Death Blow to County Health Services for Poor Feared : Medicine: Bill headed to Wilson will cause catastrophe for poverty-stricken, health care providers predict.

A crumbling county health care system, with closed emergency rooms and chronically ill poor people left without medical attention, would result from legislation apparently headed for the governor’s signature, some San Diego County health care providers predicted Friday.

“A lot of suffering, disability and death will occur,” said Jim Lott, president of the Hospital Council of San Diego and Imperial Counties. The association represents 32 hospitals.

That’s how Lott summed up a bill that the Assembly passed late Thursday that would let counties reduce medical service to uninsured poor people, about 600,000 of whom live in San Diego County alone. Gov. Pete Wilson is expected to sign the measure into law.

The legislation aims to relieve counties of an expensive state-required medical program, a gesture made to offset a plan for the state to take a greater share of property tax revenue from counties to balance the state budget.

However, some leaders of San Diego County’s medical community made dire warnings that the legislation would cripple health care for poor people and leave paying patients with higher bills and unreliable emergency room service.

“Our system would become so overburdened, the entire system would back up,” said Stephen Shubert, director of the San Diego Council of Community Clinics, which represents 40 clinics serving about 225,000 indigent people.

Under the proposed tax shift to prop up California’s ailing budget, San Diego County is expected to lose $20 million to $40 million in property tax revenue, Lott says.

He fears the County Board of Supervisors will partly deflect the financial blow by cutting medical care for the poor.

“Health and welfare would be the top on their list of (revenue) pots to make reductions,” Lott said, predicting that “we could see serious denigration in health care for chronically ill patients.”

Among the people he fears for is the indigent population suffering heart problems, diabetes and epilepsy--diseases that require medical maintenance, including periodic office visits and medication.

As those people are dropped from the health care system, Lott believes they will wait until their conditions become critical and go directly to hospital emergency rooms.

“We’re going to see more chronically ill patients get sick and die or find their way to hospital emergency rooms,” he said.

Some emergency rooms will become so congested, he predicted, that they will be shut down or put on limited status.

In some cases, patients with medical coverage might have to go farther to find an open emergency room, he said, and the additional travel time “could mean the difference between life and death.”

State law requires emergency rooms to at least stabilize patients, and Lott says hospitals will be forced to pay the cost of serving non-paying poor people. The expense, he said, will be passed along to insured patients.

Community clinics handle most of the county’s needy, and Shubert expects the cash-strapped county to cut their funding.

Already, he said, “we’re expected to keep our doors open with spit and gum.”

He said clinics will fight to remain open, turning to the community to raise money to offset the loss of county funding.

“We’ll have to raise a hell of a lot of money,” he said. “What we intend to do is cope with the situation as best we can and hope the community will help.”

The county’s health care network already shows signs of cracks and fissures because of the state’s desperate financial condition.

Valley Medical Center in El Cajon has started refusing to accept non-emergency Medi-Cal patients because the state has delayed payments until the Legislature finally approves a budget. A spending plan is already more than 50 days late.

Other hospitals say they will turn away Medi-Cal patients in a few weeks if the Legislature and Gov. Wilson fail to resolve the budget impasse.

But the Assembly bill that would give counties more freedom to slash health services has produced the latest anxiety as Sacramento seeks program cuts to offset the state’s multibillion-dollar revenue shortage.

Until the entire budget package is passed and signed by the governor, it’s hard to tell exactly where the spending cuts will be deepest. However, San Diego County’s supervisors are likely to have little choice but to curtail spending for the poor.

“I would suspect we’ll have to deal with some cuts to health and welfare,” Supervisor John MacDonald said. “We’re facing some real tough priorities.”

He wouldn’t speculate on what the board might do but pointed out that supervisors already have ordered reductions of general welfare. That action prompted a lawsuit that is before the court.

Not everybody is reacting with alarm, at least not yet.

Dr. Robert Reid, past president of the San Diego County Medical Society and now chairman of the Access to Health Care Commission, said the legislation heading for Wilson’s signature is “a bad sign, it may be the harbinger of a whole host of things.”

However, he advised caution, saying, “let’s let it filter down and see what the dollars and cents are.”

Local health care providers are concerned that additional legislation could further damage programs for the poor, not just by lifting responsibility from counties but actually cutting direct state funding for health care.