hospitals are able to serve this population. To the east, all the way to the county line, there is nothing; to the west, there is Cedars-Sinai, and to the south, past USC's main campus, you have nothing until you reach [Martin Luther] King Hospital.

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Q: How does L.A. County-USC fit into our health system?

A: L.A. County-USC is the foundation for the entire health-care delivery system. If the medical center didn't exist, the emergency services, especially for this immediate region, would be markedly underserved. A recent study . . . showed this area has a huge need because the population is so dense. If County-USC didn't exist, those patients wouldn't have access and likely die in transition to other hospitals.

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