Health Care Takes Deep Cuts

Los Angeles County supervisors made the deepest cuts ever to their troubled health-care system Wednesday, voting unanimously to shutter 11 of 18 public health clinics, end inpatient services in High Desert Hospital and eliminate 5,000 positions.

The vote came although about 1,000 people showed up to plead with the supervisors to preserve a health-care system that cares for 800,000 annually, most of whom are uninsured and have nowhere else to go. At one point a shouting match erupted between union officials and supervisors.

“Billions of dollars were found to fight terrorism. Billions of dollars were found to save airlines,” said Mandy Johnson, who represents private clinics that will see their funding cut by 25%. “How do you tell people with no health insurance, no child care or transportation that there is no appointment available for their sick child, their diabetic mother or father with bronchitis?”

But supervisors insist that there is not enough money to sustain the current system and that change is long overdue. After roughly 75 minutes of public testimony, they voted for a plan that seeks to reduce patient visits by 29% and trims staffing by 22%. The cuts would save about $150 million when fully implemented.

Later in the day, the supervisors approved an overall budget that cut the Sheriff’s Department funding by at least $60 million and reduced other services as well.

Supervisors also directed their health department to prepare for far more severe cuts in October should they fail in their effort to secure a $350-million bailout from the federal government. Those cuts could pare services at two hospitals, possibly Olive View and Harbor UCLA Medical Center. Officials would consider eliminating emergency rooms and even inpatient services at those facilities.

“This is a very difficult time for all of us,” Supervisor Yvonne Brathwaite Burke said during the morning session on health care. “We hope for a miracle, but we have to work with what we have.”

The reductions approved Wednesday are not technically final until a lengthy series of public hearings is completed this summer. If supervisors reaffirm their vote at the end of that process, the facilities will close by October, though unions and health-care advocates vowed to fight to keep them open and some hinted at possible legal challenges. Elected officials and private medical providers in the Antelope Valley are trying to assemble a last-ditch plan to keep High Desert open as well.

Labor leaders and patient advocates said the supervisors have enough money on hand to fully fund the health department for another year and complained that they are moving too fast.

“Cutting back essential services is not brave--it’s an abdication of leadership,” said Kathy Ochoa of the Service Employees International Union Local 660, which represents most of the health department’s 23,000 workers.

But the supervisors replied that they were making cuts they should have made long ago, when they first turned to the federal government for help in running their health department. Since 1995, when they made what was an unprecedented layoff of 3,500 workers in a last-ditch effort to balance the budget, the agency has relied on two five-year, $1-billion bailouts from Washington to stay open. The final bailout declines next year and runs out completely in 2005.

Supervisors had promised to streamline the health system as part of the bailouts, but have failed to meet their goals.

“We have to do what we probably should have been doing five years ago,” Burke said.

Changes Possible

Still, supervisors left the door open to saving some of the services. Supervisor Mike Antonovich, whose district is home to High Desert Hospital, told the health department to consider proposals by Antelope Valley health providers who want to keep High Desert open before beginning hearings to end inpatient services there.

Supervisor Zev Yaroslavsky called for further exploration of ways to fund the clinic system, which he has supported. And Supervisor Don Knabe directed the department to explore ways to reconfigure the system with health experts.

Though the health department has $160 million in reserve available for next year--and the county has nearly $500 million--officials argued that such money is available only once and cannot be relied upon to keep the health system afloat.

Still, while finalizing the county budget later Wednesday, the board voted to spend $4 million in surplus funds to keep alive a program for poor mental health patients. That drew an objection from Supervisor Gloria Molina. “The argument this morning and the tough decisions we made, we’re undoing them one by one.”

Other supervisors said the expenditure was necessary and relatively small.

During the morning session, the county’s new health director warned the supervisors against digging into reserves to maintain his agency.

Spending the reserves “really wouldn’t change much,” Thomas Garthwaite told supervisors. “It would just delay the pain slightly.”

Speaker after speaker challenged that contention.

“I’m here to ask you to try and rise to the occasion,” Lark Galloway-Gilliam, executive director of the Community Health Councils, told supervisors. “You don’t have to accept this as reality.”

Lynn Kersey, executive director of a maternal and child health access advocacy group, said the county should use its surplus to keep the system afloat while experts look for less painful ways to save money. “We’re not saying keep the same broken system open,” she said. “There are ways of fixing this system that do not have a slash-and-burn kind of impact.”

‘Asking for a Hand’

Patients said the cuts would jeopardize their lives. Dora Soto, 63, works part time as an aide in a middle school in Littlerock in the Santa Clarita Valley and gets treatment for her diabetes and arthritis at High Desert Hospital. If High Desert closes as planned, she will have to drive 50 miles to Olive View in Sylmar for treatment. If that hospital closes in October, as is also planned, Soto will have an 87-mile trek to the nearest county hospital.

“The majority of our residents don’t have access to transportation or health stamina to travel long distances for medical care,” South-Central Los Angeles resident Thelma James Mwanza said. “We’re not asking for a handout. We’re just asking for a hand.”

With their 700-person hearing room full and hundreds milling about outside, supervisors set 75 minutes for public testimony, saying that full comments can be made during the public hearings process. They gave each speaker two minutes, which irritated several of the members of the public, including Annelle Grajeda, the general manager of Local 660.

Grajeda stepped onto the speaker’s dais and began to rapidly read a four-page statement, accusing supervisors of sacrificing patients for political expediency. She said the cuts made little sense--pointing out that the county is slashing outpatient care while one of its stated goals is increasing outpatient care.

‘Let Her Speak’

In his role as board chairman, Yaroslavsky told Grajeda to stop talking when her two minutes were up. But Grajeda continued.

“Let her speak!” the crowd chanted.

“Annelle, you know the rules,” Yaroslavsky warned her.

“This plan includes 5,000 layoffs. I think that deserves five minutes of your time,” Grajeda shouted back.

Yaroslavsky directed county workers to cut off Grajeda’s microphone, but she kept speaking. After trying to quiet the crowd, Yaroslavsky stormed out of the boardroom, and Burke andMolina urged Grajeda to step down, saying others had a right to testify.

Grajeda stayed at the dais for several minutes, allowing others to speak. When other union members tried to yield their time to her, Yaroslavsky blocked them. Finally, Ochoa stepped up and finished reading Grajeda’s speech.

After the supervisors voted, union members retreated to the plaza between the Hall of Administration and civil courthouse, where Grajeda outlined a series of demonstrations and exhorted anyone who wanted to to sign up for civil disobedience training.

But Ochoa said the supervisors clearly had their minds made up. She said the public hearings this summer, required by law before health reductions can be approved, are “a moot point.”

“I don’t think they’re committed to a public process,” Ochoa said. “The money is already gone.”

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(BEGIN TEXT OF INFOBOX)

Closing Clinics

County supervisors on Wednesday approved cuts that would shut down 11 of 18 health centers. The clinics facing closure are:

1. Alhambra Health Center

2. Azusa Health Center

3. Bell Gardens Health Center

4. Pico Rivera Health Center

5. Norwalk Health Center

6. Florence/Firestone Health Center

7. Imperial Heights Health Center

8. Lawndale Health Center

9. San Antonio Health Center

10. North Hollywood Health Center

11. Tujunga Health Center