Los Angeles Times Examines Los Angeles County Health Department Deficit, ER Overcrowding

Faced with a $800 million health department deficit by 2005, the Los Angeles County Board of Supervisors this week will consider a plan that would "reduce the number of places patients can receive general medical care but ... preserve high-end hospital care and emergency rooms," the Los Angeles Times reports (Riccardi, Los Angeles Times, 6/24). The Department of Health Services has recommended closing 11 health clinics, eliminating school-based medical programs and converting Lancaster-based High Desert Hospital to an outpatient clinic. In all, the changes would save an estimated $158 million by next year (California Healthline, 6/18). According to the Times, county Health Director Thomas Garthwaite is attempting to cut routine services while retaining specialized services based on the assumption that the working poor might "be able to pay for normal doctor's appointments but not for pricier specialty care." Through such a plan, which critics say is an "impossible balancing act," the county is attempting to "maintai[n] its commitment to take all comers, even while making it more difficult for patients" to locate care. "It's a Darwinian kind of care rationing. Let's cram more people into small spaces and see who can get in first," Mark Tarnawsky, a spokeperson for the union representing many health department employees, said. But county Supervisor Gloria Molina said that over the years, the county has been providing more services to residents than neighboring regions and now has to "downsize" the department to remain solvent. "[Patients are] just going to have to drive farther, wait longer," Molina said (Los Angeles Times, 6/24).

Garthwaite's plan to reduce the county health department's budget deficit by closing certain facilities and scaling back services is the "best hope" for financial solvency and would "make sense even without a looming deficit," a Times editorial states. Although the county supervisors will hear "howls of pain" from residents, the board must vote to make the department more efficient if "more severe cuts are to be avoided." The Times concludes, "Garthwaite has taken a cogent, systemwide look at how to deliver the best care allowed by limited resources. ... The supervisors, accustomed to competing for clinics and hospitals in their districts, must give his plan a chance" (Los Angeles Times, 6/23).

The Times on Sunday also examined emergency-room overcrowding in Los Angeles County, which seen more than 20 ERs shut down in the last 10 years and has "one of the worst ambulance-gridlock problems in the nation." The congestion has led to five-hour waits for some patients seeking care and is "endangering patients' lives," the Times reports. Waiting patients often are cared for by paramedics and ambulance workers, who sometimes have less than six months of formal training. The Times adds that emergency workers who are waiting in hospitals cannot pick up additional patients, contributing to a delay in ambulance response times. The gridlock problem is in large part a result of a critical nursing shortage, too few inpatient beds and low payments for emergency and trauma care, which has forced ERs to close (Ornstein, Los Angeles Times, 6/23). The full article is available online.