COUNTY/USC DOCTORS FEEL BETRAYED BY PUBLIC APATHY.

Byline: Roger G. Fink and Donald E. Miller

THEY trusted the inscription over the front door, etched in stone, that promised "no citizen of the County shall be deprived of health for lack of such care and services."

For decades, the front doors of L.A. County/USC Medical Center have symbolized the safety and security of a nurturing, yet rock-solid "granite mother," who could always be trusted to stand in the face of adversity and deliver care to all who sought it.

But now she is beginning to crumble. Stone by stone, her impressive facade is being dismantled, riddled with charges of inefficiency, corruption and wrong-headed leadership.

But the real tragedy playing out every day at the hospital is the sense of betrayal that the physicians and other health care professionals feel because the people of the county, in their eyes, have abandoned the mission to care for the poor and left them holding the bag.

Based on interviews with a cross-section of about 30 County/USC physicians, the true crisis is not one of economics, but of conflicting values that have rent the moral fabric of the community. Unless resolved, L.A. County as a "national laboratory" for health care reform is doomed to fail.

For almost 50 years after the medical center was first constructed in 1932, the surrounding community felt a sense of civic pride in caring for the indigent and uninsured. Health care for the poor and unfortunate was widely regarded as a social responsibility.

But by the late '70s came a shift. As inflation soared, productivity plummeted and real income growth declined, economic pressures wiped charity off the faces of middle-class America.

In its stead emerged a disheartening attitude that dehumanizes the poor and indigent classes, especially illegal immigrants, and spawns indifference to their plight.

On the other hand, the vast majority of physicians, and every physician spoken with, made a deliberate choice to practice medicine for the county.

Highly qualified and certainly marketable in the private sector at more than double their current salaries, these physicians stay at County/USC out of a sense of altruism and sacrifice. They are the medical missionaries in dedicated service to the poor.

Thus, it is no wonder that this legion of battered healers, all the while believing that society saw their service as a noble and moral pursuit, now feel double-crossed.

Many of them dedicated their entire professional lives to the treatment of uninsured and indigent patients who had nowhere else to go. The demoralization now runs deep.

Society is at war with itself, pitting the fleeting nature of public opinion against traditional values. As a result, policies forged by the Board of Supervisors have been shiftless and handed down pell-mell without much foresight or overall vision.

If L.A. County is to restructure its health care system to move strategically into the 21st century, the new director of the Department of Health Services must guide us with a coherent moral vision that reconciles those deep divisions.

Unless the trust of patients, physicians and the public itself is re-established, there's little chance of a rational health policy.

The universal access that has always been afforded to the poor and uninsured must now be translated into a universal concern for the overall health of the public by all members of the community. Otherwise, our communal experiment will fail.

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Photo L.A. County/USC Medical Center "Granite mother" is beginning to crumble. Daily News