REGIONAL REPORT : Counties Reel Under Impact of $781-Million Budget Cut

Reeling from dramatic budget cuts, Los Angeles County officials said Wednesday they plan to close 400 hospital beds, gut the county’s health center system, close down most of its mental health centers and deny medical and psychiatric services to tens of thousands of would-be patients.

While Los Angeles must absorb the biggest budget cuts, counties across California are also experiencing a money squeeze, particularly in the health and mental health fields, court systems and child welfare services. The state is cutting its funds to the counties by $781.5 million, according to the County Supervisors Assn. of California.

The deterioration of Los Angeles County’s medical system, the hardest hit of all county services, could trigger the closure of some private hospitals in the region as indigent patients seek help at private emergency rooms, officials predicted.

“Some people with health-care needs that aren’t basically life-threatening won’t be treated,” said Irv Cohen, director of administration and finance at the county’s Department of Health Services. “Ultimately it will lead to even more critical medical problems.”

While Los Angeles County must absorb the biggest budget cuts, counties across California are also experiencing a money squeeze, particularly in the health and mental health fields, court systems and child welfare services. The state is cutting its funds to the counties by $781.5 million, according to the County Supervisors Assn. of California.

Riverside County--where troubled juveniles had to wait a year for help--will see its successful mental health pilot project axed. In San Diego, a health-care program for the working poor, which was hit with a $14-million cut, could be dissolved.

In Ventura County, the opening of a new courthouse in Simi Valley is threatened because there is no money to staff the courtrooms. The county also lost all its money to pay lawyers to represent poor defendants facing the death penalty.

“It was sort of a question of honor even by the most stringent death-penalty advocates that before we gas a person, we should make sure he was adequately represented,” said Public Defender Kenneth I. Clayman.

The cuts could be fatal to Butte County, one of many rural counties that are tottering on the edge of financial disaster. The county is considering becoming the first ever to declare bankruptcy.

“You’ll get the same horror story from any other county auditor in the north,” said Mendocino County Auditor Dennis Huey. “It can’t get much more bleak.”

The budget crisis was precipitated by Gov. George Deukmejian’s deep cuts after the Legislature had already cut $2.7 billion.

But Orange County’s budget chief is hoping that the county’s new authority from the state to raise more revenue will relieve some of the pressure. Orange County, faced with a possible deficit of $46 million, hopes to raise fees and taxes to absorb up to $20 million in red ink.

The Los Angeles County Board of Supervisors will meet on Monday to determine what cuts will be necessary and what might be done to limit the damage. County heads huddled in a closed-door meeting Wednesday to determine the cuts they will recommend to the supervisors. In Los Angeles and other counties, just what services will be sacrificed remained unclear a day after the governor signed his $55.7-billion budget.

In Los Angeles, health-service officials, grappling with an $80-million cut, said they will propose closing 400 beds throughout the county’s six-hospital system. The overcrowded hospitals, with a total of 3,000 beds, already are routinely closing their emergency rooms to ambulances because all beds are filled. With nowhere else to go, poor patients will flood private hospitals, possibly threatening the ability of people with medical insurance to get admitted, county officials predicted.

“It’s not only going to be the indigent population who will feel the cuts,” said Kathryn Barger, health deputy of Supervisor Mike Antonovich. “If a hospital is full, it’s full. That will really hit home. It’s pretty scary.”

“I think that is going to have several unpleasant repercussions,” said Dr. David Chernof, president of the Los Angeles County Medical Assn. “It will affect the financial stability of a number of hospitals. Some hospitals will be put in financial jeopardy.”

“We expect and are preparing for further emergency room, burn center, obstetrics and trauma center closures because of these budget cutbacks,” said David Langness, of the Hospital Council of Southern California. “That will affect every patient in Los Angeles County, not just the poor.

In addition, the public health centers will largely abandon their role of treating people who are sick but not sick enough to be in a hospital, Cohen said. Many people with diabetes, heart conditions, viruses, sore throats, colds and other such ailments will no longer be helped at the clinics.

Instead, these people will be sent to the county hospitals. The medical staffs will be forced to decide who will get help and who will not, Cohen said. The unlucky ones might be asked to return in a week, month--or never.

“Our health-care providers will have to do a tremendous job to determine which patients can be deferred and which must be treated quickly,” Cohen said. “It puts them in a very serious situation.”

The public health centers will remain open to provide the services necessary to prevent the spread of contagious and communicable diseases, Cohen said. The centers will provide immunizations and the treatment of venereal disease and tuberculosis.

The news from Sacramento was just as bleak for the county’s Department of Mental Health, which expects to close all but eight clinics. Department officials had been planning for months on how to squeeze $10 million in cuts out of their clinic network, which a county report this spring had called “decimated” and “largely dysfunctional.”

But mental health officials were flabbergasted when they learned the cuts had mushroomed to about $43 million.

“It will decimate our system,” said Francis Dowling, the department’s chief deputy.

Tens of thousands of severely mentally ill will go without treatment, Dowling said. Some of those who no longer receive medications for suicidal tendencies or hallucinations will land in jail or at one of the county’s four psychiatric emergency rooms.

But the busiest one, at County-USC Medical Center, is already closing its doors daily to delusional and suicidal people because it is too dangerous to let any more people inside, physicians there said.

“I don’t want to be an alarmist, but I frankly think that given this kind of cut, within the year, the number of homeless people will double from 30,000 to 60,000,” said Richard Van Horn, chief executive officer of the Mental Health Assn. of Los Angeles County. “Whatever people are seeing on the street now, they’ll see double.”

Elsewhere in Los Angeles County, the Probation Department might have to close up to three juvenile camps to absorb a cut of roughly $12 million, said Barry J. Nidorf, the county’s chief probation officer. Camp closures, he warned, ultimately will cost taxpayers twice as much because troubled youths will be sent to the more expensive state youth authority facilities. Juvenile halls will become more overcrowded and more teen-agers will be sent home prematurely.

School districts across the state were scrambling to cope with the budget cuts.

Los Angeles Unified School District officials expressed shock at the governor’s education cuts and warned that layoffs could result unless the Legislature restores the money.

But officials in other school districts in the county said they had already incorporated some cuts into their budgets after being warned by Deukmejian that he might reduce the cost-of-living increases that districts receive in funding based on average daily attendance.

“We don’t anticipate we’ll have to make a lot of cuts,” said Robert Frick, an assistant superintendent in the West Covina School District. The district had anticipated that the cost-of-living funds would be cut from 4.7% to 3% as announced by the governor on Tuesday, he said.

But the cuts will cost the Los Angeles district about $71 million, officials said.

Supt. Bill Anton said he was especially concerned about a $600,000 cut in the district’s child abuse prevention program that slashed 75% of that program’s operating funds.

Contributing to this story were Times staff writers Jim Newton, Blake Fontenay, Jenifer Warren, Denise Hamilton, Shari Roan, Harold Maass, Daryl Kelley and Jack Searles.