Proposed Fund Cuts Worry Clinic Managers

Kamal Von Essen has run a doctor’s office for the last seven years that offers the only health care most of the people who go there can afford.

For the 125,705 people who went last year to the Beach Area Community Clinic, which Von Essen manages, and its 16 other counterparts scattered throughout the county, the government-subsidized facilities are a critical part of their day-to-day medical needs.

But now, Von Essen and other clinic administrators fear that the network of health facilities is in jeopardy because of President Reagan’s proposal to eliminate federal revenue sharing, which pumped $2.7 million into the clinic system last year.

The county received $12 million this fiscal year from the 12-year-old federal revenue-sharing program that was established as part of President Richard M. Nixon’s “New Federalism” plan to decentralize government. About $3 million remains, and the San Diego County Board of Supervisors will begin setting priorities for that remaining money Tuesday should Congress decide to end the program.

Meanwhile, Von Essen and other administrators are scrambling to find a replacement for revenue sharing, which is the backbone of some clinics’ funding.

Even the post-Proposition 13 fiscal squeeze, probably the most debilitating to the county clinic system, was handled with a combination of belt-tightening and staff streamlining.

“As an administrator of a government-funded program, I’ve dealt with my fair share of budget cuts, but this is pretty bad,” said Von Essen, whose clinic receives about $145,000 of its $554,000 budget from revenue sharing.

Despite the predicted disasters after Proposition 13, the 17 community clinics survived those cuts. But it is the latest round of threatened funding cuts that has administrators worried.

On one side of the fence are the more optimistic, like Von Essen and Stephen Shubert, executive director of the Council for Community Clinics, who hope that there may be some alternate state or perhaps private funds available to keep the clinics afloat after the revenue sharing funds are long gone.

Von Essen even ambitiously envisions the possibility that her facility could start an infertility or herpes treatment clinic that would subsidize the general-medicine clinics, which are used mostly by the poor and currently are paid for by the $145,000 in revenue sharing funds the beach facility receives.

On the other side, however, are people like Betty Bassoff, an administrator of the small East County Community Clinic, who believe that if Congress votes to cut revenue sharing and if the Board of Supervisors fails to pick up the slack by allocating money from the county’s general fund, the clinics will be wiped out.

“It’s ludicrous. You cannot run a health care facility on foundation grants,” Bassoff said. “It’s the county’s responsibility to provide care for the indigents, and they’re trying to get out of their responsibility.”

Bassoff is even more pessimistic about garnering state funds, especially since the state is trimming the budget of its own health care provider--Medi-Cal--by requiring benefactors to receive care through preselected Health Maintenance Organizations.