New London — For the third time in less than a year, Lawrence + Memorial Hospital announced that is laying off staff due to reductions in revenues from Medicare, Medicaid and other sources.

The hospital cut 33 positions Tuesday, adding to the 22 layoffs announced last November and hourly reductions and layoffs of another 22 since January. The new layoffs include 11 per diem positions — staff who work on an "as needed" basis — six from clinical areas, four managers, two directors and nine staff who are members of one of the three hospital unions, among others. There were also two union employees whose hours were reduced. L+M employs about 2,500 people. Editor's note: This updates information in original version.

The cuts will eliminate the hospital's involvement in the Safe Kids New London County, which provided child car-seat inspections at the hospital, parenting classes, and other child injury prevention programs. Also eliminated are a teen pregnancy prevention program and the Faith in Action Network, which involved 30 congregations in health education and promotion activities.

"It's been a terrible day," said Laurel Holmes, who headed Safe Kids as director of community health outreach and partnerships. The hospital is working with the Child & Family Agency of Southeastern Connecticut to have that agency take over the programs, she added.

About 1,200 families had their car seats inspected at a station in the L+M parking garage in the past year, she said. Families will be directed to other places in the community where the services are available, such as some police and fire departments. Holmes said about one-quarter of the families who came for the inspections received a free car seat. The free seats were available to qualifying low-income families.

Harry Rodriguez, president of the health care workers union, said six members of his local have been laid off. There are 852 maintenance and support staff in the union.

"My people are very upset. They are the least paid workers, and we've been taking the brunt of the layoffs," Rodriguez said, referring to the three rounds since November. "Senior management has not offered to take a pay cut or furlough days to fix the budget, and they have not responded to our offer to sit down and figure something out" to avoid the layoffs.

Rodriguez said he expects the layoffs will be a major issue in the upcoming contract negotiations between the hospital and the other two unions that represent nurses and technical staff. He also said he expects more layoffs in the next few months.

L+M President and Chief Executive Officer Bruce Cummings said the hospital was forced to cut positions because of the "sheer magnitude" of Medicare and Medicaid reductions.

"L+M and other hospitals are contending with massive structural changes that are happening very rapidly," he said in a news release. "We are also experiencing unexpected — and previously unbudgeted — cuts in federal (Medicare) and state (Medicaid) funding."

Specifically, these cuts came as a result of Congress' continuation of Bush-era tax cuts, resulting in a $1.3 million-per-year loss to the hospital for five years, Cummings said. In addition, automatic reductions in federal spending known as sequestration mean a $1 million loss this year and another $1 million next year, he said.

In addition, a 20 percent cut in Medicaid payments to hospitals proposed by Gov. Dannel P. Malloy and approved by the state legislature reduced payments to L+M by $1 million total for July, August and September, and will mean a $4.3 million to $6 million reduction next year, he said.

"A lot of what happened today is based on what happened in Hartford," L+M spokesman Mike O'Farrell said.

He noted that other hospitals in the state have also laid off employees recently. Among them are the Western Connecticut Health Network, which laid off 116 employees at Danbury and New Milford hospitals in July, and St. Vincent's Medical Center in Bridgeport, which laid off 100 employees in June.

O'Farrell said the new round of layoffs will keep the hospital on track to stay in the black for the current fiscal year. L+M's board of directors has set a target of a 3 percent operating margin of revenues over expenses for the hospital to maintain financial health.

"That's our goal," he said.

j.benson@theday.com