Collapse of County Health Care Predicted : Budget: Medical officials tell supervisors that proposed cuts would endanger even minimal treatment.

Los Angeles County’s already-troubled health care system could collapse to Third World status if proposed budget cuts and threatened closures of dozens of facilities are approved, medical authorities warned the Board of Supervisors on Wednesday.

In continuing hearings on the county budget, medical professionals painted a grim picture of communicable diseases going unchecked, emergency rooms jammed and unable to provide even minimal levels of care, and of manageable illnesses becoming deadly and expensive problems because of budget cutbacks.

More than 1,000 health care workers and patients, many in wheelchairs, packed the supervisors’ meeting room and spilled out onto the sidewalks, where loudspeakers were hastily erected to broadcast the proceedings.

“Today we begin the debate on whether we allow people to die because they don’t have health insurance,” said Dr. David Baker of Harbor/UCLA Medical Center. “This is not hyperbole. We know what happens when sick people don’t get medical care: They get sicker and they die.”

Dr. Areta Crowell, director of the Department of Mental Health added: “It’s difficult not to be melodramatic” about the devastation to the system being proposed.

Unlike other years, when cuts in the $3-billion health care budget typically affected only services for the poor and destitute, medical authorities said Monday that the Draconian cuts proposed this year will touch the lives of every county resident.

The overflow of desperate patients from closed public clinics will spill into the emergency rooms of private facilities in every community, creating logistic nightmares and touching off a domino effect in which one trauma care center after another will close, officials said.

“The impact of facilities being closed cannot be overstated,” said Peter McDermott, chairman of the County Commission on AIDS.

“The people who go to these clinics have nowhere else to go,” said Mimi West of the Los Angeles Community Clinic’s Council. If the supervisors proceed with plans to shut down more than 20 facilities, “you will be inviting chaos,” West said.

Under the proposed budget, the health care system would lose more than $100 million in funding.

Four of six comprehensive health care centers would be shut down and 20 to 29 of 41 health clinics would be closed. Those facilities handle 690,000 to 1 million patient visits annually and employ 1,500 workers who would have to be laid off.

The county is the provider of last resort for medical care. It takes care of the destitute as well as the uninsured--who are routinely turned away from private hospitals and doctors.

The department provides a wide range of preventive health services such as screening and treatment for tuberculosis, measles and AIDS. County clinics also provide family planning services, prenatal care and “well-child” pediatric services. But all the services are in huge demand, and long lines and waiting periods are typical.

The county lost more than $1.6 billion in funding for the fiscal year that began July 1. Most of the revenue loss was due to action by the state Legislature, which shifted $2.6 billion in property taxes away from local governments to school districts. The continuing recession also cut deeply into county revenues.

Despite the huge crowds that turned out to fight the proposed cuts, Supervisor Gloria Molina concluded in exasperation that most people are still unaware of the county’s fiscal plight. “There isn’t an understanding of this in Los Angeles County,” she said. “We need to step up the discussion and debate in every household.”

As if to answer skeptics who believe the county cries poverty every year at this time, Supervisor Yvonne Brathwaite Burke said: “We are not kidding. If we don’t get additional money (from state or federal sources), we will start closing these facilities.”

Supervisor Ed Edelman said that given the grim prospects, much of the Department of Health Services’ work could be labeled “public safety” in nature and could therefore compete with the Sheriff’s Department and district attorney’s office for sales tax revenue earmarked for public safety.

“The very safety of the public from epidemics” is at stake, Edelman said.

Robert Gates, health department director, added that emergency care services may become difficult to impossible for many county residents to obtain, creating another public safety concern.

As the indigent ill are forced to seek emergency care at private facilities, they will create a financial burden on remaining trauma care centers. Thirteen trauma centers have closed in recent years, leaving 10. As those emergency rooms close, the pressures on the remaining facilities will increase, Gates and other hospital administrators and emergency room directors agreed.

Gates said the cuts could have an impact on the county’s economy. If the doomsday scenario of a collapsed health care network comes to pass, “Who would want to come here?” Gates asked.

At a minimum, he said, the proposed closures will force more patients into fewer facilities and produce “waits that will be excessive and I believe unacceptable.” Already emergency room patients can wait 15 hours or more to see a doctor in some facilities.

That can lead to security concerns. In February, a patient complaining of long delays and poor treatment at County-USC Medical Center drew a gun and opened fire, wounding three emergency room doctors. A report on medical center security written nearly a year earlier said overcrowded conditions “are breeding grounds for disturbances . . . the inevitable result is a hostile outbreak.”

Some medical professionals argued that the cuts will end up costing the county more in the long run. Marjorie Sa’adah of Homeless Healthcare L.A. said individual cases of tuberculosis can be treated for a few hundred dollars if discovered early, but cost tens of thousands if treatment is delayed.

Officials expressed some hope that the county might still receive additional funds from the state.

In order to quality for state grants under Proposition 98--the tobacco tax initiative--the county would have to increase its funding of the health department by about $120 million. That would entitle it to about $90 million in matching state funds.

Supervisors said they will seek state legislation to get the tobacco tax funds, without having to meet the so-called “maintenance of effort” funding test.