County Health Programs in Peril : Budget: Activists hope to preserve refugee support and prevent cuts in ‘well-baby’ and sexually transmitted disease clinics.

Nampet Panichpant-M tells the story of an elderly Hmong woman so despondent over her failing health that she was ready to commit suicide in the tradition of her people, “by eating poison leaves.”

A worker in Panichpant-M’s International Immigrant and Refugee Assistance Program spoke with the woman in her native tongue and helped her get medical and psychiatric care.

In another case, a baby had turned blue from serious breathing problems and a doctor wanted to surgically insert a breathing tube. But the Cambodian parents said no. One of Panichpant-M’s Cambodian interpreters persuaded the parents to allow the surgery, which helped save the baby’s life.

“We are trouble-shooters,” explained Panichpant-M, who manages the assistance program for the County Health Care Agency.

For nearly 12 years, the program has ministered to Orange County’s Pan-Asian community, now numbering 250,000--providing translators when immigrants needed medical care, helping breach cultural walls in child-abuse or rape cases and visiting community centers to talk about measles, AIDS, drowning prevention and other public health issues.

But with a $67.7-million revenue shortfall facing county leaders this year, the long-valued program is slated to be eliminated in September as part of $4.2 million in health-care cuts this fiscal year.

A range of community activists, from workers at Santa Ana’s Cambodian Family Agency to leaders of the United Way Health Care Task Force, recently learned of the proposal to cut the refugee support and vowed to fight it.

But Panichpant-M fears her program may be doomed--and with it, access to health care for Asian immigrants. “It doesn’t look very good,” she said last week. “Help is coming too little, too late.”

The county’s budget-cutting list also calls for:

- Eliminating 20 of 78 “well baby” clinics for low-income children.

- Eliminating three staff positions in the county’s sexually transmitted disease clinic. (Officials say the cuts are not expected to affect treatments for those infected with the AIDS virus.)

- Reducing dental care and nursing services in county jails.

- Scaling back water-quality sampling at public beaches to twice a month instead of weekly.

- Eliminating a 19-year-old noise-control service that investigates complaints in unincorporated areas and monitors rock concerts at Pacific Amphitheatre in Newport Beach.

Health Care Agency Director Tom Uram said that those and about 30 other county health programs were targeted for cuts because none involve services that are mandated by federal or state law. And since “we have to make cuts,” Uram said, they were vulnerable.

“All these cuts are very, very difficult,” Uram said. “You lose sleep over making them. We brought all the managers together. We prioritized our cuts. . . . Just the same, it causes sleeplessness. You’re affecting people’s lives.”

If the 20 child-health clinics are closed, some patients “will have to travel longer distances and wait longer,” Uram explained. “But they’ll get served eventually.”

As for the refugee assistance program, Uram said, “we have lots of access for people who don’t speak English. Some of them may have to bring their own interpreter.”

In 1979 and the early 1980s, as Vietnamese refugees began immigrating to Orange County, the assistance program was paid for with federal funds. But in recent years, county officials have had to pay for it out of general funds. And now, they say, the county can no longer afford it.

The Board of Supervisors is expected to approve the first $3.5 million in health-care cuts Tuesday, when they are scheduled to adopt the overall county budget. But the most sensitive of this year’s recommended cuts--the refugee program, the child-health clinics and reduced staff at the sexually transmitted disease clinic--cannot be made until a special hearing is conducted Sept. 17.

Under state law, counties are required to hold so-called Belienson hearings, named after the senator who wrote the law, whenever they cut or eliminate health programs that directly serve the poor. In Orange County, the Belienson law has been invoked just once, after supervisors in the late 1970s sold the county hospital to UC Irvine.

In accordance with the law, legal notices of the hearing are now posted at 87 county health facilities in a dozen languages, including English, Spanish, Laotian, Cambodian and Chinese.

For all that, many of the county’s clients--the unemployed or working poor--don’t seem to have noticed. At the county’s 17th Street Clinic in Santa Ana this week, harried-looking parents stood in a long line with toddlers and babies, waiting hours for childhood immunizations. Asked about the hearings, several of the parents shrugged and said they really didn’t understand.

If the cuts are approved, the refugee program will lose its entire budget of $322,397 and all 12 staff positions. Interpreter services for about 4,000 county patients are expected to be limited, though bilingual clinic staff members may still be able to help.

The 20 child-health clinics--which last year offered immunizations and medical exams to 3,000 children, from newborns to 6-year-olds--would lose four staff positions and $239,827. And if that cut is made, health officials predict that waiting times for a child’s first appointment will jump from the current two to four weeks to at least four to 10 weeks, and possibly as long as 14 weeks.

As for the sexually transmitted disease clinic, it would lose three staff positions and $132,557. The move would lead to longer waiting times for those with syphilis, gonorrhea and other sexually transmitted diseases, and about 6,000 patients with less severe infections will be referred for follow-up care to private or community clinics, county officials say.

But late last week, some community advocates were gearing up for a fight in September. “We’re opposed to the cuts,” said Chauncey Alexander, chair of the United Way Health Care Task Force, who wants the well-baby clinics, the sexually transmitted disease program and the refugee-assistance program to escape the budget knife.

At the task force’s meeting Thursday, “everybody was concerned about those because they’re obviously such good and preventive programs.”

Alexander was especially concerned about the ending of the refugee program, warning that if it is cut, Asian refugees will have difficulty finding public health services. “It just arbitrarily eliminates a whole class of people,” he said. “They’ll end up in the emergency room.”

Dr. Melvyn Sterling, chairman of the Orange County Medical Assn.’s committee on access to care, also expressed concern about the three programs to be cut in September. “It’s going to take a long time for children to find their way into health care,” he predicted.

Sterling noted that if some clinics are closed, some parents may not be able to take their children to another county clinic. “Logistically, it’s impossible,” he said. “In this population, the patient often does not have an automobile.”

Asked where the county should get the money to fund all three programs in full, Sterling admitted: “I don’t know. But one thing is clear. If you take a long view of this, this is being penny wise and pound foolish. Probably the best bang for your buck is giving immunizations and identifying problems” in children early, so they can be remedied without permanent damage.

Also concerned about the proposed cuts was Dr. Felizardo Camilon, a pediatric ear, nose and throat specialist in Orange who teamed with a county refugee assistance worker last month when a Cambodian baby needed surgery.

The 10-month-old boy was brought into the emergency room at Children’s Hospital of Orange County in severe respiratory distress, Camilon recounted. He needed a tracheotomy. But his Cambodian parents did not want the baby’s throat cut open.

“It’s so hard to tell the parents,” Camilon said. They did not want to believe “that the child is not perfect and we need to put an opening in the neck.”

With the help of the county’s Cambodian health care worker, Camilon was able to persuade the parents to accept the surgery.

“Without them, I don’t think it’s possible to take care of these people,” he said.

Could he find a Cambodian interpreter somewhere else? “It’s going to be tough--if not impossible,” Camilon said. “There are not too many people who know this language--and who know medicine.”

“Very seriously, I don’t know what would happen,” Camilon continued. In the case of the 10-month-old Cambodian boy, he said, if the county translator had not been there the parents probably would just have gone home. “This baby--he could have died at home.”

BIG BUDGET, FEW CHOICES: Supervisors have control over about 13% of the county’s $3.7-billion budget, leaving little leeway. B3