Officials object to clinic closure plan

A majority of the Los Angeles County Board of Supervisors raised objections Thursday to plans to shut 11 clinics, even though health officials have quietly floated contingency plans for far more drastic cuts in the coming year.

Three supervisors said the county should look elsewhere for the painful cuts that lie ahead, but severe cost-cutting looks increasingly inevitable as deficits of $195 million to $331 million are projected for the department in the next fiscal year.

Under a worst-case scenario, county health officials have privately suggested closing all six of the county’s comprehensive outpatient health centers along with its medical clinics, according to a confidential draft of the plan obtained by The Times. Under that plan, patients would lose county facilities that provide more than 160,000 urgent care visits and nearly 180,000 specialty care visits a year, mostly from the uninsured and poor.

Yolanda Vera, director of the health advocacy group LA Health Action, said such cuts could have a crippling effect on the region’s healthcare system as patients overload busy emergency rooms because they have nowhere else to go.

“It would be a complete meltdown of the total system,” she said. “It would be the poison pill that we’ve all feared.”

The proposal was drafted in case the county fails to resolve disputes with the federal government over $137 million in funding. Health department officials said they were unsure whether the money would come through and declined to comment on the plan.

“We’re not going to say where we’re going with phase two because we don’t know the size of it at this point,” said John F. Schunhoff, chief deputy director of the county Department of Health Services.

More cuts in future years could also run long and deep. Within four years, the county’s shortfall is expected to hit $1.6 billion.

The county has blamed the deficit on rising costs for treating indigent and uninsured patients, coupled with federal and state reimbursements that have failed to keep pace.

Supervisor Yvonne B. Burke, whose South L.A. district includes some of the poorest neighborhoods in the county, said health officials should find alternative savings to cutting county clinics. She expressed doubts that local private, nonprofit clinics could replace them.

“Many of them are on the brink of bankruptcy, because they don’t have people who contribute millions of dollars to them,” she said. “Our clinics are a vital part of our whole system.”

Supervisor Don Knabe said in a statement that he was “shocked by the proposal and deeply concerned.” He cautioned that the county should examine the effects the cuts would have on already overcrowded hospital emergency rooms.

Supervisor Zev Yaroslavsky warned that closing county facilities for good could mean longer travel times for poor patients relying on public transportation to get to care. And he called on the department to slash administrative costs and other services first. “Ambulatory care cannot be the sacrificial lamb for a budget deficit,” he said.

County health executives described their proposal as a “work in progress.” They are expected to make a formal presentation before the Board of Supervisors on Tuesday. A final vote is not expected until June.

Under the plan made public this week, county health executives say they would retreat from directly providing primary care services and seek contracts with private, nonprofit clinics to provide care for most of the displaced patients.

The county clinics and comprehensive health centers get about 400,000 primary visits a year, nearly two-thirds from uninsured patients. The county also contracts with private clinics to provide more than 700,000 visits for primary care and other services each year.

Supervisor Mike Antonovich was alone on the board in praising the proposal, which he said would help explore ways for the county to cut costs without reducing services. He said a primary care visit costs the county $197 at one of its own facilities. Under current contracts, the county pays private clinics $94 for each visit.

“The department of health ought to evaluate whether they should be in the business of outpatient services when the private and nonprofit healthcare providers are able to provide those services efficiently and cost effectively,” he said.

Should county clinics close, several private clinic operators said they could absorb many of the county’s patients if they were given adequate time and money. Some said private clinics could take over operations at the county facilities as they have in the past.

“I think it’s an idea that’s worth exploring, but in the short term it could have tremendous unintended consequences if it’s done too quickly,” said Kimberly Wyard, chief executive of the Northeast Valley Health Corp., which took over two county clinics during a round of budget cuts in 1995. “The community clinics can’t afford to go bankrupt and need to know where the dollars are coming from.”

Jamesina E. Henderson, the chief executive of T.H.E. Clinic, just south of downtown Los Angeles, agreed, saying that her clinic’s costs for each visit are nearly double the county’s reimbursement rate of $94.

“We would be able to absorb the patients if we’re adequately funded,” she said.

But any closure of clinics is likely to face opposition from union leaders, who said they were concerned that cuts would result in layoffs of county employees and would harm patients.

“The first line of defense is when patients arrive at the primary care clinics,” said Annelle Grajeda, president of Service Employees International Union 721, which represents thousands of healthcare and other workers.

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jack.leonard@latimes.com