Los Angeles County healthcare officials unveiled a draft cost-cutting plan Wednesday that calls for closing all but one of the county's dozen clinics and reduces services at its six comprehensive outpatient health centers.
Officials said a $195-million deficit makes the cuts necessary even under a "best-case scenario" for the badly strapped public healthcare system. The county faces the threat of more reductions in state and federal aid in the next few months. Health department officials have privately floated the possibility of deeper cuts if the projected deficit grows.
The current proposal, if approved by the Board of Supervisors, would dramatically retreat from the county's longtime role in providing primary care to the indigent. The clinics and comprehensive centers get about 400,000 primary care visits a year, nearly two-thirds from uninsured patients.
Officials said they plan for private, nonprofit clinics to step into the gap and provide care to most of the displaced patients for a lower cost than the public system. The county currently has contracts with private clinics, and those would be expanded.
But several healthcare advocates questioned the proposal. "On paper, it looks like they're trying to achieve savings without cuts in services, but the numbers leave more questions unanswered," said Yolanda Vera, director of LA Health Action, which advocates for improved community healthcare for the poor.
Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils, said the county had failed to make good on promises to expand specialty healthcare in South L.A. after closing Martin Luther King Jr.-Harbor Hospital last year. The area, she said, already lacks enough private clinics.
"In South L.A., there is a heavy reliance on county clinics," she said. "It's very scary."
County officials said the plan would allow them to focus on protecting the most crucial parts of the region's safety net: trauma, hospital and specialty care services. The state and federal governments reimburse the county for much of that care.
"What we're trying to do is keep the safety net intact," said John F. Schunhoff, chief deputy director of the county Department of Health Services. "If we're successful . . . we're going to be preserving patient care. We're just shifting who's providing it."
But closing the clinics could shift many patients into the already overburdened hospitals.
Norma Parada, 23, a legal immigrant from Mexico who is uninsured, was one such patient. On Wednesday she was paying her first visit to the Glendale Health Clinic to see a doctor about getting medication for her kidneys. Parada, who had a kidney transplant in 2001, had previously gone to Olive View-UCLA Medical Center in Sylmar for medical care.
Parada said she takes 15 pills a day for her kidneys and that her medication costs about $5,000 a month, paid by the county.
Frustrated by the constant lines and long waits at Olive View, Parada asked where she could go that was closer to her North Hollywood residence and was referred to the Glendale clinic. "If they close," said Parada, a part-time delivery driver for Papa John's Pizza, "I know I'll just be back in that line at Olive View."
Supervisor Zev Yaroslavsky, voicing opposition to clinic closures, said the county has spent more than a decade emphasizing preventive care by operating facilities where patients can go for checkups and treatment for minor illnesses.
He said spending on prevention has saved the county in acute care treatment costs, and he called on the department to cut administrative costs before reducing services.
"It's outrageous," he said. "Here I am trying to expand ambulatory care to the underserved communities that I represent. And to be shrinking it at a time when we need to be expanding is a fool's errand."
In 2002, the last time the county faced major budgets woes, it closed 11 health clinics.
Cutting primary care services would save the county about $73 million. Under the plan, the county would then spend an additional $10 million on specialty care services and pay private clinics $25 million to handle most of the patients currently using public clinics.
The private clinics would be paid enough to treat all of the patients who lack insurance of any kind. But many patients who do have limited insurance, including Medi-Cal, would have to find other places to go.
The county would also use savings from previous years along with other funds to bridge the nearly $200-million gap projected for the next fiscal year.
Another way to close the deficit that has been discussed in private would be to shut the comprehensive health centers, according to a county source who spoke on condition of anonymity. County health officials declined to say what measures they would consider.
The clinic closures would not affect 14 centers run by the county Department of Public Health that provide immunizations and screenings for tuberculosis and sexually transmitted diseases.
The county has faced the prospect of a massive health department deficit for the last several years as federal and state reimbursements have failed to keep pace with the cost of providing healthcare to the indigent and uninsured.
Without dramatic long-term changes in healthcare funding, the county will almost certainly have to consider deeper cuts in the years ahead, as its healthcare deficit is expected to hit $1.6 billion within four years.
Moving out of the business of operating clinics and concentrating on specialty and hospital services might make sense given the bleak financial picture, said Dr. Robert Ross, president and chief executive of the California Endowment, a nonprofit health foundation. "In an environment where resources are painfully scarce, it's a tough decision, but it's probably the right move," he said.
But at the Glendale Health Clinic, patients expressed concern. Honayun Anwar, 65, said he brought his daughter, Ferima, 17, and son, Ruman, 9, to the clinic for their school immunizations. He said his family, which is on Medi-Cal, has been going to the clinic since November, when they arrived from Lithuania.
"It's definitely better than what we had in Lithuania," he said. "The American government has been very accommodating. And it would be sad to see them cut some of these services that we immigrants need."
The county's chief executive, William T Fujioka, said budget officials were still working on the proposals, which were far from final.
But he pledged that the cuts, if approved, would not go into effect in areas where the county had not yet found a private clinic willing to take over the services. Health officials have already determined that it would be hard finding a private clinic to serve the Antelope Valley and so decided that the county's South Antelope Valley clinic would not close.
"We won't walk away from any communities," Fujioka said. "We have an obligation to treat these people. And we want to minimize the impact."
Times staff writer Charles Ornstein contributed to this report.