Cuts proposed to help balance Orange County's budget would limit health care for the poor, could put more mentally ill patients on the streets and slow authorities' response to outbreaks of disease.
Not just the poor would be hurt. Cutbacks in the county laboratory also would affect the timeliness of water testing, potentially exposing swimmers and surfers to disease-causing bacteria, according to a list of $8.4 million in programs and services identified Wednesday to help trim the county's $4-billion budget.
If the cuts are enacted, it is likely that some of the smaller county-run clinics would close, said Pat Markley, a spokeswoman for the Orange County Health Care Agency. The clinics provide free immunizations, testing for and treatment of tuberculosis, venereal disease and HIV, prenatal care and preventive care for poor children.
"I'm very concerned about the cuts already identified, and believe any additional reductions will directly impact the safety net of health services that our Orange County citizens require," Julie Poulson, director of the Health Care Agency, said in a statement issued Thursday.
Health care advocates went further. They called the cuts shortsighted and predicted they would lead to higher costs in the long run as people no longer eligible for preventive care become ill and require costly emergency room care.
"Any time deep budget cuts hit, it's the underserved and that underinsured that are hit the hardest," said Bill Wood, president of the PacifiCare Foundation, a nonprofit group in Santa Ana that funds programs dealing with health, education, social services, women and seniors. "It's the poor whose backs are broken."
Health care advocates have long maintained that Orange County is stingy when it comes to funding services for the poor. They said the proposed cuts may exceed those imposed after the county filed for bankruptcy in 1994.
"This is definitely the worst I've seen in 20 years," said John Gilwee, vice president of the Hospital Assn. of Southern California.
Officials said the shortfall is the result of the county being caught in the squeeze of the state budget crisis, which could mean tens of millions less for Orange County. It also must grapple with reduced revenue from property taxes as well as the huge debt incurred during the 1994 bankruptcy.
Across the state, county governments are waiting for the Legislature and Gov. Gray Davis to work out a budget compromise to find out how much they will get. Davis' original budget left little for the counties, but Democrats in the Legislature have proposed tax increases to ease the blow.
The proposed $8.4 million in cuts for the fiscal year beginning July 1 would amount to about 11% of the $71 million the health agency gets from the county. An additional $2.5 million in cuts is recommended the next year.
The Health Care Agency's budget is $471 million, which includes federal and state funds, much of that earmarked for mandatory programs. The county cuts would come in addition to expected reductions in state funding for health care for the poor.
Gilwee said he's heard estimates that as many as 50,000 people in Orange County could lose coverage as state eligibility rules change for Medi-Cal, a program that serves mostly poor children and pregnant women.
"It's likely people will go unserved with their health needs because we have been the safety net for the poor and the underserved in the county," Markley said. "We are very concerned about the cuts, and we're looking at restructuring how we do business."
She also said the Medical Care for the Indigent program, which provides services for those 21 through 64 who make too much to qualify for Medi-Cal and are too young for Medicare, could face cutbacks, as could other programs for the poor.
Mental health care also would be affected. Thirty-three of the county's 544 locked psychiatric beds would be eliminated. Health care advocates said many of those patients probably would land in jail instead of receiving treatment.
"There's an insidious crossover between the mental health system and the criminal justice system," Gilwee said.
A nurse's shift for jail mental health services also would be eliminated.
At the Theo Lacy Branch Jail, the number of sickbeds also would be cut. The number was not available Thursday.
Cutbacks would slow the work of the county's disease control operations and its response to outbreaks of disease and follow up with patients, Markley said.
"It could have a bearing on diseases spreading more quickly," she said.
"We're already in a hiring freeze," she said. "And if we're looking at closing some of the clinics, there will be fewer places to be treated and tested."
Also at risk is a program that sends nurses to the homes of newborns with health problems to ensure they are receiving proper care.
Cuts to the agency's lab budget would slow analysis of patient test results. One program affected would be the testing of the ocean for dangerous bacteria, which lead to beach closures when levels became too high. At present, water samples are turned around in a day, Markley said.
"We're in a lot of trouble," said Felix Schwarz, head of the Health Care Council of Orange County.