PATIENT LOAD DROPS AT HOSPITAL\High Desert open despite massive cuts.

Byline: Karen Maeshiro Daily News Staff Writer

Three months after what one staffer dubbed the "nuclear meltdown" of cutbacks and layoffs at High Desert Hospital, the county-run facility has seen a 12 percent to 20 percent drop in patient numbers.

The decline in the hospital's inpatient census and outpatient visits is being attributed by administrators in part to the flurry of media coverage surrounding the slashing of services and the threatened closure of the hospital.

"The bottom line is the workload has dropped," administrator Bill Fujioka said. "There is confusion in the community on whether or not we're still open and whether or not we provide a full range of services. There was so many articles regarding the possible closure that I think it confused the general public. We want to put the word out now that we're alive and well, a little battered but alive and well."

With cuts in inpatient services in October, the hospital had estimated an average daily inpatient census of 81 patients, but that number has been running about 10 below that target in the low 70s, a difference of about 12 percent, Fujioka said.

The outpatient volume has dropped 20 percent, according to Fujioka. There were 5,300 outpatient visits in July compared to 4,200 outpatient visits in November.

Effective Oct. 1, county health officials made $14 million in cuts at High Desert Hospital, including the reduction of skilled nursing care by 30 percent and the elimination of an eye clinic and nine other outpatient services. Overall, outpatient services were cut 25 percent, affecting some 10,800 patients, hospital administrators said.

Also eliminated were inpatient pediatric services and the 6-year-old cooperative obstetrics program under which women received prenatal care at High Desert and delivered their babies at Antelope Valley Hospital.

The program handled about 1,200 births annually. Prenatal care was shifted to the county health center on Avenue K-6 in Lancaster, where the number of patients has risen about 10 percent since the cuts, figures show.

While the patient numbers are down, the work has not decreased for the staff, which was cut by 120 positions from 700 to 580. Compounding that was the loss of about 30 employees through attrition, and the more than 20 people who were supposed to transfer from other hospitals to High Desert but never showed up because the commuting distance was too long, among other reasons.

As a result, there are 35 "critical vacancies" in departments ranging from nursing to clerical, a staffing problem that has contributed to the low inpatient census, Fujioka said. The hospital now has authorization to hire 13 nurses, he said.

"It's more work for the staff, and there's the emotional toll of staff leaving, being laid off and reduced," Fujioka said. "The facility is very resilient. Overall, it's doing fine, but it takes time to heal. We're working towards that right now."

In a partial restoration of services, the hospital in November opened up an urgent care walk-in clinic that offers some of the subspecialty outpatient services that were cut, but at reduced hours. These include urology, surgery, obstetrics/gynecology, neurology and nephrology.

"We opened it because of the need. We didn't want people to travel all the way to Olive View (Medical Center in Sylmar)," Fujioka said.

Opened in 1961 as a tuberculosis hospital to treat county jail inmates, aging High Desert Hospital has emerged from the latest round of budget cuts a bit scarred, hobbling into the brave new world of reduced services at public hospitals.

Two sides of the health care equation - patients and hospital staffers - are finding each other to be at times irritable and impatient.

In the waiting rooms of the walk-in and pediatric clinics one day last week, some patients said the wait is about the same as before the cuts, while others said it has become longer.

While some patients empathized with employees facing staff shortages, others complained about the service, rude staff and waits of up to six hours.

"I've been coming here since 1991. It used to be great. I never had any complaints," said Elaine Fisk, 63, of Palmdale, while waiting at the walk-in clinic with her husband, Harland, 67. Now, she said, "it's terrible. You just sit and wait and wait. They cut all the good people, and we're left with morons."

Deborah Hoffman, 40, of Acton, drove her daughter-in-law and two grandchildren to seek care at the pediatric clinic for the younger grandchild, a 10-month-old boy.

She said they had come the day before and waited 1-1/2 hours only to find out they had the wrong appointment time.

"It's hard sitting and waiting and not being called," Hoffman said. "Before it was a little bit more organized, it was easier to see a doctor and it didn't take as long."

Other than that, Hoffman praised the staff and appreciated that High Desert was still open, a sentiment expressed by others.

"The staff is very good. They are very polite and patient with people who are impatient," Hoffman said. "I'm glad they are here, considering the cuts that were made. The other option is Olive View."

"What if you need antibiotics? Imagine driving to Olive View," said Vanita Niederberg, 36, of Lancaster, a patient in the walk-in clinic. "I really rather see something here, even if it's just a skeleton crew."

Some staffers, meanwhile, said morale is low and job stress has increased. They said they are doing more work with fewer people, performing additional duties for, in some cases, less pay.

They described the post-cuts work environment as "chaotic" and "overwhelming." Some people have had to take on tasks that they've never done before or for which they haven't received proper training.

Other employees transferred to High Desert make lengthy commutes from as far away as Compton and Pasadena.

"It's much more stressed beWcause of the increased workload," said pediatric clinic clerk Caryn Butler. "I notice co-workers at the hospital are stressed out. I see short tempers, and people are not quite as patient as they used to be."

Butler added: "People are happy they still have jobs, but it's doing different tasks, co-workers being gone, and people transferring and having it tough on them."

Pediatric nurse Leah Lara said because of the cuts and a charge nurse spread thin supervising three clinics, she is the only registered nurse on duty at the clinic, which is like an emergency room at times.

Uninsured patients show up and must be stabilized before being sent to another facility.

"It's been so stressful. You have so many responsibilities," Lara said. "It's busy all the time. It's not supposed to be a walk-in clinic, but yesterday we saw more walk-ins than appointments."

For those patients seeking services that were eliminated by the cuts, the walk-in clinic has become the "catch basin," nurse Tom Bretz said. "Anything canceled comes to us now," Bretz said. April is the earliest the clinic can schedule routine appointments.

Sometimes the clinic is limited in what it can do. Bretz said in one day he referred five people with orthopedic problems to Los Angeles County/USC Medical Center because there was no doctor available.

The orthopedic specialist is scheduled at the clinic once a week for four hours. "When he's here, he's overwhelmed," Bretz said.

"Patients are more irritable and are waiting longer to be seen for routine stuff," Bretz said. Rather than endure a six-hour wait at the clinic, Bretz fears some people may wait until their affliction reaches a critical stage before seeking treatment.

Because ancillary services were cut, Bretz and other nurses are now having to do the work of the lab and EKG technicians and respiratory therapists who are no longer there.

It's not an ideal situation for health care providers, Bretz said. In terms of patient serviWce, he draws an analogy to commercial retail stores, saying it's Kmart, as opposed to, say, a Mervyn's.

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Photo (1) People wait at the pediatric clinic at High Desert Hospital. Although, some expressed dissatisfaction, others were grateful the facility is open. (2) Steven Sabbah, 12, of Palmdale is X-rayed by radiology technologist Joel Wall at High Desert Hospital. Jeff Goldwater/Daily News