Proposal for Drastic County Health Cuts Criticized
By LAURENCE DARMIENTO
Staff Reporter
The county’s proposal to radically downsize its health department in the face of a $700 million deficit is facing sharp criticism because of fears that it could overwhelm private health care providers with uninsured patients and that supervisors are far too eager to embrace it.
The plan, which will be formally presented to supervisors this Wednesday, calls for cuts in services that will save $57 million in the fiscal year starting July 1 and $352 million the following year.
And should the county not obtain extra funding from the state or federal governments in the coming months, Health Services Director Dr. Thomas Garthwaite is asking supervisors to approve additional cuts in October that would save $133 million and $503 million respectively.
“There is no plan except ‘we need to cut,'” charged Jim Lott, executive vice president of the Healthcare Association of Southern California, the hospital industry’s regional trade group. “It’s elected and appointed officials abandoning their responsibility to all of the rest of Los Angeles County.”
The plan would consolidate all advanced hospital care at Los Angeles County/USC Medical Center and convert High Desert Hospital in Lancaster to an outpatient facility. Eleven county health clinics would be shuttered as well, forcing patients to travel farther to the county’s larger comprehensive health centers.
Without additional funding, Harbor-UCLA Medical Center and Olive View-UCLA Medical Center also would be converted to outpatient clinics, while the county would eliminate its contracts with 100 private clinics, which uninsured patients visit 500,000 times each year.
Strain on hospitals seen
While the county held several meetings this year with hospitals, doctors and others interested parties, Lott charged the plan was developed in isolation by county officials intent on balancing a budget, resulting in a proposal that would swamp hospitals and emergency rooms with uninsured patients, straining already crowded and often financially troubled private hospitals.
“There is no doubt that costs are going through the ceiling for them and everyone else and they need to redefine their mission,” he said. “But they just can’t stop providing service in a geographic area and not take into account the effects on the rest of the health-care delivery system.”
Garthwaite, who met with hospital industry officials earlier this month to alleviate some of their concerns, defended the proposal as a carefully planned document that all parties had a chance to comment on but that would inevitably cause disruption given the massive budget deficit.
“Their concern is the patients they will face if we can’t continue to take care of more of the uninsured,” he acknowledged. “But it’s hard to imagine we could do more.”
Even so, Garthwaite said he has agreed to provide additional data to the healthcare association, which wants to run it through a computer model to better determine the plan’s effects on hospitals in specific geographic areas.
Also criticizing the plan was Local No. 660 of the Service Employees International Union, which represents nearly 20,000 of the department’s 24,000 workers.
Mark Tarnawsky, the local’s communications director, said Garthwaite’s insistence on making drastic cuts immediately, as well as supervisors’ public comments about their inevitability, amounts to the county “throwing in the towel” before even mounting a concerted fight to secure outside funding.
“They seem to be giving up before they even started,” he said. “The discussion seems to be dominated by counting the beans.”
He was joined in that criticism by Lark Galloway-Gilliam, executive director of the Community Health Councils, a health advocacy group, who said county health officials had failed to rally support to pressure the state and federal government into providing additional funding.
“Where is the leadership in this town?” she said. “Nobody is championing health.”
Supervisor Gloria Molina, who clashed several years ago with her colleagues in trying to prevent a downsizing of the main county hospital, said she was disappointed by the criticism but understood it.
“I have been at the Board of Supervisors now for over 10 years, and the last eight years of it has been about the deficit in the health department,” she said. “Believe me, we have not tried to be quiet about it.”
Mandy Johnson, executive director of the Community Clinic Association of Los Angeles County, said she was concerned that the cuts would either trim or eliminate county funding for the association’s member clinics, forcing them to operate on smaller budgets.
But she said it would be impossible for the county to even have a chance of getting additional state or federal funding unless it had a plan to improve efficiency.
Health Plan: County health director’s main proposals for cutting costs.
-Convert High Desert Hospital, Harbor-UCLA and Olive View-UCLA Medical Centers to outpatient facilities.
-Eliminate psychiatric services if they cannot be reduced 20 percent.
-Close 11 county health clinics.
-Better link health department employee compensation to performance and productivity.
-Reconfigure the county’s hospital network to avoid duplication of services by facilities.
Source: L.A. County Department of Health Services
