Groups Assail County Health Care Reforms

Patient-advocacy groups say Los Angeles County’s hastily drawn plan to reform its health system is inadequate because it fails to restore budget cuts that left thousands of poor people unable to get proper care for diabetes, cancer and other chronic diseases at county-run specialty clinics.

County supervisors slashed $100 million from scores of the hospital-based clinics during last fall’s budget crisis, forcing some to close and others to limit patient visits.

The county plans to pump $20 million back into the clinics as part of its scheme to overhaul the nation’s second-biggest public health system. But advocacy groups say that is not nearly enough and jeopardizes the health of many people who need ongoing care from specialists in oncology, neurology, orthopedics and other fields.

The advocates’ complaints are being weighed by the U.S. Health Care Financing Administration, which must decide whether to approve the county’s request for a waiver of federal rules so it can remake its $2.3-billion-a-year network of hospitals and neighborhood clinics along the lines of a private HMO.

County officials hope to stave off future financial crises by moving patients out of expensive hospitals and into neighborhood primary-care clinics.

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In separate responses to last fall’s near-collapse of the system, President Clinton pledged $364 million in federal bailout aid to keep it afloat and county supervisors laid off more than 2,500 health workers, including doctors and nurses.

A spokeswoman for federal Health and Human Services Secretary Donna Shalala said federal officials plan to issue the county a “comfort letter” as early as today saying that they are likely to approve the waiver. The rule change would allow federal dollars now spent in county hospitals to be used to deliver care through neighborhood clinics.

But the spokeswoman cautioned that the letter will not constitute formal approval of the waiver, and county and federal negotiators remain divided over crucial details that could affect the scope of the reforms.

In a March 25 letter to the federal health care financing agency, six patient-advocacy groups said the reform plan “fails to restore, at any meaningful level, hundreds of thousands of annual outpatient visits for some of the most chronically ill and/or disabled county residents who require specialized treatment.”

Nearly 300,000 specialty clinic visits were erased by budget cuts, according to county figures. Since patients often have multiple clinic appointments each year, county officials could not say how many individuals are affected.

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But Beth Osthimer, an attorney for San Fernando Valley Neighborhood Legal Services and one of the letter’s signers, said the number of people affected was “thousands, if not hundreds of thousands.”

Fourteen clinic specialties were eliminated at Olive View Medical Center in Sylmar, more than at any other hospital, according to county figures. Among the clinics shut down were those offering care in vascular surgery, diabetes, endocrinology and dermatology. An additional 19 clinic specialties limited patient appointments.

Dr. Irwin Ziment, Olive View’s acting medical chief, said patients previously seen once a week may now be seen twice a month, while others who visited a doctor once every two months may be forced to wait six months.

Ziment said physicians were “taking a calculated risk” with some patients by stretching out appointments. He used the example of an asthma sufferer who could become unstable between appointments and wind up in the emergency room.

But Ziment said the hospital was trying to offset risks by making more telephone lines available for patients to stay in touch with doctors, even if they cannot get frequent appointments.

Lark Galloway-Gilliam, executive director of Community Health Councils Inc., another patient advocacy group, said the clinic cutbacks could produce situations in which patients would be diagnosed with serious illnesses, such as breast cancer, but have difficulty getting chemotherapy or other follow-up treatment.

“I think they’re rushing to go to this primary care” in neighborhood clinics, she said. “To get the support of the federal government, they said ‘We’re going to move everything to primary care.’ ”

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County Department of Health Services chief Mark Finucane said he agreed that the cuts create a gap in the county medical network, the provider of last resort for 2.6 million residents without health insurance.

But he said it’s “too early to say” how many clinics will remain closed or downsized as county planners refine the plan’s details.

The advocacy groups also charged that the scheme will create a “two-tier system” of health care for the poor, with more services going to those insured under the state’s Medi-Cal program than those with no insurance. Medi-Cal is a major source of health funding for the county.

Finucane denied that the county is trying to walk away from the uninsured, saying it remains committed to maintaining a medical safety net for those unable to pay for care.