Wednesday, April 28, 2004
Injunction Against Cutting County-USC Capacity Upheld
By KENNETH OFGANG, Staff Writer/Appellate Courts
A preliminary injunction barring Los Angeles County from going ahead with a plan to reduce the number of hospital beds at Los Angeles County-USC Medical Center by 100 was affirmed yesterday by the Ninth U.S. Circuit Court of Appeals.
The injunction by U.S. District Judge Florence Marie Cooper of the Central District of California also forbids the closing of Rancho Los Amigos hospital in Downey. Another injunction granted by Cooper on different grounds, also barring the closing of Rancho Los Amigos, was affirmed in February by the same Ninth Circuit panel that ruled yesterday.
“Plaintiffs presented evidence that the county healthcare system is not equipped to absorb indigent and uninsured patients...who would be displaced by the threatened closure of Rancho and the reduction of beds at LACUSC,” Judge Harry Pregerson wrote for the court. “Further, plaintiffs submitted evidence that the County’s proposal would delay treatment, cause avoidable death, disease, and suffering, increase risk of infections, spread of communicable diseases, and medical complications, and ultimately lead to unnecessarily lengthy and expensive hospitalizations.”
The cash-strapped county had hoped to save tens of millions of dollars annually, beginning in Fiscal Year 2005-2006, by shuttering 207-bed Rancho Los Amigos, which specializes in care for patients with long-term disabilities, and by reducing capacity at County-USC. But Pregerson said the plaintiffs, the Los Angeles Coalition to End Hunger and Homelessness and eight individuals identified as regular users of the services offered at the two hospitals, are likely to prevail on their claims that the cost-cutting measures would violate state and federal law.
Cooper issued the injunction on the basis of a provision in the Medicaid statute requiring that facilities receiving federal funds to care for indigent patients offer an adequate “discharge plan” for each such patient. (The earlier injunction was based on the Americans With Disabilities Act.)
She also cited sections of the California Welfare and Institutions Code that require counties to provide “appropriate aid and services” to the “needy and distressed,” to assist residents who are “incapacitated by age, disease or accident” and have no other means of support, and to “adopt standards of aid and care for the indigent and dependent poor.”
Pregerson noted that appellate review of preliminary injunctions in the federal courts is deferential. The plaintiffs’ showing of likely success on the merits, and the irreparable nature of the harm they would suffer, were sufficient to establish that the district judge did not abuse her discretion, Pregerson said.
The judge acknowledged that there are strong public policy considerations on both sides, and expressed sympathy for the county’s claim that it will have to cut health care programs for lower-income patients who do not qualify as indigent in order to comply with the injunction.
But Pregerson described those concerns as “much more speculative than the probable injury the chronically ill plaintiffs face absent preliminary injunctive relief.”
Judge William A. Fletcher and Senior Judge Robert E. Cowen of the Third Circuit, sitting by designation, concurred in the opinion.
Principal Deputy County Counsel Sharon Reichman said the county was disappointed by the decision, but was not surprised given the panel’s decision on the earlier injunction, Rodde v. Bont· (2004) 357 F.3d 988. That decision, she noted, is now final since the court denied the county’s petition for rehearing.
A decision on whether to seek rehearing on yesterday’s decision will have to be made by the Board of Supervisors, which next meets in two weeks, she said.
The case is Harris v. Board of Supervisors, 03-56028.
Copyright 2004, Metropolitan News Company