Prostate Cancer Funds Cut

State budget cuts are forcing the gradual shutdown of California’s first-in-the-nation prostate cancer program for low-income men who lack health insurance, leaving more than 320 patients in limbo.

The day after Christmas, state health officials ordered doctors at the program, based at UCLA Medical Center, to stop enrolling new patients. Since then, more than 20 men diagnosed with prostate cancer have been told they cannot receive state-paid treatment for their disease. Their names have been placed on a waiting list in case the policy changes.

Since the men cannot afford to obtain private care, state officials in Sacramento have suggested that they turn to the public healthcare systems in the counties where they live. But the availability and quality of that care varies greatly depending on the county involved.

One of the men denied entry to the UCLA program died last week in Los Angeles of advanced prostate cancer, although it is unclear how much longer he might have survived had he gained admission.

The phase-out of the program is part of a $1.1-billion wave of state budget cuts initiated by former Gov. Gray Davis and adopted by his successor, Gov. Arnold Schwarzenegger.

The new governor and state lawmakers will face a multitude of decisions in coming months about what programs to cut in an effort to close a projected $14-billion shortfall in the next state budget.

Last week in Los Angeles, Dr. Mark S. Litwin and his staff at the IMPACT program -- Improving Access, Counseling and Treatment for Californians with Prostate Cancer -- began the difficult task of deciding which of their more than 320 patients would have their cancer treatment end by June 30, the close of the fiscal year.

At the direction of state officials, Litwin submitted contingency plans this week to provide patient care through June 30 or Dec. 31, depending on how much money is available.

Litwin, a UCLA urologist and professor, said he was facing “a horrible ethical quandary” as a doctor being put in the position of wielding the budget ax. “We’re triaging patients. I didn’t sign up to play God,” Litwin said. “The bottom line for me is I’ve got guys dying.”

He said he felt that the state had “a moral and ethical responsibility to help people less fortunate.”

So, when a state Department of Health Services official in Sacramento informed him recently that the $4.6-million-a-year program was being phased out, Litwin asked: “What am I supposed to tell these guys diagnosed with prostate cancer?”

Litwin said he was told: “The governor is doing the best he can to balance the budget.”

Since its inception three years ago, the state-financed prostate cancer program has seen its budget shrink from $20 million to less than $5 million.

“It is an unfortunate reality of the budget situation,” said Dr. Donald Lyman, chief of the state Division of Chronic Disease and Injury Control.

He said the program was “clearly very vulnerable” to budget cuts once its funding source was shifted from tobacco settlement money to the deficit-plagued state general fund.

“The administration is desperate to find general fund money to plug the hole” in the budget, he said.

Lyman said higher-ranking department officials last year had been forced to decide which statewide health programs should continue to be funded during the budget crisis.

“Medical care in this country is rationed,” Lyman said. “The assumption when you provide the services in a public health program is you can show a reduction in the death rate,” he said. “I can do that for breast cancer. I can do that for cervical cancer. At the moment, I can’t do that for prostate cancer.”

Litwin disagrees. Early stage prostate cancer is curable, he said. Advanced prostate cancer is not.

Finance Department spokesman H.D. Palmer said the cuts had been approved by the Davis administration before Schwarzenegger was sworn in as governor on Nov. 17. Palmer said the new administration had no plans to review the decision.

Notice of the $4.2-million reduction in the IMPACT program was given to lawmakers in a package that Finance Director Donna Arduin sent just before Christmas. The day after Christmas, Deborah Sonognini-Smith, assistant chief of the Cancer Detection Section at the state Department of Health Services, notified Litwin that “due to budget adjustments” made by the Department of Finance, “IMPACT should not enroll any new patients or re-enroll existing patients as of today.”

Lyman insisted that men already enrolled in the program would be treated for the rest of this year. But he said the same was not true for men on the waiting list who would “be left to the tender mercies” of their county health system. “And that’s not a nice world.”

The cuts are disturbing to patients already enrolled in the program and those who are now being denied entrance.

David Fryer, 53, an account representative for a financial company in San Diego, said he was upset that a program that treats predominantly poor and minority men was targeted for termination. Three-quarters of the patients in the program are African American or Latino.

Fryer said he was out of work, his unemployment benefits had run out, and he had no health insurance when his cancer was diagnosed in late 2001. He said his health would be failing without the radiation treatment arranged by the IMPACT program and paid for by the state’s taxpayers.

A resident of California for 20 years, Fryer is grateful for the care he received. “Prostate cancer is a disease that can be treated if you catch it in time,” he said. “I’m living proof of that.”

Robert Lara, a 62-year-old ceramic tile contractor from Montebello, is undergoing radiation treatments at Huntington Memorial Hospital in Pasadena. He is a big fan of IMPACT. “It’s a very sad thing that the cuts have to be made in a program that is so helpful,” Lara said. “I’m sure there are many men that could benefit.”

A Native American born and raised in Los Angeles, Lara said he had worked and paid taxes throughout his adult life but did not make enough to afford health insurance. His wife, Sally, lost her health insurance after being injured on the job in 1993.

Sally Lara said the IMPACT program had extended her husband’s life. “This program is a giver of time for people,” she said.

The prostate cancer program was opened to patients in July 2001. Members of the Legislature’s Black Caucus pressed for creation of the program because African Americans are two to three times more likely to get prostate cancer and die from the disease.

IMPACT is the only state-funded program in the nation that provides treatment to poor men with prostate cancer, many of whom work but do not have health insurance. To qualify, men between 18 and 65 years old must earn less than $18,000 a year.

The post-Christmas ban on new admissions could not have come at a worse time for Raul Campos. The Los Angeles parking lot attendant had been ill with prostate cancer since October 2002. He died last week in East Los Angeles at the age of 54.

His daughter, Jeannette Campos, said her father would have benefited from the IMPACT program even late in the disease. “I do believe it would have made a difference,” she said.

Charlie Hayes, a 61-year-old gardener in San Diego, is one of the men denied admission and is now on a waiting list should funding be restored. Hayes said he went to the emergency room at a San Diego-area hospital on Christmas Eve. A subsequent blood test found he had an elevated level of prostate specific antigen, a potential indicator of prostate cancer.

Hayes, who does not have health insurance, said he qualified for the IMPACT program but could not be admitted for treatment because of the budget cuts. “It’s really frustrating that the system is the way it is,” he said. “It’s really aggravating.”

But Hayes has faith that eventually he will get the treatment he needs. “By God’s grace, I’ll make it,” he said.