The Board of Supervisors Tuesday approved a $162.6 million plan for the seismic retrofit of Rancho Los Amigos National Rehabilitation Center but postponed a decision on another $242.5 million in upgrades for the Downey hospital.
The county is required by the state to retrofit the facility to meet current seismic safety standards by 2020.
"If we don't move forward we could lose Rancho as a very valuable resource," county Chief Executive Officer William Fujioka told the board.
Department of Health Services Director Mitchell Katz had hoped to get approvals for two new outpatient centers and modernization of administrative buildings on the Rancho Los Amigos campus in addition to seismic retrofit and a related renovation of inpatient facilities.
The proposed work would actually shrink the size of the medical center by nearly 40 percent and create staffing, energy and maintenance efficiencies estimated to save $2.9 million annually, according to Katz.
But Supervisor Gloria Molina objected to the project's growing scope, given all the uncertainties facing the county under pending health care reform.
When the board approved seismic retrofit and a much smaller set of upgrades in 2006, the work at Rancho was expected to cost $55 million.
"I do not want to leave my successor in a fiscal straitjacket, trying to pay for this with the credit card that we're using," Molina said.
Fujioka said he was confident that the county could cover the debt service on bonds issued to fund the hospital renovation.
Molina also objected to the lack of analysis of the need for hospital beds at Rancho, while acknowledging that she was still stinging from the fight she waged to increase the size of Los Angeles County-USC Medical Center, which opened in 2008.
"It's really different when it's one side of town versus another side of town," Molina said. "Overbuilding beds where they are not needed doesn't make sense."
Supervisor Don Knabe, who represents the Third District where Rancho Los Amigos is located, said the proposed renovation would actually cut the number of beds.
But how many beds the county will ultimately need will depend on how successful Katz is in attracting newly insured patients when the Affordable Care Act goes fully into effect in 2014.
"I'm not sure that our facilities will attract new patients with insurance," Molina said, though she's been an aggressive advocate for the county's healthcare system. "They're going to go to the Huntingtons, to the Cedars, they're going to go to the White Memorials," she added, citing private hospitals.
Molina asked that the needs analysis be completed before the board votes on the outpatient and administrative elements of the project, and her colleagues ultimately agreed.
The board's vote was unanimous in favor of approving the seismic work and inpatient renovation. Katz was directed to return by Jan. 22 with an analysis of the need for hospital beds countywide.