April 09, 2003 -- California Public Health Crisis a warning to nation

It almost seems as though this AP article were especially beamed to
San Francisco. The Health Commission has rightly refused to endorse
the Health Clinic cuts, and the Mayor's office has said they are no
longer under active consideration, but the next bad fiscal news could
bring them back from the grave. This article focuses on the LA County
health system as an indication of where current political and economic
forces are willing to let public health go.



Associated Press, Wed Apr 2, 4:06 PM ET

Calif. Public Health Crisis a Harbinger


By ROBERT JABLON, Associated Press Writer

EL MONTE, Calif. - On her second trip to the El Monte Comprehensive
Health Center, Candy Guerrero spent nearly an hour waiting for an
appointment. The first time, she waited in vain for two hours.

"I went home crying," said Guerrero, 61, who suffers from diabetes
and a heart condition. "I could not make an appointment. I could not
see the doctor."

The mother of nine, who can't afford health insurance on her pay as a
part-time nurse's assistant, used to go to a clinic closer to home.
But it was among 16 closed by Los Angeles County last fall in a bid to
keep the nation's second-largest public health system from collapsing.

Health officials across the state and throughout the nation say a
larger problem is reflected in Los Angeles County.

Many of the 3,000 local public health departments around the country
are hurting financially, said Patrick Libbey, executive director of
the National Association of County and City Health Officials. More
than 75 percent of about 500 departments surveyed by the group earlier
this year said they had made cuts or expected to have them.

"Large immigrant populations, increasing unemployment ... the burden
of preparing for terrorism. All these are weighing heavily on the
system," said Skip Moskey of the National Association of Public
Hospitals.

The New York Hospital and Health Corp., a quasi-governmental agency in
charge of New York City's public hospitals and health clinics, has cut
13,000 jobs and dropped 2,871 hospital beds out of service since 1994.

In California, where an estimated 6 million people are uninsured -
about 17 percent of the state's population - the public health systems
in Alameda County and Contra Costa County in the San Francisco Bay
area have made multimillion-dollar cuts.

"Many of our members refer to themselves as L.A. counties in waiting,"
said Karen Butler of the California Association of Public Health.

The Los Angeles County system has teetered on the edge of collapse for
a decade only to be rescued by more than $2 billion in state and
federal bailouts. A voter-approved property-tax increase passed last
fall will help keep emergency and trauma rooms open for now.

A big part of the problem here is the sheer enormity of the system. It
is a safety net for the largest reservoir of uninsured patients in the
nation, 2.5 million people, many of whom are poor immigrants. It
serves an estimated 800,000 people a year, more than the population of
South Dakota.

As a condition of receiving the federal money, the county has been
required to reform the system to make it more financially stable.

Some progress has been made. Since 1995, the system has slashed 731
hospital beds and reduced the number of hospital admissions by 30
percent. Costly emergency room visits are down more than 40 percent.
Outpatient clinics now handle flu cases and other minor complaints.

But the increasing emphasis on outpatient care has had the unintended
consequence of raising costs. Doctors handling more patients
discovered many with untreated, chronic problems such as hypertension
or diabetes, increasing overall costs.

"It's really a balancing act," said John Wallace, director of external
relations for the county Department of Health Services.

After last fall's closures, the county was left with nine primary
clinics and six comprehensive centers, which are larger and provide
specialty care and extended hours. The county also cut services at
dozens of private outpatient clinics with county contracts. Overall,
the changes cut annual patient visits by nearly 500,000.

But the results can be measured in longer waits and potentially sicker
patients.

At the El Monte clinic, patient visits are up 15 percent to 20
percent per month since the closures, and a hiring freeze has hurt,
said Hugo Almeida, the center's administrator.

"It is busier, the waits are longer and staff are doing the best they
can," he said. The center relies on staff working overtime and on
temporary help to serve some 450 patients a day.

"It is really a cut-and-paste-type solution," Almeida said.

Critics say the clinic closures are false economy that will prevent
people from seeking care until they are so sick that expensive
treatment or hospitalization is required.

At St. John's Well Child Center in Los Angeles, a nonprofit clinic
that contracts with the county, patient visits have nearly doubled to
about 150 cases a day. The center also has begun to see patients with
more serious ailments who might have gone to the now-closed clinics.

As state and federal budget problems mount, the problem is forecast to
get even more acute.

For example, proposed state cutbacks could throw an unknown number of
people off the Medicaid program and into a health network that has
seen its number of patient visits soar by about 800,000 since 1995.

Federal and state officials say the county is unlikely to receive
another huge bailout.

Wallace said there are no long-term guarantees about the county
system's stability.

"The number of uninsured sure isn't going to go down," he said. "It's
going to be a constant crisis until there's some type of national
reform in terms of providing care for the uninsured."