Supervisors Fund Medical Programs

After spending nearly four hours speaking of the need for tough decisions to close a dangerous deficit in its health department budget, the Board of Supervisors on Tuesday separately voted to pump $86 million into a package of politically popular medical programs.

The expenditures, made late in the afternoon with little discussion, contrasted sharply with the board’s earlier rhetoric about the need to cut the troubled health department. The department faces a $506-million deficit in five years, similar in size to one that almost dragged the county into bankruptcy in 1995.

As they have for the last two months, the supervisors put off any decision on how to solve the health department’s financial woes, county government’s most crucial problem. They did suggest, however, that they are moving toward layoffs and other cost-cutting measures early next year.

But before delaying action, they bashed bureaucrats and unions and even themselves for being obstacles to reform.

“What we’re also saddled with is a Board of Supervisors who talk tough . . . but cut our clinics, cut our hospitals, we go out screaming in the streets,” said Supervisor Gloria Molina, who has fought cuts to the county hospital in her own district.

Molina was the sole supervisor to vote against the new expenditures in anti-smoking and other public health programs. The new money comes from the more than $100 million the county rakes in annually from its share of the national settlement of lawsuits against the tobacco industry. Molina had wanted all the money to be saved to deal with looming deficits. Under the plan approved by the board, the remaining funds are put in a reserve.

Health advocates and other supervisors argued that the programs will actually save money by cutting smoking, which can lead to severe illnesses that cost the county far into the future.

Also, said Supervisor Zev Yaroslavsky, the county’s filing of a lawsuit against the tobacco industry four years ago “wasn’t with the intention of raising money to prop up the existing system. . . . The last thing we should do with that is use it to avoid the responsibility we have for restructuring the system.”

Tuesday’s chaotic meeting encapsulated the reasons the county, after 10 years of trying to balance its books, still finds itself staring down a crippling deficit in its $2.4-billion health department.

The county has received two bailouts from the federal government, the first only after supervisors were forced to lay off 2,900 workers and found themselves on the brink of bankruptcy in 1995. The latest $1.2-billion grant, won in June, begins drying up in three years before ending in 2005 and leaving the county $884 million in the hole.

Although supervisors have known about that looming deficit since June and have spoken repeatedly of the need to start cutting quickly, they delayed until Tuesday considering the health department’s plan to balance its budget.

Health director Mark Finucane proposed a wide-ranging plan that includes 2% staff cuts every year, exploring the use of contractors for key medical work such as emergency services and lab operations, and closing an unspecified number of clinics in the hope that private operations will pick up the county’s patients. If necessary, he proposes further cuts of as much as 10% of the agency’s staff.

Even with all the cost savings in Finucane’s plan, the department will still face a $129-million deficit in five years.

“The numbers are so big, the environment is so harsh and our options are limited,” Finucane said.

But supervisors--mindful that the last time Finucane tried to cut health costs he fell tens of millions of dollars short--peppered him with sometimes angry questions and demanded more details on his plans, especially about potential service cuts.

“We’re just getting more delays, more delays,” Supervisor Mike Antonovich said.

“Why should I trust you?” Molina pointedly asked Finucane. She asked him repeatedly why he had failed to provide her with information she requested last week that would show how he would actually make the cuts.

In the end, supervisors told Finucane to plan to enact his program but to return in December to answer more than a dozen questions from them on how it would be implemented.

But even as the board made it clear that it is prepared to lay off county staffers, union members urged supervisors to hire more nurses and not cut their jobs.

“The director of health services will have to begin [layoffs] with his own management staff,” said Kathy Ochoa, a health care expert for the union that represents most health department staffers.

Simultaneously, representatives from the American Heart Assn. and other groups pushed for increased public health funding out of the tobacco settlement fund.

“Every time we curtail anti-smoking activity in Los Angeles County, the smoking rates and the cost [of treating cigarette-related ailments] go up,” said Ray Durazo, a member of the county heart association board.

Supervisors ultimately approved a complex package of expenditures that county officials said total $86 million over two years. The money would boost smoking-cessation programs, increase outpatient care and provide mental health counseling for children in schools.

In another indication of the difficulties supervisors have in making decisions about their health department, they gave a lukewarm reception to a report from their handpicked blue-ribbon task force on restructuring medical services.

Supervisors hoped the group of medical experts and community leaders would guide them in trimming the budget. Instead, the panel issued broad recommendations that even task force members acknowledged was not comprehensive.

Task force members said their deliberations were hampered by the presence of health department staffers during their meetings.