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Prognosis Doesn't Look Good for Acclaimed Rancho Rehab Center

Some patients have nowhere else to go, but the county says it can't afford to keep it open.

November 01, 2002|Lisa Richardson | Times Staff Writer

Raul Lopez is stoic while Dr. Irene Gilgoff taps his lung for fluid. The needle is barely out of his chest when she gently explains her expectation that he will go to college.

"I know you're very interested in finishing your education," she says, smiling. The 18-year-old looks at her and manages a nod. It still hurts just to breathe.

Just a month before, he was brought to Rancho Los Amigos National Rehabilitation Center after being shot in his Crenshaw neighborhood. Now he is paralyzed below the waist. He is not yet well enough for physical rehabilitation. But after 22 years at Rancho, Gilgoff, who is head of pediatrics, can pretty much tell who will thrive and who will not.

She isn't worried about Lopez; he has inner strength. She is far more worried about the fate of the hospital itself, and where patients like Lopez will go if it closes.

The county Board of Supervisors voted Tuesday to shut down the Downey facility after 114 years of operation, citing a looming budget deficit. The decision, though not final, has drawn protests from rehabilitation experts around the county -- and the country -- who see Rancho as one of the best in the business.

Deciding to close Rancho, supervisors said, had been painful. But the health-care deficit, projected to reach $500 million to $750 million in three years, threatens the county's entire hospital and clinic system, and could drag the county into bankruptcy.

"The pressure we feel is not just about this one closure," said Supervisor Zev Yaroslavsky. "The pressure we feel is if the entire system goes into meltdown."

The Department of Health Services determined that Rancho could not sustain itself. Its closing, the department predicts, will save the county as much as $70 million a year.

The county health department director, Thomas Garthwaite, agrees that Rancho takes on "difficult patients and [does] miraculous things." The issue is how best to serve the greatest number of patients with dwindling funds.

Rancho offers an uncommon constellation of specialized services -- from spinal-cord and neurological care to vocational training. But nearly a third of its patients are indigent.

The county estimates it would have to pay $15 million to $30 million a year just to cover uninsured patients.

"You have to ask, is that the best use of that money?" Garthwaite said. "Shouldn't that $15 million go to more emergency room visits, more outpatient services, more immunizations for children? There are no good choices here."

A Costly Commitment

Just caring for a gunshot victim like Lopez, who arrived with no insurance, costs about $200,000 the first year and about five times that over a lifetime. Medi-Cal does not cover all of these costs. And Rancho makes a lifetime commitment to treating its patients -- about 9,500 people a year, most of them outpatients.

The payoff is illustrated on Gilgoff's office wall, in a photo collage of the young patients she calls "her kids." They beam back at her in caps and gowns and prom tuxedos.

"This is a sad chapter -- all those who benefited from Rancho will have to either do without or seek care elsewhere," said Fernando Torres-Gil, the director of the UCLA Center for Policy Research on Aging. "On a larger picture, it's just another nail in the coffin for the collapse of our overall health-care system."

Torres-Gil has more than an academic appreciation for Rancho. He's been both a researcher and a patient there.

He's being treated for post-polio syndrome, a progressive weakening of muscles that strikes polio survivors anywhere from 10 to 40 years after their bouts with the disease. If Rancho closes, Torres-Gil said, he and about 100 others who need similar care will have to travel to the Bay Area or even to Washington, D.C.

"The reason Rancho is so crucial is that so many of the experts in polio have passed away," he said. "Rancho Los Amigos is one of the very few places attempting to educate a new generation of doctors, nurses and therapists about treating these millions of polio patients who are now getting old."

Trauma experts -- especially orthopedic surgeons -- around the country echoed his concerns. Rancho, said Dr. Daniel Lammerste, president of the American Spinal Injury Assn., helps teach the country how to treat the complications of spinal cord injuries.

For many rehabilitation experts, Rancho Los Amigos' significance should be considered in historic terms, not just practical ones. The field of rehabilitation has its roots there, and the center's influence has been felt in ways large and small.

Hospital advances now taken for granted, such as identification wrist tags, came from Rancho. Major innovations such as "the halo," which is used to support the head and neck of a patient with a spinal cord injury, were invented there. Rancho was the first to use plastics for prosthetic limbs instead of wood.

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