Doctor Says Public Health Prognosis Is Grim if Center Is Closed

To cut costs, the Los Angeles County Board of Supervisors is considering closing the Mid-Valley Comprehensive Health Center in Van Nuys. The county faces a $1.6-billion budget shortfall and believes it can save $78.6 million by shutting Mid-Valley and other regional centers and smaller clinics throughout the county. Shutting down Mid-Valley would save $2.4 million, the county says.

But Dr. Vincent Gualtieri, a Sherman Oaks urologist who serves as secretary of the Los Angeles County Medical Assn., believes the closure of Mid-Valley would cause major public health problems and cost more than it would save in the long run. The following is an interview with Gualtieri, conducted by Times reporter Jack Cheevers.

Question: What would be the impact on public health of closing Mid-Valley?

Answer: I’m told that the Mid-Valley facility conducts about 85,000 patient visits a year. . . . That translates into about 20,000 patients they take care of. Aside from that, I think the (smaller) clinics conduct about 60,000 visits a year. That amounts to a lot of health care that people get.

In the absence of these facilities, you would have a crisis on your hands. A lot of people who can no longer seek care at those facilities who would either have to travel long distances to other county facilities, and in the process lose time, lose work. Your private hospitals with emergency rooms would be inundated with sick people. The amount of uncompensated care would increase; the hospitals would probably have a bigger economic burden on their hands. A lot of them might close.

Q. They would close from having additional patients? How would that happen that they would close?

A. What happens is when patients who can’t afford to pay go to an emergency room, they have to be taken care of.

Q. By law?

A. By law. You can’t transfer them. You’ve got to take care of them. If a hospital starts taking care of large numbers of people . . . and they don’t get paid, then this increases the (hospital’s) burden. They’re already heavily burdened as it is. Some of them may close their emergency rooms. They won’t close the hospitals, but they may suddenly stop providing emergency room service.

Q. Essentially to keep the poor people out, to avoid the financial burden?

A. Well, not to keep the poor people out but to stay viable as a hospital. No one is interested in keeping poor people out. Physicians and hospitals want to give care to everybody. But because they’re private hospitals they have to stay afloat. The county facilities that are going to see the overflow of these patients will be in trouble because they’re already extremely overcrowded.

I think an average wait in the emergency room at Olive View is something like five, six hours. And sometimes it gets beyond that amount of time. When they start seeing a lot more patients and they have already overcrowded conditions, then you’ll see considerably longer waits. When you see a lot of patients and you don’t have a lot of physicians, the quality of care gets a little bit skimpy.

So everybody involved is going to have trouble. A lot of sick people probably will wait until they get very sick, and then they’ll wind up going to any emergency facility and having to be admitted.

There will be people who won’t get their routine care. Women won’t go to be examined and get their Pap smears. . . . People will suffer more from these diseases because they won’t be detected early. Your infectious diseases won’t be treated properly. You won’t have the amount of immunization for children, for instance. That’s very important. Measles and polio and smallpox--we’re already beginning to see incursions into these areas that previously had been almost eliminated.

You’ll get tuberculosis, which is on the rise. . . . It’s extremely important that some of these conditions be discovered early, controlled.

Q. At Mid-Valley alone, there were 187,000 immunizations in the ‘92-93 fiscal year--for tuberculosis, measles, other kinds of communicable diseases.

A. If those immunizations aren’t done by the county, is there another agency of government that would pick it up? Would the school district, for instance, pick it up? Or do you think those kids would just not get their shots?

I think the majority of kids probably would not get their shots. I don’t know how vigorously the school health facilities promote these programs. It’s possible that some of the children might get it through the school system; I’m not quite sure how that works. . . . But I believe that the county has been the major provider of these services. I see a tremendous problem arising if those facilities are closed.

Q. Let’s talk about tuberculosis for a minute. You say it’s on the rise in the Valley?

A. It’s on the rise in the county. I don’t know what the specific figures are for the different regions. But it’s on the rise in the areas where the indigent live, because they seem to be less inclined to get the kind of care they need.

Q. Do you have any statistics on how much it’s increasing, the number of new cases?

A. I haven’t seen those figures. I get bulletins from time to time that mention that TB is on the rise.

Q. Another of the important functions of the Mid-Valley center is treating sexually transmitted diseases. The center both treats cases that they see and tracks down the sexual partners of people that they’ve treated, so that they can be treated also. Can you discuss what would happen if the STD clinic is closed?

A. I’m told that the STD clinic now has about 1,500 patient-visits a year. Again, if that service is lost, these people would either have to seek private care--and many of them can’t afford private care--or go to free clinics that offer some of these services, here and there. I don’t know how viable these free clinics are. I don’t know what kind of volume they can handle. The major thrust for this care comes from the county facilities. And when you lose the ability to discover and trace partners, then you’re in bigger trouble. Because now there’s going to be a rampage of more sexually transmitted diseases. You want to very, very vigorously try to control that. They also do HIV testing. . . . The Mid-Valley unit has 2,800 visits a year in their HIV-testing area.

Q. Do you see instances of preventable deaths occurring? Do you think it will reach that extreme?

A. Oh, sure. I see this in almost every area. Not only in infectious disease, but if you don’t recognize and treat diabetes, people with high blood sugar who don’t know they have diabetes, you can get critical situations with these people.

You’re going to have people who are going to have breast tumors missed, cervical tumors missed. . . . They have a large colposcopy clinic, which examines the cervix and the vaginas of large numbers of women, and they do Pap smears and they do early detection of cancer. So that’s an extremely important area. Once these diseases are out of control, then you’re going to have deaths.

Q. Mid-Valley also has pediatric services, prenatal services, family planning services. This is obviously an area with a very high birth rate, particularly among Latinos. Can you discuss that?

A. They take care of 2,300 pregnant women a year, and they provide prenatal care for these people. They also have a family planning clinic, 6,000 visits a year that involves about 3,000 patients.

With pregnant women, if you suddenly lose a center that gives prenatal care, then again you’re going to have tremendous burdens on the local hospitals, or these pregnant ladies who are ready to deliver are going to go long distances for their care.

And most of the time they’ll wind up in the local emergency room. They’ll go into labor, and they’ll show up at an emergency room. . . . A lot of them may have problems with their deliveries, with birth defects if they don’t get the proper care.

Q. The county says it can save $2.4 million by shutting down Mid-Valley alone and more than $78 million by shutting down all four health regional clinics and the 20 smaller clinics associated with them. Do you think that’s cost-effective?

A. Not at all.

The county may save those monies initially, but the problems that will arise from the care that these people don’t get is going to amount to much, much larger figures. When you have to hospitalize sick people who could have been otherwise cared for early, the cost of care rises immensely.

And when you have many of them who are lacking proper care for early diseases, it’s really a false . . . economy. It isn’t an economy at all. It’s going to cost many-fold what it would normally cost to have these facilities.