Medical Cuts for Poor Bode Ill for Everyone, Experts Warn : Medicine: The Los Angeles County plan, in response to the state budget crisis, could mean more epidemics and a decline in the general health of communities, they say.
Fern Seizer has no illusions about what will happen at the Venice Family Clinic, which she runs, and other private medical clinics if Los Angeles County carries out plans to drastically cut health services to the poor.
“It’s awful, just awful,” Seizer gasped Tuesday. “We see 169 patients a day, six days a week, and we already are turning away about 60 people a day.”
Seizer’s reaction was typical among private health care providers, staggered by news that the county may close 16 of its 47 health centers and cut hospital clinic services by 35%. The proposal, contained in a confidential Department of Health Services memorandum obtained by The Times, is a response to the state’s budget crisis and anticipated severe reductions in state aid to counties.
County officials estimate they are $77.7 million short of the amount needed to retain current medical services, but that may be only the first blow. Still unknown as California enters its 64th day without a budget is the effect of cuts to the state’s Medi-Cal program for the poor and other specific health services funded by the state.
Some health experts privately estimate that Los Angeles County could lose as much as $120 million in public health funds.
The dismantling of public health services that such funding losses would require bodes ill for everyone in Los Angeles County, not just the poor, public health experts warn.
“We can look forward to a recurrence of the really disgraceful epidemics that we have had in the last few years,” said Dr. Lester Breslow, a professor of public health at UCLA who served as California’s health director from 1965 to 1968. “It will take years to rebuild what is being broken up.”
Breslow cited the four-year measles epidemic that killed 41 children in Los Angeles County between 1988 and 1991.
Dr. Robert E. Tranquada, a professor at USC and chairman of a county task force on health care access, said other indicators of poor community health are sure to rise.
He noted that the incidence of tuberculosis has tripled in the county over the last five years as public health resources in California and the nation have dwindled. He predicted a continuation of the trend.
Los Angeles County already posts a higher infant mortality rate and lower birth weight than California as a whole. Nearly 3 million residents of the county are estimated to be without health insurance.
“There will be sick children in the schools, sick folks in the streets, in shopping centers, and there will be a general decline in the health status of our communities,” Dr. Robert Valdez, a health policy analyst at the RAND Corp. think tank, said in a recent interview. County officials on Monday expressed hope that private clinics, hospitals and doctors might pick up patients squeezed out of public services. The clinic closure plan to save $77.7 million would affect about 200,000 of the roughly 1 million people treated annually at county hospitals and health centers.
But few private health care providers were optimistic Tuesday.
“It is virtually impossible for the private sector to absorb these patients,” said James Yoshioka, president of California Medical Center in downtown Los Angeles. “Many of us are already operating near the financial danger zone.”
Yoshioka’s hospital has a solid record of taking care of poor and Medi-Cal-insured patients, who are considered undesirable by some hospitals because Medi-Cal pays much less than private insurers.
But Yoshioka said Tuesday that he can take no more.
“My emergency room is just totally saturated,” he said. “My obstetrics unit is up to a thousand visits a month. I’m simply jammed.”
It doesn’t help that Medi-Cal, which had been paying with IOUs since the fiscal year began July 1, stopped paying altogether two weeks ago. The money, covering the care of all county maternity patients at Yoshioka’s hospital, will not flow again until a state budget is adopted.
Not all private hospitals are as jammed as California Medical Center. The average occupancy rate throughout Los Angeles County is 50%, according to the Hospital Council of Southern California. Yet Medi-Cal’s low rate of pay even before the budget debacle discouraged acceptance of the program’s patients.
UCLA Medical Center, for one, has reduced the Medi-Cal portion of its hospitalized patients from 28% to 25% and has cut Medi-Cal clinic volume by 10% to keep the hospital financially sound, according to medical center spokesman Mark Laret. It is unlikely, therefore, that UCLA will be able to rescue many patients abandoned by the county, he added.
In choosing the 16 clinics that could close, health officials tried to spread the pain evenly throughout Los Angeles County. But some doctors who reacted to the proposal could see little sensitivity or long-term financial savings in the scheme.
“The fallout from children not getting immunizations and not getting regular medical screening is far more expensive” because of the serious illnesses they risk developing, said Dr. Carolyn Lytle, director of outpatient and emergency pediatrics at the largest public hospital, County-USC Medical Center.
Dr. Brian Johnston, an emergency room doctor in East Los Angeles, suggested consequences beyond a rise in preventable illness. He recalled the riots and the conditions of poverty and powerlessness that fueled them.
“The seeds of social revolution are sown,” Johnston warned, “when someone you love dies in your arms because you couldn’t get medical care.”
