Patients Fight a Grim Prognosis : Courts: Plaintiffs in federal lawsuit challenging health care reductions foresee their access to doctors denied. County officials say it’s a matter of choosing its own survival over non-emergency services.

Who will pay for Marti Villery’s chemotherapy treatments?

Who makes sure that young Alex Flores, suffering from Down’s syndrome and other health problems, can see his doctors and get his medications?

And where will these patients and many, many more who depend on Los Angeles County’s vast health system go when the doors close in five weeks?

Answers to these vexing questions are at the heart of the massive federal lawsuit filed by Villery, Flores and other patients challenging sweeping reductions in the county’s health system. And they virtually define the national debate about health care.

The case of the patients--who presented the human face behind the lawsuit to reporters Friday on the steps of County-USC Medical Center--boils down to a simple question: Does Los Angeles County bear the ultimate responsibility for providing health care to poor patients?

Not far away, at the headquarters of the nation’s largest county government in Downtown Los Angeles, the questions are different.

It’s how the county can survive when it doesn’t have the financial wherewithal to provide the kind of care these patients have been receiving.

Ultimately, a federal judge is being asked to decide life-and-death questions that the President, Congress, the governor and state lawmakers have been unable to answer.

Patient rights issues have been in the courts for years, but these patients have a powerful new ally in the Americans with Disabilities Act, the cornerstone of the case against the county and the Board of Supervisors.

“We’re talking about thousands and thousands of patients facing serious disability and death,” said Beth A. Osthimer of the San Fernando Valley Neighborhood Legal Services, the lead attorney in the suit.

To county doctors who appeared with the patients outside the nation’s largest public hospital, the prospects are grim.

“The disaster that is about to occur is not only an economic disaster, it is a personal disaster to everyone who’s going to have access to health care denied,” said Dr. Cynthia Stotts, a county pediatrician.

Conjuring up the dark images of a science fiction movie that painted an especially bleak future for Los Angeles, Stotts said: “This is a forerunner to ‘Blade Runner.’ ”

In equally stark terms, county officials fear that unless the sweeping reductions in health centers and clinics and outpatient services at hospitals are enacted, the county itself cannot survive financially.

“Given its financial situation, the county cannot be expected to undertake to provide health care for every man, woman and child who wants it,” said Supervisor Zev Yaroslavsky. “If the U.S. government cannot provide it, if the state government cannot provide it, what makes anybody think that a county teetering on the brink of financial oblivion, let alone a healthy county, can provide it?”

Yaroslavsky said the issue goes far beyond Los Angeles: “Poor people without health insurance, that is a national responsibility. That is a societal responsibility.”

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Those are issues being debated in major cities across America, as tax-cutting lawmakers stem the flow of money to social programs and businesses back away from any notion that health care is a right of every American.

Increasingly in recent years, the steady stream of federal and state dollars for health care has been drying up, leaving local government with the responsibility to either put up more of its own dollars or close many of its health facilities, leaving poor patients to find care on their own.

“Everybody is going to be watching Los Angeles,” said Drew Altman, president of the Kaiser Family Foundation, a national health think tank and research organization.

He said health-care downsizing is a national problem. The problems Los Angeles County is experiencing are rising to the surface in cities elsewhere in the nation.

“All over the country hospitals are being downsized,” he said. “The question at this point is not that the safety net is shrinking, but how much of it can be saved.”

Faced with an enormous, $655-million deficit in health services, county supervisors on Aug. 1 adopted a budget that requires the closure of six comprehensive health centers, the shutdown of 28 community clinics and a 75% reduction in outpatient services at county hospitals.

It was a choice no one liked, but all five supervisors voted for.

“The dismantling of the county’s safety net cannot occur,” Board Chairwoman Gloria Molina said. But without more financial assistance from Sacramento and Washington the county may have no choice.

Determined to stop the cuts scheduled to take effect Oct. 1, anti-poverty lawyers filed a class-action lawsuit Thursday on behalf of “all residents of Los Angeles County with insufficient resources to pay for their medical needs who depend and will depend on the County of Los Angeles . . . for necessary medical care.”

They alleged that the board’s actions will affect between 800,000 and 900,000 county residents who visit their doctors at least three times a year.

But the county’s lawyers plan to wage a vigorous defense. “There is just not enough money to provide the level of services the plaintiffs desire,” said Ada Treiger, senior deputy county counsel.

Treiger said supervisors acted within their authority in deciding to allocate scarce dollars to maintenance of essential emergency services, instead of non-emergency care. “They didn’t violate any law.”

In the suit, as well as in interviews, the patients described in graphic detail problems they face as the county begins dismantling its walk-in clinics. The clinics provide the ongoing services critical to those hardest to treat--diabetic, heart and cancer patients and those suffering from many other lingering maladies that require regular care.

Villery, lead plaintiff in the suit, is a good example. A bright, attractive 40-year-old secretary who attended UCLA for three years, she said at the news conference that she relies on the county for chemotherapy treatments required to combat breast cancer. She worked all her life until the intensive chemotherapy treatments forced her to quit.

She said the chemotherapy treatments brought on nausea, caused the loss of all her hair and required regular trips for treatment and occasional hospitalizations. She said the treatments also weakened her heart.

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Even if the cancer goes into remission, which she will not know until later this month, Villery, who is receiving public assistance and was forced to move in with her 21-year-old daughter, will require constant comprehensive checkups for the next five years, her doctors say.

As for Flores, the 17-year-old is dependent on his mother and physicians at County-USC. Flores, who suffers from Down’s syndrome and related health problems, was born at the Eastside hospital and has been a patient since.

Although his treatment is paid for by the state’s Medi-Cal program, “other doctors have refused to care for Alex because they cannot provide the treatment that he needs,” the suit says. “If the county implements the service reductions, Alex will be left without any medical care.”