L.A. Schools in Line for U.S. Health Funds

Plans to pump up to $50 million into Los Angeles schools to provide medical care for children who otherwise might receive none were announced Thursday by the county Board of Supervisors.

The board proposes to enter an unusual partnership with the Los Angeles Unified School District and the federal government to beef up health services, so that minor maladies such as ear infections and sore throats are not left to become serious--and costly--illnesses.

More than a third of the children in the mammoth district are without health insurance. When they get sick, those 271,000 children are sent home to be treated by doctors their families can’t afford or to endure the hours-long wait at a public health clinic.

To remedy that, Supervisor Zev Yaroslavsky said, he has received tentative approval from Washington to expand the county’s own public health network. The plan would use as much as $50 million a year in federal funds for improved school health services.

That way, sick students can be treated quickly by nurse practitioners or doctors at schools or in nearby clinics and hospitals instead of--or before--being sent home. Immunizations also will be done routinely at the schools.

If all goes as expected, county officials say, the program will be operating throughout the school district by July 1, the beginning of Washington’s fiscal year. The federal government already has approved somewhat similar arrangements in more than a dozen states, including Michigan, Florida, Pennsylvania, Texas, Kansas and Arizona. The number of children in need at L.A. Unified exceeds the total student population in the latter two states combined.

“What we are doing is providing a medical home for these uninsured kids,” Yaroslavsky said at a morning news conference attended by a number of county and school district officials--and beaming school nurses. “Instead of sending them off to find health care, we’ll be bringing health care to them.”

Los Angeles Unified Supt. Ruben Zacarias praised the effort, saying that many of the district’s students often go without medical care because the tiny core of nurses and doctors who work for the district are far too overwhelmed to do anything but identify sick children and send them home.

In recent years, district officials have moved to expand health care in a few “pilot” schools, from providing basic medical screening and first aid to administering inoculations against communicable diseases, such as tuberculosis and hepatitis. Nurse practitioners also treat common ailments such as head lice, earaches and sore throats, said Assistant Supt. Sally Coughlin, who is in charge of student health and human services.

But, at the moment, that more comprehensive system only operates in about two dozen of the district’s 668 schools, some of which are served by mobile vans obtained as part of the earthquake relief effort.

“It’s been successful,” Coughlin said Thursday. “It’s just so small.”

Many of those pilot clinics are only open part time, Coughlin said, and nurses there lack the time and resources to address students’ needs. “Can you imagine every school providing immunizations?” Coughlin asked after Thursday’s news conference, with a broad smile. “We’d get to all those little ones.”

In the schools, the news was greeted with the same kind of excitement.

At Holmes Avenue Elementary School in southeast Los Angeles, nurse practitioner Helga Magar said she hopes to expand the hours of her tiny clinic from three mornings a week to five, and perhaps stay open in the afternoons, evenings and weekends.

Right now, though, it’s just Magar, and another nurse who helps out two mornings a week, facing the crushing load of children who come in with everything from colds and flu to illnesses so serious that they can be fatal if not diagnosed and treated quickly.

“I just love the idea!” Magar said of the proposed expansion. “There is such a need that nobody knows unless you’re there. They have so many problems.”

The proposal may not be without controversy: The district does provide some reproductive health services to teenage girls, but only with parental consent. Coughlin said, however, that school policy on the issue would remain the same.

Unique Approach

Yaroslavsky described the proposal Thursday as unprecedented, saying it is the first time any county in the United States has teamed up with a local school district to tap federal funds for such a partnership. The cooperative ventures that have worked particularly well in Pennsylvania, Kansas, Texas and Arizona are between the state and school officials, he said.

Yaroslavsky went to Zacarias with the idea several months ago, after discussing it with federal health officials who are overseeing the county’s billion-dollar overhaul of its vast health care system.

In 1995, Los Angeles’ bloated hospital-based public health-care bureaucracy almost went bankrupt and threatened to take the county with it. As part of a federal bailout, the Board of Supervisors has since been receiving Washington’s aid to transform its system from one based on in-patient care at hospitals to one emphasizing preventive care at community-based clinics.

As part of that effort, the federal Health Care Financing Administration promised to match every dollar the county spends on clinic-based health care.

With that in mind, Yaroslavsky says, he and other county officials proposed that since schoolchildren are, essentially, covered by the county health system, that school-based clinics also receive matching funds.

Since the district spends between $30 million and $50 million on health care, it would be eligible to receive that amount in matching federal funds if federal officials approve the county’s application, Yaroslavsky said.

“We have talked to them, and they are very receptive to this,” he said. “They just need an application.”

Sally Richardson, director of the Center for Medicaid and State Operations in Washington, said her agency has been favorably disposed to such proposals because “schools are where most recipients of [federal health benefits] are found. This sort of program has the advantage of reaching our clients where they are.”

In fact, Richardson said, “most states are using federal education funds for school health care. These arrangements are a more appropriate use of funds.”

On Tuesday, Yaroslavsky’s proposal will be voted on by the Board of Supervisors. The school board will take up the issue Oct. 27. Both are expected to approve it unanimously.

“How can we not do something about the health of our young children?” Zacarias asked. “Especially when health plays a key role in a child’s ability to learn.”