More Health Care for Poor Urged : Clinics: The grand jury offers a stinging indictment on the lack of medical services. Officials say the funds aren’t there.

Saying that Orange County’s overburdened community clinics meet “an urgent need” for a growing number of residents who lack health insurance, the county grand jury Wednesday called on the Board of Supervisors to expand these services and “take more responsibility for basic health-care for the poor.”

While offering few ideas on how the county should pay for such an expansion, the grand jury recommended that supervisors assume leadership by “educating the citizenry to accept basic health care for the poor as a social obligation.”

Top county officials called the fact-finding body’s latest report well-intentioned but said they had no idea where they could find the money to expand services at county and community-operated clinics.

“Where’s the source of funding?” asked Don R. Roth, chairman of the Board of Supervisors. “Yes, we ought to expand the availability of services to the poor, but we’re limited by the amount of dollars available.”

Grand juror Frank Spittle said he and his colleagues did not deal in detail with the question of funding in their report because it is the supervisors’ job “to set those priorities.”

Supervisor Gaddi H. Vasquez noted that in March the board recommended giving community clinics $1.5 million from California’s new tobacco tax. But beyond that, he said, “the money is just not provided by the state” and key state legislators now appear willing to accept the deep cuts in health care recommended by Gov. George Deukmejian.

Deukmejian proposed 1990-91 budget slashes of $19.1 million from county health-care programs, and overall, the county projects a deficit of more than $20 million next year. In this environment, Roth, Vasquez and Supervisor Harriett M. Weider said, expanded health services were unlikely soon.

But Margie Fites-Seigel, vice president of the Coalition of Community Clinics which represents the 12 community-run clinics, applauded the grand jury findings, especially one that asked supervisors to give community clinics “a stable source of funding.”

She added that it was time for Orange County to “come to terms with what is basic health care . . . and then ensure access to basic health care for all citizens.”

Noting that more than 2,500 pregnant women were turned away from county-run prenatal clinics last year because those facilities were full, Fites-Seigel said, “Orange County should be ashamed of itself. From the community clinic standpoint, we should not have gotten to that point.”

The grand jury was the latest group this year to ask county government to assume a broader role in the health care of the poor. Earlier, the Orange County Medical Assn. and the United Way Health Care Task Force asked supervisors to offer a wide range of general medical services at county-run clinics and also ease crowding at Medi-Cal hospitals by operating their own birthing center. But supervisors have repeatedly said they have no funds for such ventures.

According to the grand jury report, more than 120,000 people with Medi-Cal coverage or no insurance at all use the county’s community clinics each year as their primary source of care. There, the report said, they receive “accessible, comprehensive, quality, cost-effective treatment,” for very low fees, sometimes only $20--or a donation by the patient.

The 12 clinics form a diverse group, most struggling to survive on a mix of private and public funds. Two of them are operated by UC Irvine. Others include four family-planning clinics operated by Planned Parenthood and general medical clinics such as the Share Our Selves Clinic in Costa Mesa, La Amistad de Jose in Garden Grove and the South County Community Clinic in San Juan Capistrano.

In addition to offering “well-child” visits, these clinics now offer “primary care” also known as general medical care, the report said, treating such problems as respiratory infections, abdominal pain and chronic headaches.

Besides the community clinics, the county Health Care Agency operates clinics for state-mandated services that include prenatal care, immunizations, child health screenings and treatment for sexually transmitted disease.

But the report said: “The four permanent county public health clinics are busy beyond capacity, causing some clients to stand in lines in hallways waiting for services sometimes for hours.”

Among the Grand Jury’s recommendations were suggestions that supervisors provide a larger and more stable share” of financial support to community clinics, expand locations of county clinics, especially in South County and link public and private resources to help the poor get care. (The county did that this year, the report noted, when supervisors allocated $1.3 million from tobacco tax funds to start a birthing center at Western Medical Center-Anaheim.)

In addition, the grand jury asked county officials to expand county clinic services to provide a primary care, which is a wide range of outpatient medical services beyond those mandated by state law.

County Health Care Agency director Tom Uram called many of the recommendations “interesting ideas” that would be reviewed. But he said he would recommend against expanding county clinics to offer primary care. “We’re a broker of services. We’re not a provider. We contract for primary care,” Uram said.