Acclaimed Juvenile Health System Imperiled

Behind orange metal doors that are always locked at the San Fernando Valley Juvenile Hall is a medical refuge for what physicians here call the “forgotten children of our community.”

Up to 13,000 teen-agers file into the cinder block infirmary every year. At least 30% of the girls have venereal disease, 10% are pregnant and 60% of the teen-agers are considered at risk for AIDS. Many of the incarcerated patients were abused by their families or have no family at all. Most haven’t seen a physician in years and as a group are in much worse health than average teen-agers.

Over the years, Los Angeles County’s Department of Health Services has been highly praised for its efforts in providing top quality medical care to these incarcerated youngsters and those at two other juvenile halls and 16 camps. But the program is on the verge of being dismantled.

Services Praised

The department’s work in the largest juvenile detention system in the nation has been hailed by physicians and juvenile justice experts throughout the country.

“The image of the system there is one of very conscientious, excellent medical providers. The people there have really been leaders nationally in maintaining basic standards and basic quality of services,” said Dr. Dick Brown, a clinical professor at UC San Francisco and director of adolescent medicine at San Francisco General Hospital.

But faced with a tight budget, the county’s Department of Probation has proposed that a private New York corporation provide medical services at the juvenile hall in Sylmar and four detention camps in the San Fernando and Santa Clarita valleys. If the pilot project is successful, the Probation Department anticipates expanding it countywide.

The county initially expects to save $132,996 from the switch and anticipates more savings if the entire system eventually is handled by a private corporation.

Easing Standards

Leading pediatricians at Cedars-Sinai Medical Center, Childrens Hospital and UCLA Medical Center, however, maintain that saving money does not justify scrapping an excellent program. The new operator would employ fewer nurses, discontinue the program’s affiliation with UCLA’s School of Medicine and would meet some, but not all, the professional standards currently adhered to by the health department staff.

Some health professionals worry that the switch could catapult the county back to a stormy time in the 1970s when its juvenile health program was the target of a federal lawsuit. The litigation led to wholesale changes and the selection of the health department to take over.

“This may be the beginning of steps that will place the county on a collision course with those organizations that advocate basic juvenile rights,” warned John Hagar, the American Civil Liberties Union attorney who monitors conditions in Los Angeles County penal facilities.

Probation Department officials dismiss such predictions. They say they must save money somehow and safeguards will ensure that the quality of care will not suffer.

“What we are trying to do is make our very limited dollars go as far as possible,” said Joan Ouderkirk, a deputy director in the Probation Department.

Department officials say they are pleased with their choice, EHE National Health Services, one of four bidders. The 30-year-old company primarily has provided medical services for federal agencies and corporate clients across the country. Among its services, EHE conducts pre-employment screenings, disability examinations and in some cases provides on-site medical treatment.

EHE also began treating prisoners at the county’s Mira Loma Jail in Antelope Valley two years ago. The county has enjoyed a “very good relationship” with EHE, which is providing a “satisfactory level of health care,” said William H. Kern, director of medical services for the Sheriff’s Department.

Previous Operation

The company has provided services in just one juvenile detention facility. EHE operated the medical program at New York City’s juvenile center from 1981 to 1983, when it lost the contract to a nonprofit hospital. An outside audit, paid for by New York, gave EHE high marks in 1982, saying it provided “we care” medical services.

But Dr. Mark Wade, medical director of Montefiore Medical Center, which has provided medical services at the New York facility since 1983, said it would be a “huge mistake” for Los Angeles County to hire EHE. Wade, who reviewed every child’s chart after EHE departed, said he was “very disappointed with the level of care provided.”

Citing the 1982 audit results, Jane Roth, EHE’s vice president of operations, shrugged off Wade’s accusation as coming from a competitor.

“We are very confident we will be able to provide very good quality health services,” Roth said. “We are known for that. We have done it in the past.”

April 4 Vote

But with concerns raised about EHE’s limited juvenile health-care experience, the Board of Supervisors is being lobbied to postpone the decision. The board is expected to vote on the contract April 4.

So far, the board has ignored all requests to scrutinize the appropriateness of a private company taking over.

For instance, last year the county’s Public Health Commission and the Commission for Children’s Services unsuccessfully urged the supervisors to delay making any decisions until it could convene a task force composed of representatives of the Los Angeles County Medical Assn., the American Academy of Pediatrics and others to review the health care needs of the detained juveniles.

Geraldine L. Dunn, the former head of the Public Health Commission, expressed her worries at a meeting last year:

“The Public Health Commission is concerned that contracting out the health care program . . . could jeopardize many of the accomplishments made during the past 11 years and fragment the present health care system. We believe that this will result in the loss of accreditation, medical school affiliations, and the lack of a comprehensive health care program for children with special needs.”

Delay Refused

Two weeks ago, Supervisor Ed Edelman failed to persuade the board to wait until the grand jury released its report in April about the status of health care in the juvenile justice system. The report was prompted by concerns that while the money for medical care is shrinking, the number of incarcerated teen-agers is expanding.

Edelman was instrumental in forming the task force in 1976 after the Western Center on Law and Poverty filed suit against the county for poor medical care and conditions at its juvenile facilities.

The task force, composed of government officials and physicians, made three key recommendations. It suggested that medical responsibilities be shifted from the Probation Department to the health department, that the program be affiliated with a medical school and that medical standards should meet those of the American Academy of Pediatrics.

Eliminating UCLA

Those recommendations were adopted. But they would be scrapped if the county proceeds with its plan. EHE would answer to the Probation Department and UCLA would sever its ties. EHE would be held to standards set by the National Commission on Correctional Health Care, but it would not be required to meet the tighter standards of the pediatrics academy.

Jaye Anno, vice president of the National Commission on Correctional Health Care in Chicago, said “one of the biggest pitfalls” in this field is requiring doctors to answer to jailers. Medical staff “become identified with correctional staff and that sometimes means they sometimes compromise medical care for security interests,” she said.

Larry Roberts, a deputy director with the county health department, defended the proposed changes.

“It doesn’t necessarily have to go back to those conditions, the way it was back in 1976,” he said. “There is nothing that says a vendor can’t do an outstanding job.”

In part, EHE proposes to run a cheaper shop by employing fewer nurses. EHE will fill 18 1/2 nursing slots. In contrast, the health department, which also bid on the contract, proposed a staff of 24 nurses.

Additional Doctors

EHE promised to hire the equivalent of 1 1/2 physicians. In its bid, the health department also proposed a full-time and part-time pediatrician, but in addition it included two or three doctors from the medical school. For a nominal yearly fee, a UCLA fellow in adolescent medicine as well as one or two pediatric residents from UCLA and Cedars-Sinai work each day at the Valley’s juvenile hall.

The health department’s administration has forbidden its physicians, who are distressed about the proposal, to testify before the supervisors next month, some department physicians said. Dr. Charles Baker, the medical director of Juvenile Court Health Services, said he was instructed not to talk to the Los Angeles Times about the controversy.

Last fall, the National Commission on Correctional Health Care bestowed on Baker its award of merit, given annually to the person the commission feels contributed the most in the field. Baker has been cited for his work in AIDS education for minors and his involvement in setting health standards for juvenile facilities. In addition, Baker’s program was the first in the country to be accredited by the National Commission on Correctional Health Care and has received $340,000 in grants for health prevention programs.

Baker did explain why he thought the health department lost the bidding war.

“We can’t lower our standards,” Baker said, “unless directed by the board.”