By ANN DONAHUE

Staff Reporter

When the 800 doctors employed by L.A. County voted to unionize, they hailed the victory as one for their patients.

"Today we physicians begin to take back the practice of medicine throughout Los Angeles County," said Dr. Janice Nelson, medical director of the blood bank at County-USC Medical Center. "We will take our place at the table whenever health care issues are discussed and whenever important decisions that impact our patients are made."

But in the days after the May 28 announcement, some county health care officials questioned how much of an impact unionization can really have on patient care.

While presenting a united front can get some concerns addressed, implementing a union's ultimate weapon during negotiations a strike would be anathema to most health care workers because of the life-or-death ramifications that follow.

For now, the newly unionized doctors will focus on identifying what levels of staffing and services they will push for during future collective bargaining efforts. But their main objective during the next 12 months will be preventing a repeat of the massive layoffs and service cuts that occurred because of a county budget crisis in 1995.

More than 2,600 doctors, nurses, lab technicians and clerical workers were laid off and at least six county clinics were privatized before the federal government bailed out the system with an infusion of $364 million.

"We had no say as to who left and we had no say in the services that were cut," said Dr. Louis Simpson, a physician at King-Drew Medical Center. "There are 3 million uninsured patients in Los Angeles County alone. This is an enormous crisis and what does the county give us? Cuts and more cuts."

That federal money is due to run out next year, and the prospect of more cuts was a primary factor in the vote by doctors to join the Union of American Physicians and Dentists.

The push by doctors to become players in administrative decisions has angered top county health officials.

"It's a little bit offensive, the assertion that the rest of us hired to be responsible for patients haven't been looking after them," said Dr. Donald Thomas, the county's chief medical officer and associate director of health services. "I don't think there will be anywhere near as much impact on patient care as the union thinks or the doctors think. They're going to find the constraints of budgets and politics aren't as moveable as they think they are. And I don't think they'll strike to get their way. It's unethical to leave your patients because of a contract dispute."

Indeed, the county has seen first-hand what kind of chaos health care professionals can create when they stage a walkout. To protest layoffs, trauma nurses at County-USC Medical Center staged a one-day sickout in 1995 causing a three-hour shutdown of the emergency room at the nation's largest public hospital.

One man died from gunshot wounds after his ambulance was diverted from County-USC to nearby White Memorial Medical Center a private hospital without a trauma center.

Officials at both hospitals said at the time that the man would have had a greater chance of survival if an experienced trauma team at County-USC had treated him.

But the sickout did get results. Many of the proposed layoffs in the Health Department trauma division were rescinded and county officials ordered the rehiring of more than 300 emergency room, operating room and intensive care unit employees.

Doctors said it would take dire circumstances for them to walk off the job.

"Doctors voted to unionize, not to strike," said Dr. Dan Lawlor, an official with the American Federation of State, County and Municipal Employees, which oversees the union joined by doctors. "I wouldn't want to rule it out, but we have so many other options. Most contract disputes can be solved without job actions. Doctors will never put patients at risk."

Nelson said county doctors could protest in ways that are less disruptive to patient care. "Everybody always gets hung up on the strike issue," she said. "There are alternatives, like not doing elective surgery and civil disobedience."

Gary Robinson, executive director of the UAPD, said the union's 5,000 members have never gone on strike in its 27-year history.

"This idea that unions are always going to go on strike is out of the 1940s," he said. "It's a stupid tactic."

The county doctors might learn a lesson from contentious negotiations that ended May 26 with a 4 percent raise over one year for 2,100 nurses at UCLA Medical Center.

Kathy Daniel is a negotiator for the California Nurses Association who has worked at the university for almost 20 years as a critical care nurse.

"Our biggest concern is really patient safety," she said. "We don't have enough people to look after patients. Nurses have to work overtime. Nobody sits down You go home exhausted and still all you can think is, I haven't done enough. It's a manic place to work."

Although the exact terms of the CNA contract will not be released until union members give their formal approval, Daniel said the agreement does contain provisions to improve the staffing situation.

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