At a time when Los Angeles County public health facilities are understaffed and a shortage of nurses appears likely to worsen, the county’s health care system is facing continued belt-tightening and a hiring freeze that should last through September.

The hiring freeze was put in place while the county negotiated to renew a waiver of federal Medicaid reimbursement rules that adds about $1.2 billion to county funding over the next five years. The freeze is likely to remain in place until county health officials return to the Board of Supervisors this fall with a game plan for making the county self-sufficient by the time that five-year period ends, said Ron Hansen, health services deputy for Supervisor Zev Yaroslavsky.

“Everyone needs to kind of size this entire thing up and see where we’re going with it,” Hansen said. “(The hiring freeze) is a conservative move, but it needs to be done just to make sure we know where we are going before we move forward.”

The county Department of Health Services has agreed to reduce expenditures by $91 million over the next five years to meet the terms of the waiver, on top of $70 million last year and $260 million during the few years before that. Most of those savings have come, and will continue to come, in the form of staff cuts, said Mark Finucane, the department’s director.

“We’ve been on this diet, so to speak, for a while,” he said. In addition, Finucane has promised the Board of Supervisors that he will reduce annual hospital and clinic costs by $82 million.

More trouble on horizon

Despite the cuts, Finucane believes county facilities can survive with current staffing levels but in two years, that may not be the case. A state law that goes into effect in 2002 would require a higher ratio of nurses to patients than exists now. Once that law goes into effect, the county will need more money from the state and federal governments to pay for the extra nurses, Finucane said.

Without a commitment on the part of elected officials to fund health care for the uninsured, the county won’t have the money to wrest nurses away from private hospitals, he said. And because there is already a major shortage of nursing school graduates, there may not be enough trained nurses available to meet the need in 2002 anyway.

“RNs are in a scarce supply now, and I can’t imagine the bidding war (that will take place in two years),” Finucane said. “That’s probably the most significant problem I see on the horizon right now for us.”

Union officials say the waiver funds are adequate and it’s time to end the hiring freeze and relieve personnel shortages worsened by the current hiring limits.

What is needed is relief in levels of staffing and pay, especially in areas where shortages are worst, said Bart Diener, assistant general manager of Service Employees International Union, Local 660, which represents most county employees. The most serious shortages in the county system are within the nursing ranks, Diener said, as well as pharmacists, physicians, occupational and physical therapists.

Pay raises and hiring needs will be the first issues discussed during upcoming contract negotiations. The contract that covers roughly 20,000 health services employees represented by Local 660 comes up in September.

Beth Osthimer, a senior policy attorney with San Fernando Valley Neighborhood Legal Services, a legal aid program that runs a health consumer center on Van Nuys Boulevard, thinks supervisors are prudent to move slowly.

Even though there is a gap in personnel, Osthimer said, it’s hard to know which areas have the biggest needs until health officials can map out a plan.

“I don’t have numbers,” Osthimer said. “What I have is a lot of patients who had problems with long wait-times for certain types of specialty care. There’s definitely holes in the system now, but to have the best sense of where you want to plug those holes is really why the board is asking the department to come back.”

The need for more people will only get worse, Osthimer said.

“It’s a problem that we have to deal with, through affiliations with universities to hire doctors and nurses willing to practice quality medicine,” she said. “It’s going to be increasingly difficult to find them and keep them, and patients are going to suffer.”

Impact at County-USC

Roberto Rodriguez, director of L.A. County-USC Healthcare Network, oversees more than 7,000 employees, many of whom will require retraining once a new, leaner County-USC Medical Center is opened to the public, now set to happen in 2006.

Rodriguez said his staff will be extensively reshuffled in the coming years as its bed count at County-USC is cut by 150, outpatient services in his network are increased, and staffers are retrained. But the situation is already dire.

“It’s not limited to nursing,” Rodriguez said. “There’s an assortment of professions here in critical stages that make the delivery of care more challenging. We constantly have to look at training residents, meeting requirements, sustaining quality.”