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Poor Could Suffer Most From Cuts

Antelope Valley: Medical staff fear plan to turn hospital into outpatient clinic would put care out of reach for many.


High Desert Hospital sits in a remote location next to a state prison. It has only 75 beds and no emergency room.

But local officials say the small public hospital in Lancaster plays a crucial role in the Antelope Valley, offering free or nearly free health care for the 25% of area residents who lack insurance.

On Monday, doctors and nurses were alarmed by the Los Angeles County Health Department's recommendation to shut down the hospital's in-patient services, or any care that would require a hospital stay of 24 hours or more.

"That means we will only be able to operate on lumps and bumps," said Indra Vyas, the hospital's chief of surgery. "The people who come here have no insurance, and usually no money .... Where will I send them?"

Antelope Valley authorities say the area cannot afford to lose another hospital. During the 1990s, the valley population grew by 27%, to 318,000, but two of its five hospitals closed. That has left the valley with a ratio of 1.5 acute-care beds per 1,000 residents, compared with 2.5 beds per 1,000 in the rest of Los Angeles County, according to the High Desert Hospital advisory council, a group of government and health care officials fighting to save the facility.

"Already, some patients are very sick and need to go to the hospital, and a lot of times there's just no beds for them," advisory council board member Norm Hickling said. "If High Desert closes down, more people are going to have to drive 60 miles to get medical attention."

County health officials say they can save $13.5 million a year if they scale back the hospital's services and operate it as an ambulatory care clinic, offering outpatient services only.

During fiscal year 2000-01, the hospital provided inpatient services to 1,000 people. County Health Director Thomas Garthwaite said officials believe they can serve far more people with a clinic.

Vyas said the inpatient services are crucial for the many poor and working-class patients. While they could go to Antelope Valley or Lancaster Community hospitals, both private facilities in Lancaster, many are afraid to sign the forms that make them liable for any bills incurred there, and wind up skipping treatment altogether, he said.

Others will have to drive to the closest county facility in Sylmar when they are seriously ill.

"There are so many indigent patients who don't have a car and who can't even afford a taxicab," nurse Claudia Karner said. "Some are going to die before they even reach the emergency room."

Miranda Hernandez, 27, who is uninsured, underwent major abdominal surgery at High Desert last week. She hasn't been able to keep a job because of her medical problems, and the bills forced her to move in with her parents a few months ago.

The hospital is only a few miles away from her parents' home in Lancaster, but she does not know how she would get to the Sylmar hospital in the event of another emergency.

"My parents have been helping me out, but they work," said Hernandez, who was still recovering at the hospital Monday. "I can't depend on them all the time." Some help may be on the way. A private company, Universal Health Services, is planning to open a 120-bed hospital by 2005, Lancaster spokeswoman Barbara La Fata said.

But Dr. Russell Gross, a surgeon at High Desert, said a new private hospital won't mean much for poor patients.

"When people with no insurance show up at places that expect to get paid, they really get kicked around," he said.

"[Our patients] are either going to go into town and flood the ERs there, or flood the system down in Los Angeles."

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