LOOKING TO 1991 : The...

While turf battles threaten to distract some of the county’s elected leaders, experts in the health field will be grappling with issues in 1991 that could become a matter of life and death for Orange County’s poorest.

They offer a bleak forecast for the new year that includes predictions of a collapse of the county’s Indigent Medical Services program and further erosion of trauma and emergency services as well as obstetrical care for poor women.

Likewise, social service officials warn that the demand for public and private welfare services in Orange County will continue an upward trend in 1991 and providers will be hard pressed to meet the needs.

Although Orange County remains one of the wealthiest communities in the state, it has taken on increasingly urban characteristics that--combined with such factors as a faltering economy, the high cost of living and expanding numbers of lower-paying service jobs--bode ill for many residents.

The numbers of families on welfare shot up 35% in 1990, and social service officials do not expect that pace to slacken in 1991.

“My mood is somber,” said county Social Services Director Lawrence Leaman. “I feel the state and counties will be at a fiscal crossroads this next year and I worry about whether government can afford to continue the (current) level of services and programs. . . . I foresee programs being cut, but what and how I don’t know.”

Leaman and others in the field said the only hope they hold for 1991 is that social problems will become so severe that local and state leaders may be forced to finally deal with them.

Similarly, health experts warn that the low priority given to health care needs of the county’s poorer residents will ultimately harm the entire system.

David Langness, vice president of the Hospital Council of Southern California, said that Orange County is poised on a precipice similar to one faced by Los Angeles County a few years ago.

“The consistent neglect of the needs of the poor led to increasing numbers of people coming into the system who couldn’t pay,” said Langness. “The system itself began to collapse and trauma, emergency rooms, burn centers went under. People finally began to realize that those services help everyone, but they no longer exist regardless of your ability to pay.”

Although experts predict that health and social services may hit bottom in 1991, there were a few hopeful signs:

“Governor-elect (Pete) Wilson appears to be making some excellent moves by saying he wants the thrust of services to go . . . towards stabilizing families,” Leaman said.

Said County Health Care Agency Director Tom Uram: “One highlight I see is the coming together of community clinics to coordinate services for the poor and I think the county will be involved in cooperating.”