Fate of county-USC hospital in hands of supervisors.

A decision on a replacement for the aging, quake-damaged Los Angeles County-USC Medical Center could come as early as this summer, participants in the discussion say.

But just what that decision will be remains hotly debated.

At one end of the spectrum is L.A. County Supervisor Gloria Molina, whose First District includes County-USC. Molina supports a plan to build a 750-bed replacement facility, as proposed by Department of Health Services Director Mark Finucane.

Waging strident, if polite, battle against her is Supervisor Mike Antonovich, who would like to see a far smaller, 391-bed facility built. Somewhere in between is Supervisor Zev Yaroslavsky, who strongly favors a 500-bed center.

What's at issue is money - not so much the cost of construction, but the amount it would cost to operate the various proposed facilities. Running a 750-bed center, obviously, is more expensive than running one with 391 beds.

In contrast, "the difference in debt servicing costs (incurred by construction financing) is only about $10 million (a year) between the cheapest and most expensive proposals," said Al Compher, an assistant director at the Department of Health Services who has helped oversee planning of a replacement facility.

Though seemingly miles apart on the replacement facility issue, the Board of Supervisors is likely to act soon, some observers say. That's because, to be eligible for federal funding, construction should begin in the next four years, The various tasks required prior to groundbreaking - everything from securing permits to issuing a request for proposals - will take about two and a half years.

And every month that passes without a decision increases total costs by between $3 million and $4 million.

"They're going to have to decide, I would think pretty quickly, about what to do," said Finucane.

For 32 years, officials have known that County-USC should be replaced. The buildings' walls are earthquake-cracked, the huge staff and hundreds of beds cost more than the county can afford to maintain, and the facility's inpatient focus goes against the grain of a county goal to shift resources to outpatient care.

"They knew it needed to be replaced back in 1965," said Larry Colvin, director of the facilities planning division of the Department of Health Services. "This has been going on for more than 30 years."

The Board of Supervisors actually took steps toward a replacement facility in 1990 when it approved a County-USC master plan published by the Department of Health Services.

The so-called Health Facilities and Replacement Plan called for construction of a 946-bed medical center - 550 fewer beds than at the existing hospital - and for new beds to be added at facilities in other parts of L.A.

With the board's approval, planning for the new facility began in earnest. But two years later, the board put the brakes on. The trouble had less to do with the new County-USC facility than with the board's attitude toward adding beds at other sites.

A new, slimmer plan was put together and the County-USC project was once again on-track.

To help pay for a replacement center, the county is counting on funding from the state. But to be eligible for the funding, L.A. had to submit its plans to Sacramento by June 1994. Because of the 1992 delay, "We had just two years to design 2 million square feet of space," said Compher.

The county just made it - but not before the Northridge earthquake wreaked havoc on the medical center.

Ironically, the quake only underscored the need for a new center, and opened the possibility of nearly $500 million in Federal Emergency Management Association funds to help pay for the replacement facility. It is eligibility for that FEMA money for which the Board of Supervisors must now scramble.

The earthquake was not the final calamity to hit County-USC. In the spring of 1995, L.A. County faced an anticipated budget shortfall of $1.2 billion. In a panic, the county first considered closing the medical center entirely, and then asked the federal government for help.

President Clinton complied, bailing out the county with a five-year plan that would pre-pay some projected Medi-Cal billings. But to qualify for the money each year, the county must show it is successfully downsizing total inpatient capacity - with total capacity being reduced by one-third at the end of five years. That downsizing is to be accomplished through partnering with private-sector community health care management.

County-USC replacement plans were again put on hold. More studies were done including one by the Harvey M. Rose Accountancy Corp. in 1995 that recommended a 788-bed replacement facility. That basic proposal, minus 38 beds, is what Finucane now has on the table before the Board of Supervisors and which Molina is backing.

But the supervisors have taken no action on a replacement facility for nearly two years, causing frustration in some quarters.

"I think we've studied this enough," said Dr. Brian Johnson, president of the Los Angeles County Medical Association. Johnson's group has come out in favor of the 750-bed model.

For their part, the supervisors (excluding Molina) say there should be no rush to judgment.

"Nobody is more aware of the need to replace County-USC than the supervisors," said Joel Bellman, a spokesman for Supervisor Zev Yaroslavsky. "It's a fiendishly complicated policy problem to try to unravel."

While Molina and Antonovich are on opposite ends of the debate, the remaining supervisors fall somewhere in between. And therein may lie the solution.

With just three votes needed to approve a plan, Yaroslavsky and supervisors Yvonne Brathwaite Burke and Don Knabe could push through a compromise plan of their own, forcing the hands of Molina and Antonovich.

One such possibility that has been informally floated is construction of a 750-bed "shell" medical center, with immediate funding for just 500 beds-worth of staffing. Bellman said Yaroslavsky would be willing to consider such a plan, but like Burke and Knabe, is so far remaining uncommitted.