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."

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