Fatal Cut in County Health Plan May Put Thousands at Risk : Funding: Death of County Medical Services program, which serves about 25,000 working poor, will be felt throughout the community. Administrators blame state for reneging on money.

Thousands of people in San Diego County could be cut off from regular medical care next month because the county says it must kill the program under which they see doctors and obtain medication.

Announcing the planned elimination Friday of the County Medical Services program, county administrators accused the state of operating an “Alice in Wonderland” funding process.

“The big picture of this issue is: none of this is necessary,” said David Janssen, the county’s assistant chief administrative officer. “San Diego County citizens should not have found themselves in this kind of a situation, where you are living from budget to budget, desperately, going in a downward spiral.

“It all has to do with the financial ‘Alice in Wonderland’ system that county governments are faced with,” he said. “It’s got to stop.”

The state repeatedly has shunted medical programs onto the counties, promised to fund them, and then reneged, Janssen said. Last year, it halved the funding provided for medically indigent adults.

The current San Diego plan to cut off health care to about 25,000 San Diegans who are among the working poor emerged this week, because the CMS system has been operating in the red since December, Janssen said.

The Board of Supervisors is expected to vote Feb. 26 on whether to end the system March 15. The board may also be asked to declare a state of emergency, the effect of which hasn’t been determined, Janssen said.

Since December, expected funding from other sources has not materialized. The program is now $4 million over revenues and is costing another $1 million every 10 days, Janssen said.

The county auditor refuses to allow any more money to be spent, he added.

The $40-million-a-year County Medical Services program is separate from Medi-Cal, which covers indigent people on public assistance programs. CMS cares for “medically indigent adults”--the working poor and others whose incomes can’t cover doctors or health insurance.

An estimated 26.5% of all non-military adults in San Diego County have no health insurance, and the number is thought to be climbing. The death of CMS could have tragic results for these people and for the entire medical care system in the county, health care providers say.

“About one-third of our budget for primary care is for medication,” said Stephen C. Shubert, director of the San Diego Council of Community Clinics. “We have people who have multiple health problems and are taking multiple drugs. Without those drugs, those people are at risk.”

The top two health problems at the 16 community clinics he represents are hypertension and diabetes, both of which need to be treated with continuous medication that people couldn’t otherwise afford, he said. Uncontrolled, both can also lead to heart disease, kidney failure, stroke and death.

“I can tell you flat, there are people who will die. There are people who will suffer significant disability,” Shubert said. “There are people who are receiving, for example, chemotherapy. Those people’s chemotherapy will stop--and you tell me what that means if you have cancer.”

Jim Lott, director of the Hospital Council of San Diego and Imperial Counties, suggested the cuts could flood emergency rooms with uninsured people who have nowhere else to turn.

And hospitals will have to absorb the costs of those visits, because there would be no county CMS money to partly reimburse them, as occurs now.

“We may lose a couple of emergency rooms that will downgrade (to stop taking ambulance patients),” Lott said. “If you’re going to be inundated with chronically ill patients, taking the ambulance runs may put them in increased jeopardy.

“More importantly, the hospitals will have to decide where to cut off their triage. They may have to actually put sick people back on the street. That is not being planned, but in a worst-case scenario that might happen,” he said.

Lott noted that the shutdown of just one emergency room, that of San Diego General Hospital, over the last two weeks has already increased emergency visits at Mercy Hospital by 25%.

Furthermore, a CMS shutdown could threaten the county’s system of trauma hospitals, which lost nearly $8 million last year on uncompensated care. Without CMS, there would be no funding to pay the bills of the 35%-50% of trauma patients who are uninsured, said Paul Simms, the county’s chief of physical health services.

“Everyone who lives in this county ought to be worried about this, because it’s going to come to them soon enough,” Shubert said.

“You are dealing with the fact that perhaps 600,000 people in San Diego County one way or the other can become dependent on public health care,” he said. “When you’re dealing with those kinds of numbers, the system is starting to collapse. I have no doubt that the system is collapsing.”

County officials will meet with representatives of hospitals, doctors and community clinics over the next two weeks to discuss such issues.

They will try to work out ways to save a few crucial pieces of the CMS system--such as funding for drugs to control chronic illnesses--at minimal cost, Simms said.

CMS helps to fund everything from doctor visits to therapeutic drugs, and also partly reimburses hospitals for emergency room visits.

At one time the state administered and fully funded care for the medically indigent, but in 1982 it gave that responsibility to counties, promising to pay 70% of the cost. But the percentage of funding has fallen steadily since then. State spending on medically indigent adults in San Diego County has fallen from a high of $55.5 million in 1983 to just $19.8 million this fiscal year, Simms said.

In setting that level of state funding, the Legislature assumed that another $20.4 million would come to the county from two other sources: $7 million from the federal government, and $13.4 million from charging school districts and other taxing bodies a new “user fee” to collect their property taxes, Janssen said.

But the federal government hasn’t even appropriated its assumed contribution, and school districts are suing to get the user fee overturned.

Schools account for about $9 million of the shortfall, not a cent of which the county expects to collect while the suit is pending, Janssen said. And several bills in the Legislature seek to rescind the user fee altogether, he said.

In Sacramento Friday, a spokesman for the state Department of Health Services said he didn’t think San Diego County could legally abolish its program.

“Lack of funding apparently is not a sufficient cause for termination of their program,” said Michael Kassis, chief of the medically indigent adult section. “They can say they can do it, but I don’t think they can do it.”

Janssen said county attorneys believe the program is the state’s obligation, not the county’s.

The department could take no compliance actions against the county, but abolition of the CMS program would make the county ineligible for special tobacco-tax money, which is budgeted at $19 million this fiscal year, he said.

Supervisor Susan Golding met with Gov. Pete Wilson Friday afternoon and planned to raise the issue of the county’s CMS crisis, Janssen said.

The discussion was brief and produced no immediate results, said the governor’s press secretary, Bill Livingstone.

The dispute over money is only the latest in a long-running disagreement between San Diego County and the state. The county ranks 56th out of 58 counties in per-capita funding from the state. In a case now being heard in Superior Court, the county has sued for equity in mental health funding.