L.A. County Proposes Cuts to Clinics, School Programs

Los Angeles County health officials are recommending the closure of 11 health clinics, the elimination of its school-based medical programs and the conversion of High Desert Hospital into an outpatient clinic as the first steps toward closing an $800-million deficit, according to documents obtained by The Times.

The proposals would amount to the deepest cuts in the county’s frayed public health system in seven years. But they may represent just the beginning of a dramatic reduction and restructuring of the system.

The health department’s plan, to be considered by the Board of Supervisors next week, outlines far more severe cuts to come in October should the county fail to persuade the federal government to once again bail it out of a financial crisis. In that event, the county would consider ending inpatient services at Harbor-UCLA near Torrance and Olive View in Sylmar, privatizing Rancho Los Amigos Medical Center in Downey and shuttering its network of nearly 100 private outpatient clinics.

This is not the first time the board has been confronted with the prospect of closing hospitals and clinics due to financial hardship. It has relied on federal bailouts and aggressive borrowing to avoid drastic cuts. But some medical and county officials believe those moves worsened the problem and that supervisors this time will not be able to avoid painful curtailments.

For several weeks, health officials have hinted at the cuts they were considering to deal with a steady decline in federal aid. But late last week they began briefing supervisors on what appear to be their final recommendations, which are scheduled to be discussed at the supervisors’ June 26 meeting. The plans will be posted on the department’s Web site Wednesday.

The proposed cuts amount to a declaration of defeat for some of the county’s most highly touted health initiatives that were launched after its last major health care crisis in 1995. After receiving a $1-billion bailout by the Clinton administration, county officials pledged to scale back large hospitals and create an efficient network of outpatient clinics in neighborhoods and public schools.

But that bailout is exhausted, and more recent federal aid is dwindling. The county faces an $800-million deficit in three years. With the state and federal governments wrestling with their own deficits, county medical officials now have modest hopes.

“The exercise we’re going through here is to try and balance a budget, not to meet all the health care needs that exist in Los Angeles County,” said Dr. Thomas Garthwaite, the county’s new health director. “That’s not what we’re trying to do. It’s not like we’re meeting those already.”

Even if the county receives federal aid, Garthwaite is recommending cutting inpatient services at High Desert, closing 11 of the 18 health centers, the six clinics in Los Angeles schools and reducing contracts with private clinics by 25%. In all, those facilities registered 350,000 patient visits annually. The health department has not yet determined how many full-time jobs would be eliminated by those initial reductions, but an earlier estimate for slightly more severe trims put the number at about 4,600, officials said.

The service reductions would fall most heavily on people like Tina Avalos, 66, who choked up in the waiting room of the Alhambra Health Center on Monday when she heard it was slated for closure.

“What will my daughter and I do without this place?” Avalos asked. Two years ago, she recalled, doctors at the clinic rushed her to County-USC Medical Center when she had trouble breathing due to swallowing a fish bone.

Like many in the waiting room Monday, Avalos and her daughter, Linda Flores, had to take a cab from their home to the clinic.

“This is truly the only way my mother could have been treated,” Flores said. “We can’t afford the $30 cab ride to the next clinic, and we can’t afford the $1,000 trip to the ER.”

Supervisor Yvonne Brathwaite Burke has four similar health centers in her district slated for closure. She said she does not want to eliminate them but may not have a choice.

“If I do it, it will be with tremendous, tremendous heart-breaking and considerable sorrow,” Burke said. “And I wish I didn’t have to. But unless something happens in the next few days, we’re going to have to do what we have to do.”

Supervisors have always had difficulty cutting the health department. In December, they voted to study expanding some of the hospitals that now may be downsized into clinics. The move was part of a decade-old pattern in which supervisors talk about the need to cut the health budget, then approve more spending in hopes of getting more money in the future.

It will be difficult for supervisors to maintain the pattern this year, because their traditional escape routes may be sealed. The federal government has signaled that it will not give the county the same help it has in the past. The state is grappling with record deficits.

“Those are the only two places that we can look for any kind of remedy, and both of them don’t seem prepared to act or even respond,” Supervisor Gloria Molina said. “We’re kind of at the end of our rope. We have nowhere else to go.”

The supervisors do have some options--and some time. The deficits will not appear until next year. The county has about $500 million in reserves to keep the department afloat. In the past, the board has taken on a controversial amount of debts, even mortgaging its own offices, to keep hospitals open. But many officials, including the county’s budget chief, have criticized such methods as fiscally unsound.

Mark Tarnowsky, a spokesman for the union that represents most of the health department’s 22,000 employees, said it was “irresponsible” for the board to consider cutting medical services to poor people before their budget had even reached a deficit.

“We understand how difficult it is” to find new sources of money, Tarnowsky said. “All we’re saying is that that ought to be the focus, not cuts.”

Supervisor Burke, however, said the county must cut immediately. “The more we delay, the greater the problem,” she said. “If we had done some of these a little earlier, maybe we would not have the magnitude [of problem] that we have now.”

Cutting health services is guaranteed to trigger a political imbroglio at the board. Supervisors are traditionally protective of health facilities in their own districts. The most significant prior cut in health services was the shrinking of the replacement of County-USC from 750 to 600 beds, which became one of the state’s nastiest political battles and took three years to resolve.

On Monday, Supervisor Mike Antonovich, who represents the area served by High Desert, said the health department needs to ensure the care provided by the hospital can be replaced.

“We need to ensure that North County residents have access to medical services,” Antonovich said.

Grim as supervisors sounded about the first round of cuts, all agreed that those cuts are nothing compared to the health department’s proposals for the fall.

The cuts at High Desert and clinics, coupled with other administrative savings, are expected to save $158 million by next year. Health director Garthwaite is proposing those reductions even if the county gets additional help from the federal government this fall.

But should that help not materialize, Garthwaite has sketched out an additional $259 million in reductions. Though not yet fixed, they include the conversion of Harbor and Olive View into clinics. Both hospitals operate busy emergency rooms and have a combined 930 licensed inpatient beds. High Desert, by contrast, has 75beds and no ER.

Closing major hospitals could overwhelm the region’s entire medical system, health experts say. Emergency rooms would be snarled, and private trauma centers that treat victims of gunshots would collapse under the strain.

Times staff writers Richard Fausset and Garret Therolf contributed to this report.