SR-106-040-02
F:\HSD\SHARE\COMMISSIONS-ADVISORY BOARDS\Disabilities Commission\Staff Reports\Rancho CC doc.doc
City Council Meeting December 17, 2002
Santa Monica, California
TO: Mayor and City Council
FROM: City Staff
SUBJECT: Request from Disabilities Commission that the City Council Approve a
Letter to the Los Angeles County Board of Supervisors Requesting
Reconsideration of the Decision to Close Rancho Los Amigos National
Rehabilitation
Introduction
This report transmits a letter drafted by the City’s Disabilities Commission for
transmission by the City Council to the Los Angeles County Board of Supervisors. This
letter opposes the Board’s decision to close Rancho Los Amigos National Rehabilitation
Center, further requesting that the Board reconsider its position.
Background
In 1995, the L.A. County public health system received a $1.2 billion Federal bailout to
remain operational, with an extension of the funding in 2000 for an additional five years.
The Centers for Medicare and Medicaid Services (CMS) have now reported that
another bailout of this size is not forthcoming; and have instead offered $150 million to
assist the County in maintaining medical services in its healthcare system. The County
Department of Health Services (DHS) has stated that this will not be enough to prevent
closures of three major hospitals and a number of clinics.
- 1 -
DHS has announced that it is facing another large deficit ($750 million by 2005), despite
the recent passage of County Measure B, which will provide an estimated $170 million
per year to fund trauma centers countywide. In an effort to address the deficit, DHS
closed several outpatient health clinics in August and September 2002. The Board of
Supervisors voted in October to also close Rancho Los Amigos National Rehabilitation
Center (usually referred to as “Rancho”) in Downey in June 2003 as another step
toward minimizing or eliminating the projected deficit. The L.A. Times reports that
closing Rancho will save the County approximately $65-$70 million per year. About
33% of Rancho’s patients are indigent, and the County estimates it would have to pay
$15 million to $30 million per year to cover treatment for these patients. The Board of
Supervisors also voted preliminarily in November to close Harbor-UCLA Hospital in
Torrance and Olive View-UCLA Hospital in Sylmar as additional cost-cutting measures.
The passage of Measure B will likely save the emergency rooms at these hospitals, but
it is unknown if the inpatient services and outpatient clinics at either, and the research
facilities at Harbor, will remain open. The Board of Supervisors will take a final vote on
these two closures in January 2003.
Discussion
Rancho is a County-owned and –operated medical center providing specialized adult
and pediatric treatment and rehabilitation services for a wide range of conditions,
including head trauma, spinal cord injuries, amputations, stroke and neurological
diseases such as Parkinson’s, Alzheimer’s, post-polio syndrome and multiple sclerosis.
Last year, Rancho served 2,600 inpatients and 8,700 outpatients; it has 207 beds and
- 2 -
1,400 employees. Although Rancho’s patients come from around the world, all of those
with no ability to pay are L.A. County residents.
Rancho does not provide trauma care per se: it receives and cares for patients ranging
from those who need further stabilization after a traumatic injury or acute illness before
they can begin rehabilitation to those who have completed rehabilitation and only need
ongoing follow-ups and primary care. Most physicians are not trained in the long-term
treatment needs of post-traumatic injury/illness patients. These patients need
specialized primary care throughout their lives, which Rancho provides, along with other
specialized interventions for patients who are past their initial rehabilitation and are now
living with the sequelae of their injuries and illnesses. Rancho is also the home of the
Center for the Study of Aging and Disability, whose mission is to study and develop
information on the physiological and psychological long-term effects of aging with a
disability. This is especially critical now that people with disabilities are living far longer
than ever before.
Rancho has earned the distinction of being a Center of Excellence in Rehabilitation, one
of only 12 in the United States, and is ranked among the top ten in the world. It is the
only public facility to achieve this ranking. In addition to providing patient services, a
number of advances in patient treatment, both general and specific to traumatic injuries,
originated at Rancho, including the patient identification bracelet and the halo neck
brace (used to stabilize neck fractures).
- 3 -
On November 27, Governor Davis formally asked the Federal government to provide
additional resources to stabilize Los Angeles County’s public health system. This
included a request for unspecified additional funding and a Medicaid waiver that would
allow the County flexibility in using Federal health care funds, according to the L.A.
Times. Negotiations with CMS will take place in January 2003. County Supervisor Zev
Yaroslavsky said that the proposal to the Federal government will allow DHS to keep its
four major medical/surgical hospitals open and to maintain a network of outpatient
clinics and health centers. Rancho is not one of the four hospitals that would potentially
remain open if CMS agrees to the State’s request.
Budget/Financial Impact
This Council action will not result in any direct fiscal impact to the City.
Recommendation
Staff recommends that City Council receive the draft letter and take appropriate action.
PREPARED BY: Barbara Stinchfield, Director
Julie Rusk, Human Services Manager
Tracy Scruggs, Human Services Supervisor
Janet Hand, Sr. Administrative Analyst, Human Services Division
Community and Cultural Services Department
ATTACHMENT: Letter to Board of Supervisors drafted by the Disabilities
Commission
- 4 -