Rally Calls for End to Health Care Delays

As Los Angeles County and the state and federal governments inched closer to a deal to fund the nation’s second-largest public health system Tuesday, more than 150 doctors, workers and patients marched on the county Hall of Administration demanding a swift end to the delays, which have thrown their futures in doubt.

“I’m here to talk about a crime,” Beth Osthimer, a lawyer with San Fernando Valley Neighborhood Legal Services, said to a cheering crowd of doctors, workers and uninsured patients. The government is “literally swimming in dollars . . . yet here today we’re talking about clinics, public and private partners and patients drowning.”

A waiver of federal Medicaid rules, which allows the county to be reimbursed for outpatient care, expires in two weeks. If it is not extended by federal officials, the county supervisors will be forced to close a $250-million deficit, possibly by slashing health services to the region’s nearly 3 million uninsured patients.

Mark Finucane, the county’s director of health services, told supervisors Tuesday that after a 12-hour negotiating session in Washington on Monday, the county is close to getting some of the waiver. “There are a lot of details that would have to be worked out,” Finucane said. But county staff members hope the deal will be closed next Tuesday at another meeting in Washington.

Negotiations had been stalled for months because the state hesitated to chip in any of its $13-billion surplus to boost funding for the county health system’s attempt to transfer its focus from hospital to ambulatory care. On Monday, according to officials, the state offered to pay $60 million annually to that end, matching a $60-million pledge from the county. County officials Tuesday were analyzing the state’s complex proposal to see if it added up.

Still, county officials remained nervous. They have frozen all new health department spending, including outpatient contracts with a network of more than 100 private clinics that was created after the first waiver in 1995 saved the county from bankruptcy.

Supervisor Mike Antonovich said he had spoken with Grantland Johnson, the top state health official, on Monday and what Johnson said gave him little hope that the state would contribute its fair share to the waiver.

President Clinton and Gov. Gray Davis “appear to be holding their breath waiting for the other to give and meanwhile the ship is sinking,” Antonovich said. “We’re going to end up in shark-filled waters.”

Indeed, despite reports of progress in the negotiations, supervisors went behind closed doors Tuesday afternoon to discuss possible health cuts, in case they do not get the waiver. Representatives of uninsured patients and clinic operators who had waited hours to speak to the board asked supervisors to discuss at least some of the matter publicly, but had to settle for a quick presentation from Finucane and comments from Antonovich.

It was the second consecutive week that supervisors had gone behind closed doors to discuss the waiver, citing a provision of the state’s open-meetings law that allows elected officials to privately discuss matters that involve litigation. County lawyers argue that because the board may cut contracts with private entities that could sue them, it is allowed to talk behind closed doors.

But Mandy Johnson, president of the Community Clinics Assn., said she is unaware of any planned litigation. And Osthimer, an attorney specializing in health issues, said she has not advised supervisors of any intent to sue them. Lawyers specializing in the 1st Amendment contend that public bodies must cite specific threats of lawsuits to go into closed session.

Kathy Ochoa, a health care analyst for the union that represents many medical workers whose jobs are at risk, criticized the board for going into closed session. “The public is shortchanged in any ability to understand the parameters of what is under discussion,” she said.

Before the board went into closed session to discuss possible cuts, which health staff said could not be legally implemented until August, it heard more than an hour of pleas from uninsured patients that it not slash services.

“Some of us are making just $5, $5.75 an hour,” said Marta Melgar, a Pico-Union mother of four and housecleaner who is treated at a clinic with a county contract.