No hospital in the state lost more pediatric beds in recent years than Los Angeles County-USC Medical Center, which has long served many of the county's neediest patients.
The downsizing began more than two years ago as hospital officials prepared for their move into a new state-of-the-art facility with only two-thirds of the space of the old campus.
First the hospital cut children's beds by nearly half, from 135 to 74.
Then the new building opened its doors in November with only 36 beds dedicated to children. An additional 19 are available for pediatrics, but can also be used for adults.
The decision to downsize was made by Los Angeles County supervisors in 1997 amid worry that a larger facility would be too costly to build and operate. But that choice came before more than two dozen local hospitals shut down or reduced the size of their pediatric units.
"I'm very concerned," said L.A. County Supervisor Gloria Molina of the level of pediatric care now available at County-USC. "We are going to watch this very closely, and I don't think we know the full extent of the consequences yet."
Molina, who took office in 1991, waged an extremely bitter and unsuccessful fight for a larger hospital.
Officials with the county Department of Health Services said they believe the cuts in children's beds will be offset by a shift from inpatient to outpatient care, making it possible to maintain the same level of service.
But front-line pediatricians strongly dispute that pediatric care will not suffer. Dr. Lawrence Opas, County-USC's chief of pediatrics and director of graduate medical education at USC's Keck School of Medicine, said he believes the effect will be acutely felt throughout the county.
One troubling question is whether the smaller facility will be able to handle the 7,000 foster children that had been treated annually. County-USC staff, who have specialized training in mental health issues and abuse, diagnosed more than 40% of the children referred by the Department of Children and Family Services with previously undetected mental health needs.
"We're breaking down the safety net for abused and neglected kids," said Dr. Astrid Heger, director of the hospital's Violence Intervention Program. "The kids who will be shut out will still have their broken arm treated somewhere else, but the doctors probably won't diagnose whether it's an accident or not."
Molina, whose district includes County-USC, said another concern is whether the far-smaller pediatric unit will hurt USC's pediatrics teaching program.
She credits the program with supplying top quality physicians despite the hospital's below-market salaries.
Heger said she believes the damage has already been done, noting that the program is now the smallest such university-affiliated program in the nation.
"The program will be noncompetitive to intern applicants except the poor performers from low-ranked medical schools," she said.