Dispute Delays Plan to Boost Health Care

A tussle between Los Angeles County supervisors and one of the county’s unions has delayed use of a $40-million fund that could reduce a critical shortage of nurses and other skilled medical employees.

The money is intended, at least in part, to retrain some of the 20,000-plus employees in the county’s sprawling health department to perform critical tasks, union and health officials said. These would include working as dialysis nurses or technicians who can read brain scans.

A scarcity of workers with these skills has contributed to life-threatening delays at County-USC Medical Center, where doctors said three people died in the last 10 months after prolonged waits for emergency dialysis. In addition, physicians said, basic medical tests are delayed for hours because of a shortage of trained technicians.

The retraining program was supposed to be in place by now. But it has been held up because the Board of Supervisors and the union representing most of the county’s health workers are bickering over how to administer it.

The union said it has long been promised a say in how the retraining programs are run and the money is spent. Supervisors said that they never approved such a deal and that management needs to be left to county administrators.

“We really and sincerely believe the only way this can be successful is if the union is a full and equal partner in this,” said Kathy Ochoa, a health care analyst for the union, the Service Employees International Union Local 660.

Supervisor Zev Yaroslavsky disagreed, saying the department has to retain control of its priorities, especially as it must cut positions to close a looming deficit.

“County management should have the discretion on how to use that money because the issue on who to retrain and what kind of jobs will be in play is a management issue,” he said.

The debate over retraining is flaring up after a Times report on delays in critical care at County-USC. Supervisors today will consider a proposal to beef up nursing recruitment and retention.

The struggle between supervisors and the union is a sign of the difficulties that the county faces as it tries to restructure its health department.

The $40 million is a small part of a $900-million federal bailout won last year to keep the Department of Health Services solvent. Under this bailout, the county is required to make its health system more efficient and patient-friendly.

But Local 660 and the county supervisors are at loggerheads on some key changes. For example, supervisors have been steadily cutting vacant positions from the health department to streamline it. But union officials have called those cuts shortsighted and called for more hiring.

The retraining issue is another example of this power struggle. Last year, Local 660 pushed hard for retraining while county officials were negotiating the bailout. They saw the fund as a way to find new jobs for workers displaced by health department cuts.

Now, union officials are saying that the fund also could be used to train nursing assistants to be registered nurses, or other health workers to operate machinery used for brain or heart scans.

The union said the original plan was for a nonprofit jointly administered by the county and the union to disburse the retraining funds.

Bart Diener, the assistant general manager of the union, said it has launched similar programs in other cities that have had great success. “We believe labor has a lot to add here, in that our members know what kind of training will be effective,” he said.

But Yaroslavsky said the board never approved the arrangement. And in May, the board directed the health department to come up with an alternative.

“You cannot run a health department . . . by committee,” Yaroslavsky said. “That’s a prescription for gridlock, and in a life-and-death business, gridlock is not a good thing.”

Diener said he is optimistic that the issue can be resolved. Still, he cautioned that the retraining money would certainly not solve the deep financial problems facing the health department.

“It is not going to solve the overall staffing problem in the county, which is chronic and . . . due to chronic under-funding,” Diener said. “This is something on which I think we and the supervisors see eye to eye.”