O.C. Health Cuts Hurt Elderly and Poor : Bankruptcy: Private providers say they can’t possibly undo the damage wrought by fiscal crisis.

It seems so small in the scheme of things, a blip in the county budget, yet Bill Swartz can’t fathom its loss. After all, the tiny Eldercare program saved his life.

Three years ago, Swartz, now 60, was playing the classic diabetic-in-denial, downing pies, cakes and assorted sugar-laden goodies like there was no tomorrow. There wouldn’t have been, he believes, if an itinerant nurse visiting his senior center hadn’t begun monitoring his blood sugar, insisted on radical dietary reform and hustled him into a health-education group.

But if all goes as planned, Cheryl Lowes, the woman he glowingly describes as “a godsend” to low-income and uninsured senior citizens like him, won’t be coming to his senior center much longer. Her job will end June 30, as will those of four other roving nurses who provide health screening, education, referrals and friendly but firm nudges to thousands of elderly people across the county.

The $131,000 cut to Eldercare, like so many other county health programs, comes not because it is unimportant, nor because it is inordinately costly, but because the county is bankrupt. No longer, officials say, can the county afford this ounce of prevention.

This sort of slashing, critics say, puts the health care “safety net” the county has so carefully woven over the years, in concert with private providers, at risk of unraveling. And, with no public hospital to fall back on and county-funded services cut to the core, private providers say they can’t possibly undo the damage the county bankruptcy has wrought.

Unless the county restores some of the money it has lopped from primary care and prevention, critics warn, people will get sicker, diseases will spread faster and farther, and more patients than ever will receive their care at the last minute, when its price is highest--in hospital emergency rooms. One way or another, they say, everyone will pay for that.

“My worry is in the long range, we will have problems with every aspect of health-care delivery,” said Barbara Talento, chairwoman of United Way’s Health Care Council. “That’s not just affecting the medically indigent; those things flow over into the larger community, and that’s scary.”

These days, few programs are sacred. Even basic patient services, touching the lives of thousands of county residents, are being targeted in the budget cuts.

Gone, if all proceeds as expected, will be a health clinic in Westminster providing immunizations, family planning and children’s checkups; a program for women with abnormal Pap smear results; a series of services to people with chronic mental illnesses. Cut will be payments to hospitals and doctors for indigent care and programs for the impoverished, the young and the elderly.

“Yes, it’s a terrible bankruptcy,” said Dottie Andrews, who runs a nonprofit perinatal outreach program. “But is it so terrible that we have to eliminate these small kinds of things that make such a difference in people lives? Or that could mean a person’s life?”

The fate of some of these services is already sealed. Others, such as Eldercare and the Westminster clinic, are to be discussed Tuesday at a Board of Supervisors’ hearing, which is required by state law before a final decision is reached.

But no one is holding out much hope, and some forecasts are dire.

“The impact is going to be felt by those least prepared to deal with it, the poor and the disenfranchised,” said Dr. Hugh F. Stallworth, the county’s public health officer, who throughout the bankruptcy crisis has chosen his words cautiously. “It’s going to be bad, very bad.”

This “puts us at the razor’s edge of being able to deliver services to the community,” said Timothy P. Mullins, mental health and drug abuse services director, whose division took about half the $12.1-million cut sustained by the Health Care Agency for the next fiscal year.

The impact will be magnified by the loss of millions of dollars in state revenue that had supported the slashed programs. In the cutbacks to be discussed Tuesday alone, the county would lose $2.8 million in state money for the $1.2 million it proposes to cut.

County supervisors say they have no choice but to spread the fiscal pain. The 30% cut to the Health Care Agency’s county funding for 1995-96, in fact, is considerably less than the overall reduction of more than 40% for the county general fund.

“There is no question, with the enormous reduction in the budget, programs are going to be hurt. They are going to be hurt very badly,” said Supervisor Marian Bergeson. But “the bottom line is, it’s not business as usual. It’s such an overwhelming crisis.”

Bergeson said the county will grab whatever other opportunities it can to find additional resources, but it is up to cities and the private sector to take on some of the burden the county can no longer carry. In some cases, the Health Care Agency has managed to reduce its costs by shifting programs to the private sector, such as prenatal services to Medi-Cal patients and home health-care services.

Bergeson believes there is room for more of that. “I think (the crisis) requires people to sit down and say, ‘This is a program we want to keep. We’re going to find a way to make it happen.’ ”

Don’t count on it, say charities and nonprofit health-care providers.

“I know the county is hoping somebody else is going to pick up the slack,” said Talento of the United Way Health Care Council. “Well, I’ve spoken to those ‘somebody else’s,’ and they don’t have the funds to do that.”

Talento said the county’s nonprofit community clinics only recently, through cutbacks, emerged from a financial crisis of their own. And hospitals, already burdened by losses from uncompensated care, are in no position to pull the county health agency out of its mess, she said.

One of the largest cuts, if approved, will come in compensation to hospitals and physicians for Medical Services to the Indigent. The $33-million program would take a $1-million hit. The county is proposing to make fewer patients eligible for the program, but providers say they will end up caring for the same pool of patients, regardless of their eligibility.

In a speech March 22 to the Assembly Select Committee on the Insolvency of Orange County, UC Irvine Medical Center Executive Director Mary A. Piccione said Medical Services to the Indigent cutbacks would reduce access to care, endanger outpatient programs, and increase the need for costly inpatient stays.

“We will have a fragmented, costly and chaotic system for MSI patients,” Piccione said.

In general, she said, “Any further cuts in the MSI program would jeopardize (physicians’ and hospitals’) ability to provide services.” Echoing the sentiments of many health providers in the private sector, she dubbed the county’s cuts overall “penny-wise (but) pound-foolish.”

Andrews, who runs the nonprofit Maternal Outreach Management System, or MOMS, believes poor women and children will be the first to suffer, and some, she fears, will die. Closing the Pap smear follow-up clinic, for example, will mean some women will not get treatment until they have cervical cancer, she said.

About 900 women a year are examined in the program, which costs the county $107,000 annually. By the county’s own estimates, as many as 90% of the patients will experience “extreme difficulty” in getting alternative care.

“ ‘Extreme difficulty’ in follow-up can result in death,” Andrews said. “This (expense) is a little thing. What does cutting it save?

“I realize we’re not talking about large numbers of women--it’s not lots of doom and gloom. But we have to worry about the one or two or three women who may not be diagnosed soon enough. Do we not care that we lose people?”

Nowadays, when nurse practitioner Linda Dunzo gazes at the women and children crossing an overpass, on foot, to the county’s Westminster clinic, she worries what will become of them.

Some, no doubt, will take the bus to other public clinics in Costa Mesa or Santa Ana. Others will scrape up the money to pay private doctors or will be seen in community clinics. But all too many, she fears, will not get care for themselves or their children at all.

“They’ll just be lost,” Dunzo said.

Last week, clients arriving for an immunization clinic, leading children by the hand and pushing babies in strollers, wondered aloud where they would go for medicine. Some berated the Board of Supervisors; others almost spat the name of former county Treasurer-Tax Collector Robert L. Citron.

“Why should we pay for his mistakes?” said Esther Rodriguez, who had brought her 8-month-old grandson, Connor, for a checkup. “It’s totally unfair.”

Rodriguez, 59, has custody of Connor, who she said was born addicted to cocaine. She recently had surgery on her shoulders and would have difficulty riding buses.

“This would really create a hardship for me,” she said. “Now, I can walk to the clinic. But to take the bus to Santa Ana takes an hour and a half with all the stops and transfers--and to do it while carrying a baby? Impossible.”

Over the months, she has attended well-baby sessions at the clinic and received coupons for baby formula and medicine.

“At first . . . he was just a tiny little thing and he had such a hard time,” she said. “But look at him now,” she said, pointing to the chubby, smiling boy.

County Public Health Officer Stallworth said the budget constraints forced him to propose closing one of the five county clinics, and shutting the Westminster location was deemed least disruptive. The savings: $137,000.

It may put services beyond reach for some of its 3,700 patients each year, he said, adding, “It is probable that some will not receive care.”

In the area of mental health, critics say, the effects are perhaps worse because the public mental health system, long the victim of budgetary belt-tightening, was very lean to begin with.

“I didn’t have any prevention programs” to cut, said Mullins, the county’s director of mental health and substance abuse. “My prevention programs went in 1986.”

Most of what’s left to be slashed are core services: $328,000 in funding for homes serving chronically ill patients; more than $1 million in cuts to inpatient and residential care. Outreach programs to the homeless have already taken a hit.

Some patients will remain in high-cost hospitals longer because lower-cost beds are gone, officials say. Others, who may be unstable, will remain on the streets, they said.

Sparr Village, a 29-bed transitional home in Santa Ana for the mentally ill, has lost its county contract and will subsist on federal funds residents receive, program director Patricia Daniel said. But a third of its staff has been laid off, there are fewer outings and group sessions for residents, and seriously ill patients will have to be referred to locked facilities. Another 17-bed program for mentally ill people with substance abuse problems, and a six-bed home for Sparr Village graduates, will probably close.

“They cut back on staff quite a bit here,” said John Greenhalgh, 34, a Sparr Village resident who said he is manic-depressive. “There’s less people to talk to when you need help.”

Without outreach, many mentally ill people will remain unaware of treatment options or too fearful to pursue them, said John Seltzer, a recovery specialist at the Garden Grove Activity Center, which helps homeless, mentally ill people to develop coping skills.

“You’re going to see a lot more people with shopping carts, muttering to themselves,” Seltzer said. “They’re going to end up stepping on people’s toes. They’ll end up in the jails or in the system (anyway).”

Seltzer, 26, knows the perils of the streets firsthand. Several years ago, he was homeless, suffering from severe depression.

If he had not been referred to the activity center, he said, “I don’t think I’d be sitting here talking to you right now. I probably would have killed myself.”

Times staff writer Lisa Richardson contributed to this report.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Catalogue of Cuts

To carve $12.1 million from the 1995-96 county Health Care Agency’s funding, numerous programs and services must be reduced or eliminated. In some cases, this will mean loss of additional state and federal funding. Also, the Health Care Agency must contribute $3.5 million it has coming in state revenue to the county general fund. Some of the major reductions, in thousands: *

REDUCTIONS Category: County savings Indigent medical care: $1,000 Mental health inpatient/residential care: $1,000+ Reimbursement for private medical care: $575 Jail medical staff: $573 Custody medical contracts: $542 Services in sexual disease clinics: $194 *

ELIMINATIONS Category: County savings Home health agency services*: $792** Perinatal outreach: $430** UCI mental health residency program: $374 Transitional mental health home and nine staffers: $328 Prenatal Medi-Cal services*: $223 Westminster maternal/child health clinic: $137 ElderCare: $131 Abnormal Pap smear follow-ups: $107 * To be transferred to private sector

** State or federal revenue

Source: Orange County Health Care Agency