Hospital Rebuilding Project OKd

The Los Angeles County Board of Supervisors on Tuesday approved an $820-million project to rebuild County-USC Medical Center, the aging, earthquake-damaged heart of the county’s sprawling public health system.

The decision to award what officials say is the largest construction contract in county history comes at an awkward moment as the county appeals to the state and federal governments for help in closing a health department budget deficit of several hundred million dollars.

Yet county officials said the huge expenditure is a necessary part of reorganizing the system to put a greater emphasis on outpatient services. And there is widespread agreement among doctors, advocates for patients and county officials that the time has come to replace the aging hospital complex.

One of the county’s most recognizable landmarks -- the complex’s 20-story General Hospital was for years shown during the credits of the soap opera “General Hospital” -- the hospital was badly damaged in the 1994 Northridge earthquake. Some sections are badly out of date. Because there are no fire sprinklers in the General Hospital and the Women’s and Children’s Hospital, for example, the county pays for 24-hour fire patrols in the buildings.

How best to replace the hospital was at the heart of a years-long and frequently bitter dispute over the appropriate size of a replacement. The fight pitted Supervisor Gloria Molina, who argued for a larger, 750-bed replacement hospital, against the other four members of the board.

Though the supervisors resolved those differences two years ago, Tuesday’s final approval of the 600-bed, 1.5-million-square-foot project marks the first significant step toward actual construction.

Groundbreaking for the project is scheduled for this spring, with completion expected in 2007.

The new facility, which will be built on land adjacent to the existing one, will consist of four buildings, including a seven-story outpatient building, an eight-story inpatient tower, a five-story diagnostic and treatment building and a central plant. How the existing building will eventually be used remains unclear.

Although the dispute over the size of the new hospital is over, arguments about the potential cost continue.

The estimated price tag for the replacement hospital has already increased more than $2.5 million over original projections, and the construction contract was awarded to the sole bidder on the project, McCarthy, Clark, Hunt, a joint venture.

“This could balloon into the billion figures easily,” said Supervisor Zev Yaroslavsky.

Without adequate county controls over unauthorized construction expenditures, Yaroslavsky said, the hospital replacement project “would resemble what we went through with the MTA.”

During the late 1990s, audits of the Metropolitan Transportation Authority’s construction projects found skyrocketing design and engineering costs. One 1997 audit found that cost overruns on the 13.6-mile rail line from Union Station to Pasadena nearly doubled the cost from a budgeted $47 million to an estimated $93.6 million.

First opened as a two-story brick building in 1878, County-USC has long functioned as the core of the county health system and as its most visible symbol.

Last year, the hospital provided more than 785,000 emergency and outpatient visits, and County-USC treats about 35% of HIV/AIDS patients in the county.

County-USC also enjoys a high political profile. As a primary teaching site for generations of medical students and residents, the hospital occupies a sentimental place in the hearts of thousands of influential doctors who trained there. Unionized health-care workers often choose the site as a backdrop for walkouts or strikes.

“It’s always been the cornerstone of the system,” said Dr. Jonathan Fielding, director of public health for the county Department of Health Services.

But for all of its status and stature, the physical condition of the venerable institution has been in a state of accelerating decline for years.

After the Northridge quake and an extended squabble with the Federal Emergency Management Agency over the scope of the damage, the county eventually received more than $470 million in federal and state disaster aid to rebuild County-USC. Then the fight over the size of the replacement began.

County officials ultimately agreed on a 600-bed facility, 145 fewer beds than the hospital is budgeted to staff and operate.

While she welcomes the new building, Molina, who represents the Eastside area in which the hospital is located, continues to believe that the replacement hospital is too small, said Miguel Santana, a spokesman. Nonetheless, building the replacement is “a project that’s essential to maintaining the system as a whole, given that it’s the hub of the system,” Santana said.

“We have to move forward in terms of making the whole system more efficient.”

The county will fund about $331 million of the cost by borrowing money, taking advantage of current low interest rates.

Officials from the Department of Public Works, which will oversee the project, said it should be completed within its budget.

“We don’t understand going over budget,” said Tom Remillard, assistant director for the Department of Public Works. “There’s no more money.”

County rules require that any expenditures of more than $150,000 not detailed in the contract be approved by the Board of Supervisors.

But Yaroslavsky said the county is at a disadvantage in a project of this size.

“Contractors at this level know how to play this game better than anybody around here does,” he said. “We just pay for it.”