Health Chief Concedes He Has No Plan for Closings : Budget: Outgoing director also tells supervisors $90 million more is needed to keep department and hospitals running this year.

In a day of startling disclosures underscoring the depth of the county’s budget crisis, its top health official conceded Friday he has no comprehensive contingency plan for how to close hospitals and treat sick and injured patients if severe budget cuts are ordered.

Robert C. Gates, outgoing director of the vast county Health Services Department, also surprised the Board of Supervisors by telling them his department’s deficit is actually $90 million worse than the $655 million previously estimated.

After Gates’ disclosures, several supervisors complained privately that they have repeatedly asked Gates for a “mitigation” contingency plan in recent months. Board Chairwoman Gloria Molina said that without such a plan, the county risks huge liabilities and lawsuits from patients. It also, she said, risks delays in providing health services because closing hospitals is a complicated process that can take months to complete.

“In every other department, the department heads know exactly what is going to happen when the cuts are made. This department doesn’t,” said Molina, whose district includes the huge County-USC Medical Center, which has been targeted for closure. “We’ve been telling him [to prepare a report] on a regular basis, and he responds like a wall does.”

“It’s like he doesn’t believe this all is going to happen,” Supervisor Deane Dana said in an interview. “It’s very obvious he hasn’t come up with a plan, even though this all is going to happen in three weeks.”

Gates said his department may have piecemeal reports on the impact of the proposed closures and their effect on thousands of health care recipients. But, he said, “there is no contingency plan overall.”

Gates said any contingency plan to help the Health Department cope with the bare-bones budget proposed by Chief Administrative Officer Sally Reed would basically be a blueprint of how the county would turn its back on the poor and uninsured who need care.

If county facilities are shut down, Gates said in an interview, “people [will] come to hospitals not prepared to treat them, and they [will] die. Unless we get new revenues in, we’re talking about rearranging the deck chairs on the Titanic.”

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The disclosures came during a day of rapid developments about the county’s efforts to balance its proposed $11.1-billion budget:

* Sheriff Sherman Block said he will proceed with a lawsuit against the county unless he gets an immediate guarantee that he will not lose $22 million in funds as part of Reed’s proposal to cut most departments 20%. Block told the supervisors the money is earmarked to his department under Proposition 172, and that the money would revert to cities if he did not spend it.

In his most specific accounting yet of what proposed cuts will do, Block also said he would have to lay off 380 deputies in unincorporated areas, shut down an 1,800-bed jail facility in northern Los Angeles County and drop many important special units targeting gangs, narcotics, sex crimes and other menaces to society. “It is going to be absolutely devastating to public safety,” he said.

* Dist. Atty. Gil Garcetti continued to play brinkmanship with the supervisors, saying he will not make his 20% in cuts and layoffs ordered by the supervisors. Probation Director Barry Nidorf also said proposed cuts would severely undermine his department’s ability to keep criminals off the streets.

Mental Health Department Director Areta Crowell, who had effectively axed the historic Los Angeles Suicide Prevention Center in her proposed budget, said at the hearing that she would be willing to restore half the center’s $126,560 county contract for next year. However, the center’s director, Jay Nagdimon, said that unless an outside charity or foundation steps in, the compromise offered by Crowell might not be enough to keep it in operation for more than a few months.

* Molina and Block met with Los Angeles Mayor Richard Riordan to enlist his help in the county’s lobbying efforts. Molina, in an interview after the hourlong morning meeting in the mayor’s office, said she and Block asked Riordan to “look at our options,” including the so-called tippler’s tax and an added half-cent sales tax, both of which require state permission to levy. She said Riordan was willing to talk to Gov. Pete Wilson and others in Sacramento about the tippler’s tax and possible revisions in the state’s Medi-Cal reimbursements for the county, but said he would not support the sales tax proposal.

But it was the disclosures by the health services director that created the most concern--and ire--among the supervisors, who are trying to find ways to cut $1.2 billion from their budget or risk insolvency.

Gates--who in May abruptly announced his resignation, to take effect in November--told the board that he knows few details of what his department is doing to prepare for what most county officials say would be a catastrophe--closure of County-USC or four other county hospitals, as Reed has proposed.

But as chances to find aid in Sacramento and Washington diminish, county officials say such a closure is becoming more likely.

Gates defended his lack of a comprehensive plan by saying a Health Crisis Task Force established by the supervisors is working to address budget-related issues and will come up with solutions to the deficit.

In another matter, he also said he did not know whether the department has put on hold at least $10 million in expansion projects at various hospitals, but he did not believe such delays would save the county much money.

After Gates proposed closing the relatively tiny High Desert Hospital in Lancaster earlier this year, Molina and others sharply criticized the director for not first preparing a report about the impact of the cuts. When the report was done, Gates was quietly admonished again, Molina said, for preparing a report that failed to address the board’s concerns over such a hospital closure.

In fact, county officials disclosed Friday, Gates’ reaction to looming problems in his department led to his being forced from his job. Gates has since negotiated a lucrative retirement deal that includes a $25,000 pay increase that boosts his monthly pension to $5,998 and a sweetened benefits package.

Hospital closures could conceivably begin within weeks, displacing tens of thousands of patients and causing what Gates called “a meltdown” in health services for the poor and uninsured. He referred calls about the department’s response to proposed cuts to his second-in-command, Mary Jung, who is on vacation this week.

One top health official confirmed that there is no comprehensive plan to deal with the cuts.

“If they were definitely going to close,” said Carolyn McDermott, chief of staff for the department’s personal health services division, “I don’t think it would take too terribly long [to develop a plan], certainly no longer than the 60 or 90 days it would take to shut the hospitals down.”

She said the much-criticized High Desert mitigation plan is being used as a prototype that other hospitals will follow in the event of proposed closure.

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McDermott also said the department received a report this month that basically concludes that private sector hospitals will not take indigent patients unless they receive Medi-Cal or other insurance.

Some county officials suggested that even if the supervisors vote to shut down one or more hospitals, they will have to stay open to care for indigent patients still hospitalized, especially those without insurance.

“If we didn’t do that, the lawsuits would cost us more than it takes to keep the hospitals open in the first place,” said a top county official, speaking on condition of anonymity.

Gates also told the board that his lobbying effort in Washington on Tuesday made little progress in getting the federal government to shake loose hundreds of millions of dollars in additional health care funding.

Despite those unsuccessful lobbying efforts, Gates said he needs an additional $89.74 million--making the health services deficit $745 million--to account for salary increases and “potentially adverse impacts” from the state budget.

Several county officials criticized Gates for waiting until now to bring forward his request for the additional $89.74 million.

“We’ve been killing ourselves trying to get him the $655 million, and now he tells us that wouldn’t even be enough,” said a supervisorial aide, who asked not to be identified.

Times staff writers Jean Merl and Shawn Hubler contributed to this story.