Documents Urge Earlier Denials of Care : Budget: County clinics are to begin refusing new and unscheduled patients Tuesday instead of on originally scheduled date of Sept. 1, according to department memos.

As the Los Angeles County Board of Supervisors began the process of slashing health services even further Tuesday, clinic employees were being told to begin turning away the sick and injured a month before the publicly announced closure date, health department documents show.

In adopting their $12-billion budget last week, the supervisors said they were postponing dramatic cuts in health services until Oct. 1, to give officials breathing room to continue their desperate search for more help from the state and federal governments.

But a “facility closure/contingency plan” submitted to the Board of Supervisors Tuesday established Sept. 1 as the date clinics and health centers would start rejecting new and unscheduled patients as a prelude to shutting down completely on Oct. 1. Other information being circulated by the county put the date for the new restrictions even earlier: A hot line for employees said the curtailment will begin Tuesday.

Other health department memos list Tuesday as the date clinics should reject new patients, those with unscheduled appointments and those transferring from other facilities. One, a “budget crisis bulletin” dated Aug. 7, tells clinics within the San Fernando Cluster of health centers to alert all employees not to accept any requests for appointments that come in on or after Aug. 15.

Also beginning Aug. 15, the bulletin said, “We are not to accept any patients for walk-in or immunization services.”

Although the supervisors have so far spared the county’s six hospitals, officials are planning to eliminate 75% of outpatient services now being offered at those facilities. The county has slated for closure 28 of 39 clinics and all of its six comprehensive health centers. The clinics that will remain open will provide only the most basic of public health services primarily designed to prevent the spread of communicable diseases.

Advocates were alarmed at the health documents, which indicate a brisker pace for the phasing out of many health services. They contended that the public has been lulled into a false sense of security, relying on the Oct. 1 date repeatedly cited by county officials.

Susan Fogel of the California Women’s Law Center said lives could be endangered because many people showing up at health clinics expecting immediate treatment will not get it, particularly new patients and those without appointments. As a result, her legal center and another advocacy group have threatened the county with lawsuits if they try to shut the clinics down so soon.

“There is a misperception that somehow Oct. 1 is some magic date, when the county will begin turning people away,” Fogel said. But as early as next Tuesday, many of those people needing treatment, she said, “will show up and be sent somewhere, God knows where.”

Fogel and other health advocates contend that the county Department of Health Services has exacerbated the situation by giving confusing and often contradictory answers to those who try to find out exactly when clinics will begin restricting access, and to whom.

“What we have stressed with the board [of Supervisors] over the past month is that they have to do adequate planning and they have to tell people. I absolutely don’t think people know this,” said Beth A. Osthimer, senior attorney at the San Fernando Valley Neighborhood Legal Services. “We are trying to do outreach and when people hear this they are flabbergasted.”

Health Services Department spokeswoman Toby Staheli said Aug. 15 had been an unofficial “discussion” date for turning people away from clinics, but said that as of Tuesday, the official date will be Sept. 1. As for clinics still telling employees to restrict access next week, she said: “Maybe they took those [earlier] discussions as policy. I’ll have to find out.”

Whether the clinics and comprehensive health centers close next week or in September, the legal advocacy groups contend the county’s safety level will drop far below those mandated by state and federal standards. The clinics provide services including life-saving drugs and medications, chemotherapy, high-risk pregnancy monitoring, treatment of broken bones and other traumatic injuries, biopsies and post-operative burn treatments.

In a detailed letter to the supervisors and Health Services director Robert C. Gates, a coalition of legal aid groups contend that the cuts would be a “virtual meltdown of the indigent care safety net in Los Angeles,” and that they intend to sue if and when they are implemented.

“If these cuts are put into place, there certainly will be every type of action taken to stop them,” said Fogel. “It is a terrible tragedy. The public is unaware of the magnitude of the consequences to the public health of all of Los Angeles County. It is also illegal; the county has a legal obligation to provide indigent health care.”

Health officials have had no comment on potential lawsuits. But in one of their memos to employees, they refer anyone requesting information on the closures to lawyers in the County Counsel’s office.

As concerns mounted about the timing of the health cutbacks, supervisors at their weekly board meeting Tuesday gave Chief Administrative Officer Sally Reed seven days to prepare a detailed blueprint for slashing another $25 million to $75 million in health-care services, on top of the more than $500 million in health cuts approved last week.

The supervisors said they needed to identify potential cuts now because of Gov. Pete Wilson’s veto last week of a bill that would have allowed them to siphon $75 million in transit funds in each of the next five years for health services. Wilson has suggested he would support a one-time infusion of $50 million for the county, but even that cannot be counted on until the state Legislature reconvenes Aug. 21.

The supervisors also approved the hiring of an independent cash-flow adviser to make sure they don’t run out of cash during the year, an unusual safety measure proposed by Reed because of the county’s precarious financial situation.

At least $300 million of the money in the supervisors’ annual spending plan is not guaranteed, and Reed said she wanted to make sure the additional strains on the county’s cash flow don’t result in it running out of cash. Details of who the board will appoint as a cash flow manager, or how much it will cost, were not available Tuesday.

During the board’s discussion on whether to hire a cash flow adviser, board Chairwoman Gloria Molina suggested that the supervisors instead appoint a blue-ribbon task force similar to one created to restructure the county’s health care.

The panel, she said, would take a broader view of the county’s financial affairs. Instead of simply monitoring its incoming revenues and outgoing expenses, it would analyze the entire budgeting process, develop strategies on downsizing the entire county government and work to improve ways of securing state and federal revenue--which outnumber county-originated dollars in its budget 5 to 1.

At least one supervisor scoffed at Molina’s idea. “They’d probably recommend another czar,” as the health crisis task force did, said Supervisor Yvonne Brathwaite Burke. “We don’t need another czar. We’re going to have nothing but czars and czarinas around here.”

The board put off discussion on that matter until next week.

Also Tuesday, Reed told the supervisors that the county is continuing to have problems in getting reimbursement from the federal government for earthquake repairs, including to their own building, the badly quake-damaged Hall of Administration.

The Times reported Saturday that the county government headquarters building was damaged nearly beyond repair, and that refurbishing it would be enormously expensive.

While the county has sought federal funds to help it perform earthquake-related repairs at its headquarters, as well as at hospitals and other buildings, Reed said the Federal Emergency Management Agency instead is insisting on pursuing a “patch and paint” approach that does not address structural issues.

“They consistently manage to divide by 50 or 100 to give us the number they think is appropriate,’ Reed said.