County Ordered to Restore $7.6 Million in Health Cuts : Courts: Judge’s ruling casts doubt on legality of plan to slash additional $12.6 million from medical services.

A Superior Court judge on Wednesday ordered that $7.6 million in health care cuts be restored by Los Angeles County, throwing into question the legality of the county supervisors’ plan to cut an additional $12.7 million in medical services next month.

The development intensifies pressure on the supervisors to come up with money they had hoped to receive from the Proposition 134 liquor tax before voters defeated it last week. On Tuesday, supervisors voted to seek the help of legislators from the county in lobbying Gov.-elect Pete Wilson to restore state aid to public and mental health services.

Representatives for Supervisors Deane Dana and Mike Antonovich said they would have to confer with county lawyers before commenting. “I don’t know where we are supposed to get the money,” said Katherine Barger, Antonovich’s deputy for health affairs.

Supervisor Ed Edelman said he would favor tax levies by the county or reductions in other departmental budgets if Wilson’s transition team rejects the county’s bailout pleas.

Deep cuts in allocations to counties were ordered by Gov. George Deukmejian last summer to deal with the state’s deficit. The health cuts, in adult outpatient clinics of the county’s public hospitals, have substantially limited patient access to those clinics and lengthened the waiting times for those who are treated.

The Los Angeles County mental health system also faces $41.9 million in cuts, which advocates say will effectively destroy the system.

The preliminary injunction issued Wednesday in the public health case was sought by groups representing poor patients dependent upon county health services. Judge Dzintra Janavs found that cutting $7.6 million in services from the already overburdened county hospitals unacceptably reduced the accessibility and quality of medical care. State law mandates medical services for the poor be comparable to those available to non-indigent people.

The Western Center on Law and Poverty and the Legal Aid Foundation of Los Angeles, who filed the class-action lawsuit last August, now must submit their own plan for reinstating the eliminated services. Melinda Bird, the Western Center’s lawyer in the case, said she would do so by Friday.

The county then must file a response, which typically contains objections to the timing or feasibility of the advocates’ proposal, Byrd said. It will be up to the judge to resolve those differences in an instructional order to the Department of Health Services. The injunction also could be appealed to a higher court, Bird said.

County Counsel Patrick Woo, who handled the case for the Department of Health Services, could not be reached for comment.

Bird said the injunction’s most immediate effect may be to deter the county from going ahead with additional cuts. If the supervisors order those cuts--a hearing is scheduled Dec. 13, followed by a vote on Dec. 18--Bird said her organization will ask the court to block their implementation.

Edelman said he has no intention of voting for more cuts, just as he opposed the first round.

Irving Cohen, director of administration for the Department of Health Services, said he was awaiting instructions from county lawyers before beginning the process of restoring medical services to their pre-August level.

It will not be easily done.

About 70 employees were laid off and more than 100 others were transferred. Simply sending the latter group back to their previous assignments could lead to service disruptions where they now work, Cohen said.

“Usually when you get an injunction, it is before you cut so you don’t have to restore anything,” Cohen said. “But now we hope the judge will give us enough time to figure out how to restore all this.”

Of the six county hospitals, only High Desert Hospital in Lancaster was spared cuts in its outpatient services.

Generally, the effect reduced the number of patients seen each month in cardiac, neurology, eye, joint and other clinics, and increased the wait for appointments. Already averaging 12 weeks for a first appointment, the cuts in clinic hours and staffing added at least four weeks to the process.

Janavs found that these delays left “a number of indigents without minimum medical assistance and in some cases with perhaps none.”

She cited the example of the gynecological oncology clinic at Women’s Hospital, where patients are referred who already have abnormal PAP smears, an indication of cancer. Women’s Hospital is part of Los Angeles County-USC Medical Center, which was hard hit by the cuts, along with Martin Luther King Jr./Drew Medical Center.

According to evidence in the case, the clinic was forced to reduce patient visits from 1,000 to 500 per month. The Department of Health Services had argued that patients who couldn’t be seen at the hospital clinics would be able to get care at county-operated health centers.

But there are no gynecological oncology services at the health centers, and comparable clinics at other county hospitals could not take the overflow from Women’s Hospital, the judge said. Accordingly, the cuts in service and treatment delays constituted “irreparable harm” to women with gynecological cancers, the judge said.

Janavs also cited testimony from Dr. James Houghton, King/Drew medical director, that the hospital’s neurology clinic was so curtailed that new patients now wait five months for an appointment. The waiting period in obstetrics and oncology is four months, he said.

The judge found that King/Drew’s emergency room was already operating at a “minimally adequate level” when cutbacks at the clinics forced a new load of patients on the emergency room staff. That, too, constituted irreparable harm to patients, the judge ruled.

In a related development, state auditors on Wednesday said the county Department of Mental Health has failed to adequately monitor millions of dollars in contracts with private clinics.

More than half of the contractors failed to make changes in procedures ordered by the department during a two-year period, according to the report by the office of the state auditor general. Such lack of oversight reduces confidence that mental health clients are receiving good care at reasonable cost, the auditors said.

In a written response, county Mental Health Director Roberto Quiroz said he generally agreed with the auditors’ conclusions, and has taken steps to improve contract monitoring.

Anthony W. Harris, executive director of the Assn. of Community Mental Health Agencies, which represents clinics under contract to the department, said he has no problems with the report or the prospect of more scrutiny.

“We just hope there is a mental health system left in Los Angeles County to audit,” he said, referring to the $41.9 million in funding cuts the supervisors are scheduled to vote on Tuesday.