Los Angeles County+USC Medical Center
UPDATE: In late January 2023, a Request for Proposals (RFP) has been issued by the County of Los Angeles for the reuse of the General Hospital Building and portions (12 acres overall) of the West Campus. The County, with leadership coming from Supervisor Hilda Solis' office, is looking for equity partners and a master developer to adaptively reuse this long-underutilized historic healthcare facility. In addition to other uses, the RFP anticipates housing as a primary use, with a requirement for a minimum of 600 housing units, at least 25 percent of which must be set aside as affordable housing. Incentives are available, including $50 million allocated in the 2022-23 state budget for structural stabilization and retrofit. Proposals are due June 2, 2023.
The site of numerous significant events in the history of public health, the Los Angeles County+USC Medical Center contains one of the city's most recognizable Art Deco buildings. The facility is located in Los Angeles' Lincoln Heights neighborhood and has previously been known as County/USC and Los Angeles County General Hospital.
Made famous to daytime soap opera aficionados with its appearance in the opening credits of General Hospital, the massive Art Deco structure was designed by the Allied Architects’ Association of Los Angeles. The consortium of architects also designed the 1925 Hall of Justice, with input from the County Architect, Karl Muck.
The twenty-story concrete building was constructed between 1927 and 1933, against the backdrop of the Great Depression.
Its design reflects New Deal ideals of scale, centralized organization, and beauty in efficient form.
Imposing concrete statues by Salvatore Cartaino Scarpitta overlook the entrance to the building. Occupying the central position is the Angel of Mercy, who comforts an infirm couple. Representations of Western history’s great medical minds—Pasteur, Harvey, Vesalius, Hippocrates, Galen, and Hunter—flank the central figure.
The spacious foyer features exquisite ceiling murals by artist Hugo Ballin of Asclepius, the Greek god of medicine, and his sons. Ballin also painted the interior of the Los Angeles Times Building and the Griffith Observatory. The saint-like rendering of these figures suggests that an exalted place for the gods of medicine and their earthly instruments.
The sheer size of the entire complex, the largest single hospital facility built west of Chicago, is also a bold architectural statement.
In addition to its architectural significance, the facility is also notable for its relationship to the Chicano Movement of the 1970s and community organizing in response to the HIV/AIDS crisis in the 1980s and '90s.
Due to the age of the facilities and equipment, as well as new earthquake safety standards for medical buildings, most of the operations of the LAC+USC Medical Center have been relocated to a new adjacent building. The 1933 building has since been converted to office use.
The origins of the Los Angeles County healthcare system date to 1856, when six members of the Daughters of Charity of St. Vincent DePaul in Maryland relocated to Los Angeles to form St. Vincent’s Hospital. At that time, the County was able to subsidize the operations of the Daughters for $1.22 per day.
Responding to the growing need to serve all of Los Angeles County’s health needs, the LAC+USC Medical Center was proposed in the 1920s. Despite reluctance from taxpayers, a bond measure and voluntary tax increase narrowly succeeded in supplying the necessary financing for a state-of-the-art facility.
In December 1933, the new concrete monument to public health opened to the public. The 1,680-bed facility had cost the County $12 million and encompassed more than one million square feet.The USC Keck School of Medicine, which had partnered with the County since its founding in 1885, would later train generations of medical students inside the commanding walls of this new institution.
Despite auspicious beginnings, however, the combined forces of the "White Flight" phenomenon, tax revolts, competition from private hospitals, and a staggering number of uninsured patients strained the staff and operating budget of the hospital during the postwar years. By the 1980s, the hospital had entered a period of crisis with declining federal and state funding due to rising budget deficits and ever-increasing demand.
In 1985, it was estimated that nearly 1 out of every 200 children in the United States were born at LAC+USC.
During this time, the facility suffered from out-of-date medical equipment, crowded conditions, and an influx of patients who were victims of violent crimes. Law enforcement maintained a near-steady presence at the hospital.
Conditions improved with the onset of the twenty-first century, and the operations of the LAC+USC Medical Center have been relocated to a new adjacent building. Now housing office use, the original building stands as a testament to Los Angeles County’s struggle to realize equitable healthcare.
In 1975, LAC+USC Medical Center and its doctors became a flashpoint within the Chicano Movement with the significant legal case Madrigal v. Quilligan, which shined a spotlight on the practice of non-consensual sterilization of Latina women.
Dolores Madrigal, one of the ten monolingual Spanish and low-income sterilized plaintiffs, agreed to the procedure after she had been told her husband had already given his signature. She would later learn that this was untrue. Other women were threatened with the loss of state financial assistance or were led to believe that the procedure was reversible. In three cases, no form of consent was granted.
Despite testimony from a medical student confirming that the head of Obstetrics and Gynecology would regularly disparage low-income and minority women for having too many children and boast about his efforts to lower the birthrates of African American and Latina women, the case was settled in the hospital’s favor. The presiding judge ruled that the sterilizations resulted from cultural misunderstanding and that there was no malicious intent on the part of the doctors. Learn more about Madrigal v. Quilligan in the 2015 documentary No Más Bebés >>
The onset of the HIV/AIDS crisis once more placed the hospital at the center of debates over civil rights and public health. In 1988 and 1989, the hospital was the site of a series of climactic protests and vigils organized by the Los Angeles Chapter of the AIDS Coalition to Unleash Power (ACT UP). At the heart of ACT UP's campaign was the inadequacy of County’s response to the epidemic, both in terms of research and treatment.
While thousands were afflicted with and dying from HIV and AIDS in Los Angeles County, the LAC+USC Medical Center did not offer specialized treatment programs. Hospitals in Los Angeles lagged behind those in other cities like New York and San Francisco, which were increasingly providing care to AIDS patients. In many cases, community-based healthcare organizations stepped up to fill the void. Rue's House in the Arlington Heights neighborhood, for example, grew out of popular nightclub Jewel's Catch One.
In response, ACT UP members picketed the hospital and occupied the lobby in April 1988.
Law enforcement forcibly removed the protesters, and three members were arrested.
In response to increasing pressure, the hospital proposed the creation of an AIDS ward accommodating twenty beds. ACT UP decried the proposal, deeming it too little too late, and demanded that the County provide fifty beds in the short term and expand to one hundred by the following year. The organization also called for greater funding for AIDS research and treatment programs.
ACT UP subsequently organized a week-long protest in late January 1989, staging a mock AIDS ward outside the hospital. Activists, some of whom were themselves afflicted with HIV or AIDS, lay on cots as they were tended to by others dressed as doctors and nurses.
ACT UP planned the LAC+USC actions from Plummer Park, the local chapter's meeting space. The hospital did eventually create an AIDS ward, but with twenty beds as originally proposed.
Though separated by more than a decade, at stake in both the Madrigal case and the ACT UP protests were pervasive inequities in the treatment of marginalized communities within the healthcare system, including people of color, women, and LGBTQ individuals. Both events underscored the need for greater cultural sensitivity and social awareness within the medical and political establishments towards the diverse health needs of the county’s minorities.