Supervisors OK $2.7 Million for Syphilis Control

Amid widespread criticism that the county has mishandled an outbreak of syphilis, the Los Angeles County Board of Supervisors voted unanimously Tuesday to spend $2.7 million to expand and intensify efforts to control the disease.

The board also voted to suspend the $20 fee charged for diagnosis and treatment of venereal diseases and tuberculosis at county-run health clinics--a fee that some health officials believe has contributed to the rise in syphilis.

“You know, it was stupid, absolutely stupid, to put a fee on in the first place,” said Supervisor Kenneth Hahn, in whose district the outbreak has hit hardest. He said the county should have thought not of the revenue that could be raised “but what a syphilis epidemic costs the community.”

Expanding Services

The money allocated Tuesday is to be used to expand the hours and services of county clinics, none of which are currently open during evenings or weekends. It will also pay for a larger field staff to track down the sexual partners of people infected with syphilis.

In addition, the county Department of Health Services is expected to consider initiating a mobile syphilis-screening unit, speed the transfer of health records among county health offices and tighten surveillance of laboratories and hospitals to ensure reporting of all syphilis cases.

“I think (the measures approved Tuesday) definitely will have an effect,” said Jean Champonnier, a member of the county’s Public Health Commission. The commission and the county health department recommended the changes to the supervisors.

The rate of infectious syphilis in the county has risen since 1985 from 24.3 to 55.6 per 100,000 population--nearly four times the national level. Health officials have said that the rise in some areas is the worst they have seen since the introduction of penicillin in the 1940s.

County and federal officials trace the increase to a combination of factors including reductions in federal, state and county manpower and a shift in resources to the fight against AIDS. They also blame the rising use of crack cocaine and the exchanging of sex for drugs.

Some critics, including members of the county health department, also argue that the department has failed to make syphilis control a priority. Some contend that the department’s structure, even with a budget boost, is ill-suited to marshaling resources to address a public health threat.

“The $2.7 million is not addressing the organizational issues,” Champonnier said after the supervisors’ vote. The Public Health Commission is appointed by the supervisors to advise them on public health matters.

It was not clear where the $2.7 million will come from. The supervisors simply directed Richard B. Dixon, the county’s chief administrative officer, to make sure that the amount is allocated in the department’s budget, which is currently being prepared.

Under the plan approved Tuesday, the department will suspend for six months the clinic fees imposed in August, 1986. Clinic attendance for VD screening has dropped 40% since that time, and the number of reported cases of infectious syphilis has risen more than 60%.

Will Study Results

After six months, the department will attempt to determine whether the fees contributed to the drop in turnout. Some officials have argued that there is no hard proof that they did; they say that turnout at the clinics was declining even before the fees.

A typical six-month period yields about $200,000 in fees.

The department is also to embark on a public information campaign to publicize the causes and symptoms of syphilis and treatment services available. And it is to revise clinic registration procedures to speed the process of obtaining care.

County Health Director Robert C. Gates said he will declare the “syphilis epidemic to be a major public health problem” until syphilis rates have returned to “pre-epidemic levels.” He said that declaration may help win federal and state money for fighting the disease.