County Clinic Staff Opposes Contract Care

Angry nurses, radiologists and union leaders picketed the El Monte Comprehensive Health Center on Wednesday to protest a county proposal to turn health care services at the public clinic over to a private contractor as a cost-saving measure.

The private contract, which could be voted upon by the County Board of Supervisors as early as July, would be the first in the county allowing private doctors, nurses and technicians to operate a county health center.

Chanting “stop contracting” and carrying signs reading “Save Our Clinic,” about 50 protesters complained that a private company would be motivated by profits, not by a desire to provide poor people with high-quality medical care.

“Many of our senior citizens can’t pay a thing, but we still have all the services for them,” said Margarita Lopez, a registered nurse. “How can the private sector do the same thing when they have to think of revenues?”

However, Dick Collins, chief of contracts and grants for the county Department of Health Services, said that if the Board of Supervisors decides to award the contract to the sole bidder--EHE National Health Services of Washington, D.C.--his department will ensure that services do not suffer.

“We would of course have a vigorous monitoring program to review services so we would know almost immediately if there was any deterioration in services,” Collins said.

He said the fears among employees at the center “are premature, because at this stage none of us knows whether this contract is going to be approved.” In fact, he said, the county is not certain that the proposal will actually save money and is still studying it.

But union leaders promised that Wednesday’s protest was just the first volley against the county’s plan to use private nurses, technicians and doctors at El Monte and other public health facilities across the county, a trend that could affect thousands of public health care workers.

“The county has been contracting out a lot of functions over the last eight years, but not nurses and doctors,” said Abby Haight, a spokeswoman for Local 660, Service Employees International Union. “The worst thing about it is that profit is going to be foremost in their minds.”

Haight said the county could not ensure a similar level of service once it turns the center over to a private company. She said that typically private contractors in the health field cut costs by cutting staff and requiring patients to wait longer to see a doctor.

“Longer waits is the only way to lower costs--cutting down on staff, providing shorter appointment times and making people wait for care,” Haight said. “We are talking about immunizations for kids, treatment for venereal disease, prenatal care for pregnant women--you want to get these people into an appointment as quickly as possible.”

David Duran, an X-ray technology supervisor, said a private company “simply could not charge the low prices we charge for radiology.” For example, he said, a mammogram--a check for breast cancer--costs $50 at the El Monte clinic, but private health care providers charge about $250.

Bob McCloskey, a spokesman for Local 434, Service Employees International Union, said county employees would be allowed to keep their jobs but would lose their Civil Service protection. Through attrition, he said, the original employees could be replaced with lower-paid employees.

‘Mess Up a Good Thing’

“The doctors would no longer be county doctors, and the nurses won’t be county nurses--people who right now are giving an excellent level of service,” McCloskey said. “We are saying, why mess up a good thing?”

Collins, the county spokesman, said that the changes would not affect the center’s pharmacy employees or lab workers, but that most of the current nurses, doctors and radiologists would probably be moved to new jobs elsewhere in the county system. He confirmed that the private company “will be allowed to set its own rate of pay.”

McCloskey also expressed concern about the center’s Ability to Pay program, which provides free care to the poorest patients and charges only a few dollars to others who qualify.

He said the Ability to Pay program, which is mandated by state law and is popular with residents from extremely poor communities, could be jeopardized by the proposed contract.

“The county says the Ability to Pay program will stay in effect, but in the long run it is really questionable whether a for-profit company can continue to offer free care,” he said.

McCloskey also said the bidder, EHE National Health Services, operates health service programs for federal agencies such as the Internal Revenue Service but has no experience running a large public health clinic catering to low-income people.

Collins confirmed that the company has served workers at federal agencies but noted that the company was awarded a contract by the County Board of Supervisors in March to treat the inmates at the county’s Mira Loma jail facility.

“If those aren’t poor people, I don’t know what is,” Collins said.

However, Haight said the El Monte center serves a significant segment of the poor in the San Gabriel Valley, a task she said is a “far greater challenge” than serving a jail clinic. The El Monte center treats about 100,000 mostly poor residents annually, offering basic medical services for little or no cost. Typically, patients pay $25 per visit.

“Los Angeles County would be giving this out-of-state company a learning lab if they let it become the provider of care to the San Gabriel Valley,” Haight said.