County Clinics--Reducing the Waits : New State Money Will Ease Burdens of the Medically Indigent

The young, pregnant woman grimaced with discomfort as she slowly shifted in her seat.

“It’s too long,” said Martha Martinez, one of dozens of expectant mothers jamming the waiting room of one of Los Angeles County’s large public health clinics near downtown. She had arrived at 7:30 a.m. for her appointment, planning to miss only a couple of hours of work. At 2:30 in the afternoon, she still had not seen the doctor.

Martinez, a receptionist who has no health insurance, is one of the so-called medically indigent--the working poor who rely on the county for low-cost medical care. The $40 or more that a private doctor might charge--twice the county clinic fee--is “too expensive” for her and her husband, a part-time painter. So she waits--often several weeks--for appointments and then several hours at the clinic. “You get tired,” she said.

A few miles away, at the county’s Department of Children’s Services office in Hollywood, social worker Joyce Scheckwitz was troubled about her handling of a neglected 7-year-old boy, who was taken away from his mother after he had been left unattended.

Between juggling home visits, reports and court-ordered evaluations on about 40 other cases of abused and neglected children, Scheckwitz had not found time to track down a foster home for the boy, who suffers from emotional problems. He was placed in a group home, a temporary, mini-shelter serving several children. “He was isolated, without the support of a family-type setting,” she said.

Now the boy, who had gotten into trouble at the group home, had been transferred to MacLaren Children’s Center, the county’s crowded central children’s shelter. “I would have liked to have spent more time (on him),” Scheckwitz said.

The health clinic waits faced by Martinez and child abuse caseloads carried by workers like Scheckwitz were two major problems that the Los Angeles County Board of Supervisors hoped to ease with new state funds proposed this year by the Legislature.

As part of $501 million in recent budget vetoes, Gov. George Deukmejian eliminated proposed increases for child welfare services. But he left intact the Legislature’s boost in funds for health care for the poor.

Overall, the $34.8-billion state budget signed by the governor includes nearly $30 million more for Los Angeles County medical and mental health programs than Deukmejian proposed, an increase that sets the stage for the supervisors’ final round of actions on the county budget beginning today.

The increase includes $20 million for the medically indigent--low-income people who have no public or private health insurance--and about $7 million for new programs for mentally ill street people.

For health clinic users like Martinez, the news was the best in years. Within a few months, health department officials expect to begin adding new medical staff to reduce waiting times, which have doubled since the county took over responsibility for indigents from the state in 1983.

“Two years ago, our average wait (for an appointment) in the prenatal clinic was four weeks,” said Anthony Rodgers, director of the H. Claude Hudson Comprehensive Health Care Center that Martinez uses. “Now it’s nine weeks. In the adult medicine clinic, the average wait is 12 weeks,” he said.

The new money should cut some waits in half. “I would feel by October you would see benefits of the new money,” Rodgers said.

‘It Sounds Good’

That means Martinez, who expects to deliver in November and will be visiting the clinic regularly, is likely to see the improvements. “It sounds good,” she said.

But the situation is less certain for Scheckwitz. Deukmejian vetoed a $20-million increase for child welfare services, saying child abuse caseloads appear to be leveling off statewide and that there have been increases in child welfare funds in the last two years.

The veto means a $5-million loss of new funds for Los Angeles County that was targeted largely to reduce the number of abused and neglected children assigned to social workers like Scheckwitz. Officials in the Department of Children’s Services say that if the Board of Supervisors does not increase funding, caseloads will go higher.

Scheckwitz said that while caseloads have decreased in recent years, they are still too high to meet state requirements for monitoring treatment of abused and neglected children. Those include writing reports and making a minimum of once-a-month visits to each child and the parents. “You have to let certain things go,” she said, noting that she was unable to visit two of her children last month.

While the new state money is less than county officials wanted, it reflects an improving relationship in recent years between local and state elected officials, observers said. Much of the change is because large surpluses are making it easier for the state to share money.

In the years immediately after passage of Proposition 13 in 1978 and through the recession of the early 1980s, state and local officials were often competing for the same scarce revenues. “There’s a lot less standing toe to toe, screaming at each other, ‘it’s my money, it’s your money,’ ” said Peter Detwiler, consultant to the Senate Local Government Committee.

But some observers, including Larry Naake, executive director for the County Supervisors Assn. of California, said another important change has occurred in the governor’s office. Deukmejian, who has named a special liaison to work with local governments, is more interested than his predecessor, Edmund G. Brown Jr., in working out complex local government finance problems, Naake said.

Changes in Attitude

An Administration task force worked closely with key legislators last year to shape a major package of bills that gave cities and counties stable new funding sources, Naake said. “There’s much better access, much better communication, a much better understanding of the problems,” Naake said.

Detwiler agreed, saying there have been changes in attitudes in the Legislature as well. “We’re far enough away from Proposition 13 and we’ve learned enough to deal with the complexities of local government problems. . . . I think we’re beyond the chewing gum and baling wire stage,” he said.

Some Los Angeles County officials saw the final state budget as a significant political victory. “We got our message through. A lot of our needs have been met by the governor,” said Supervisor Deane Dana, a longtime Republican ally of Deukmejian who was among the officials who lobbied the Administration to retain the Legislature’s health and welfare funds in the budget.

But Supervisor Kenneth Hahn, who last week failed to get approval for a motion calling for a legislative override of the governor’s spending cuts, was less enthused. Money cut from children’s programs “will come back to haunt us in the future” because troubled children will be deprived of the “support and counseling they need to become responsible adults,” Hahn said.

The supervisors still must wrestle with competing demands by departments to spend tens of millions of dollars more to deal with jail crowding, backlogged courts, the cost of sheltering the homeless and the AIDS (acquired immune deficiency syndrome) epidemic. But the overall budget is up only about 3% and there are very limited funds available to deal with those problems, officials say.

Services for Children

“Children services is an area where we have to do something,” Dana said. “But I expect (the rest) to be fairly calm.”

A still-unresolved, large-cost issue is employee pay raises. The county budget, which Chief Administrative Officer James C. Hankla has described as “precariously balanced,” contains no money for salary hikes and only a small reserve. Board representatives have begun negotiations on new contracts with unions representing most of the county’s 70,000 employees. Employees averaged 2.5% annual pay hikes over the last two years and unions have vowed to make up lost ground in the next contract. Each 1% pay increase costs the county approximately $15 million.

The board, with the help of the unions, is trying to get new funds for pay raises via a bill now in the state Senate that would increase vehicle license fees, giving the county an additional $50 million.