In the fall of 2025, USC announced that all faculty and staff were mandated to enroll exclusively in the EPO or PPO USC health insurance plans. Yet, there are not enough physicians and other medical providers, especially in women’s health, primary care and mental health, to meet the needs of the USC community. 

When leadership suddenly closed the Labor and Delivery unit at USC Verdugo Hills Hospital in August 2024, it became clear that there was little to no interest in sustaining a thriving general obstetrics and gynecology service line. The reduction in obstetric services by USC contributes to the growing crisis occurring across California, particularly for women in remote areas, but now extends to urban centers like Los Angeles. 

Ultimately, I decided to resign from my position as Chief of the Division of Obstetrics, Gynecology, and Gynecologic Sub-Specialties at the Keck School of Medicine due to Keck Medicine of USC’s failure to prioritize women’s reproductive health despite repeated warnings and internal advocacy. 

Faculty and staff should be aware of the situation when seeking healthcare services through Keck. Below is an edited version of a letter I sent on Jan. 16 to senior leadership at both Keck Medicine and KSOM as well as to the interim president, Beong-Soo Kim. I did not receive a response.

This is my final attempt, after seven years of service at USC, to advocate for our patients, especially the USC community of women and other individuals who need obstetric and gynecologic care.  

I was hired, among other reasons, to build a practice at VHH, which I did despite the lack of adequate resources and support from Keck needed to ensure operational success. I recruited five female physicians of color, a women’s health nurse practitioner and a certified nurse midwife to join me, all of whom have resigned or were terminated. Our group had the highest percentage — over 25% — of USC EPO/PPO patients across all Keck practices. 

Having been involved with the OB-GYN community in Los Angeles, including other academic institutions, for over 30 years, I can attest to the advanced expertise of the members of my division. We cared for high-risk obstetric patients with excellent outcomes and offered complex gynecologic services, including advanced benign gynecologic surgery. I was one of only two menopause experts in our department. The assumption on the part of leadership that we were no different than other generalists in the community reflects a lack of understanding and a devaluation of everything we had to offer.  

We implemented the Complex Family Planning service line at Keck, offering pregnancy termination and other services to high-risk patients. As a result of Keck’s decision to close L&D at VHH, our specialist, who had trained other providers and assembled a core group of nursing staff who were comfortable assisting with these patients, felt she had no choice but to resign. No attempt by department leadership was made to convince her otherwise, nor are there plans to replace her.

As of today, there are only two general OB-GYNs who are part of the Keck Medical Group, and one community doctor who provides Tier 1 OB-GYN services at USC Arcadia. For benign gynecologic surgery, two physicians are working with a part-time nurse practitioner at Keck Hospital. This group of providers cannot meet the current demand for women’s health services at USC. Instead, Keck has advised patients to see their primary care providers for well-woman care.

During open enrollment, USC leadership informed the community that they could find Tier 1 and Tier 2 providers on the Personify Health website. However, when last checked on Jan. 16, the list of OB-GYN physicians contained numerous errors, including multiple redundancies and names of physicians who have not been part of our department for over five years, rendering it utterly useless. Anyone who has tried to find a physician already knows this.

Now that the university requires faculty and staff to sign up for the USC EPO and PPO health insurance products, the lack of access to obstetric and gynecologic care for thousands of individuals is astounding. Those who choose the EPO due to affordability have extremely limited options, while others feel compelled to select the PPO at a higher cost, so they can see doctors outside of the USC system. Still more will end up paying out of pocket when they need urgent care and cannot get an appointment. 

Overall, what is missing from Keck Medicine and USC  is a fundamental interest in women’s health services, other than when women have cancer. Encouraging your community to use Tier 1 providers because it saves them money, while you knew full well that you did not have enough Tier 1 providers in the first place, does them all a major disservice. While they wait for appointments or try to find other doctors, they will experience delays in care, ultimately causing harm to the community you claim to serve. 

During my time at USC, I did everything I could to bridge the many gaps and inequities that women face in accessing quality health care. I hoped that the stated mission and vision of USC would align with my values and efforts, but ultimately, they did not.  

Perhaps USC will have another chance to make things right by your employees and women across Los Angeles and beyond who deserve so much better.  

Signed,

Laila Al-Marayati, MD

Laila Al-Marayati served as an Associate Professor of Clinical Obstetrics and Gynecology at the Keck School of Medicine.