Public health experts reacted with dismay Friday to legislation apparently headed for Gov. Pete Wilson's signature that would gut historic guarantees of health care for the state's poor.
They predicted public health consequences for all Californians, including rising rates of communicable disease and further erosion of the state's emergency services network. Among the poor, they said, deaths almost certainly will rise from diabetes, hypertension, asthma and other treatable illness.
"It is not a pretty picture," said Dr. Robert Tranquada, chairman of a Los Angeles County task force on access to health care. "This is not the kind of action that could be tolerated under any other than the most desperate kinds of fiscal circumstances."
The Assembly on Thursday approved two bills giving counties wider latitude in cutting public health and welfare services. The legislation, which Gov. Pete Wilson said he would sign, cleared a major stumbling block to ending the state's budget stalemate, now in its 53rd day. Counties, faced with sharply reduced state funding, had sought relief from obligations to provide services.
The bills eliminate the requirement for counties to provide indigents with health care comparable to that available to private paying patients, known as the "community standard." The community standard has provided advocates for the poor with a powerful legal tool to block cuts in county health services.
Legislators left intact state law obligating counties to be health-care providers of last resort. But advocates view the elimination of a standard for measuring the quality or quantity of that care as a devastating loss of protection for the poor.
"There is nothing now for the courts and the community (to use) to force accountability on the part of the counties," said Maryann O'Sullivan, executive director of the statewide watchdog group, Health Access.
"A lot of suffering, disabilities and deaths will occur," said Jim Lott, president of the Hospital Council of San Diego and Imperial counties.
Counties in California vary widely in their provisions for public health services, with populous, urban counties such as Los Angeles and San Francisco supporting extensive public hospital and clinic networks, while others, such as Orange County, hewing to the minimum required by law.
Weakening the law, many observers said, not only removes a useful tool for poverty advocates, it undercuts the ability of county health officials to claim priority for their programs.
