Clinics

Amid the economic downturn and slow growth for retail and outpatient medical care services, pharmacy giants Walgreen Co. and CVS Caremark Corp. are rolling out new specialized services at their in-store clinics, going beyond treatment of routine maladies.

Los Angeles County supervisors on Tuesday approved $44.8 million in extra funding for dozens of private clinics that treat the growing ranks of uninsured patients. The county has been reimbursing clinics for primary care, dental and specialty medical services for the last 13 years, and currently budgets $54 million annually for payments to clinics. The new funding, which will be paid over the next three years, includes $35.5 million in services for new patients, $7.8 million for equipment and construction, and $1.5 million to create a countywide Internet-based medical records system.

This is Los Angeles, where laws that seem sensible on the first quick reading turn out to be studded with exceptions or are enforced sporadically. Consider billboards. The city's porous legal barriers encourage rogue sign companies to ignore the law and then to sue when they are challenged. They often win -- because the laws were so clumsily drafted or applied as to be deemed void by the courts. As it is with billboards, so it threatens to become with medical (ahem) marijuana and the city's attempt at a regulatory scheme to accommodate Proposition 215, the "compassionate use" act that voters adopted in 1996.

The deed was stomach-turning: Hooded gunmen burst into a Ciudad Juarez drug treatment center, gathered together those inside and lined them up before opening fire with semiautomatic weapons. When the shooting was over, 18 people were dead. Attention focused immediately on the site of Wednesday night's killings: a rehab center, where addicts go to get clean, suggesting a new level of depravity in Mexico's drug violence. Theories abounded: The victims were targets of rival gang members.

Los Angeles County healthcare officials unveiled a draft cost-cutting plan Wednesday that calls for closing all but one of the county's dozen clinics and reduces services at its six comprehensive outpatient health centers. Officials said a $195-million deficit makes the cuts necessary even under a "best-case scenario" for the badly strapped public healthcare system. The county faces the threat of more reductions in state and federal aid in the next few months.

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.

WHAT a Monday morning this was shaping up to be. Carrie Clemens' head pounded, breathing through her stuffy nose was difficult and her symptoms were worse despite a weekend of bed rest. But work beckoned -- and she had no time to visit the doctor. And so, before checking in at her job, Clemens stopped by a small walk-in clinic at a Costa Mesa Rite Aid.

A trendsetter in many ways, California is behind the curve when it comes to retail-based health clinics. Other states, such as Minnesota and Ohio, have seen dozens of such outlets open and flourish in the last five years, but California has only a few. Now owners of retail-based clinics, plus some healthcare consultants and economists, are pushing for changes in laws that could make the state more accessible to them.

HealthSouth Corp. said it would sell about 600 outpatient rehabilitation centers in 35 states to privately held Select Medical Corp. for about $245 million as it proceeded to focus solely on post-acute care while recovering from a $2.7-billion accounting scandal. HealthSouth is shedding a division that once formed the most visible part of its business and helped make it the nation's largest rehabilitation chain. Chief Executive Jay Grinney said Birmingham, Ala.

UC San Francisco has taken over a post-transplant clinic for kidney patients at Kaiser Permanente's San Francisco hospital, bringing to an end Kaiser's brief -- and scandal-plagued -- foray into the organ transplant business. The takeover means that UC doctors now will care for Kaiser's kidney transplant patients before, during and after their surgeries. Kaiser had been caring for about 1,500 patients who had already received transplants. "This is the last piece of the puzzle," said Dr.