Kizer Warns Hospital on Cutback Plan

State Health Services Director Kenneth Kizer has informed officials at the busy downtown California Medical Center that if they implement emergency room cutbacks Aug. 1 without his permission, he will shut down the entire hospital by revoking its license to operate, hospital attorneys said Wednesday.

Kizer could not be reached for comment on that point. But he said in an interview earlier Wednesday that he believes he has the legal--though untested--authority to block several major private hospitals, including California, from drastically curtailing emergency room services next month.

But hospital attorneys disputed Kizer’s claim. One said the matter has escalated into a “a high-stakes crap game.”

Writ of Mandate

Kizer’s threat, attorneys added, will probably prompt hospital officials at California Medical Center to protect themselves by taking the very unusual step of seeking a writ of mandate from a judge before implementing cutbacks. The writ is used as a vehicle to compel public officials to do their job, which in this case would be to approve a change in a hospital’s emergency room license, hospital attorneys said.

While attorneys for the state and the hospitals continue their legal research of the complex matter, Kizer met privately Wednesday with executives of seven private hospitals--California Medical Center, Hollywood Presbyterian Medical Center, White Memorial Medical Center, Brotman Medical Center, Daniel Freeman Memorial Hospital, Queen of Angels Medical Center and Hospital of the Good Samaritan.

These hospitals have threatened, for financial reasons, to downgrade their emergency rooms to standby status in order to shut off public ambulance traffic that tends to bring hospitals their sickest and poorest patients.

The meetings are designed to brainstorm new financing mechanisms to help hospitals offset the cost of providing free care to medically indigent patients.

Kizer and hospital officials said they have avoided any discussion of the legal aspects of down-licensing and instead engaged in a positive discussion of ways to resolve problems.

‘Playing Hardball’

Jim Ludlam, attorney for California Medical Center and the Hospital Council of Southern California, said the state is “playing hardball to a degree, but we’re convinced Kizer is trying his hardest. The problem is that he doesn’t have the authority to solve the problem.”

Stephen Gamble, the hospital council president who has attended the discussions, informed county supervisors in a letter this week, “Disintegration of the emergency medical safety net for the people of Los Angeles has fallen to a terrifying new level of exigency.”

He reported that he sees “little hope” of finding remedies that might “delay this impending disaster.”

“The problem has been allowed to grow too big, and the resources brought to bear on a solution are too small,” Gamble said. Anthony Abbate, a council spokesman, added: “Once the system starts coming undone, it will be impossible to put it back together.”

He said next year’s state and county budgets, which are being finalized, do not contain a sufficient “pool of money” to maintain the trauma and emergency services network.