Vote Cuts Care for Juveniles in Custody

The Los Angeles County Board of Supervisors voted Tuesday to begin dismantling its much-praised health-care program for juvenile offenders and turn the job over to a private firm.

The board expects to save $132,996 in a one-year pilot project under which a New York corporation will provide medical care at the San Fernando Valley Juvenile Hall in Sylmar and four juvenile camps run by the Probation Department.

The move was opposed by the county’s Public Health Commission and the Commission for Children’s Services. In the weeks before the board’s decision, leading pediatricians at Cedars-Sinai Medical Center, Childrens Hospital and UCLA Medical Center had urged the board to save the county’s program, which has been hailed by physicians and juvenile experts across the nation.

Sued Over Conditions

The program has been run by the county’s Department of Health Services, which took over medical treatment at the three juvenile halls and 15 juvenile probation camps after the county was sued for poor conditions at the facilities in the mid-1970s.

Supervisor Ed Edelman and other critics of the one-year pilot project, which will begin July 1, warned that the county could be turning back the clock to that stormy time by using a firm with little experience in the juvenile health-care field.

Under the terms of the $1.9-million contract, EHE National Health Services, a 30-year-old corporation that has provided medical services to federal agencies and corporate clients across the country, will service the facilities primarily with 18 1/2 nursing slots. The health department had proposed employing 24 nurses.

“I have grave reservations about contracting out in this case,” Edelman said Tuesday. “This is an area where the county has established a recognized program. . . . To save $132,000 and run the risk of getting ourselves into the same predicament again doesn’t seem to be worth it.”

Only Supervisor Kenneth Hahn agreed with Edelman. The conservative majority on the board, Supervisors Mike Antonovich, Deane Dana and Pete Schabarum, voted for the change. The board’s approval continued a trend favored by the three Republicans to “privatize” local government by awarding contracts to private firms to handle county services.

Barry J. Nidorf, the county’s chief probation officer, told the board that he was forced to find a cheaper way to provide medical care for 1,020 incarcerated youths because of deep budget cuts throughout the department.

Last Chance

Gov. George Deukmejian has proposed slashing nearly in half the funds earmarked for running juvenile detention camps across the state. Without those state funds, county officials said, the county would close 14 of its 15 camps, which are considered a last chance for teen-agers who are not yet hard-core offenders.

Nidorf said the department hopes to save much more than $132,996 by avoiding the cost overruns the Department of Health Services has incurred each year. He also expressed confidence in the new contractor, EHE.

“I recommend and feel comfortable with this particular provider and the provision of medical services,” Nidorf said.

But Dr. Robert Morris, assistant medical director at the Valley’s juvenile hall and assistant clinical professor of pediatrics at UCLA, cautioned that there would be insufficient safeguards to ensure that the current quality of medical care will be delivered by the for-profit company.

Wholesale Changes

EHE primarily intends to save money by employing fewer nurses than are now used, county officials said. EHE also promised to hire the equivalent of 1 1/2 physicians, the same as the county agency.

But in addition to the full-time and part-time pediatrician proposed in its bid, the health department included two or three doctors from the medical school for nominal fees.

Jane Roth, EHE’s vice president of operations, recently tried to assure skeptics that there will be no change in the level of medical treatment.

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

The present system was adopted after the scandal of the 1970s when the county formed a task force that suggested wholesale changes in health care for juvenile offenders. Three key recommendations were adopted: The health department took over responsibility for medical services from the Probation Department, the program became affiliated with the UCLA Medical School and medical standards were improved to meet those of the American Academy of Pediatrics.

Medical Guidelines

Under the pilot program, all that will change. The Probation Department will resume responsibility for the medical services. EHE will not seek affiliation with UCLA, according to an executive with the firm. In addition, EHE will not adhere to standards of the American Academy of Pediatrics but will be required to meet the looser medical guidelines of the National Commission on Correctional Health Care, county officials said.

Morris expressed bitterness after the vote.

“What’s the point of providing excellent health services?” he asked. “The better it gets, the more likely they will contract out.”