A majority of the Los Angeles County supervisors say they have agreed to vote today to replace the earthquake-damaged County-USC Medical Center with a new 600-bed facility, thereby reducing the number of beds in the region's largest public hospital by more than one-third.
At the same time, the supervisors appear ready to authorize a number of new outpatient clinics, the first of which would be in the largely Latino Eastside neighborhoods around the Boyle Heights hospital.
The implications of the supervisors' painfully patched together consensus are vast: County-USC is the keystone in a network of hospitals and trauma centers that stretches as far as the San Bernardino County line. The facility cares for half the region's hospitalized AIDS patients, half its sickle-cell anemia sufferers and 25% of trauma cases. All told, 55,000 patients pass through County-USC each year, and an average of 860 beds are filled on any given day.
By opting for the smaller hospital, the board is moving with the statewide tide that has pushed California's counties to scale down or close medical facilities in favor of contracting for services with private medical providers.
"A smaller facility will save limited resources and allow us to continue to develop public-private partnerships and to enhance our outpatient medical program," said county Supervisor Mike Antonovich, who supports the plan along with colleagues Yvonne Brathwaite Burke, Zev Yaroslavsky and Don Knabe. Supervisor Gloria Molina, who represents the district around County-USC, continues to hold out for construction of a 750-bed hospital. Antonovich earlier had advocated a much smaller facility of 391 beds.
Policymakers are still debating the merits of the majority's approach, which has led to competition and in some cases extreme animosity between private and public hospitals. If the supervisors' bet is wrong, the results could be severe.
"If we undersize it, there's great human damage," said county Health Services Director Mark Finucane, who strongly backed a proposal to build the hospital large enough to handle 750 beds. "If we oversize it, there's great financial damage."
"I worry about the unpredictable," said Dr. Alan Heilpern, president of the Los Angeles County Medical Assn., who supports building a 750-bed hospital.
"A little over 15 years ago, AIDS was identified here in Los Angeles," Heilpern said at a rally organized by Molina's allies. "Who could have predicted a new disease that has had such a profound impact on the health care system?"
The compromise number of 600 beds, said the county's chief administrative officer, David Janssen, represents the minimum allowable for the county to continue to provide trauma care and other vital services. It also is the break-even point financially, according to health department figures.
If it goes as expected, today's vote will be a serious defeat for Molina, who had lobbied ferociously for 750 beds.
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As part of that effort, Eastside and Southeast county legislators including Assembly members Martin Gallegos (D-Irwindale), Antonio Villaraigosa (D-Los Angeles), Grace Napolitano (D-Norwalk) and others have met with each of the supervisors, imploring them to support the larger facility. Every major county health care organization has signed on to Molina's proposal, which is also backed by health department chief Finucane and the Los Angeles City Council. A chaplain at the medical center has even embarked on a hunger strike.
At issue are two key elements of the shift to managed care and profit-driven health services: the related questions of who will serve the very poor and who will pay for it.
"There is a huge fight in every large county in California and the ultimate question is who gets stuck with the bill," said author William Fulton, publisher of the California Planning and Policy Report.
According to one school of thought, county hospitals ought to take fuller advantage of Medi-Cal rules, which make it profitable to care for patients who qualify for the joint state and federal program. The money generated by the Medi-Cal patients, proponents of this approach say, could be used to treat indigent patients at the same facility.
But others, including a majority of Molina's board colleagues, believe that private hospitals, which are aggressively seeking lucrative Medi-Cal patients, will agree to take indigents if it means more money from Medi-Cal.
So the board, in a move based as much on politics as on policy, is ready to hold the line at 600 beds.
Supervisors also appear prepared to reject a compromise proposed by Janssen, which would have authorized a hospital large enough to handle 750 beds, but initially containing only 600.
That approach, Janssen said, would allow the county to increase capacity if the 600 figure proved unrealistic.
