Budget Delays Taking Toll of Health Workers : Economy: Fast changes in proposed cuts leave staff and patients near panic. O.C. officials fear worsening of an already bad situation.

The state’s budget deadlock, which may mean deep cuts to health and welfare programs, has hospital administrators and health care workers in a state of near panic while they try to go about business as usual and handle frightened patients’ questions about the future.

And while proposed cuts seem to change every day, uncertainty about when, where and how heavily the budget ax will fall has already disrupted patient services, health care officials say, and is taking an enormous toll of staff morale.

In Orange County, any loss of state aid to health care would worsen an already bad situation, said Tom Uram, director of the county’s Health Care Agency.

“We’ve already suffered an 11.6% cut (by the County Board of Supervisors), and now we’re waiting for the other ax to fall,” said Uram. “Our programs were already skeletal before the (county) cuts came. I think health care is getting to the crisis stage in Orange County.”

Dr. Howard B. Waitzkin, a professor of internal medicine at UC Irvine and chairman of the Orange County Task Force on Indigent Health Care, said, “What these cuts will do in Orange County is transform a totally inadequate health care system to one that will resemble those in the poorest countries in the world.

“Already, we clearly are not able to address basic health care needs of poor people. . . . Just this week we’ve had two patients with cancer on whom we’ve not been able to obtain biopsies.”

Under the current county Indigent Medical Services contract, doctors are reimbursed for about 11 cents on each dollar of fees, Waitzkin said. Under Gov. Pete Wilson’s proposed cuts, he said he expects Orange County to cut that reimbursement rate in half.

“So you are talking about doctors having to work for 5 cents for every dollar of services rendered, which will lead to even further deterioration in the 5% to 8% of doctors in this county who accept IMS and or Medi-Cal patients,” the internist said.

Jean Forbath, a board member and founder of the Share Our Selves charity in Costa Mesa, said the state’s proposed cuts on health care would cause clinics for the poor to be heavily overburdened. She said SOS’s medical and dental clinic for the poor already is turning people away.

“It’ll just get worse if there are more cuts,” she said.

Gary Erb, executive director of the Laguna Beach Community Clinic, said he is worried about what the state cuts will do to health care for the poor. “It seems like health and welfare programs are the first to go when (government) gets in a pinch,” he said.

In Los Angeles, 43 dying patients in two hospices run by the AIDS Healthcare Foundation are finding the future is indeed harrowing.

Gov. Pete Wilson has proposed cutting Medi-Cal funding for hospice care. If legislative leaders agree, Healthcare Foundation President Michael Weinstein said, he will have no choice but to load the hospice patients into ambulances and send them to Los Angeles County’s already overcrowded public hospitals.

Weinstein said he is appealing to every legislator he knows to fight Wilson’s plan, while scrambling to reassure staff and patients. But as the budget impasse in Sacramento appears to worsen, Weinstein and other health care providers say their reassurances ring hollow.

“It’s terrifying,” said Jeri Trabin-Baker, a social worker in the pediatric rheumatology unit of Childrens Hospital in Los Angeles. “Our patients have chronic conditions, joint problems where they cannot bend or cannot straighten out a particular part of their body. If the budget cuts mean that certain (medical) services are done away with, these kids will lose the kind of care they need.”

She said 70% of the unit’s 400 children are covered by Medi-Cal. Some of them require 10 to 15 prescription drugs a day, exceeding Wilson’s proposed coverage limit of 10 prescriptions per month. Many need splints and regular physical therapy to maintain mobility--equipment and services that Medi-Cal would no longer pay for under the governor’s proposal.

Trabin-Baker said the consequences are agonizing to contemplate.

“We are talking (about) the difference between someone who can grow up to be an independent contributing adult and someone who is going to be absolutely and completely dependent,” she said.

The constant reports of new proposals and program cuts as Wilson and Democratic leaders seek to close a $10.7-billion state budget shortfall are particularly disruptive, health care officials say.

“It is so hard because things literally are changing by the hour,” said Katharine Pierce of the California Assn. of Public Hospitals, which is trying to keep county hospital and clinic administrators posted on the budget negotiations.

“These people have full hospitals and very sick patients and budget constraints that would strain most (private) hospital administrators,” Pierce said. “People who are doing the front line work down in the clinics--their whole programs are up in the air. It is tremendously difficult for them.”

Ralph Silber, director of the Alameda Health Consortium, representing agencies serving 50,000 poor residents of Alameda County, said the agencies are finding it difficult to do even short-term planning.

Asian Health Services in Oakland’s Chinatown section, for example, is putting off replacing the optometrist who quit this month because optometry is one of the Medi-Cal services Wilson has earmarked for elimination. Pamela Haag Schachter, program director at Centro de Ninos y Padres in East Los Angeles, can’t hire a speech therapist to work with the developmentally delayed toddlers that her agency serves because her own budget hinges on the state’s.

“Everything is on hold,” Schachter said Wednesday. “My staff feels depressed and overwhelmed. They are at me all the time to tell them what’s happening, and I don’t know. At this point I would do anything just to have a budget so I can answer some of these questions.”

Hospitals are in a similar bind, hampered in the most routine business dealings while trying to prepare for possible consequences of sharp reductions in state health funding. At stake is the potential dismantling of an emergency and trauma care network that took California’s hospitals and health officials years to develop, according to Anthony J. Abbate, a senior vice president at the Hospital Council of Southern California.

“The private sector is going to be hurt as much as the public, and anyone who thinks only the indigents will feel this isn’t paying attention,” Abbate said. He added that the seeming lack of progress in resolving the budget impasse has many hospitals “panicked” about how they will pay suppliers and staff, or care for uninsured and indigent Medi-Cal patients.

Since July 1, Medi-Cal has been paying hospitals and other health care providers with IOUs. Providers have had to turn to their banks for cash in exchange for the IOUs, called registered warrants. Yet major banks have indicated that they are not willing to cover the state’s debts indefinitely--yet another uncertainty adding to the general anxiety.

Childrens Hospital of Los Angeles, for example, has negotiated coverage of the warrants with Bank of America through July. That amounts to $1.5 million for the hospital a week, or 53% of its cash flow, according to Scotty Margheim, director of patient business services. The money covers staff salaries, supplies, utilities and many other daily operating expenses.

Times staff writer Kristina Lindgren contributed to this report.