Judge Halts Shutdown of CMS Program : Health: Court says uninsured and poor who receive medical care from it would die, urges county and state to settle their dispute politically, not legally.

A San Diego judge halted the county’s plans Monday to end its medical care program for the uninsured and the working poor, noting that the dispute is not about the need for services but about who should pay for them.

Indeed, the political dispute should not even be in court, Superior Court Judge Harrison Hollywood said.

“This is essentially a political matter and not a legal issue,” he said. “I’m very hopeful that somehow some arrangements can be made between the two entities here to solve this problem.”

Hollywood added that he intends to keep the pressure on the entities--the county and the state--to do so. He began by issuing a temporary injunction to preserve the County Medical Services program, or CMS, which had been scheduled for termination at midnight tonight. CMS patients would die if he approved the shutdown, the judge said.

“It would be totally unfair for us to follow the Board of Supervisors’ lead on this and to cancel the program,” Hollywood said. “I don’t know of any better showing (of harm) that one can make than a matter of life or death.”

The CMS shutdown would have immediately eliminated the only source of life-sustaining care and medicine for about 17,000 people in the county.

But, in papers filed with the court, the county said this temporary salvation for CMS will pull $112,000 a day out of other county programs.

“Appropriations (will) have to be transferred from other essential county programs and services such as mental health programs, juvenile diversion, child-abuse counseling, probation honor camps, the . . . juvenile gang unit, court expenditures, park operations and law enforcement,” said David E. Janssen, deputy chief administrative officer, in a statement filed with the court.

However, Hollywood suggested that neither the state nor the county has been very creative in trying to avoid such dire consequences by resolving their dispute outside the courts.

And he noted that his eleventh-hour reprieve would not have been necessary at all if the county had accepted a Feb. 25 state offer of a $9-million loan to pay for CMS.

Hollywood’s injunction will remain in effect until he rules on the merits of the case filed by the Legal Aid Society of San Diego. He said he hopes to settle the matter within a month.

The next court step will come--”appropriately,” the judge said--on April 1, April Fool’s Day.

At 3 p.m. that day, Hollywood will hear an injunction request in a related suit, in which the county wants the state to be ordered to pay for CMS. Although it had been scheduled for Monday, the request could not be considered because court papers for the state had been accidentally delivered to the wrong address.

That amounts to a $1-million-plus mix-up because it thwarted the county lawyers’ strategy of asking the judge to order the state to pay for CMS while the suits are pending.

Hollywood was not sympathetic, saying the county would not suffer irreparable harm if its “abrupt” decision to terminate CMS were delayed.

Early in Monday’s proceedings, smiles tickled the faces of Legal Aid attorneys as Hollywood repeatedly interrupted the county’s lawyer, Valerie Tehan, to hint that he found no merit in her position that CMS should be allowed to die.

The county contended that its $12-million annual subsidy of UC San Diego Medical Center meets any obligation it has to care for the county’s poor.

The CMS program reimburses clinics, doctors and hospitals for providing life-sustaining medical care to about 25,000 people every year who have no insurance and earn too little money to pay for their own care. Many CMS patients are accident victims or are middle-aged--old enough to be prone to chronic illnesses such as heart disease and cancer but too young for Medicare. There are an estimated 700,000 uninsured people in San Diego County.

This fiscal year, the state cut its funding for the $41-million CMS program to $19 million. The county contends that the state should provide the full amount.

The County Board of Supervisors voted in February to shut CMS down unless the state provided the money. After last-minute negotiations failed to produce a state guarantee of the amount, the county declined the loan offer and proceeded with plans to end the program.

Hospital officials had predicted a breakdown in the entire emergency medical system if CMS patients began flooding emergency rooms seeking care they could get no other way.

They, community clinics and patients were relieved by the judge’s order.

“I’m encouraged and most definitely pleased,” said Mary K. Farrell, a plaintiff in the Legal Aid suit. But she added that she is worried that some doctors will still decline to care for CMS patients while the suit is being decided, because they fear not being reimbursed later.