Warning Issued on County Health Cuts If Tobacco Tax Fails

If California voters do not approve a ballot initiative on Nov. 8 which would raise money for health services by hiking the cigarette tax, top Los Angeles county officials said they will have to immediately slash more than $70 million from health care for the poor--including possibly shutting down the entire Harbor General-UCLA Medical Center as well as the Pediatrics Pavilion hospital for children in East Los Angeles.

In a memorandum to the Board of Supervisors obtained by The Times Friday, Health Services Director Robert Gates suggested the supervisors choose $70 million worth of cuts from a list he prepared of possible health care reductions totaling $128 million and affecting 500,000 patients a year.

At a board meeting on Tuesday, the supervisors are expected to review the list of proposed cuts, culling out their final targets and giving a 30-day notice of a formal hearing on them.

Funding of the far-flung county health system totals about $1.5 billion in government funds, including about $250 million from the county.

Health care attorney Melinda Bird branded the proposed cuts “unthinkable” and vowed that they would not escape a court challenge.

“People are already dying,” she said, because they have to wait so long for surgery and other care at county hospitals and clinics. “If the proposed cuts are implemented,” she continued, “there will be a 100-fold or even 1,000-fold increase in the number of preventable deaths.”

Gates was unavailable for comment Friday, but in his letter to the supervisors he stressed that cuts would be necessary only if the Cigarette and Tobacco Tax Initiative, known as Proposition 99, fails to pass. The health department’s budget is balanced “on the assumption of receiving substantial cigarette and tobacco tax revenue,” amounting to $41 million a year. Because about one-third of the county’s fiscal year, which begins in June, has already elapsed, Gary Wells, the health department’s deputy director of finance, said that the supervisors will have to cut $70 million in annual costs to make up for the shortfall.

Gates has suggested shutting down the entire Harbor-UCLA Medical Center at an annual savings of $65 million. He reported that another $29 million could be saved at County-USC Medical Center, cutting 147 beds from the General Hospital, reducing care at its Women’s Hospital, and shutting down Pediatrics Pavilion, which handles about 65,000 patient visits a year.

The pavilion is the county’s largest facility for ailing children. It also houses an intensive care unit for AIDS patients.

Wells defended the wholesale closure of the pavilion and Harbor General by pointing out, “When you’re talking about cuts of this size, the greatest efficiency in saving money comes from closing an entire institution, because you save overhead and fixed costs.”

Wells said that the list of proposed cuts was compiled by Gates, with input from the supervisors. The only major health facility that did not make Gates’ list was Olive View Medical Center in Sylmar.

Gates proposed annual savings of $11 million from closing all except rehabilitation medical services at Rancho Los Amigos Hospital.

Martin Luther King Jr./Drew Medical Center in Watts, according to Gates’ list of proposed cutbacks, could yield annual savings of $4.53 million by substantially curtailing walk-in clinics, which now handle about 45,000 patient visits a month.

Elsewhere, walk-in clinics would be eliminated or services drastically reduced at all five comprehensive health centers and the numerous satellite public health clinics. About $11 million could be saved from cuts in these outpatient facilities, which now handle a large portion of the county’s total patient load.

Last year Legal Aid attorney Patricia Nagler, Bird and other public interest lawyers waged a successful court battle staving off $6.8 million in health care cuts by the county that jeopardized the care of 87,000 patients annually.

Bird, an attorney at the Western Center on Law and Poverty, said, “If the judge found that cutting $6.8 million was intolerable, what they’re proposing now is patently ridiculous.”

About 80% of the total patient load is poor. Two-thirds of them are not eligible for Medi-Cal or other insurance programs, meaning they generally cannot get care at private facilities.

Bird said that Harbor General-UCLA is a critical linchpin in the county’s health care delivery system. Many doctors from the medical center, she added, filed sworn declarations last year attesting to serious overcrowding there and lack of adequate resources.

In a prepared statement, Edward Foley, Harbor General’s administrator, said only that he expects Proposition 99 to pass so that the hospital will not have to close.

Asked whether the proposed cutbacks are simply a last-ditch tactic to prompt voters to vote for the cigarette tax, Wells said county officials do not know if Proposition 99 will pass, but “I can guarantee you if this initiative doesn’t pass, there will be a budget shortfall.”

He said the only way left to forestall health services cuts would be for the state to bail out the county health system or for the county supervisors to spread the cuts among other departments.

The county’s principal administrative analyst, Carol Kindler, said the other departments have already absorbed $36 million in cuts this year.

Times staff writer Victor Merina contributed to this story.