Health Cutbacks to Curtail Immunizations for Children

As part of its recently approved plan to cut health-care costs, Los Angeles County will significantly reduce immunizations for children, screenings for sexually transmitted diseases and treatment for communicable diseases.

The reductions in public health services have received little of the attention or opposition sparked by proposals to close clinics and hospitals. But some health-care advocates worry that the effects could be damaging and far-reaching.

The Board of Supervisors on Tuesday approved a health-care plan that cuts up to 84,000 of 97,000 annual childhood immunization visits, along with up to 38,000 of 88,000 visits for treatment of communicable diseases.

Service reductions were also approved for patients with tuberculosis and sexually transmitted diseases.

These and other cuts to disease control efforts total $8.9 million, about 10% of the county’s spending on public health (excluding funding from state and federal governments). They come on top of the board’s decision Tuesday to close 11 primary-care centers and four school-based health centers by Oct. 1.

The county is making the cuts because the Department of Health Services faces an $800-million deficit within three years.

The immunization clinic at Curtis Tucker Health Center in Inglewood saw 265 patients in the first two days of this week, and the clinic was flooded with patients again Wednesday.

“School’s starting,” said nurse manager Elvie Tuttle as she scanned the full waiting room. “The idea that they’re going to cut these services, well, I just don’t know what to say.”

The public health cuts will take several weeks to phase in. The health department will detail the cutbacks--reduced hours or fewer available appointments at each public health clinic--next week. But officials acknowledge that some patients may go without medical services.

“None of these cuts are cuts that we want to make,” said Dr. Jonathan Fielding, the county’s director of public health. “They’re done because we have a fiscal obligation.... We don’t want to cut any of this.”

Some of the children who seek immunizations at public health clinics have private medical insurance but don’t want to wait for an appointment with their physicians, Fielding said. As a result, the county has picked up the tab.

Others, he acknowledged, don’t have insurance.

In a cramped examination room at the Tucker Health Center, Kenrick Haylock tried to gird his 5-year-old son, Kenrick, for a series of five immunization shots.

Haylock, 32, has medical coverage but said his son isn’t covered.

“I can’t enroll him in school without an immunization record,” Haylock said.

As the nurse detailed the necessary follow-up visits, Haylock said of the coming cuts, “I don’t think they should do them. It’s not just poor and lazy people who use these services.”

Those seeking care for communicable diseases, such as sore throats, lice or respiratory infections, will be sent to their primary care physicians for an exam. “Instead of evaluating them, we’re going to refer them,” said John Schunhoff, the county’s chief of operations for public health.

Fielding said some of the cutbacks approved by the supervisors look worse on paper than they actually are. For instance, the supervisors allowed the health department to cut 20,000 of 70,000 treatment visits by people with tuberculosis.

In reality, though, Fielding said, all TB patients will continue to be seen. Clinics will be asked to schedule appointments closer together and reduce idle time.

“In some cases, [the clinics] are not seeing as many patients as we feel is optimal,” Fielding said. “This is really an issue of efficiency.”

Among the other cuts:

* $335,000 to help county offices and nonprofit groups design exercise programs for work breaks.

* $400,000 for chlamydia testing outreach.

* $700,000 to help patients find care options.

Critics say the cuts are dangerous, particularly those related to immunization. They worry that the cuts will undermine the recent push to immunize youngsters against a host of communicable diseases, such as measles and chicken pox.

“I don’t know where they think people will go,” said Lynn Kersey, executive director of Maternal and Child Health Access. “There’s no capacity.”

Sharon Swonger, a nurse who works for the Los Angeles Unified School District, said many students have nowhere else to turn--they don’t have health insurance or a private doctor. “Children need their immunization to get into school, so there’s going to be a huge backlog,” she said.

Fielding said many children will be able to get immunizations at free clinics or through nonprofit groups that receive money from the state and federal governments specifically for vaccinations. Still, he said, the county plans to keep a close eye on immunization figures to see if their changes roll back progress.