Problems Arise Over County Bid for U.S. Health Care Bailout

The state Medi-Cal policy chief told more than 400 community health activists Thursday that problems had developed with Los Angeles County’s bid for $364 million in federal aid for its hospitals and clinics, but declared that he still expects the request to be approved by the Clinton administration.

Ben Thomas, of the state Department of Health Services, said the problems center mostly on the county’s lack of a concrete plan for restructuring.

State and federal health care administrators reviewing the county’s bid want the county to be more specific in outlining its proposed health care overhaul plan, Thomas said.

The $364 million was conditionally approved in the fall by President Clinton but only with the stipulation that it provide for a restructuring that would solve the county’s chronic health care funding problems.

With the promise of the money, the County Board of Supervisors was able to scrap plans to close county health clinics and some hospitals. But the board’s mandate was to come up with a restructuring plan that places less emphasis on costly in-hospital care and more on a community-based primary care system. Since then, the county has been struggling to craft a plan that passes the muster of state and federal officials.

“We want to do this one time and no more,” Thomas told Los Angeles County health workers who gathered at Mount St. Mary’s College for a “health crisis summit.”

Thomas added that he believes the county’s application will be approved.

Walter Gray, an assistant director of the county Department of Health Services who has helped draft the county’s application, said county health executives are still working on the plan. “I don’t think it’s in trouble at all,” he said.

“What the federal government wants to know is how specifically we are going to provide the care. We have put together some additional material on that,” Gray said.

But he said the county effort was complicated by budget negotiations between congressional leaders and the president that could dramatically reduce money for local health programs. “It is an issue of committing to something before we know what they are going to fund.”

The public and private health care workers met at Mount St. Mary’s campus near downtown Los Angeles to explore new ways of coping with a system beset by shortages of funding, intense competition and growing numbers of uninsured patients.

The participants included members of the sponsoring group, Community Health Councils, a coalition of community groups with an interest in county health services, along with hospital administrators and representatives of health care associations, labor unions, churches and others.

*

Among the ideas discussed during the daylong series of meetings was the broader use of schools, fire stations and churches as places where residents could go for basic health care, such as immunizations or diagnostic exams from mobile clinics.

The proposal to use the churches was made by Dr. Reed V. Tuckson, president of Los Angeles’ Charles P. Drew University of Medicine and Science, the only primarily African American medical school west of the Mississippi.

“We came to this meeting in shock and certainly in anger,” said Tuckson, who brought the large audience to its feet with an emotional speech. Tuckson said he felt betrayed by state and county decision makers who were ready to close dozens of county clinics and several public hospitals before Clinton stepped in with the promise of federal aid.

Commenting that “we are too much alone . . . we are faced with problems that we can’t possibly solve,” Tuckson said churches could help by staying open five days a week, providing a safe after-school gathering point for children. The churches, he said, could be staging areas for dispensing limited kinds of health services.

A number of churches in Hollywood and central Los Angeles open their facilities to hospitals for use as clinics, but not to the degree proposed by Tuckson.

Broad agreement was expressed by members of the coalition for creating a semiautonomous county health authority that would have decision-making powers over health programs that now rest solely with the five-member Board of Supervisors.

“When we have the kinds of problems we are facing in our health care system, we need people who have the commitment and expertise to devote full time to solving them,” said Lark Galloway-Gilliam, executive director of Community Health Councils.

The supervisors rejected a similar proposal last month.