Last year’s closure of King-Harbor as a full-service hospital was not merely a symbolic defeat for the community. It was a stunning blow to the health care needs of the most medically under-served population in Los Angeles County.
While urgent care is still provided, the closure was a falling domino that dispersed patients into emergency rooms at already overcrowded hospitals elsewhere in the region. About 250 ambulance rides a month take patients from King to County emergency rooms elsewhere.
King-Harbor must be reopened as a full-service hospital at the earliest possible date under the management of a competent and accountable partner. I am not comfortable with a quickie band-aid-type fix, however, and I fear that may happen if we rush too quickly to accept a new management that would try to do too much too soon.
I believe in reopening King-Harbor in stages. Our first priority should be to restore it as a quality in-patient care community hospital. As that is accomplished, we can then add specialty services like trauma care, specialized surgeries and specialized critical care functions. We need to build a core of medical expertise that is solid and stands on its own merits for the long haul.
I think the collaboration of a teaching institution, preferably a UC system school, (as I proposed in my recent letter to the Governor) is important, particularly for reestablishing needed training programs and for the restoration of teaching hospital status.
Who oversees the work of any management partner is also critical. While maintaining oversight and control of county funding, the Board of Supervisors cannot and should not be the primary interface. The County needs an independent, expert and accountable structure to do this.
The most attractive alternatives would be a County Health Authority dominated by health care and health management professionals sufficiently insulated from political vagaries to provide firm and dispassionate oversight, completely transparent in what it does and the way it does it. Proposals to form such an authority have been on the table for a decade and have not advanced, but that’s no reason to discard the idea. A new idea that needs to be explored is the creation of an independently elected County Surgeon General position. A new governance system with competence, transparency and accountability is mandatory for the credibility of the rebirth of MLK hospital.
Whatever we do, we must acknowledge that the current system does
not work. King-Harbor was a victim of that system and the entire health
care delivery system of the County has suffered as a result.
The restoration of the hospital to a full-service, fully-licensed facility would return federal funding lost by virtue of the loss of accreditation. The structural imbalance between costs of operation and revenue to pay those costs would remain, however, so long as the size of the uninsured population continues to grow. That imbalance is true for the entire County, where 25% of the population is uninsured, but especially true for the population served by King-Harbor, where upwards of 50% of the population is uninsured.
Currently, the County pays just under 20% of the total public cost of the health care delivery system. State and federal funds make up the rest. As with the County, state and federal funds are constrained and significant reductions are pending in Sacramento and Washington, D.C.
King-Harbor is symbolic of a health care safety net that is frayed and in danger of collapse in the County and elsewhere. More than anything else, what is needed is a system of health care that is universal and national, a system that will provide through equitable patient funding the resources needed to keep hospitals open and health care professionals willing and able to provide care.
Improving Health Care in the 2nd District
There are several initiatives I will pursue to improve health care in the 2nd District. My appointee to the First 5 LA Commission will support First 5 funding for continuous and comprehensive health insurance coverage for young children in families with incomes under 300% of the Federal Poverty Level, support funding for programs in the District that expand and improve prenatal care, preventive care for young children, dental care, behavioral wellness screening and early mental health treatment.
Either through the First 5 program or as part of the County outpatient clinic program, I would want to see mobile units periodically stationed at locations such as malls and schools to provide diagnostic services along with immunization and low level treatment.
A disproportionate number of below acceptable Health Inspection grades are received by restaurants in the 2nd District, putting patrons at risk of food-borne illness. I would work to improve the educational aspect of the County’s restaurant inspection program to bring restaurants in the District into more consistent compliance with health standards.
As I have done on the City Council, I would support limitations on the permitting of fast food restaurants as well as the posting of nutrition data at all restaurants. To further combat childhood obesity and diabetes, which are at epidemic levels in the District, I would also support soda and junk food bans at all schools, as is currently the practice at LAUSD.
A significant portion of the uninsured population in the District is homeless or living at risk of homelessness, many if not most with physical and mental health vulnerabilities. In addition to working to enhance the Year Round emergency shelters program county wide and in the District, I would work to include health and mental health clinicians among the shelters’ staff.
Emphasis needs to be given to the population in our community that are fortunate enough to have medical insurance but fail to use the prevention and ongoing monitoring that is provided. As most diseases and ailments in the 2nd district are preventable through education, exercise and routine examinations these features are used moderately as general research in the medical care industry states that 20% of the insured clients use 80% of the medical care services which is and clear indication that they fail to use the preventive elements of their plan but wait until they are either diseased or seriously ill before they seek medical attention.
Finally, due to its location, age of housing stock, lack of a connected public transportation system and past industrial/manufacturing businesses the second district includes or is impacted by major polluters or existing pollution. (LAX, Harbor, oil fields, brown field locations, abandon industrial sites or parcels of land, green house gases from emissions and lead based paints to name just a few). It is imperative that there is a major need for sensitivity on the full impact of these environmental concerns on the health of 2nd district residents, visitors and workers, with particular emphasis on children. Air, water and soil quality inspections are mandatory to provide the needed preventive and educational guideline to all but eliminate or at least reduce and mitigate their impact on the health of the community.
Outside Management of Outpatient Clinics
As a philosophical matter, I am not opposed to third party management and operation of the County’s outpatient clinics. The County has successfully contracted with third parties to run everything from its airports to golf courses and there is nothing inherently sacrosanct about County employees staffing outpatient clinics. As with other privatization and semi-privatization proposals, however, the test must be whether the service can be provided at less cost with equal or superior performance results and the County staff has not yet made that case with respect to outpatient clinics. The governance of out patient clinics should not be based on a pre-conceived notion or theory but on the most effective manner that health care services can be delivered. A thorough investigation of multiple models should include an evaluation of all available options from private, public-private, public, educational institution to any appropriate combination of the above.
Health Care Money
Fundamentally, there is not enough local, state and federal money available individually to sustain health care facilities and health care services in the County and other major jurisdictions around the country. As the availability of care is increasingly limited, the uninsured and underinsured population is growing, and the demand for care is rising. It is very apparent that funding must be leveraged, services co-located and coordination of services across jurisdictional lines must exist. The collective efforts of the future must replace the current fragmented and isolated efforts of the today.
As I indicated earlier, the health care safety net is badly frayed. Ultimately, a system of universal health care must be implemented or the current systems will collapse, as has nearly happened at King-Harbor. Universal health care is the foremost domestic challenge this nation faces and the only option available to prevent implosion of the health care network in the County and ultimately elsewhere in the country.
The County simply does not have the resources to financially underwrite the system back to a healthy condition. The County could spend all $3.6 billion of its discretionary General Fund budget on health care and not come close to meeting the costs required to operate our public hospitals and clinics and to keep emergency rooms open.
There are four things that must be implemented immediately a) stop the state legislature from routinely cutting Medi-Cal to balance the state’s budget ( recent 10% cut is one of many in the past years), b) stop the implementation of the new federal Medi-Cade guidelines that will reduce funding in the State of California by $600m and the County of Los Angeles by $240m, c) the state must negotiate a better deal with the federal government on waiver/reimbursements that impact the funding of the state’s Medi-Cal Program and d) stop all state unfunded mandates.
