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County-USC's opening nears amid infighting

The major dispute involves beds for children at the new Eastside hospital.

May 23, 2008|Garrett Therolf and Mary Engel | Times Staff Writers

With the long-anticipated debut of the new Los Angeles County-USC Medical Center only months away, doctors and politicians are still sparring over scarce bed space, workers are trying to fix last-minute glitches, and contractors are struggling to incorporate new technologies.

The shimmering new facility was made necessary by the 1994 Northridge earthquake. It has been in the works for a decade, and was first expected to open by 2004, and then 2005 and then 2006.

Now the hospital is expected to be ready in October, but it looks like the rearranging and infighting may continue until the day the doors open.

The most pressing dispute, which pits adult patients against sick children, is emblematic of the struggle to open a county facility amid scarce resources and increasing demand. And the fight is all about bed space.

When doctors and patients move from the current Depression-era campus, the number of budgeted beds will drop from 671 to 600. It is unclear how many will be dedicated exclusively to children. Twenty-five beds are certain, but some people, including Supervisor Gloria Molina, are waging a fierce fight for 19 more, for a total of 44.

Without the additional beds, they say, the USC pediatric residency program would be at risk of shutting down and sick children from the Eastside would be forced into hours-long bus rides to other county medical facilities.

But health officials who want the beds to be open to adults say that the length of time emergency patients would have to wait for a bed elsewhere in the hospital would skyrocket if 19 additional beds were allotted to children only.

Ambulances throughout the Eastside struggle to find a hospital with space for patients, and the current County-USC campus is shut off to them a little more than half the time, so even the relatively small number of beds makes a difference.

The battle over beds is the continuation of a larger fight waged 10 years ago over how big the hospital should be.

"Supervisor Molina, when this decision was being made, argued for having at least the expansion capacity to go up to 750 beds," said Jim Lott, executive vice president of the Hospital Assn. of Southern California. "That wasn't paid attention to. Now we're squabbling over, do we hurt pediatrics or do we hurt overall services such as the ER. That's a decision we shouldn't have to make."

The debate over the 19 beds has never been publicly aired, although each of the five county supervisors has been briefed privately on the issue. County Chief Executive William T. Fujioka told The Times that his staff hoped to present a solution to the dilemma in the coming weeks.

The bed issue is only one example of eleventh-hour snags -- some of them substantial -- that will affect patient care at the new facility.

The most difficult problem, people on all sides of the issue said, is the product of a political and financial decision made in 1998 when Southern California's public and private hospitals were already struggling but had significantly more beds than they do today.

Since county supervisors decided on a 600-bed County-USC hospital, fifteen hospitals that receive emergency patients have closed in the county; only seven have opened or reopened.

Additionally, the county dropped plans in 2000 to open an 80-bed County-USC annex in Baldwin Park because of lack of money.

Now, although the new hospital is the largest construction project in Los Angeles County government history, nearly everyone's focus is on how small it is.

"Anybody can tell, you just can't make it work," said Molina, whose district includes the hospital. "It's a simple issue. Something is going to burst."

Ten years ago, Molina burnished a reputation for toughness and grit in her fight for a 750-bed hospital, finally pushing a plan to build a hospital with 750 beds but with the staffing for only 600. Her four colleagues voted for a firm 600-bed cap.

Anything more, they said, could bankrupt the entire county healthcare system.

The bitter fight left all sides feeling bruised, and many county officials seem especially chagrined to see it resurface.

The controversy seemed to divide officials into camps defined by ethnicity; virtually every elected Latino official in the area stridently lobbied the board to approve the larger 750-bed proposal and complained bitterly when they were denied. The rhetoric sometimes cut deep. Supervisor Zev Yaroslavsky, a chief proponent of the smaller hospital, complained privately that his opponents' criticisms were anti-Semitic, aides said.

Despite the hard feelings, Molina is pressing forward.

"Of course, the fight is back," she said.

Yaroslavsky declined to comment, but he has worked behind the scenes to maintain the 600-bed cap.

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