County Health Officials Warn of Cuts in Service Unless Funds Are Restored

Charlesetta Marsh has been waiting nearly three hours to see her doctor in a cardiology clinic at the county’s busy Martin Luther King Jr. Hospital near Watts.

The 52-year-old Compton woman anxiously eyes the clock on the waiting room wall. The afternoon is wearing on, and Marsh knows that the hospital’s low-cost pharmacy will soon be closed. That will mean a return trip by bus to the hospital the next day for medications.

“They don’t have enough help,” she says softly.

Across town at the huge County-USC Medical Center, Regina Hughes, a 29-year-old hit-and-run victim who must use a walker, has spent nearly seven hours getting through a checkup in the orthopedic clinic. A regular patient at the clinic, Hughes says, “I can’t imagine (the waiting) being any longer.”

County health officials say, however, that if Gov. George Deukmejian and Democratic legislative leaders do not resolve a bitter budget fight, cuts will have to be made that could indeed mean longer periods of waiting. They say that Marsh, Hughes and other low-income Los Angeles County residents will also find fewer services and more crowding at public health facilities as early as next month.

The funding dispute involves $283 million in statewide education and human services programs, including more than $20 million in medical funds for Los Angeles County. As of last year, the state allocated to counties a new category of funds to help cover costs of caring for increasing numbers of indigent patients. This year, the governor vetoed this category of funds, which in the case of Los Angeles County was the $20 million already budgeted.

If the dispute in Sacramento is not resolved, county officials say they will have to make the largest slash in county medical services since 1981, when fiscal conservatives took control of the Board of Supervisors and began targeting large social programs to deal with post-Proposition 13 budget cuts.

Unlike that fiscally troubled time, however, this year’s threat to health care services, which has become entangled in partisan election-year politics, is not caused by lack of money. Both Deukmejian and legislative leaders say that funds are available and that the cuts are unnecessary.

What they have not been able to agree upon is where the money to pay for the programs should come from. Democrats want to tap a $1-billion budget surplus. But Republican Deukmejian, who has made fiscal responsibility a major plank of his reelection campaign, has insisted that the surplus be maintained for unforeseen emergencies.

Deukmejian wants those programs financed with surplus money from the state public employees retirement fund. Los Angeles Mayor Tom Bradley, the governor’s Democratic challenger, last week charged Deukmejian with holding vital education and health programs “hostage.”

Extended Session

State lawmakers remained in the capital this week for an unusual extended legislative session to try to resolve the matter.

Health officials say the cuts could take effect beginning Oct. 1 if the state funding is not provided.

Mostly affected would be Medi-Cal and Medicare patients and low-income residents without medical insurance.

About 150 hospital beds at three hospitals would be eliminated, $10 million in outpatient clinic services would be cut and programs such as drug rehabilitation for the disabled and methadone treatment for heroin addicts would be sharply curtailed, according to county health officials.

In all, the cuts would come from programs handling nearly 75,000 patient visits a year.

6,000 Visits a Month

This would be a small fraction of last year’s 1.8 million patient visits at county health facilities. But officials say the cuts would worsen service for a significant share of patients because more than 6,000 visits per month would have to be absorbed into a trimmed health program.

Robert C. Gates, director of the county’s Department of Health Services, said: “It cannot help but make it more difficult to receive treatment in our system. I’m not saying they would not be able to, (but it would be) discouraging to patients.”

The cuts would range from elimination of outpatient surgery services at the El Monte Comprehensive Health Center to reductions in dental services at High Desert Hospital in Lancaster and County-Harbor-UCLA Medical Center near Torrance.

By far the biggest chunk of the cuts would fall on the large inner-city facilities of County-USC Medical Center and Martin Luther King Jr. Hospital, where health programs for the poor are most heavily concentrated.

At King, several specialty clinics handling more than 12,000 patient visits a year, including patient Marsh’s cardiology program, would be closed. Among programs listed for closing if the state funds are withheld is a hypertension clinic, which King officials say is crucial in a black community where the rate of high blood pressure and deaths due to heart disease is more than twice as high as in white communities.

Emergency Surgery

King officials, who already struggle to find beds for a high volume of emergency surgery cases associated with violent crime, would have to cut 20 hospital beds--almost 5% of its total.

At County-USC Medical Center, officials said they would have to close their large outpatient clinic program about one day a week--which would mean more than 25,000 patient visits a year would have to be absorbed elsewhere.

“It would be awful,” groaned Hughes, the patient in the orthopedic clinic.

Joellen Murata, project director of the Los Angeles Health Care for the Homeless Program, said cutbacks in the County-USC Medical Center clinics could worsen a Skid Row tuberculosis problem. The rate of TB in the central area of the county is already four times that of the county as a whole, according to county health reports.