Public Health Cuts Loom in Ventura County
By the end of July, Ventura County officials will probably close the public health clinic that is the main source of medical care for retired handyman John Jones and his wife, Joann. He is diabetic and needs a daily shot of insulin. She is wheelchair-bound, the victim of a nerve disorder and requires a new round of epilepsy medication every three weeks.
Their income consists of a veteran’s pension, their transportation depends on rides from fellow church members and their prospects for easily accessible health care are fast dimming.
Like thousands of others in Ventura County, the Joneses are bracing for the closure of all the county’s clinics and the reduction of many services at its only public hospital--an eventuality that will inconvenience some patients and cast many others into a frightening void.
In some respects, the Joneses, who can now make their way unaided to the West Ventura clinic a block away, are among the more fortunate. When they can get rides, they will be treated in the emergency room of the Ventura County Medical Center, the county’s public hospital just a few miles from their home.
But people in Simi Valley at the county’s eastern end will face a round trip of nearly 100 miles--not to mention hours-long waiting periods in the suddenly overburdened emergency room. No bus operates between Simi Valley and Ventura, and buses between other areas of the county and Ventura are infrequent.
“There’s no doggone sense to it,” said Joann Jones. “The county should do what it’s supposed to do.”
Apparently it cannot. Sweeping cutbacks in state health subsidies--the state now pays only 57 cents of every dollar spent on care on health care for the poor--have reduced the county’s ability to foot ever-escalating medical bills. And a series of financial mistakes that the Ventura County grand jury described as “gross mismanagement” has hardly helped.
As a result, county officials overwhelmed by a $10-million health-care deficit are on the brink of dismantling key parts of the public health system that has served the county since 1887. Ventura supervisors say they must either wrest additional cash from state coffers, a prospect they say is dubious, or find additional areas for pruning in the county’s $500 million budget-- which they claim is even more doubtful.
Failing on either score, they will hold a state-mandated hearing July 16 before deciding whether to:
Lay off 285 of the county’s 1,500 health employees, including custodial workers, technicians, nurses and physicians.
Reduce inpatient beds at the Ventura County Medical Center from 70 to 43.
Close the system’s six outlying clinics, located in Simi Valley, Moorpark, Oxnard and Ventura. Those clinics handle 30,000 patient visits a year.
Eliminate mental health services for 500 to 800 patients in Simi Valley, Thousand Oaks, Camarillo, Santa Paula, Oxnard and Ventura.
Decrease employees and hours available for a broad range of additional medical services, including family planning, prenatal care, and ultrasound diagnosis.
“What’s going to happen?” asks Dr. Sarah Miller, director of the Ventura County Health Care Agency. “It will be more difficult for people to get early care. It will be tougher for them to get here, and some may find it too hard to try.”
People who cannot afford to pay their medical bills made up about 25% of the caseload at county facilities last year, up from about 15% in 1984, Miller said. At the same time, state funding for Medi-Cal dropped by nearly half.
Ventura County’s problems have been compounded by the failure of health administrators to keep track of their budgets. Over the last three years, billing fell as far behind as 18 months. Health officials grossly overestimated the amount of revenue they would get from the state, borrowing $17 million for operating expenses on the mistaken premise that they could soon pay it back.
“It is appalling that this situation has been permitted to exist and in fact worsen for more than three years,” the county grand jury concluded last week. The panel recommended an immediate reorganization of the county’s health bureaucracy.
Since the beginning of this year, three top county health officials resigned and Miller is scheduled to retire later this month, although she says her retirement is not linked to the county’s health-funding problems. She and other county officials say those problems would have cropped up regardless of the county’s management errors; cutbacks still would have been forced, they say, only more gradually.
“The Board of Supervisors didn’t move quickly enough,” said James R. Dougherty, the supervisor representing Simi Valley and Moorpark. “We’ll take the rap for that. But even if we had, it just would have meant that the pain would have been slower.”
Shrinking federal and state subsidies have forced more than half of California’s 58 counties to chop at least $1 million from their health programs, but Ventura is the third hardest hit, behind depressed Shasta and Yolo counties in Northern California, according to Carol Emmott, executive director of the California Assn. of Public Hospitals.
Even Los Angeles, where the Legal Aid Foundation charges that care at county facilities is “unacceptable by any standards,” is in slightly better financial shape, she said.
“Some counties are using up their reserves,” Emmott said. “Those who can afford to kick in extra money are telling us this is the last year they’ll be able to afford it.”
Money’s Run Out
If that is so, they can look to Ventura for a glimpse of the dilemma with which they will soon grapple. County officials say money for health care simply has run out, thanks to the fiscal policies of Gov. George Deukmejian and Republican legislators.
Critics of the county, however, claim the supervisors can find additional money in their own bloated budget; health care, they say, should not be allowed to take a back seat to county construction projects, airport improvements and the other municipal functions that are not essential to human survival.
“Pointing to Deukmejian is just a ruse to take the heat off themselves,” said James M. Farley, a Ventura attorney who tried unsuccessfully to forestall the first round of hospital layoffs on behalf of a client who is a frequent patient at the hospital.
“The county has to do away with unnecessary programs,” he said. “I see they’re in the process of approving $743,000 for runway lights for Camarillo Airport, which doesn’t even have commercial flights. And I don’t see any of these well-paid county management types volunteering to take pay cuts, either.”
Barry Hammitt, executive director of the Public Employees Assn. of Ventura County, which represents county health workers, agrees.
“If I were a county supervisor,” he said, “I’d ask which is a greater priority--decent health care or a new government center in the eastern end of the county? Do we need to build another jail right now? Do we need to finish the Ojai riding trail right now?
“The problem,” said Hammitt, “is that some of these are political sacred cows. And the supervisors don’t want to send a message to Sacramento that they actually have the money.”
‘We Need the Money’
The message they have been sending, said Supervisor John Flynn, is “We need the money and Sacramento’s got it.”
Flynn, who insists that county projects on the drawing board for next year are essential, has failed to crack the coffers in Sacramento. He and officials from other counties lobbied fruitlessly for a share of the $700-million surplus Deukmejian planned to distribute as tax rebates. He engaged in shouting matches with recalcitrant legislators. He tacked a flyer titled “Notice of Public Hearing on Reduction of Health & Medical Care Services” to Deukmejian’s office door in a vain effort to change the governor’s mind.
“He didn’t respond,” recalls Flynn. “The notice was gone within an hour.”
“It reminded me,” Flynn said, “of trying to go to a basketball game and influencing its outcome--when you’re not a player, coach, manager or owner. It was difficult to get anybody’s attention.”
That is not likely to change soon, according to some industry observers.
“Our advisers are telling us that there will have to be a lot more blood in the streets, a lot more of a clear-cut case that people are dying because of inadequate funding, before we can reach this governor,” said Emmott, of the state public hospital association.
Dramatic as they might sound, the Ventura cuts will not likely yield blood in the streets, say county health officials.
Not Stopping Health Care
“We want to make services available at some level so everyone can reach them,” said Dr. Richard Ashby, a physician who directs the medical center’s outpatient services. “We are not closing the hospital. We are not stopping health care. We are not summarily dropping all elements of the county health system.”
But the cuts will be deep enough to taint the quality of the health care that is offered, say the critics.
“If they lay all these people off, you’ll see nurses going to the laundry, distributing sheets and pajamas and cleaning the rooms,” warned Hammitt of the public employees association. “If there are spills on the floor or beds to be cleaned, who’s going to do that? You’re going to have to take expensive, highly trained personnel and have them do these functions--and not as much of what they were being paid for in the first place.”
If Ventura’s public hospital curtails patient care, the county’s eight private acute-care hospitals will be forced to absorb some of the patient overflow.
State law requires hospitals to examine anyone who shows up in an emergency room, regardless of their ability to pay. “The hospitals in Ventura County will see more and more medically indigent people in their emergency rooms,” predicted Monte Clark of the California Hospital Council, an industry group. “And many of them won’t wind up there until they really need assistance.”
11 Hospitals Have Closed
Private hospitals suddenly burdened with the cost of indigent care might close their emergency rooms, Clark said, pointing to the 11 hospitals in Los Angeles that have done so in the last 18 months.
“There’s no money in the system to pay for the masses who are coming into them,” he said.
That’s why doctors in the front lines wonder how some of their patients will manage.
“Some of these people don’t own cars, and some are so sick they can’t drive,” says Dr. Jack Adelman, who has run the county clinic in Simi Valley for 13 years. “Or if they do drive, they’ve got cars that might not make it to Ventura and back.
“They ask me what I’m going to do and I say, ‘I don’t know. I’m just going to sit tight, I’m going to take it a day at a time.’ I can do that. But I ask myself what they’re going to do and I just don’t know.”
The patients who forgo routine treatment of their high blood pressure, the pregnant women who cannot borrow cars to travel to Ventura for prenatal care, the diabetics who cannot appear for routine checkups--all those with easily treatable conditions that can easily get out of hand--are the patients who worry physicians the most.
“Many of them just won’t seek care,” says Dr. John Ford of the West Ventura clinic, warning that the county will ultimately bear the burden of such neglect.
“In the long run,” he said, “maintaining outpatient clinics where people can come in and be seen regularly saves money, as opposed to paying for emergency care where people come in with the heart attacks and strokes that might have been prevented.
“And the supervisors understand that,” he added. “But the crisis is now--not in the long run.”