Citing Losses, CHOC Cuts 83 Positions

Children’s Hospital of Orange County eliminated the equivalent of 83 full-time jobs Thursday, saying losses that totaled $13 million last year are jeopardizing its mission to care for all the county’s youngsters.

The broadly distributed cuts included janitors, nurses, computer and clerical workers, medical technicians, a public relations director and an assistant to the president who was assigned to another job at less pay.

Officials estimated the reductions to the overall staff of about 1,100 will save $3.5 million a year, part of a multi-pronged strategy to balance the books at the hospital, which cares for children with life-threatening diseases whether or not they can pay.

Layoffs totaled 42, said hospital spokeswoman Jaynie Boren. Some were part-timers, and the effect was the same as cutting 33 full-time jobs. Reduced hours yielded the equivalent of nearly 21 jobs, and the rest came from eliminating open positions and attrition.

Officials said they tried to protect crucial workers like critical care nurses, but even some of them had their hours cut. Still, the reduction was structured “to minimize its effects on direct patient care,” said Kimberly C. Cripe, the hospital’s acting chief executive.

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Bad as they were, the cuts were far smaller than a wave of nearly 200 layoffs in June 1995. Officials blamed both rounds on the managed-care plans that have reduced Children’s Hospital admissions by more than 25% over the past five years, and patient days by 35%.

“It was absolutely necessary because of the declining number of patients,” said L. Kenneth Heuler, chairman of the hospital’s board of directors. “You just need fewer people to take care of 80 patients than if you had 120 patients.”

Officials said the hospital’s staff level of about 1,100 is still higher than at most similarly sized pediatric hospitals, and more cuts are under study, department by department.

Thursday’s cutbacks will reduce the ratio of staff to patients from 9.2 to 8.27. The U.S. average for children’s hospitals is 6.2 staff members per patient, Boren said.

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Allan DeKaye, an Oceanside, N.Y., hospital consultant, said such “bench marking” comparisons of staff levels are common, and the staff levels at Children’s Hospital still seem high enough to raise eyebrows.

“If they’re straight-up with their people, they’ll probably tell them there will be some more reductions in their work force,” DeKaye said.

People familiar with the hospital said staffers were well-aware the cuts were coming, and some already had quit for other jobs.

The already departed employees included two social workers who had introduced families of cancer patients to the Orange County Foundation for Oncology Children and Families, which sponsors camps for the families, said foundation President Karen Sullivan.

“It’s a shame, because those two were the best they’ve ever had,” Sullivan said. “I heard they left because it was just too unstable.”

Efforts also continue to ally Children’s Hospital with nearby St. Joseph’s Hospital, which operates three Orange County facilities, officials said. Hoag Hospital in Newport Beach might also become part of the alliance.

As a group, the hospitals would have powerful leverage to strike better bargains with insurers whose managed-care contracts are the most important source of patients for California hospitals.

As managed care has expanded in both the Medi-Cal and commercial markets, reimbursement for patient care has fallen and demands on hospitals to cut costs have intensified.

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Heuler said Orange County’s switch of its Medi-Cal program to a managed care format had led smaller hospitals to bid for Medi-Cal patients for the first time, seeking the high volume of patients that the plans guarantee.

But while impoverished children with standard troubles--a bad case of measles, say, or needing tonsils removed--can be handled at those hospitals, Children’s Hospital still winds up with the expensive, hard-to-predict cases such as cancer victims.

“We end up with the toughest and they keep the easiest stuff,” Heuler said.

He said the hospital will continue to study whether to eliminate some of its “exotic programs” such as transplanting bone marrow and umbilical cord blood.