In Poor Health

<v Woman 1>[music plays] L.A. County USC Medical Center is bursting at the seams. <v Man 1>Patients come in who are in need of immediate help. <v Man 1>And we're not able to help them immediately. <v Man 1>We are slowly committing criminal acts against the poor. <v Narrator 1>Major funding for By the Year 2000 was provided by the James Irvine <v Narrator 1>Foundation to promote civic and social responsibility and the development <v Narrator 1>of sound public policy through the understanding of community issues. <v Narrator 1>And by the Michael J. Connell Foundation. <v Narrator 1>Additional funding is provided by the law firm of Latham and Watkins, proudly <v Narrator 1>supporting public discussion of community issues. <v Eric Burns>Being poor is a burden. In Los Angeles, being poor and in need of a hospital can

<v Eric Burns>turn a burden into misery. <v Eric Burns>At the rate we're going by the year 2000, health care for the poor will exist in name <v Eric Burns>only. I'm Eric Burns. <v Val Zavala>And I'm Val Zavala. <v Val Zavala>California has been spending less on health care for the poor every year. <v Val Zavala>We now rank behind almost every state in the nation. <v Val Zavala>47th in per capita spending. <v Val Zavala>Even in Mississippi, the poor get a better break. <v Eric Burns>In Los Angeles, the poor usually end up at the Los Angeles County USC Medical <v Eric Burns>Center. It's a massive facility strained to the limit. <v Eric Burns>As for the quality of health care it delivers. <v Eric Burns>Critics call it third world. <v Val Zavala>While researching this story, we requested permission to videotape areas of the county <v Val Zavala>hospital where crowding is severe. <v Val Zavala>But hospital officials denied our request, believing that the public has a right to know <v Val Zavala>what is going on in this public facility, we obtained some of our video through the use <v Val Zavala>of a hidden camera. Here's our report. <v Val Zavala>[sirens]

<v Man 2>Welcome to the war. This is the closest to our a- army combat evacuation <v Man 2>hospital you're gonna get to without being shot at. <v Woman 2>Sometimes there just isn't an operating room. <v Woman 2>So we do the best we can. <v Man 3>Somewhere around 3 or 4 in the morning uh we ran out of instrument packs. <v Woman 3>Someone who's been stabbed or shot has to ?inaudible? for someone who needs their leg <v Woman 3>operated on. <v Val Zavala>The sounds of a MASH unit. But this one is in the shadow of downtown Los Angeles. <v Val Zavala>L.A. County USC Medical Center, the largest public hospital in the country. <v Val Zavala>L.A.'s hospital of last resort for the poor and uninsured. <v Val Zavala>By law, it has to treat everyone who shows up at its door. <v Nurse 1>It's like this is the final place dumping ground is is is called, <v Nurse 1>you know, the buck stops here. <v Val Zavala>But today, the county's flagship hospital is bursting at the seams. <v Val Zavala>It is crowded with the growing number of people without health insurance who can't get <v Val Zavala>treatment anywhere else. The hospital is understaffed and underfunded. <v Val Zavala>There are long waits for emergency room visits, for surgeries, for intensive care beds.

<v Val Zavala>Resources are stretched so thin that doctors and nurses say patients are dying from <v Val Zavala>neglect inside the hospital. <v Physician 1>Sometimes I've gone to these codes where the patients are stiff. <v Physician 1>They've been dead for hours and the only time that they find them is <v Physician 1>the next morning when they have a change of shift. <v Val Zavala>Numerous lawsuits filed against the county also charge that delays in care <v Val Zavala>are resulting in injuries and deaths. <v Val Zavala>The county admits it paid out eleven million dollars last year in malpractice <v Val Zavala>settlements involving the medical center and then insisted on gag orders for most of <v Val Zavala>those cases. The county says they do this to keep the information from becoming <v Val Zavala>public. Everyone agrees the medical center is overburdened. <v Val Zavala>But what does that mean for the patients who come here and for the taxpayers who pay the <v Val Zavala>bills. To find out, we looked at three areas of the medical center that experts say <v Val Zavala>are especially overcrowded: the emergency room, intensive care and <v Val Zavala>labor and delivery.

<v Val Zavala>1 out of every 200 babies born in the United States is born in <v Val Zavala>this building. <v Val Zavala>This tape, [crying] taken with a hidden camera last month, shows what staff members say <v Val Zavala>are frequent conditions on the labor and delivery ward. <v Val Zavala>Most of these women have not had prenatal care and are at high risk for complicated <v Val Zavala>deliveries. Yet 11 women are in labor in the hallways because of overcrowding. <v Val Zavala>3 in this hall, 3 in this hall, 3 in yet another hall [screaming], 2 <v Val Zavala>in front of the nursing station, and more coming in. <v Dr. Debra Grubb>On a busy day we have a- all of our labor rooms full. <v Dr. Debra Grubb>We put usually 2 laboring beds in each of our hallways so we <v Dr. Debra Grubb>have 6 to 8 patients laboring in the hallways. <v Dr. Debra Grubb>And if there are more than that, they have to wait in ?terrace?. <v Val Zavala>The facility is designed and staffed for 34 deliveries a day. <v Val Zavala>Last month, the daily average was 56. <v Val Zavala>When it's this busy, doctors say it's difficult to monitor patients adequately. <v Dr. Debra Grubb>Usually if the patients are in the hallway, there isn't a nurse assigned to watch them.

<v Dr. Debra Grubb>And whoever happens to be available at the time will have to do the best they can. <v Val Zavala>The best they could do was not good enough for Amelia Lopez, who recently filed <v Val Zavala>a claim against the county. She gave birth to one year old Gabriel at County USC <v Val Zavala>last July. He has been diagnosed as brain damaged. <v Amelia Lopez>[speaking Spanish] [translator speaking] It pains her to see her son so ill. <v Val Zavala>Last July, Lopez was in labor for nearly 24 hours at County USC. <v Val Zavala>[child whimpering] She says during three of those hours, she was in labor in the hall. <v Val Zavala>She was hooked up to a fetal monitor. <v Val Zavala>Lopez's attorneys, Michael Piuze and Jeff Wells, had an obstetrician review <v Val Zavala>the fetal monitor tapes. <v Val Zavala>They allege that the readings were normal for 17 hours. <v Val Zavala>Then they charged the fetus went into distress, an indication that immediate surgery <v Val Zavala>was required, say the lawyers. <v Val Zavala>But according to their obstetrician, the fetus remained in distress for more than an hour

<v Val Zavala>before his cesarean section was performed. <v Val Zavala>On the baby's chart is the diagnosis severe perinatal asphyxia. <v Val Zavala>In other words, he was deprived of oxygen. <v Michael Piuze>We know from the fetal monitors strips that just before he went into severe fetal <v Michael Piuze>distress, he was in effect, a normal baby. <v Michael Piuze>And we know that when he was delivered 60 to 90 minutes later, <v Michael Piuze>his life was irreparably wronged. [child crying] <v Michael Piuze>Because this child was deprived of oxygen, major portions of his brain were destroyed <v Michael Piuze>permanently. And so this baby was never going to be ale to walk, talk, take <v Michael Piuze>care of his bodily function needs or lead a normal life. <v Val Zavala>The county would not comment on this case. <v Val Zavala>However, hospital officials admit that in general, conditions on the ward can lead to <v Val Zavala>injuries. Dr. Tom Kirschbaum, director of labor and delivery, says it's not <v Val Zavala>unusual for all the operating rooms to be full, causing women to wait hours for an

<v Val Zavala>emergency cesarean section. <v Dr. Tom Kirschbaum>We've had women who've had to wait uh 4 to 6 to 8 hours for cesarean section <v Dr. Tom Kirschbaum>lose part of their cervix because of the pressure, the presenting part against the cervix <v Dr. Tom Kirschbaum>uh during the period of time between the time of the medical decision and the ability <v Dr. Tom Kirschbaum>to carry out the procedure. <v Val Zavala>Recently, Dr. Kirschbaum wrote this letter to administrators warning that the medical <v Val Zavala>staff cannot be responsible for the safety of patients. <v Dr. Tom Kirschbaum>The principal problem, from our point of view, uh from the point of <v Dr. Tom Kirschbaum>view of the medical staff, is that we're being called upon to deal with more patients <v Dr. Tom Kirschbaum>than it's safe for us to have. <v Val Zavala>Doctors say staffing is so thin on labor and delivery that more than two simultaneous <v Val Zavala>caesarean sections can take all doctors and nurses off the floor, leaving <v Val Zavala>patients unattended. <v Dr. Tom Kirschbaum>We've had instances where um uh in the midst of several emergencies, <v Dr. Tom Kirschbaum>one doctor has been uh uh obligated to look after 30 or 40 women <v Dr. Tom Kirschbaum>who are laboring. And you simply can't do that.

<v Dr. Debra Grubb>You might leave 40 women attended by no one if everyone is in a delivery. <v Val Zavala>Dr. Sol Bernstein, chief of staff at the medical center, admits present conditions in <v Val Zavala>labor and delivery could result in patient harm. <v Dr. Sol Bernstein>Whenever you work under chronic stress there are op- <v Dr. Sol Bernstein>there's a potential for mishap. <v Dr. Sol Bernstein>You're more liable to make some errors. <v Val Zavala>[child crying] Amelia Lopez claims her child's delivery was one of those potential <v Val Zavala>errors. Experts estimate that medical care for a child like Gabriel over the <v Val Zavala>course of a lifetime could cost up to a million dollars. <v Val Zavala>[inaudible speaking] In <v Val Zavala>the emergency room, overcrowding causes similar problems. <v Val Zavala>Unlike private hospitals, County's emergency room can't close when things get busy. <v Val Zavala>[woman speaking on phone] The emergency room is handling 50 percent more patients today

<v Val Zavala>than it did in 1982. <v Val Zavala>But the size of the staff has remained the same. <v Val Zavala>It is not unusual, according to emergency room staff, for seriously ill patients to wait <v Val Zavala>up to 8 hours to see a doctor. <v Val Zavala>Sandy Correia is an emergency room nurse. <v Sandy Correia>Patients with appendicitis can wait in the emergency room for hours because they're not <v Sandy Correia>deemed critical. In our emergency room, they can wait hours and hours ?inaudible? <v Sandy Correia>um seizure t- patients that have had seizure disorders. <v Sandy Correia>They can wait, you know, 2, 3 hours to see a doctor on a busy night. <v Val Zavala>This was a scene on a busy Saturday night last month. <v Val Zavala>A man waiting to see a doctor in the emergency room fell to the floor in convulsions, his <v Val Zavala>body expelling blood and urine. <v Val Zavala>[nurse shouting sir] According to doctors, after patients are seen in the emergency room, <v Val Zavala>the ones that need to be admitted to the hospital sometimes wait on gurneys in the hall <v Val Zavala>for up to 4 days. Nurses say the situation is so common that it's

<v Val Zavala>part of the hospital system. <v Clayton Cortinas>We'd start carried off hallway slots. Hallway 1, hallway 2, or hallway 37. <v Clayton Cortinas>Hallway 38. Until we have every patient with a slot, that's all for the <v Clayton Cortinas>uh patient uh computer that lists location. <v Val Zavala>Eventually, all the patients who need a bed on the regular ward will get one if they're <v Val Zavala>willing to wait. But in the intensive care unit, there are only 14 beds and doctors <v Val Zavala>say not every patient who needs one will get one. <v Val Zavala>Doctors in the ICU face tough choices. <v Val Zavala>Which of the critically ill patients will receive intensive care and which will not? <v Val Zavala>Dr. James Tuschmidt is director of the Medical Intensive Care Unit. <v Dr. James Tuschmidt>1, 2, 3, 4. We have 5 patients- <v Val Zavala>Each morning, he and his team of residents have to decide which patient they will admit <v Val Zavala>to the ICU. <v Dr. James Tuschmidt>As a physician, I have a primary responsibility to the patient <v Dr. James Tuschmidt>uh that comes through the door and to uh be in a position

<v Dr. James Tuschmidt>where I have to decide um to admit one patient to the intensive <v Dr. James Tuschmidt>care unit or another patient to an intensive care unit, puts me I think, in a very <v Dr. James Tuschmidt>awkward uh position from a uh ethical point of view. <v Dr. James Tuschmidt>[chattering] Clearly yeah I think out of out of these other patients I mean <v Dr. James Tuschmidt>this patient probably has the most reversible uh disease process here. <v Dr. James Tuschmidt>No one ever was said anything about this when I went to medical school. <v Dr. James Tuschmidt>If they did, I'm not sure I'd be here today. <v Dr. James Tuschmidt>But uh because these are clearly very, very tough uh decisions that people <v Dr. James Tuschmidt>have to make. <v Val Zavala>Tuschmidt says that his patients face the prospect of not receiving care because <v Val Zavala>politically there's no one to stand up for them. <v Dr. James Tuschmidt>Many of our patients are kind of invisible. <v Dr. James Tuschmidt>They are not voting members of society. <v Dr. James Tuschmidt>Um many of them are very indigent. So they don't have a lot of clout in terms of of <v Dr. James Tuschmidt>politics. And um as a consequence, they're <v Dr. James Tuschmidt>kind of a forgotten uh group of people.

<v Val Zavala>When there's no room in intensive care, critically ill patients are put in a holding area <v Val Zavala>called the Red Blanket Room. <v Physician 1>These are patients who have had heart attacks and they can have fatal <v Physician 1>arrhythmias or irregular heartbeats that can literally kill them in <v Physician 1>or within the first 24 or 48 hours. <v Val Zavala>Yet because there aren't enough intensive care beds, these patients can end up in the <v Val Zavala>hallways. Clayton Cortinas is a nurse in the red blanket holding area. <v Clayton Cortinas>We have 18 monitored beds available but we average anywhere from 34 to <v Clayton Cortinas>48 patients a day in the room at any given time. <v Val Zavala>Further evidence of overcrowding in the Red Blanket Room was provided last April when the <v Val Zavala>L.A. City Fire Department cited the Medical Center for Fire Code violations in the area. <v Val Zavala>The report warns overcrowding of this area causes an extreme life safety <v Val Zavala>problem. All aisles and exits are blocked with patients. <v Clayton Cortinas>We had one patient that arrested that we could not get the crash cart ?to? <v Clayton Cortinas>the crowd. It was so crowded we took the equipment off and hand it around the room until

<v Clayton Cortinas>we could get the crash cart. It took us a good 5 to 10 minutes to get the crash cart over <v Clayton Cortinas>to the patient. <v Val Zavala>Another danger of overcrowding in the Red Blanket Room, according to the doctors and <v Val Zavala>nurses, is that the area is not staffed or equipped to handle so many <v Val Zavala>unstable patients. <v Physician 1>Sometimes we don't even have enough monitors because it gets so crowded <v Physician 1>and these patients can can literally die and we won't <v Physician 1>know it. <v Clayton Cortinas>Essentially, the patients are watching each other. <v Clayton Cortinas>They have somebody that's in a hallway and they're laying off to the side of the room, <v Clayton Cortinas>one they're not attached to a monitor. <v Clayton Cortinas>They're not attached to a monitor not not attached to a alarm system. <v Clayton Cortinas>If they're not attached to an alarm system, if something happens and there isn't anybody <v Clayton Cortinas>looking at 'em right at that moment then the chances are that it may go unnoticed. <v Val Zavala>Does that happen? <v Clayton Cortinas>Uh yeah, it could happen. And it has happened. <v Physician 1>The nurse can come by with some medication that the patient, you know, <v Physician 1>is supposed to be receiving and find that the patient's not breathing or

<v Physician 1>you know, doesn't have a pulse. <v Physician 1>That's usually the scenario. <v Val Zavala>Chief of Staff Dr. Saul Bernstein denies reports of preventable deaths <v Val Zavala>in the Red Blanket Room. <v Saul Bernstein>If somebody dies there, it's not because of lack of attention. <v Saul Bernstein>I mean, every death is reviewed uh by us uh to determine <v Saul Bernstein>you know, whether anything could have been done to prevent it. <v Val Zavala>David Langness is vice president of the Hospital Council of Southern California, a <v Val Zavala>lobbying organization for private and public hospitals. <v Val Zavala>He claims that conditions at County USC are resulting in preventable deaths. <v David Langness>It usually happens quietly because people don't like to talk about it. <v David Langness>And it happens one by one. <v David Langness>So it never becomes a big crisis. <v David Langness>It's not like an airplane disaster or a massive car pileup. <v David Langness>Although many more people die as a result. <v Val Zavala>Many doctors and nurses at County USC blame conditions at the medical center on the <v Val Zavala>politicians who control the funding. Taking inflation into account, the facility's

<v Val Zavala>budget has decreased nearly 20 percent since 1981. <v Clayton Cortinas>I think there's a real attitude on behalf of the Board of Supervisors that <v Clayton Cortinas>uh if if you can't support yourself and <v Clayton Cortinas>uh y- you can't find your own means, then be happy for what you get. <v Clayton Cortinas>You're lucky you're getting what you're getting. Shut up and take it. <v Val Zavala>What can be done to improve conditions at County USC? <v Val Zavala>For some answers, we go to Eric and guests. <v Eric Burns>They are Carl Williams, first of all. He is the director of hospitals for the county of <v Eric Burns>Los Angeles. And next to him, Stan Dorn, an attorney for the National Health Law <v Eric Burns>Program, a group uh which deals with issues involving health care for poor people. <v Eric Burns>Mr. Williams, first of all, that last allegation that the attitude of the Board of <v Eric Burns>Supervisors is poor people are lucky to get what they can, they should accept it and shut <v Eric Burns>up. <v Carl Williams>?inaudible? to that, I don't think any of the supervisors feel that way or act that way. <v Carl Williams>The Board of Supervisors are faced with very difficult decisions to make in allocating

<v Carl Williams>limited resources between many very justified needs. <v Carl Williams>Just as the physicians are faced with difficult decisions. <v Eric Burns>Is what we just saw along those lines an accurate portrayal of what goes on <v Eric Burns>at the County USC uh Medical Center? <v Carl Williams>Well, there's no question but what there are long waits and crowded conditions <v Carl Williams>at County USC Medical Center. <v Carl Williams>Uh we've known that for a long time. And I think the staff there do a very creditable job <v Carl Williams>in dealing with limited resources and limited staff. <v Eric Burns>Let me deal with the phrase limited funding, uh limited resources that we heard. <v Eric Burns>Is that in your view, Mr. Dorn, the uh the nub of the problem? <v Stan Dorn>Well, yes and no. It is the nub of the problem in that too few resources are going to <v Stan Dorn>this county hospital system, which is the sole source of health care for all <v Stan Dorn>low income people in Los Angeles County. <v Stan Dorn>But the reason why we have too little money going to our indigent health care system is <v Stan Dorn>that very political decisions have been made both at the state and the county level. <v Stan Dorn>State support for indigent care has been cut in half over the last 7 years

<v Stan Dorn>and the county's commitment to indigent care has dropped from 16 percent of the county's <v Stan Dorn>budget 5 years ago to 8 percent today. <v Stan Dorn>So there's a reason why we have too few resources. <v Eric Burns>Which is to say the kinds of people who need this health care don't vote and thus are not <v Eric Burns>a priority of politicians. <v Stan Dorn>Well they don't vote and they don't give campaign contributions. <v Eric Burns>[sighs] Given the present limited resources, which I'm sure you both <v Eric Burns>bemoan. Can anything be done to improve the quality of health care short <v Eric Burns>of more money or differently allocated money? <v Eric Burns>Mr. Williams, first of all. <v Carl Williams>Well, certainly one of the biggest assists that would help us would be to get more <v Carl Williams>registered nurses. There is a nationwide shortage of registered nurses, <v Carl Williams>and that shortage is acutely felt in Los Angeles County. <v Eric Burns>That's a matter of more money, isn't it? I mean you're not gonna get them under the <v Eric Burns>present- ?inaudible? <v Carl Williams>Not necessarily. Not necessarily. <v Carl Williams>We have positions that are funded and we simply can't hire nurses. <v Carl Williams>A good example is the dedicated AIDS ward at County USC that we tried <v Carl Williams>to open. We have money to open 20 beds and we're only able to

<v Carl Williams>open 10 at the present time simply because we can't hire the nurses. <v Eric Burns>Let us assume we somehow could get greater allocations of uh of <v Eric Burns>money, Mr. Dorn. What should we do with it? <v Stan Dorn>Well, we should- <v Eric Burns>At county USC. <v Stan Dorn>Well, we should use it to bring the quality and accessibility of care back <v Stan Dorn>to the standards that we expect in the civilized world. <v Stan Dorn>You mentioned in your introduction that uh what goes on at county facilities <v Stan Dorn>is sometimes likened to third world medicine. <v Stan Dorn>The phrase the analogy that I've often heard used by doctors and nurses working in the <v Stan Dorn>system is not to third world countries of today, but 19th century medicine. <v Stan Dorn>They often feel as if they've stepped into textbook photos of the horrors of what <v Stan Dorn>happened to most of us 100 years ago. <v Eric Burns>Is it that bad at that hospital? <v Carl Williams>No, I don't believe it's that bad. <v Carl Williams>There are very crowded conditions. The staff work very hard, long hours, <v Carl Williams>and the patients just keep coming. <v Carl Williams>One of your earlier clips stated that we can't close that hospital. <v Carl Williams>That's not exactly true. We can close the emergency room to saturation

<v Carl Williams>and that does shut down the traffic except for patients who are in <v Carl Williams>extremis or patients who walk in. <v Eric Burns>Yeah, to shut down the traffic is to shut down the care. So that's obviously the problem <v Eric Burns>there. But let me stop at this point to say that uh we wanted to hear from more than just <v Eric Burns>the two of you today. We invited each member of the Los Angeles County Board of <v Eric Burns>Supervisors to join us in the studio, but each member declined. <v Eric Burns>Kenneth Hahn, of course, has been ill. <v Eric Burns>Ed Edelman, is the chairman of the Board of Supervisors and represents the districts <v Eric Burns>where the hospital is located. <v Eric Burns>We were able to catch him at the Hall of Administration and ask him about this matter. <v Eric Burns>Reporter Jeff Kay recorded the following interview. <v Ed Edelman>We're aware that uh there is a need to improve staff numbers <v Ed Edelman>to improve the physical facility. Unfortunately, the state which controls <v Ed Edelman>the funding for health has not provided us each year enough money. <v Ed Edelman>Now, this year, we seem to have done v- well, although we can't tell precisely, ?prob? <v Ed Edelman>99 funds are available.

<v Eric Burns>The Tobacco Tax Initiative- <v Ed Edelman>The Tobacco Tax Initiative and the CAO is uh this very moment figuring <v Ed Edelman>out how much uh money we'll be able to be put into health to improve <v Ed Edelman>it somewhat and uh hopefully uh we can continue to increase <v Ed Edelman>rather than cut back the service level ?in our? <v Ed Edelman>health ?inaudible?. <v Eric Burns>We've heard horror stories. We've heard stories about babies being born brain <v Eric Burns>damaged because the mothers didn't get the surgery they needed. <v Eric Burns>We've heard about people on gurneys, in hallways unmonitored who <v Eric Burns>sometimes have been uh die before they they receive attention. <v Eric Burns>Well, how long can those kinds of conditions continue? <v Ed Edelman>Well, obviously uh no uh condition, which you ?cite? <v Ed Edelman>is acceptable. <v Ed Edelman>Uh we have to obviously uh find the funds uh since uh ?prop? <v Ed Edelman>13, uh the county has been cut uh in terms of its funding. <v Ed Edelman>The state is up against the ?gan? limit. <v Ed Edelman>Uh they have funds, but they can't spend 'em uh we found a down rule that

<v Ed Edelman>instead of increasing the service level, uh we've seen the service <v Ed Edelman>level deteriorate because of funding problems. <v Ed Edelman>We hope that that won't continue. <v Ed Edelman>We hope that the state will face up to their responsibility. <v Ed Edelman>We face up to our responsibilities and we correct some of the deficiencies that we <v Ed Edelman>know exist there. <v Eric Burns>You know what are you optimistic or pessimistic about for the future- <v Ed Edelman>Well, I think right now we're just trying to stabilize our health system. <v Ed Edelman>We don't want it to have it deteriorate any further. <v Ed Edelman>Uh the question is, are we going to be able in the next years, the next two or three <v Ed Edelman>years, be able to increase funding for staff as well as facilities? <v Ed Edelman>That'll be the test. Right now, we're sort of in a period where we can take a breath, but <v Ed Edelman>it's gona be a short breath because uh in the next year, if we don't find additional <v Ed Edelman>revenue, we're gonna find the level deteriorating again. <v Eric Burns>It seems to me uh two questions are raised by what Mr. Edelman said. <v Eric Burns>First, do you agree that the problem or one of the problems is that the state is not <v Eric Burns>providing enough money? And second, if you do agree, what happens if the state doesn't

<v Eric Burns>provide more? ?inaudible? <v Stan Dorn>Well, it's certainly true that the state hasn't provided enough money. <v Stan Dorn>In particular, Governor Deukmejian over the years has repeatedly vetoed hundreds <v Stan Dorn>of millions of dollars for county health care expenditures statewide. <v Stan Dorn>But as I indicated earlier, the county government has to bear a huge share of the blame <v Stan Dorn>here. The county's commitment to indigent care has been cut in half over the last <v Stan Dorn>5 years. And believe it or not, county officials are proposing an additional reduction <v Stan Dorn>of 55 million dollars in health service cuts, plus what the CAO terms 75 <v Stan Dorn>million dollars in administrative adjustments, which means the potential for another huge <v Stan Dorn>step downwards. <v Eric Burns>So what happens if these cuts aren't rescinded, if larger allocations aren't made? <v Eric Burns>What do you do at that hospital? <v Carl Williams>Well, conditions won't get a whole lot better. <v Carl Williams>Uh the the way- <v Eric Burns>That's much too euphemistic. And they're mad now and they're gonna get a lot worse. <v Eric Burns>Isn't that more accurate? <v Carl Williams>The waits will get longer and uh we will have to do more triaging of <v Carl Williams>patients. We are trying to increase the services that our comprehensive health centers <v Carl Williams>throughout the county to triage some of the less critical patients out to them.

<v Carl Williams>We're considering a little tram system that will pick patients up from our waiting <v Carl Williams>rooms who are well enough to travel and take them to our comprehensive <v Carl Williams>health centers. <v Eric Burns>There are problems at the at at this hospital, not just with the health care, but also <v Eric Burns>with the uh building in which the health care is provided. <v Eric Burns>And Val now has a report that tells us something about that. <v Eric Burns>[sirens] <v Val Zavala>The monolithic structure was built more than a half a century ago. <v Val Zavala>Not terribly old, but well-worn. <v Val Zavala>County officials admit that the building will not last until the year 2000 without major <v Val Zavala>capital improvements. They include reworking the electrical system and replacing the <v Val Zavala>plumbing. The estimate to fix the plumbing alone is 60 to 80 million <v Val Zavala>dollars, and that's not all. <v Val Zavala>We obtained copies of numerous fire department citations. <v Val Zavala>Because of these violations, the federal government is ordering millions of dollars in <v Val Zavala>repairs to bring the hospital up to fire code. <v Val Zavala>Renovating the old building is only one of the options facing the Board of Supervisors. <v Val Zavala>The cost of refurbishment is still under study.

<v Val Zavala>A second possibility is to put up a brand new building. <v Val Zavala>That carries a price tag of 550 million dollars. <v Val Zavala>And a newly proposed third option is that the county not have a hospital at all. <v Val Zavala>Supervisor Michael Antonovich suggests that all health care should be contracted out to <v Val Zavala>private hospitals. With the federal government breathing down its neck, the Board of <v Val Zavala>Supervisors will have to take action soon. <v Val Zavala>The hospital isn't getting any younger. <v Eric Burns>And what should be done to keep it from aging in such perilous condition? <v Carl Williams>The building uh the buildings on that campus are in serious condition. <v Carl Williams>Uh the consultant tells us they have 5 to 7 years life for the infrastructure <v Carl Williams>left. We are very close to proposing a master plan for <v Carl Williams>the replacement of the county USC Medical Center, which would include a new 950 <v Carl Williams>bed hospital and an additional 350 bed hospital out in the <v Carl Williams>San Gabriel Valley. We feel that if a bond issue can <v Carl Williams>be issued or if other funds are available to do that, that that's the best

<v Carl Williams>long term solution. We will, at the instruction of the board, be looking at <v Carl Williams>the issue of contracting out however, and I think there is some skepticism <v Carl Williams>about whether or not the public sector or the private sector would be able to handle <v Carl Williams>those patients or in fact, with the limited funding available, would want to handle <v Carl Williams>them. <v Eric Burns>So you agree that it's necessary to give up on the present building? <v Carl Williams>Absolutely. <v Eric Burns>Your thoughts about that, Mr. Dorn? <v Stan Dorn>Well, I'd like to focus not so much on the physical plant, although it's a serious <v Stan Dorn>problem. The underlying problem is the structure of our health care financing system, <v Stan Dorn>where we rely on these year by year political decisions to determine <v Stan Dorn>the lives and the future safety of all low income residents of Los Angeles County. <v Stan Dorn>It's a patchwork system. It's doomed to fail. <v Stan Dorn>Um the only long term answer is to provide a program of universal health insurance for <v Stan Dorn>all Californians. We are the only Western country without a universal <v Stan Dorn>health care coverage program. We are the only country in the world where scenes like that <v Stan Dorn>we just saw earlier about L.A. county, USC occur.

<v Stan Dorn>And it's time for us to stop this sort of shameful uniqueness. <v Eric Burns>Is that, in fact, your view of of the ultimate long run solution? <v Carl Williams>Well, we're very open to a national health insurance or a local statewide health <v Carl Williams>insurance for the indigent. <v Carl Williams>Uh my concern would be that it be funded adequately so that the private hospitals <v Carl Williams>would be able to share in some of this money and they could uh relieve us <v Carl Williams>of some of the patients with adequate funding. <v Eric Burns>But in the meantime, there is simply no extremely short run <v Eric Burns>solution to the terrible problems of this hospital. <v Eric Burns>And it's gonna be a matter of just catch as catch can on a daily basis to to treat as <v Eric Burns>many people as can be treated. <v Stan Dorn>I disagree. I think a tone of fatalism is completely incorrect. <v Stan Dorn>The problems exist because of political decisions that have been made by state officials <v Stan Dorn>and by the Board of Supervisors. And the future of the patients of L.A. <v Stan Dorn>county now rests in the hands of the Board of Supervisors. <v Stan Dorn>They can determine that additional funds are gonna be provided to keep patients alive. <v Stan Dorn>They can make cuts that will condemn patients to death.

<v Eric Burns>Alright Mr. Dorn. Thank you, Mr. Williams. <v Eric Burns>Here now is Val with a preview of next week's edition of By the Year 2000. <v Val Zavala>Next week, we close out our month long look at medicine with a 90 minute special. <v Val Zavala>What is forcing up the cost of medical care at a rate faster than inflation? <v Val Zavala>How can we keep costs down while making care available to everyone? <v Val Zavala>What will the health care system in southern California look like in the next century? <v Val Zavala>Join us for Healing the System next week on By the Year 2000. <v Narrator 1>[music plays] Major funding for By the Year 2000 was provided by the James Irvine <v Narrator 1>Foundation to promote civic and social responsibility and the development of sound <v Narrator 1>public policy through the understanding of community issues and by <v Narrator 1>the Michael J. Cuttle Foundation. Additional funding was provided by the law <v Narrator 1>firm of Latham and Watkins, proudly supporting public discussion of community issues.