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California Vulnerable to Outbreak

Agency's findings show that the state's medical facilities aren't equipped to handle commonplace diseases or major bioterrorism attacks.

March 22, 2003|Nancy Vogel | Times Staff Writer

SACRAMENTO — While attempting to gauge California's readiness to deal with a bioterrorism attack, an independent oversight agency has found that the state's basic public health system is so disjointed and neglected that residents are just as seriously threatened by an epidemic of commonplace diseases such as the flu.

In a report scheduled for release next month, the state's Little Hoover Commission describes a 30-year erosion of a health system that has left Californians vulnerable to disease outbreaks, new germ strains, hospital-acquired infections and widespread poisoning.

Government officials and private experts interviewed by the independent agency over the past year testified that the network for tracking disease and treating mass illness or injury has "deteriorated to the point that lives are at risk," according to the draft report, a copy of which was obtained by The Times. That deterioration, it said, partly reflects a shortage of money, but also is the result of unfocused state agencies and a lack of centralized leadership in the health-care system.

Some of the commission's findings reflect long-standing concerns about the state's public health system, but the new warnings include a call for creation of a state public health department and come at a particularly delicate time, as California is grappling with a huge budget shortfall and a weak economy.

A deputy to Gov. Gray Davis said administration officials had not yet received the report, but that California's public health system has improved over the past year as it has attempted to brace for the possibility of terrorist attacks.

The report, scheduled for public release in early April, will be considered by the 13-member commission next week and could be amended. Among its conclusions:

* A key agency -- the Department of Health Services -- focuses more on insuring poor people than guarding the population against contamination and infection.

* California's laboratories for analyzing disease are too few and outdated. Sophisticated analyses must be done on the East Coast.

* No single government agency is responsible for making sure hospitals can handle a surge in patients triggered by an epidemic or attack.

* State authorities learn of only roughly 20% of the diseases and conditions that doctors and nurses must legally report, in part because the reporting system is slow, cumbersome and paper-based.

* In contrast to the governor and other state officials who believe California is well-prepared for health emergencies, county officials and private experts on the front line of disease control are far more pessimistic.

Conflicting Views

"Early in this study, the Commission was confronted by conflicting testimony: State leaders expressed confidence in a system that local leaders and private partners described as severely broken and not improving," according to the report.

The 41-year-old agency -- officially known as the Commission on California State Government Organization and Economy, but informally referred to as the Little Hoover Commission -- investigates state government and recommends improvements. Its staff is overseen by a panel of lawmakers and citizen appointees of the governor and Legislature.

The commission investigated California's homeland defense readiness after the Sept. 11 terrorist attacks and concluded in a January 2002 report that the public health system was by far California's weakest link. The commission then launched a more detailed study of the state's disease-control network.

In six public meetings between June and November 2002, the commission took testimony and advice from dozens of government officials, university researchers, medical industry representatives and security experts. The commission staff, with advice from the commissioners, drafted the report and its recommendations.

The researchers found a system ill-suited to deal with drug-resistant tuberculosis, contaminated juice and influenza epidemics, let alone an intentional release of anthrax or smallpox.

"The public health infrastructure is in poor repair," states the draft report, "providing less protection than it should against everyday threats, and unprepared to protect us against what is possible."

One contributing problem, according to the researchers, is the time and expense of administering California's Medi-Cal program, the state's health insurance program for the poor. Ninety percent of the Department of Health Services' budget is dedicated to Medi-Cal, and that job overwhelms officials who otherwise might be able to spend more energy responding to health problems, the report states.

Davis administration officials said they had not yet seen the Little Hoover Commission report. But they defended their efforts to strengthen the state's public health system, particularly in response to the threat of terrorism.

"There's no question that the state is better prepared than we were a year ago and progress is being made," said Daniel Zingale, the governor's deputy chief of staff.

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