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County OKs Major Health Clinic Expansion


Launching a new era of public health care in Los Angeles County, the Board of Supervisors on Tuesday unanimously approved the largest expansion of outpatient health clinics for the poor and uninsured in the county's history.

The addition of 36 new clinics is the first stage in a sweeping restructuring of the county's health system from an emphasis on expensive hospital treatment to less costly preventive and primary care in the community.

The move also represents the county's most extensive reliance on partnerships with private, mostly nonprofit medical groups, which will serve patients in their own facilities rather than county-owned clinics. In the past, there have been distinctly separate public and private health care systems in the county.

In a continuing sign of the challenge the county faces as it makes this shift in its health care system, 380 health workers primarily at Rancho Los Amigos, County-USC and Olive View/UCLA Medical Centers were notified Tuesday that they will be laid off or demoted in two weeks.

Altogether, 90 permanent employees and 160 temporary employees will lose their jobs and 130 others will be demoted because of Civil Service protections based on seniority.

Although some of the displaced workers may end up finding jobs in the new private clinics, it will be the largest layoff of health workers since last fall, when the county's worst-ever fiscal crisis cost more than 2,500 health workers their jobs.

The partnership contracts approved Tuesday with 20 health care organizations include provisions to give county health workers an edge in obtaining jobs in the private clinics.

The new clinics will be in downtown Los Angeles, South and South-Central Los Angeles, the South Bay, Long Beach and southeast-area cities, the Antelope Valley, San Fernando Valley and in the San Gabriel Valley as far east as Pomona. The operators range from small storefront clinics to large medical groups and include the Chinatown Service Center, the Watts Health Foundation, the Tarzana Treatment Center and Planned Parenthood Los Angeles.

"This is our first step in restructuring," said Nancy Rubin, executive officer of the Department of Health Services.

The expansion in primary and preventive care is in keeping with the county's promise to the federal government that it will eliminate at least one-third of its hospital beds and increase the number of outpatient visits at least 50% by the middle of 2000.

In return, the county received a $364-million federal bailout to rescue the health system from financial collapse last fall and $172 million this year to stabilize and transform the health system.

By paying for contractors to provide expanded outpatient services at the 36 new clinics, the county is seeking to rebuild the number of outpatient visits to more than 3.8 million this year, slightly less than had been provided before last fall's budget cuts and layoffs.

Ultimately, the county must increase the number of outpatient visits to more than 6 million a year by the end of its five-year project to establish a more modern and efficient health care system.

Before the supervisors voted, representatives of health care organizations praised the new public-private partnerships that formally end decades of separation between the two systems.

Dr. Elisa Nicholas, medical and executive director of the Children's Clinic in Long Beach, said her group will expand services to adults and treat more children.

Nicholas expressed some concern about the county maintaining enough specialists and adequate hospital care for poor and uninsured patients who will be seen in the private clinics. And she raised the question of a potential lack of adequate long-term funding.

"It is challenging enough to develop a new program, but once the community has accepted it and depends on it, I would hate to close it due to cessation of funding or contracts," she said.

The county privatized six of its 39 health clinics in the midst of its health care crisis last fall, turning over the operation of the facilities to private operators without providing funds to pay for the services.

"Last year, we began by patching something together," Elizabeth Benson Forer, executive director of the Venice Family Clinic, told the supervisors. "Now, we are creating a system of health care for people with low incomes and no health insurance."

The Los Angeles area has the highest proportion of residents who are poor or lack health insurance of any major metropolitan area in the nation. There are 2.6 million county residents without health coverage, most of whom work, and an additional 1.6 million on Medi-Cal, the joint federal-state program for the poor.

Forer said the Venice Family Clinic and its associates learned a simple lesson in the early months that "health care costs money." Because of the county's new financial commitment, Forer predicted that "these partnerships will grow and thrive."

Indeed, once the clinics are open, the county hopes to approve by the end of the year another round of contracts for additional clinics.

"We are very excited by this initiative," said Dr. Reed Tuckson, president of Charles R. Drew University of Medicine and Science, which operates Martin Luther King Jr. Medical Center with the county.

The medical school and its Metro-South Provider Network will operate a series of clinics in South and South-Central Los Angeles, Inglewood, Lynwood and Compton.

Although the new clinics will ask patients to certify their income level, they will not ask about the citizenship status of those seeking care.

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