$4-Million O.C. Health-Care Cut Spares Elderly

Orange County supervisors decided Tuesday to retain a popular health-care program for senior citizens, but went forward with nearly $4 million in other cuts to the Health Care Agency despite vigorous protest from advocates for the disadvantaged.

During a lively public hearing, speaker after speaker implored the board to rethink cuts that they said could harm thousands of people and irreparably damage the county’s already fragile health-care system.

Still, emphasizing the gravity of the county’s bankruptcy, the board slashed services ranging from a Westminster health clinic serving 3,700 patients a year to a program providing follow-up care to hundreds of women with abnormal Pap smears.

The hearing was the last step in a dramatic paring process, allowing officials to slash the health agency’s 1995-1996 county funding by $12.1 million, or 30%. Though most of the cutbacks in health care already had been approved, state law required public hearings before about a dozen additional programs serving the indigent could be touched. The final cuts approved Tuesday will save more than $1 million in county funds and mean the loss of about $2.7 million in state revenue.

Ron DiLuigi, assistant Health Care Agency director, warned that the agency could go no further without jeopardizing $100 million more in state funds. As it stands he said, “the longer-term impacts will be felt for many years to come.”

Bombarded by protest from elderly residents and their advocates, board members held back when it came to the proposed cut to the ElderCare program. At a cost to the county of $131,000 annually, the program provides health screening, referrals and education to more than 4,500 low-income or uninsured elderly people at 30 senior centers across the county.

“The cost of ElderCare is modest considering its contribution to public health,” said Shirleen Jones, assistant administrator of an adult day-care agency. “From a public health and an economic standpoint, ElderCare is a good deal.”

After the outpouring of support for the program--including a concerted letter-writing and telephone campaign over the past several weeks--supervisors rejected the proposal to ax it.

“I just don’t even know why it’s (in) there,” said Supervisor Roger R. Stanton of the proposed cut, after Supervisors Gaddi H. Vasquez and William G. Steiner expressed reservations about slashing the program.

Those who made pleas on behalf of other services, however, went home disappointed.

Gone is the Westminster health clinic that served 3,700 women and children each year, and a Pap smear follow-up program, which served 900 women annually and provided cancer screening. Cut back is a program providing dental services for HIV patients and another program that provides screening and treatment for sexually transmitted diseases.

The board also reduced staffing in tuberculosis and immunization programs, and limited public health nurses’ activities in the field. Prenatal care and follow-up visits to new mothers will be taken over by the private sector.

The programs will be closed or reduced over time rather than abruptly, officials said.

The strong presence of older people in supervisors’ chambers, and their tendency to express themselves at the polls, may have saved ElderCare, said Barbara Talento, chairwoman of the United Way Health Care Council. Impoverished people, pregnant teen-agers and others who rely on publicly funded health services often cannot muster the same show of force, she said.

“When people can lobby they make more of an impact than people who don’t show up,” Talento said.

She said she was “glad that ElderCare got the funds. It wasn’t all that much (money) and they do wonderfully good work. . . . But I’m bummed that other programs aren’t viewed with as much favor.”

Some advocates suggested the county explore alternatives to the large-scale cutbacks, including the possibility of whittling the emergency cushion of $19 million that Chief Executive Officer William J. Popejoy insisted on including in next year’s $256-million spending plan.

“We are in a crisis!” said Jean Forbath, who sits on the board of a Costa Mesa charity called Share Our Selves. “We’ve been told for years it’s necessary to have a $20-million cushion. Now that the budget’s $256 million, why do we still need a $20-million cushion?”

Stanton asked the county administrative office to look into the possibility of reducing the county’s emergency cushion.

Many at the hearing, which drew more than 100 people, chastised the board for what they called shortsighted fiscal policy. Several speakers pointed out that Orange County already spends less per capita on health care than any other California county with a population of more than 1 million.

“We urge you to consider the inevitable long-term repercussions of seeking minor savings today by depriving those most vulnerable residents of our community of basic health” care, said Esther De Leon, program director for the Public Law Center, which provides legal aid to poor people. She said the county risked “major public health and financial disasters which will affect each and every Orange County resident tomorrow.”

But Board Chairman Vasquez warned the audience early on that a certain amount of pain is unavoidable.

Clearly frustrated, he asked one of the speakers, “Do you know how much we’ve had to cut over the last 30 days? The only reason I ask is because your statement, that we should look for alternative sources . . . is so easily made. We are looking under every stone, under every possibility available to us, but we are dealing with a very, very adverse and a very difficult situation.”

Supervisor Marian Bergeson, who supported restoring the ElderCare program, nonetheless expressed concern that so many other programs could not be spared. She vowed to remember the sacrifice of these services in the future.

“We’re not going to let these programs that affect the lives of so many go unrecognized in future budget deliberations,” she said.