Pain for Health Services

Supervisors in many counties around the state will commence on Monday the traumatic process of slashing their health, social-service, probation and other budgets to conform to the cuts in state funding imposed by Gov. George Deukmejian. For San Diego and Orange counties there is limited effect, although at least one clinic will lose its doctor, but Los Angeles County faces the most painful cuts of all.

The last shred of hope for easing major reductions in the Los Angeles County budget dissolved when the governor also vetoed enabling language that would have assured the county $34 million of an $88.8-million block grant to be shared by all of the state’s counties. The governor objected that small and rural counties should receive more. Now there is doubt that the county will receive even a share based on population. The governor’s veto ignores the harsh realities of Los Angeles County, which--with 30.7% of the state’s population--has 38% of the state’s medically indigent population, 36.8% of the Aid to Families with Dependent Children caseload and 51.7% of the state’s general relief.

Now the supervisors are faced with cutting $27 million from health services, $15 million from probation, a net of $11 million in mental-health services, $10 million from public social services and $3 million from fire-related services. Few options are open to the supervisors. State-mandated and court-mandated demands are forcing major shifts of resources to meet the burgeoning jail population, running 77% above state-rated capacity, and the growth of the courts.

When the governor vetoed $28 million in funds for the medically indigent, he also swept out $12.5 million that he had restored in May. Los Angeles County lost its share of these funds, and also of funding for outpatient services for hospitals serving a disproportionate number of patients for whom there is no compensation. Lost with the veto of the medically-indigent program was $9.9 million for trauma centers, coupled with a further loss estimated at $7 million for hospital emergency care--cuts that radically raise the risks for everyone in need of emergency care, whether from heart attack or freeway crash. That rising risk is measured by the number of hospitals forced to discontinue their trauma centers.

These cuts translate into reductions in existing care even though that care is already judged as underfunded. The county staff has recommended that the $27 million in health-service cuts be made by reducing the number of acute-care beds in all county hospitals; eliminating the alcohol rehabilitation program now serving about 500 persons, most of them homeless; eliminating drug rehabilitation at Rancho Los Amigos; closing the already-crowded clinics at County-USC Medical Center for an additional day each week; eliminating some public-health clinics, and reducing services at other clinics.

Fortunately, the supervisors appear committed to a $22-million increase in the grossly under-funded AIDS program, but that expansion in itself is largely at the expense of other important county programs.

The dire results of these cuts--with implications for the health services for everyone, not just the poor--may help bring home to the people of Los Angeles County that the governor is wrong when he defends the rigid limits on state spending of the Gann amendment, that he is wrong when he resists tax increases, and that the basic services--let alone the quality of life--are being eroded by that stubborn policy.