With cash set to run out in May, Jackson Health System announced Friday plans to lay off 4,487 employees -- more than a third of the work force -- and close the system's two satellite hospitals.

``We have to act,'' Chief Executive Eneida Roldan told a board room packed with grim-faced employees. ``This is the first step to becoming a sustainable, stronger system.''

The cuts will save Miami-Dade's public health system $165.4 million by eliminating a broad range of services, including the closing of Jackson North and Jackson South hospitals. Even with the cuts, Roldan said there will remain a deficit of $64 million for fiscal 2009.

The closings are likely to mean longer waits for everyone in emergency rooms throughout the county and some people leaving without getting treatment, said David R. Small, Jackson's chief operating officer.

Roldan asked members of the governing body, the Public Health Trust, to act within 10 business days so that facilities could be closed and employees gone by early May.

The hospital closings will also need approval of the County Commission, said Eugene Shy Jr. of the county attorney's office. That's likely to extend the restructuring timetable.

Commissioners, still digesting the plan's details Friday, had mixed reactions. ``I applaud her for a bold initiative,'' said Carlos Gimenez.

Katy Sorenson said she wasn't ready to embrace the closing of Jackson South, which is in her district. County Mayor Carlos Alvarez said he didn't want to comment before studying the 38-page plan.

Roldan said the plan was necessary unless county, state or federal money suddenly became available. Such a rescue may be a long shot.

NO BAILOUT

``The county does not have the dollars to bail them out,'' Commissioner Bruno Barreiro said.

The state, meanwhile, is wrestling with a multibillion-dollar deficit. And a plan by Service Employees International Union -- one of the two big labor groups at Jackson -- to find $50 million in federal funds is likely to be some months away, if it works at all.

``Maybe we will find a Santa Claus,'' said Trust Vice Chairman Angel Medina, but ``we've only got 45, 60 days of cash. Our vendors are already putting us on credit holds,'' meaning they're not delivering supplies because Jackson hasn't paid them.

Many members of the Trust were stunned at the breadth and depth of the planned closings. Previously, Roldan had announced 900 job cuts, then agreed to a 45-day moratorium in order to work with the SEIU to find job efficiencies.

Board members searched out loud for alternatives, hoping Roldan's plan was ``a worst-case scenario.'' Several urged Roldan to ask Jackson's 10,500 union workers for a 10 percent pay cut. ``Unions must understand we're at a turning point,'' Abraham Galbut said.

After the meeting, Martha Baker, president of SEIU Local 1991, said, ``Cuts are not the answer,'' either in jobs or in salaries. She urged Roldan to continue with their 45-day partnership to find cost efficiencies in the system.

Later in an e-mail to union members, Baker urged them to object to their county commissioners. She called the plan ``totally unacceptable.''

Commissioner Sorenson said there was no way around steep cuts. ``The unions must understand that we can't go on like this. It will be pay cuts or layoffs.''

But she agreed there was a need for operating changes. ``There is something radically wrong with its billing structure and that has to be fixed.''