County Action Urged on Child Health Care

The Clinton Administration has promised to make universal child immunization and preventive care central to its health reform package, but according to a new report, Los Angeles County is ill-prepared to extend these benefits to its 1 million uninsured children.

The report found that the county Department of Health Services is so overburdened by a huge indigent population and red-tape entanglements that it failed to use--and eventually had to return--$450,000 in federal funds issued last fall to combat tuberculosis. It also delayed for several months putting to use millions of dollars for immunization programs.

The Los Angeles Roundtable for Children, in a report released Monday, said the county should act quickly to take advantage of new federal initiatives. The recommendations include coordinating medical services for children in one place and reducing the bureaucracy so families are not discouraged from seeking care.

“The primary health care system for children in Los Angeles is eroding so much that we fear there won’t be an infrastructure when the reforms take place,” said Bonnie Armstrong, a health-care consultant and author of the report, “An Agenda for Children’s Health Care in Los Angeles.”

For example, efforts to control tuberculosis are sorely needed, according to the report; cases among children under age 5 increased 23% from 1990-91. And, according to a recent study, only an estimated one-third of Los Angeles County children had been fully immunized by age 2. The county received $6 million in vaccines and $1.5 million in federal funds for immunizations in January but delayed using the funds while awaiting authority to hire staff.

But, Armstrong noted, the report closely duplicates the Department of Health Services’ recent internal review.

“The Department of Health Services is attempting to work on many of these same issues,” Armstrong said. “We are working to be as constructive as possible. We recognize that this is a very difficult moment with the state fiscal crisis and the impact on county services. But we feel comfortable that the recommendations we’re making are doable.”

The Department of Health Services also falls victim to bureaucracy outside its purview, said Dr. Arthur Lisbin, director of child and adolescent health programs for the county and a member of the Roundtable’s Healthcare Advisory Committee.

Lisbin said he was not familiar with the loss of the tuberculosis-control funds, but said red tape sometimes prevents the county from utilizing money. He said his department was supposed to receive state money to screen for lead exposure in children last July. The money still has not arrived.

“It may arrive in the next four weeks. That gives us about two months to do the hiring,” Lisbin says. “If you can’t hire in time, the funds get lost.”

The report urges the Board of Supervisors to authorize the county to move toward a prevention-based system. Now, the only care available for many poor families is through hospital emergency rooms, where services are four times more expensive than in community clinics, the report said.

Further, families seeking preventive and primary care are stymied by a lack of coordination among various county clinics that is “among the most wasteful aspects of the current public system,” the report charges.

The report calls for consolidating the delivery of some services--such as immunization, tuberculosis screening and well-baby and child checkups--and streamlining eligibility requirements.

In one case identified in the report, the mother of an ill 18-month-old child sought care at a public clinic. Because she had no Medi-Cal card and lacked $35 for an exam, she was told she would need to apply first to another agency for an emergency Medi-Cal card. But she was told she would have to wait for an appointment two days later.

The woman then sought care at a free clinic, where she was told to go to the county hospital because the baby was seriously ill. The mother believed she would be denied care there, however, because she lacked her card.

Two days later, she kept her appointment to receive a Medi-Cal card for the sake of her three remaining children. The 18-month-old already had died of pneumonia.

With public health officials so focused on long-term reform, the needs of children are not being met, said Vivian Weinstein, a consultant to the Roundtable, a 10-year-old nonprofit education and advocacy group.

“Hopefully, this report will encourage the county--even in these days of debate and discussion about what health care should be--to expand services for children within the framework that is already there,” Weinstein said. “My main concern is we not get so busy planning for the future that we forget children now.”

The report also urged the county to make better use of existing funds to help children.

Most notable is the Child Health and Disability Prevention Program, funded by the state and federal governments, that provides services to children whose families earn less than 200% of the poverty level (which was $28,000 annually for a family of four in 1992). The report estimates that only 26.5% of the county’s eligible children are receiving the services, which include physical and dental exams, hearing and vision tests, developmental and mental health screening, immunizations and basic lab tests.

“The county could be reimbursed for many children and could expand the CHDP services if they found a way to do it,” Weinstein said. “There is no cap on that money. And yet only 26% of the children are being served.”

The report said that increasing to 75% the number of eligible children would bring the county an additional $48 million in state and federal funds.

But, Armstrong said, “The state of California has not been as aggressive as many states have been in utilizing that flexibility. For example, one thing (the federal government) offers is matching dollars to help pay for the outreach to find kids and bring them in for CHDP services. We’re not using that money.”

According to the county’s Lisbin, the department will begin exploring that option this week.

“The wherewithal is there,” Weinstein said. “What is needed is the will to find a way to do it. The authority to do it needs to come from the supervisors.”