County Health System in Peril, Panel Says

As thousands of sign-carrying county employees, blowing whistles and chanting slogans, protested sweeping budget cuts on the streets of Downtown, the Board of Supervisors heard a stark warning Tuesday that they must move quickly to save the county’s health care system from collapse.

Members of the county’s Health Crisis Task Force warned in blunt terms that closing hospitals and shutting health clinics will destroy the safety net that protects the needy and uninsured and the fragile network of trauma centers that protects everyone. The task force has recommended that hospitals be spared and most of the clinics be closed, at least temporarily.

With a hospital administrator warning that the Antelope Valley faces the threat of being left with no emergency medical service, Supervisor Mike Antonovich said he would introduce motions to prevent the most serious threatened cutbacks at the county-operated High Desert Hospital there, including forming a partnership with a private hospital.

It was a day filled with drama--but no action--over closing an unprecedented $1.2-billion budget deficit that threatens to drive the county to the brink of insolvency:

* The Rev. Jesse Jackson, joined by union leaders, called for a moratorium on budget cuts and layoffs of county workers until all potential sources of funding from the state and federal governments have been exhausted.

* Despite efforts by some Los Angeles-area lawmakers, there was no sign of hard dollars from Sacramento to assist the county.

* The word from Washington was more encouraging, with federal health officials expressing interest in an experimental program to shift the county’s health care system toward outpatient care at clinics instead of far more expensive treatment in hospitals. But the county received no firm commitment in its effort to obtain up to $300 million in federal funding.

Antonovich said he would try to save High Desert Hospital by introducing a motion Thursday to form a partnership with a private hospital or health company that would keep it fully operational.

The Health Crisis Task Force has proposed eliminating inpatient services at the Lancaster hospital and cutting its outpatient services by 40%. The hospital would keep its AIDS care center, but lose as many as 16 of the 29 outpatient clinics it operates, including a joint obstetrics program it runs with privately operated Antelope Valley Hospital Medical Center.

Antonovich, who said he disagrees with portions of the task force report, will introduce a motion asking the board to:

* Initiate a joint venture with a private agency or organization to operate High Desert Hospital, continuing such services as inpatient acute rehabilitation, sub-acute skilled nursing services and outpatient rehabilitation therapy.

* Meet with private hospitals in the Antelope Valley to develop a plan to provide basic medical care for the area’s poor residents.

* Agree that any unanticipated revenue should be used first to maintain inpatient services at High Desert. In addition, full outpatient services should be restored as soon as possible.

“The Antelope Valley is a unique area,” Antonovich said. “The residents are isolated, and with the task force plan, we are worried there will not be enough access to health care there.”

The Antelope Valley’s three private hospitals have said in the past that they do not have adequate resources to care for the area’s poor and uninsured--who include many of the working poor.

But on Tuesday, High Desert Hospital’s administrator, William T. Fujioka, said that one of the area’s hospital corporations had agreed to take responsibility for at least some of the hospital’s sickest long-term patients.

Fujioka said if some arrangement is not worked out soon, the Antelope Valley could be left without any hospitals at all because poor patients are expected to flood emergency rooms of the private facilities. The private hospitals are required under federal law to care for them, but the hospitals probably would not be reimbursed. On a large scale, that could threaten their survival, he said.

“If we don’t work out some kind of financial arrangement, I think the health care system in the Antelope Valley will collapse,” he said.

High Desert, with about 730 employees, is the third-largest employer in the Antelope Valley and the second-largest user of durable goods. If it suffers the proposed cuts, about 550 of its jobs will be lost, Fujioka said.

“It’s sad,” he said, “but we’re working like dogs to save this place.”

While the largest demonstration to date took place outside the Hall of Administration, the supervisors heard task force chairman Burt Margolin warn that failure to provide medical care to those who have nowhere else to go could lead to social unrest. And he warned that closure of County-USC Medical Center would put the county’s health care system in “a death spiral with no opportunity for survival.”

Margolin, expressing the sentiment of the five-member panel formed to find alternatives to closing the nation’s largest public hospital, said the “mission of the county is the protector of public health. . . . It is literally at stake in the decisions you will make this week.”

The task force offered the supervisors a plan that would scale back operations at county hospitals but keep them all open, while closing most of the county’s community health clinics unless additional financial resources can be found within 90 days. At that point, Margolin said, the county will have no choice but to close hospitals.

While expressing interest in the task force’s recommendations, the board took the suggestion under consideration without making any decisions Tuesday. They canceled today’s budget session and will resume deliberation Thursday on bridging the deficit. In the interim, they will continue to lobby Washington and Sacramento for firm commitments of dollars to help solve the fiscal crisis.

After leading the march of county of workers, Jackson made an impassioned plea to the supervisors seeking a delay in sweeping cuts to county services.

Earlier, Jackson called on Gov. Pete Wilson and state lawmakers to give the county the ability to impose its own so-called “sin taxes” on liquor, beer, wine and tobacco that could raise hundreds of millions of dollars in new revenue.

There was no sign that state lawmakers are willing to give the supervisors the authority to impose a 10% tax on alcoholic beverages sold in bars and restaurants.

An alternate proposal to give the supervisors the ability to raise the county’s sales tax by 0.5% was given a slightly better chance. But nowhere in sight was the kind of complete package that could avert deep reductions in county services.

The signs were more hopeful from Washington after Supervisor Zev Yaroslavsky’s and board Chairwoman Gloria Molina’s lobbying trip last week. A high-level delegation of federal health officials met privately with each supervisor on Monday to express interest in assisting the county in developing a new health care system that primarily relies on outpatient care instead of far more expensive treatment in hospital emergency rooms.

While encouraging, the federal officials have not made any specific promises on how much money the county can count on in the near future to help close a budget deficit of at least $655 million in health services.

Several supervisors announced Tuesday that the federal government will come through with as much as $300 million for the experimental program. Molina publicly thanked President Clinton and Health and Human Services Secretary Donna E. Shalala for responding so quickly to the county’s pleas for help.

But federal officials said it is premature to be making such an announcement. “It is not a done deal,” said Shalala’s top spokesman, Victor Zonana.

Any federal help would require approval by the state Legislature and Wilson, and possibly state funds that the federal government would match.

Chief Administrative Officer Sally Reed told the supervisors Tuesday that even if the federal bailout plan needs no state funding, “Our experience in the past on these . . . is very bad” because the state has balked at following policy changes dictated by Washington.

Outside, protesters jammed the sidewalks in front of the county supervisors’ meeting auditorium, chanting, blowing whistles and carrying signs. There were new signs in the crowd, many of them attacking Wilson.

Times staff writer Josh Meyer contributed to this story.