Daily News, Tuesday, January 29, 2002
FIVE HEALTH CLINICS ON DEATH LIST
By Troy Anderson, Staff Writer
Faced with massive deficits, Los Angeles County officials proposed sharp cuts Monday that could lead to virtually dismantling the public health care system for the area's 3.2 million poor and uninsured people unless major new funding is found.
The Board of Supervisors will consider today the first phase of the Health Department plan involving closure of five public clinics by May -- including ones in North Hills and Burbank.
As the deficit grows from $300 million in the next 18 months to nearly $700 million in 2005, officials offered a series of harsh alternatives that could leave many people with medical treatment only for life-and-death illnesses or injuries.
"Anybody who believes we can close a half-billion-dollar deficit at the end of the day without impacting our core services is going to be seriously surprised," warned Supervisor Zev Yaroslavsky. "We have got to begin. We have waited too long."
The gloomy picture of how the needs of the poor and uninsured have overwhelmed resources comes after $2.2 billion in federal bailout money in the past six years and a bold effort to reduce costs by sending patients to lower-cost clinics for nonemergency treatment.
Those efforts have failed, said Fred Leaf, acting director of health services.
Health needs are so great that more people have gone to public health clinics, many with untreated medical conditions, driving up demand for speciality and diagnostic services and sending costs soaring.
Neither the "resources nor the will appears to exist in either Washington or Sacramento to provide adequate financial relief," Leaf wrote in a report to county officials. Without more funds, "the department will be faced with offering drastically fewer services to a much smaller population than it presently serves."
Under the worst-case scenario, all six public hospitals and more than 120 health clinics would be closed and the entire county health system privatized.
That option would leave the county's 2.5 million uninsured residents without regular public health care, and only able to get treatment in serious situations.
The 700,000 people who are medically indigent -- the very poor -- and general-relief recipients -- generally the poorest of the poor -- would, by law, be able to qualify for health services at private hospitals and clinics under contracts with the county, but treatment would be limited.
A series of steps was proposed short of that, starting in May with reducing the staff in the obstetrics unit at UCLA-Olive View Medical Center in Sylmar; closing an inpatient rehabilitation unit at High Desert Hospital in the Antelope Valley; and eliminating 100 administrative positions in the health department.
"This is going to definitely impact patients," said Jim Lott, executive vice president of the Healthcare Association of Southern California, which represents hospitals and other health care organizations. "They will have to scramble for access to (clinics) and primary care. This is definitely something we all need to be concerned with."
Patients at the Sepulveda Health Center in North Hills reacted with dismay to the clinic's possible closure.
"That's bad because it's going to make it hard to find a place to go," said Juana Chavarria of Chatsworth as she waited for an appointment.
The federal government provided $900 million to the county's $2.9 billion health system in June 2000 after a $1.2 billion bailout in 1995. Chief Administrative Officer David Janssen said the health department now faces a $300 million shortfall in the fiscal year that begins in July.
The deficit will worsen until the bailout funds run out, leaving a $688 million deficit in 2005-06.
On top of the gradual loss of the $900 million, the federal government plans to phase out $125 million due to changes governing Medicaid payments.
The first phase of the plan for cuts calls for consolidating and eliminating 100 administrative jobs for a savings of $8 million. The plan calls for moving physical therapy patients at High Desert Hospital to the Rancho Los Amigos National Rehabilitation Center in Downey.
It also calls for transferring about 45 patients on life-support systems at county hospitals to Downey and closing five health clinics, including ones in North Hills, Burbank, Los Angeles, Paramount and Compton.
County supervisors are expected to vote today to approve the plan in concept, with a final vote next month.
"Our first actions are geared to start changing the system and eliminating waste," Leaf said. "Then, as we move forward, we'll go into the larger areas of consolidation, as well as tackling the issue of varying costs among facilities with similar services. That will be one of the biggest areas of reform."
The second phase of the plan details four options for radically restructuring the health department.
One option calls for privatizing the health system and closing all county hospitals and clinics, limiting access to health care for uninsured people. That plan could overwhelm private hospitals and clinics.
"Without additional revenues, the county will be faced with a very stark choice between rationing health care and the ethical dilemma of severely cutting services to patients," said Bart Diener, assistant general manager of Service Employees International Union Local 660, which represents 20,000 county health workers.
Another option calls for closing all emergency rooms and operating only one or two hospitals with increased availability of urgent care centers.
A third option calls for closing clinics, and limiting health care to a narrow range of vital services.
The last option would close clinics but keep the six county hospitals open, focusing on providing only emergency, trauma care and other vital services.
"The only recourse will be to dismantle all the work done over the last 10 years and it will be a chaotic situation and patients won't be able to access care," said Kimberly Wyard, chief executive officer of the Northeast Valley Health Corporation in San Fernando, which operates four health clinics under county contracts.
Staff Writer Mariel Garza contributed to this story.
