A majority of the Los Angeles County Board of Supervisors raised objections Thursday to plans to shut 11 clinics, even though health officials have quietly floated contingency plans for far more drastic cuts in the coming year.
Three supervisors said the county should look elsewhere for the painful cuts that lie ahead, but severe cost-cutting looks increasingly inevitable as deficits of $195 million to $331 million are projected for the department in the next fiscal year.
Under a worst-case scenario, county health officials have privately suggested closing all six of the county's comprehensive outpatient health centers along with its medical clinics, according to a confidential draft of the plan obtained by The Times. Under that plan, patients would lose county facilities that provide more than 160,000 urgent care visits and nearly 180,000 specialty care visits a year, mostly from the uninsured and poor.
Yolanda Vera, director of the health advocacy group LA Health Action, said such cuts could have a crippling effect on the region's healthcare system as patients overload busy emergency rooms because they have nowhere else to go.
"It would be a complete meltdown of the total system," she said. "It would be the poison pill that we've all feared."
The proposal was drafted in case the county fails to resolve disputes with the federal government over $137 million in funding. Health department officials said they were unsure whether the money would come through and declined to comment on the plan.
"We're not going to say where we're going with phase two because we don't know the size of it at this point," said John F. Schunhoff, chief deputy director of the county Department of Health Services.
More cuts in future years could also run long and deep. Within four years, the county's shortfall is expected to hit $1.6 billion.
The county has blamed the deficit on rising costs for treating indigent and uninsured patients, coupled with federal and state reimbursements that have failed to keep pace.
Supervisor Yvonne B. Burke, whose South L.A. district includes some of the poorest neighborhoods in the county, said health officials should find alternative savings to cutting county clinics. She expressed doubts that local private, nonprofit clinics could replace them.
"Many of them are on the brink of bankruptcy, because they don't have people who contribute millions of dollars to them," she said. "Our clinics are a vital part of our whole system."
