Final Word: Health Care Centers Cut

Turning aside final pleas from patients and health workers, the Los Angeles County Board of Supervisors voted Tuesday to close 11 health centers and four school-based health clinics by Oct. 1.

About 700 people filled the board’s meeting room for the second time in three months to bemoan the closures and other cuts, which together will trim $31.3 million from next year’s health budget. The meeting was full of passion but lacked suspense--the supervisors signaled at the outset that the cuts were unavoidable because the Department of Health Services faces a growing deficit.

The board’s unanimous vote, which is final, paves the way for officials to begin cutting services starting Aug. 30. All 15 clinics are scheduled to close by Oct. 1.

Under the plan, public health spending also will be cut about 10% by reducing childhood immunizations, screenings for sexually transmitted diseases and visits for communicable diseases.

Also, High Desert Hospital in the Antelope Valley would be converted from a hospital to an outpatient clinic in May 2003. But supervisors provided a glimmer of hope to those trying to save the hospital. The board approved a six-month pilot project that would try to generate new revenue by offering unused beds to neighboring hospitals and medical groups.

Notices of closures will be posted in clinics beginning today, advising patients of alternative locations to find care.

Two health centers, in North Hollywood and Tujunga, will cease accepting walk-in patients on Aug. 30. Services gradually will be phased out until all sites are closed by the end of next month.

Five other clinics were ordered closed in an earlier round of cuts this year. In the end, the county will continue to operate seven health centers that offer primary health-care services.

The union representing county health workers criticized the supervisors for their “headlong rush” to make cuts.

“To ignore the voices and needs of the community would be a health-care and political disaster,” said Annelle Grajeda, general manager of Service Employees International Union Local 660, which represents 19,000 county health workers.

“Any cuts ought to be made only after careful consideration of voices and needs,” she said.

Waving placards that read “These cuts won’t heal,” SEIU members tromped up and down the sidewalk in front of the Hall of Administration, at one point marching into the street and sparking a scuffle with police.

Seventeen members of the union were arrested for failure to disperse, said Jason Lee, an LAPD spokesman.

Department of Health Services Director Dr. Thomas Garthwaite defended the cuts, saying that clients would have access to other health centers for medical care. He also said the 11 health centers slated for closure are in need of critical maintenance and repairs totaling $20 million.

The centers, he said, are inefficient compared with clinics run by private health providers. The average medical visit costs $150 at the clinics slated for closure, compared with $90 at other clinics.

Lynn Kersey, executive director of Maternal and Child Health Access, disputed the assertion that patients would be able to travel five miles to visit another clinic.

“Five miles as the crow flies is not five miles on a bus with two children,” Kersey said.

The clinic closures and public health cutbacks will displace 360 health workers, all of whom are expected to be moved to other positions. If the department proceeds with its plans to end inpatient services at High Desert and cut the number of beds at other county hospitals, officials expect to achieve 4,230 job cuts by 2006.

The supervisors first approved the cuts on June 26, which prompted Tuesday’s hearing to receive public input before the decision could be finalized.

“We are on our last leg, unfortunately, in this whole area,” Supervisor Gloria Molina said at the start of the four-hour meeting. “This is one of the most unfortunate votes I will ever make on this Board of Supervisors.”

She warned that the first round of cuts “is not as painful” as those the board may be asked to impose in October if officials cannot secure another federal bailout. That round of cuts could pare beds and services at already overwhelmed county hospitals.

In interviews, supervisors have acknowledged that they are pushing this first round of cuts partly because they hope to prove their mettle to Washington and receive another round of federal assistance. But Tuesday, the board angrily denied that it was engaging in “gamesmanship,” as one speaker put it.

Instead, Supervisors Molina and Zev Yaroslavsky criticized Gov. Gray Davis for refusing to meet with board members or offer additional money to help balance Los Angeles County’s health budget. “I want to disabuse you of the notion that this is political gaming,” Yaroslavsky said. “It’s about what the state is bringing to the table.”

“We sat and stood on the front door of Gov. Gray Davis’ office,” Molina said. “Not one time would they meet with us.”

Grantland Johnson, secretary of California’s Health and Human Services Agency, said he can’t explain why Davis wouldn’t meet with the supervisors. But he said the governor has instructed his staff to work with the county.

Before forwarding the bailout request to Washington, state officials want the county to hold additional meetings and explain how it will protect patient access to care in a smaller system.

“If we are going to be competent stewards of the health-care system in L.A. County and California, we have to understand the implications and nuances of the county’s proposal,” Johnson said. “I want to understand what they’re proposing, what the ramifications are, before we’re prepared to take that proposal to the feds.”

Marsha Temple, an attorney for the Venice Family Clinic, pleaded with supervisors to wait 90 days before approving the cuts and work with the state to find ways to keep medical facilities open.

“Each of you has promised to protect the people of this county,” she said. “If you will not protect them when they are sick and dying, when will you protect them?”

Several speakers said the supervisors were being hypocritical by cutting services while asking taxpayers in November to approve a $175-million tax to shore up the county’s fraying network of emergency rooms and trauma centers, and aid bioterrorism preparedness.

Nearly every aspect of the county’s plan came under criticism from audience members.

Anna Garcia, a sixth-grader at Vaughn Street Elementary School in Pacoima, asked the board not to close school health clinics.

“We live in Pacoima and our families are poor, but children do not have to die because they are poor,” she said.

“We need to be healthy so we can take care of you when you grow old,” she said.

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Times staff writer Nicholas Riccardi contributed to this report.