Experts Decry Lower Health Care Standards for Poor

Public health experts reacted with dismay Friday to legislation apparently headed for Gov. Pete Wilson’s signature that would gut historic guarantees of health care for the state’s poor.

They predicted public health consequences for all Californians, including rising rates of communicable disease and further erosion of the state’s emergency services network. Among the poor, they said, deaths almost certainly will rise from diabetes, hypertension, asthma and other treatable illness.

“It is not a pretty picture,” said Dr. Robert Tranquada, chairman of a Los Angeles County task force on access to health care. “This is not the kind of action that could be tolerated under any other than the most desperate kinds of fiscal circumstances.”

The Assembly on Thursday approved two bills giving counties wider latitude in cutting public health and welfare services. The legislation, which Gov. Pete Wilson said he would sign, cleared a major stumbling block to ending the state’s budget stalemate, now in its 53rd day. Counties, faced with sharply reduced state funding, had sought relief from obligations to provide services.

The bills eliminate the requirement for counties to provide indigents with health care comparable to that available to private paying patients, known as the “community standard.” The community standard has provided advocates for the poor with a powerful legal tool to block cuts in county health services.

Legislators left intact state law obligating counties to be health-care providers of last resort. But advocates view the elimination of a standard for measuring the quality or quantity of that care as a devastating loss of protection for the poor.

“There is nothing now for the courts and the community (to use) to force accountability on the part of the counties,” said Maryann O’Sullivan, executive director of the statewide watchdog group, Health Access.

“A lot of suffering, disabilities and deaths will occur,” said Jim Lott, president of the Hospital Council of San Diego and Imperial counties.

Counties in California vary widely in their provisions for public health services, with populous, urban counties such as Los Angeles and San Francisco supporting extensive public hospital and clinic networks, while others, such as Orange County, hewing to the minimum required by law.

Weakening the law, many observers said, not only removes a useful tool for poverty advocates, it undercuts the ability of county health officials to claim priority for their programs.

“We are really sorry to see this,” said Irving Cohen, finance chief for Los Angeles County’s Department of Health Services. “We think that county health services are underfunded as it is.”

Already, Cohen said, the health department has outlined program cuts to cope with at least $77 million in reduced state funding.

The measures include possible closure of 16 of the county’s 47 health centers, sharply reduced mental health services and dental care, and 25% reductions in outpatient clinic services at the county’s six hospitals.

Many of the patients treated in these clinics suffer from chronic diseases, which public health experts say can turn lethal without regular medical attention. For this reason, they expect deaths to rise among poor people with hypertension, diabetes and lung ailments.

Administrators of private health facilities scrambled Friday to gauge the impact of a retreat by counties from the health care arena.

The Assembly’s action added to tensions among hospitals already raw about the state’s decision last week to stop paying Medi-Cal bills until the budget impasse is resolved.

“It is probably the most horrendous thing I’ve ever heard,” said Peter Bastone, executive vice president of Daniel Freeman Memorial Hospital in Inglewood. “Nobody is relieving us of the responsibility to treat the people who come to our doors.”

Federal law prohibits hospitals from turning away seriously ill patients, even if they have no means of paying for their care. The state’s budget crisis has led to a 25% increase in emergency room business as private doctors turn away patients insured by the non-paying Medi-Cal program.

The situation has been viewed as temporary, with relief coming as soon as the governor and Assembly agree on a budget.

But health care analysts predicted Friday that these extraordinary emergency room loads will become the status quo once counties begin curtailing medical services. For some hospitals, the only financially viable choice will be to close their emergency rooms, said E. Richard Brown, a professor of public health at UCLA.

“We will all suffer,” said Brown, from this shrinkage of the state’s health care system.