Board Votes to End Health Care for Poor : Money: Supervisor says that, unless the state provides, funds the action could mean a death sentence for needy patients.

With one supervisor saying he knew the decision will kill people, the San Diego County Board of Supervisors voted, 4 to 1, Tuesday to abolish its health care program for the uninsured unless the state comes up with $16 million by March 5.

There are no indications that money will materialize, so the decision in effect would mean an end to regular health care for about 25,000 people who are the sickest of the county’s uninsured. The program reimburses doctors and hospitals who care for people who have no other means of paying their bills.

“I have no intention of breaking my sworn duty to follow the laws of the state of California, the constitution and the laws of the county of San Diego,” said Supervisor George Bailey. “Basically, they say I have no choice but to say this program cannot be continued, because we do not have the money.

“I recognize it could be a death sentence for many people in this county, but I have no choice,” Bailey said.

The decision, and Bailey’s comment, brought stunned and helpless anger from the few patients, health care administrators and advocates for the poor who had waited more than six hours for the decision.

They had hoped their tears and their tales of irreparable human costs would save the County Medical Services program (CMS). Instead, it is scheduled for shutdown March 16.

With Susan Golding dissenting, the supervisors voted to hand responsibility for the program back to the state and to terminate the county program March 16.

They also voted unanimously to declare a health care emergency in the county, an action that it is hoped would allow Gov. Pete Wilson to use state contingency funds to help.

On Feb. 15, county administrators recommended abolition of the $41-million CMS program because about half of its previously anticipated revenues had not come in. It has been operating without designated funding since December, they said.

But opponents of the cutback are promising an offensive to try to force the county to assume responsibility for finding a way to save the program.

Earlier in the day, the local hospital council authorized its attorneys to seek a grand jury investigation of the possibility that mismanagement is the real reason for the CMS problem, said Jim Lott, executive director of the Hospital Council of San Diego and Imperial Counties. The council is an industry trade group for all the hospitals in both counties.

The county failed to collect tax revenues from cities and school districts to pay for the health care program, he said. That source was to have accounted for $13.4 million of the CMS budget, but none of the money has been collected.

Somebody “dropped the ball, and we and the patients are having to pay for it,” Lott said. “I think that whoever did that ought to be held accountable, and brought forth and dealt with.”

A Feb. 21 letter from Supervisors’ Chairman John MacDonald to Lott indicates that the county could have had access to the money after Jan. 1 if it had chosen to act, Lott said.

David Janssen, assistant chief administrative officer for the county, ridiculed the idea that there was anything the county could have done differently to avert the health-care crisis.

He denied that there had been any money available in tax accounts after Jan. 1, the first date on which the county could collect it. There was also a question as to whether the county had the authority to withhold money from funds due to cities and school districts anyway, he said.

The hospital council is also considering a lawsuit to prevent the end of CMS, and the Legal Aid Society of San Diego also has plans for a suit.

In voting against the CMS closure, Golding said there had not been enough time to explore other options with the state. She blamed county administrators for failing to notify the supervisors of the program’s dire situation until just 1 1/2 weeks ago.

“Until I am absolutely certain that absolutely every step has been taken, that absolutely every person has been talked to, that absolutely every person has been written and every phone call has been made to those in Sacramento who might assist us, I will not vote to terminate the program,” she said.

But other supervisors opposed delaying a vote, not only because CMS is costing about $800,000 a week but also because they said the state needs to hear a clear message: The whole mess is the state’s fault. The county has long criticized the state for cutting its funding of programs that it also mandates.

“I think what we need to do right now is send a clear message to Sacramento. We can’t vacillate,” said Supervisor Brian Bilbray.

So far, the state hasn’t got that message, a letter from Sacramento on Monday indicated. The letter from Dr. Peter Abbott, chief of the county health services branch for the state, pointedly tossed the CMS problem back to the county.

“We are available to assist you in reviewing your local options,” Abbott said.

The letter also warned that, under state law, the county could not abolish the program without giving proper public notice. It said that would have been needed by Feb. 13--two days before CMS’ catastrophic problems were announced to the press.

Caught in the middle of this state-county wrangle are the 600,000 uninsured people in San Diego County who--if ever struck by accident or serious illness--would have nowhere to turn for health care.

About 100 such people attended Tuesday morning’s hearing, but by the time the decision was made at about 3:30 p.m., most had returned home unheard--because their testimony was stopped after about 15 minutes so that city officials interested in another taxing issue could testify at 11 a.m.

The patients then had to wait until 2 p.m. for testimony to resume.