When it comes to the local public health system, there is no single institution more crucial than L.A. County-USC Medical Center.

In many ways, it mirrors the overall system. It's massive treating more than 700,000 patients a year and serving as the nation's largest academic institution. It's in terrible shape 68 years old, no central air conditioning, outmoded equipment, and badly damaged from the Northridge earthquake. And it's at the center of a political firestorm state and local elected officials continue bickering in their six-year feud over how big the new County-USC replacement hospital should be.

And there is no end in sight.

Originally slated for 770 beds, the proposed replacement building has been downsized to 600 beds in the face of budgetary constraints and the belief that improvements in medical technology will result in less need for inpatient treatment.

Yet critics, led by Los Angeles County Supervisor Gloria Molina, say the new facility will be too small to handle the demand for beds. She has powerful supporters; Assembly Speaker Robert Hertzberg wrote a letter to the county Board of Supervisors urging them to delay voting on the environmental impact report for the replacement hospital project because the state is still looking at whether a 600-bed facility would be adequate. The EIR was approved anyway, over Molina's objection, but the state Assembly continues to study the issue.

"We would like to see the county build a facility adequate for its needs," said Hertzberg spokesman Paul Hefner.

Will annex be enough?

A proposal that may ease some of the concerns of the downsized hospital is a proposed annex, but its fate is still in limbo and will not be voted on by the supervisors until 2002.

Molina and her supporters believe it would be cheaper to build a larger hospital than to build a 600-bed facility and an annex. Miguel Santana, the supervisor's spokesman, said she offered two compromises constructing a smaller facility in the San Gabriel Valley to pick up some slack from the proposed 600-bed hospital, or building the new facility to hold 750 beds but only budgeting for 600.

But Mark Finucane, director of the Los Angeles County Department of Health Services, testified on June 30 before a special Assembly subcommittee studying L.A. County's health care system that the new 600-bed facility alone would be adequate to handle the patient load.

Finucane said the needs will be met by using inpatient capacity at other county hospitals more efficiently, and contracting with private-sector hospitals to handle the overflow, if necessary. County supervisors have had ongoing talks with private hospitals to do the work.

So far, however, these talks have not produced a single contract providing more ammunition for Molina, who contends there has been a lack of planning about how to handle excess patients.

Despite the ongoing conflicts, Roberto Rodriguez, executive director and CEO of the County-USC Health Care Network (the group under which County-USC operates), is confident that the impasse will eventually be broken.

"There is no question that this is going to happen," Rodriguez said.

Rodriguez says a 600-bed facility will be adequate to handle the patient load because of new technologies and advances in drug treatment. The new hospital, he says, will be state-of-the-art.

Rodriguez also downplays the problems at the existing structures. Though three on-site buildings had to be closed following the Northridge earthquake, Rodriguez says the main hospital structure is basically solid.

"We are still seeing patients and the standard of care is still being met," he said. Still, he admits that conditions like no central air, "make (treating people) tedious."

Fate of existing structure

As wrangling over the new hospital continues, there is also a lack of consensus over what to do with the old building. Though it doesn't meet safety codes required for hospitals, it might, with structural support work, be able to accommodate offices or some other uses. That matter is currently under study.

Meanwhile, other quake-damaged buildings on the County-USC campus site have been red-tagged and will be demolished. The new facility is targeted to be built on a site that the county has purchased, located about a block away from the existing main hospital.

While the process creeps along, those opposed to the 600-bed facility say they will continue fighting for more beds.

"It is not fun to be on the losing end of the issue," said Santana. "But we have a responsibility to make sure we don't stop advocating until finally we come up with something that at the end of the day will work."

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