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Orange County to Cut Health-Care Services

With costs outpacing funds, eight part-time clinics will close, and treatment of mental illness and other conditions is targeted.

June 16, 2003|Jeff Gottlieb | Times Staff Writer

As Orange County supervisors try to balance a budget with $130 million less than this year's, health officials plan to severely cut mental health services, close eight part-time clinics and reduce staff for sexually transmitted disease testing.

Although the Board of Supervisors increased the county Health Care Agency's budget 5% for the fiscal year beginning July 1, department officials say higher care costs mean they would have to get $23 million more to keep services at current levels.

Translation: fewer hospital beds for mentally ill adults, less care for emotionally disturbed children and kids on probation with substance abuse problems, greater potential for venereal disease outbreaks as testing takes longer, and more travel time for poor children who need immunizations.

For 4 1/2-year-old Shannon DeMarco, it will mean periodic interruptions in the physical therapy that in three years has taken her from being unable to sit or crawl to nearly being able to control herself on crutches despite her cerebral palsy.

Other disabled children treated by the county who need their wheelchairs repaired will have to wait a month or more instead of a week. And patients who need evaluation will have to wait 10 days instead of one or two.

"We're concerned about the level of service reductions," Dave Riley, the agency's second-ranked official, said of the supervisors' preliminary vote last week on health-care spending. "We also have to say we realize it's a very difficult county fiscal situation." Orange County budget experts said current estimates call for the county to have $4.78 billion to spend, down from an estimated $4.91 billion in the current year, ending June 30.

With higher salary and pension costs, lower investment returns and uncertain state funding, as well as $800 million in debt remaining from the county's 1994 bankruptcy, supervisors have had to make difficult decisions during public hearings on each department's budget request. A vote on the full budget is scheduled for June 24.

But health-care advocates note that Orange County already pays less per capita for care than any other large county in California.

"This is going to impact every man, woman and child in Orange County, eventually," said Felix Schwarz, executive director of the Health Care Council of Orange County, which advocates on behalf of patients. "Communicable diseases are not confined to poor people and immigrants. Cuts in mental health are guaranteed to mean there will be more homeless crazy people on the streets."

A $4.3-million increase in the health department's budget actually represents funding for the public administrator/public guardian offices, which have been put under the agency's auspices. Some of the higher costs burdening the department are faced by all county departments: a 63% increase in retirement costs, 15% in employee insurance and a 3.5% cost-of-living increase. But the health department is also bracing for a 13% rise in drug costs.

As a result, agency officials have proposed cutting about $10 million in mental health services, $5.9 million in public health programs and $6.9 million in medical services. The agency also plans to spend $5 million in reserves.

For the moment, no layoffs are planned because the agency has had a hiring freeze in place for 16 months. But some employees may have to switch positions, department spokeswoman Pat Markley said. And the staff will have to absorb more of the workload, which means delays.

Gerald Kominsky, associate director of UCLA's Center for Health Policy Research, said cuts in public health almost always fall on poor people who depend on the system the most.

Still, since "public health risks really do cross economic and social barriers," Kominsky said, "you can cut programs that affect a portion of the population, and it affects all of it."

One example may be elimination of four full-time staff positions for lab testing of sexually transmitted diseases to shave $560,000 from the agency's budget. While testing will continue, Markley said, people will have to wait longer for results.

Closing satellite clinics will save about $640,000. Four are in Santa Ana, and there is one each in Huntington Beach, Anaheim, Stanton and the El Modena area of Orange. Many of them are one- or two-room operations open a few days a week at most.

Markley said fewer patients were using these clinics, and patients can visit the county's four core clinics, in Santa Ana, Anaheim, Westminster and San Juan Capistrano.

But Isabel Becerra, director of health policy and development for the Coalition of Orange County Community Clinics, predicted that cuts in county services, especially the clinic closings, will divert some patients to nonprofit community facilities closer to home -- operations already strapped for funding.

Becerra said coalition members probably will have to provide more free care, and more patients inevitably means longer waits for appointments.

Others worry about the social cost of reducing mental health services.

"I think it's pretty sad to make these cuts to mental health," said Nancy Rimsha, director of the Health Consumer Action Center at the Legal Aid Society of Orange County.

"Nowadays we know if you catch mental illness earlier, [you can] start treating them when they're young," she said. "Then, hopefully, they don't grow up to be mentally ill as adults."

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