Dr. G’s Hard Medicine

The overflowing ER scene is only the most visible sign of the system’s distress. Last fall, hundreds of doctors, nurses and residents showed up at public hearings and begged the Board of Supervisors to keep open its 39 health clinics. Also on the chopping block were High Desert Hospital in the Antelope Valley and Rancho Los Amigos, as well as Olive View–UCLA Medical Center and Harbor-UCLA, both trauma centers that provide much-needed emergency care.

Sitting in wheelchairs, dragging ventilators, speaking through voice boxes, protesters expressed their unified plea: Keep these hospitals and clinics open, or millions of uninsured residents will suffer and some will die.

In the end, at Garthwaite’s urging, the board closed High Desert and Rancho Los Amigos along with 16 clinics whose combined annual outpatient visit load is estimated at half a million. The savings: $750 million.

“You try to do the least harm,” Garthwaite said as he pulled into the USC parking lot earlier that morning. “We’re not making decisions that are idealistic. They are really hard choices. If you see yourself as a safety net, you just try to be the best safety net and catch as many people as you can.”

The system will implode even more in June, when the health department plans to begin laying off 18 percent of its work force. Over the next several years, about 4,000 employees will get the boot, and many others will be shifted around to fill gaps in service. In July, 50 beds will be cut at County-USC, which is already operating at half capacity, and another 50 will be eliminated later. Intern and residency programs will be curtailed. And there will be additional, as yet undetermined, consolidations and cuts.

In the end, Garthwaite says, those cuts, combined with $250 million in state and federal funds, the county’s share of a statewide lawsuit settlement on Medi-Cal payments and the overwhelmingly voter-approved Measure B tax, will stave off collapse.

As public clinics and other alternatives disappear, people are landing in the emergency room in record numbers. Gary Payinda, a resident physician at County-USC’s emergency room, said he often goes home at the end of a shift only to return the next day and see some of the same patients still waiting for care. “These patients have nowhere else to go. I feel like I’m just bandaging people up until they come in sicker the next time. It’s just staving off catastrophe.”

The crisis is not new, it’s only getting worse. During the Clinton administration, the county’s health system was rescued twice from the worst budget shortfall in its history by bailouts totaling $2 billion. The money was granted on the condition that the county become more self-sufficient. When the Board of Supervisors hired Garthwaite last winter, it was a move as critical as bringing in a new doctor in the middle of an open-heart surgery that wasn’t going well. The patient — the county’s $2.9 billion health system — was nearly out of cash for the second time in less than a decade. Garthwaite stepped in with a degree of confidence and decisiveness that some found off-putting, but which gained him respect and cautious support from key players who had previously refused to budge. They know that much of what Garthwaite wants to accomplish was already the goal before he arrived. But nobody was willing — or able — to take on the job.

Supervisor Yvonne Brathwaite Burke, who agreed to Garthwaite’s unprecedented cuts in services at King-Drew Medical Center, was relieved that he signed on. “This is a career-breaking job,” she said. “There is nothing you will do that won’t cause an uproar when you don’t have the money.”

 

On that morning in early March, Garthwaite, who makes $275,000 a year, had traveled to Harbor-UCLA to meet with a group of doctors and others from Harbor and Long Beach, two of the remaining four county-run hospitals. On the agenda: hospital performance and future cuts. Driving over, Garthwaite laid out what he expected to hear. “Usually they try to hit me up with something,” he said. “It’s a combination of claiming magnificence and begging for resources.” He laughed. “I tease, I tease,” he said. “But not too much. When you get the chance to have the director down, you hit him up with the things you want him to believe. Try to change my belief system.”

In a meeting room, a few doctors had already gathered around a long narrow table when Garthwaite arrived. More than a hint of stress hung in the air. One doctor wore a “Don’t Panic” button. Others shuffled papers nervously or made small talk about bad drivers. A plate of muffins sat untouched. Garthwaite smiled and greeted everyone warmly. Tall and trim with wire-rimmed glasses and a full head of reddish-blond hair, the former athlete has a way of setting a room at ease. He grabbed a muffin and picked up on the bad-driver theme with a Bob Newhart joke. “Oh, ma’am, oh ma’am. You were in the left lane with your left turn signal on,” he said, then paused and shrugged for comic effect. “I thought you were going to turn left.” Corny, but it did the trick. Everybody laughed and the tension level dropped.