After almost a decade of service to the USC Keck School of Medicine Obstetrics and Gynecology Department, Dr. Laila Al-Marayati decided to leave.
Because her division was “disintegrating,” she said, there would no longer be a role for her as division chief, and on Nov. 3, Al-Marayati made the hard decision to resign from her position at USC effective Jan. 16.
“The idea of being by myself in a practice that doesn’t even belong to me, to work for a system that doesn’t support what we do, that turned down our every request for help, to give us more resources so we could do better,” she said, “it just doesn’t make sense to me.”
Her decision came as USC moved employees into new “Trojan Care” health plans that will steer tens of thousands of workers and their families toward Keck Medicine and its Tier 1 partners for maternity care.
On paper, the plans promise discounted care at preferred facilities. In reality, Al-Marayati and other Keck providers say there are not enough obstetricians in the Keck system to safely care for the people who are being pushed into it.
Currently, the department has only six providers, Al-Marayati explained. Of those, three are OB-GYN providers, whose work centers around obstetric or pregnancy care. For gynecological surgery, there are two physicians supported by a part-time nurse practitioner. Another physician will provide menopause care one day per week.
Seven years ago, Al-Marayati was recruited to build a general obstetrics and gynecology practice at Verdugo Hills Hospital, which at the time handled all deliveries for Keck. She built the labor and delivery unit — including a neonatal intensive care unit — “from the ground up,” staffing it with an all-women-of-color physician team.
She explained that this practice not only performed routine gynecological checks but also advanced high-risk obstetrics and gynecologic care, menopause care, specialty care, family planning, abortion services and complex contraceptive consultations.
“Not a lot of providers in general are providing this specialty care,” Al-Marayati said. “Patients can’t really get it anywhere else.”
At the end of 2024, Keck shut down that unit.
USC Health Senior Vice President for Health Affairs Dr. Steve Shapiro cited “careful and thorough examination of the hospital’s services and the shifting demographics and needs of the community it serves” as the driving factor behind the closure, in a statement to Annenberg Media.
“While the closure and subsequent provider departures reduced the number of OB/GYNs practicing with Keck Medicine,” said Shapiro, “we remain focused on enhancing our Women’s Health practice to ensure comprehensive care, spanning from routine annual visits to more complex gynecological needs.”
Providers, staff, regulatory organizations and the general public were informed “90 days prior to the unit closure as required by the California Department of Public Health,” according to Keck Medicine.
“They didn’t warn us even six months before that this could be happening,” Al-Marayati said. “They said there wasn’t enough volume to sustain it, and therefore they were closing.”
Doctors at the practice scrambled to transfer their patients to nearby hospitals and ensure they received adequate care before the closure. Amid the panic of losing their jobs, she managed to convince the doctors to hold out until the holidays for the patients who needed them.
“I convinced everybody that it was a crisis moment. We had a lot of people to deliver, and we had to sort of act like this was no big deal to the patients, and we managed to do an extremely smooth transition,” Al-Marayati said. “We literally delivered a patient at Verdugo on Nov. 4, and on Nov. 5, we delivered a patient at Glendale Adventist. It was that kind of a transition.”
After the holidays, Al-Marayati and her team attempted to negotiate with Keck leadership to secure the accommodations needed to sustain their practice. They asked for better office space, marketing for the clinic’s services, a nurse practitioner to help with some of the work and a raise.
Al-Marayati said the administration denied all of these requests. Keck Medicine and USC Health did not respond to specific questions regarding their denial of these requests.
“We were trying to say we need those resources to be busier and more productive, but they denied it,” she said.
That response, according to Al-Marayati, conveyed to the team that the department did not care about them, their patients or their practice. After the practice closed, she explained that two of the doctors decided to leave for better jobs, one was laid off due to budget cuts, and another went on maternity leave — a team of six, whittled down to no one.
“The health system worked with affected staff to support their transition. Many staff members from those units transitioned to similar roles within Keck Medicine or at other institutions,” Keck Medicine stated. “Affected patients were referred to nearby hospitals for their deliveries.”
Al-Marayati says she had nothing to offer doctors at her practice to convince them they should stay at USC. Many of them managed to find better-paying positions at other hospitals.
“Everything I had built up to create, to generate, to care for all of these patients at this high level of excellence, comprehensive, complex obstetrics and gynecologic care was done,” Al-Marayati said. “I couldn’t see a future, and I really didn’t want to be the only one left after everything that I had done.”
The lack of adequate maternity care providers within the USC employee health plans has left many employees scrambling to find coverage for themselves and their loved ones.
USC is the largest private employer in the city of Los Angeles, with more than 20,000 employees. Not only will many of these employees now seek care through Keck facilities, but their families will as well, further burdening an already oversaturated healthcare system.
Obstetrics and gynecological health clinics offer a wide range of preventive, reproductive and specialized medical care throughout a patient’s life. In addition to routine exams and pregnancy care, these clinics also provide advanced gynecological surgery, cancer care, menstrual and hormonal disorders, as well as other women’s health care services.
USC health officials frame the new Trojan Care plans as an attempt to control costs and expand access.
In an October interview with Annenberg Media, USC Chief Campus Health Officer Dr. Sarah Van Orman said that during open enrollment, faculty members chose between two main health plans: the Trojan Care EPO and PPO. A third plan, EPO Select, was available to Keck Hospital National Union of Healthcare Workers; this year, that plan is no longer available.
“While there’s a lot of change, there’s really a lot of important enhancements,” Van Orman said, “to really control costs for our employees, improve access and then make sure that we’re able to provide the best care for our employees through the plans.”
To address the shortage of OB-GYNs at Keck, the university designated other hospitals as Tier 1 to provide obstetric care. For maternity services, Tier 1 hospitals for EPO and PPO patients include Glendale Adventist, White Memorial, Long Beach Memorial, Orange Coast Memorial and USC Arcadia. Fifteen regional hospitals with maternity services are also available in Tier 2.
An agreement with MemorialCare has added 35 OB-GYN providers to Tier 1, according to Keck Medicine. Shapiro also cited the 15 additional hospitals available for maternity services in Tier 2.
The “Cost differences between Tier 1 and Tier 2 providers span across all health services,” said Shapiro.
Assistant Vice President of USC Health Plans, Dr. Alice Chen, pointed to a maternity support program called Nurturing Together, which offers outreach to high-risk patients.
She said USC ensures its network is “adequate for the needs of our population,” citing hundreds of in-network obstetrics providers within a 5-mile radius in Personify Health.
Patients seeking new providers due to changes in their insurance coverage are directed to the Personify Health provider search tool. This tool is meant to help patients navigate the provider search process.
After visiting the Personify Health site herself, Al-Marayati saw the names of former Keck employees — practitioners whom patients could not even get an appointment with.
Annenberg Media reviewed the provider list and identified multiple doctors no longer affiliated with the health campus.
“This list is completely inaccurate,” said Al-Marayati. “You’re telling people to use these providers. You want them to use Keck providers, yet the list of providers you have is inaccurate, including individuals who left our department at least seven or eight years ago. This, to me, is kind of egregious, especially when they’re rolling this out, and then the list you have isn’t useful to anybody.”
Keck Medicine did not respond to specific questions regarding the inaccurate physician list on Personify Health.
At the end of the day, Al-Marayati believes that it is the patients who will suffer because of the lack of adequate maternity providers. They are the ones who will be unable to find providers and be forced to either spend an excessive amount of money looking at outside providers or go without gynecological health care, she said.
The out-of-pocket cost for PPO members using Tier 1 is $3,000, and for Tier 2, it’s $9,000. Patients could end up spending upwards of $6,000 attempting to find care or simply going without healthcare.
“That is what it means in real time for these patients, if they cannot find Keck hospitals or providers, they pay out of pocket a lot more than they would otherwise,” Al-Marayati said. “Then, they are telling people it is in your interest to just go to Keck, which everybody wants to do, but there are no providers at Keck for these patients.”
A physician at Keck Medicine, granted anonymity due to concerns about job security, explained that from the very beginning of their employment with Keck almost six years ago, they were left with the impression that USC had no real intention of establishing the obstetrics and gynecology services program.
They explained that part of the issue with the Keck healthcare system is that the main campus hospital, Keck Hospital of USC, does not provide women’s reproductive healthcare. To supplement this lack of maternity care at the main campus hospital, they said Keck acquired other campuses such as Verdugo Hills and Arcadia Hospital. However, with the closure of Verduge Hills, the other campus is not enough.
“If you’re a low-risk, uncomplicated 40-week pregnancy, then you’ll be fine at USC Arcadia,” the physician said. “If you have any complications, if you are less than 32 weeks, USC Arcadia would not or could not offer you any care.”
The physician explained that for their own maternity care, they have decided to pay out of pocket and seek care outside the system.
“USC Arcadia is a hospital where they don’t have the tools to be able to take care of a baby that actually needs to be in the [Neonatal Intensive Care Unit], so why would I go deliver there?” the physician said. “If I can’t trust you to be able to take care of me, I’d rather pay out of pocket.”
From these doctors’ perspectives, the story is not about them. It is about what happens to patients in a system that expands coverage on paper without expanding care on the ground.
“All I care about are these patients, all these women,” Al-Marayati said. “What I realized is that no matter what your socioeconomic background is, what your privilege is, as a woman, you still get crappy care, and you’re on the bottom with whatever system you’re in. This is a systematic oppression of women in health care.”
Al-Marayati said it is the patients who are unable to receive adequate care from this healthcare system who will suffer.
“I do not see any fallout for USC,” Al-Marayati said. “I see fallout for the patients.”
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Corrections were made to this article at 12:18 p.m., Thursday, to properly reflect the USC position of Dr. Alice Chen.