Times are tough for Sacramento County — both for the indigent population and for the local lawmakers who have no money to care for them.
A preliminary injunction hearing will be held tomorrow (Friday) in Sacramento Superior Court to decide whether or not to lift a temporary restraining order that has kept the doors open at three public clinics in Sacramento County.
Feeling the pressure from budget cuts, the county earlier this month moved to shut down two clinics that had been open one day a week, and trim hours and operating expenses at the county’s only full-time clinic. That comes on top of the closures of two other clinics last year and another clinic in 2008.
All of those cuts leave the indigent population in the Sacramento area in an extremely precarious state, according to Stacey Wittorff of Legal Services of Northern California.
“The California welfare code requires counties to provide relief and support for indigents, and that includes medical services,” Wittorff said. “Since 2008 services [in Sacramento County] have been drastically reduced. They used to have six clinics there, now there’s only three, and only one of those has been full-time.”
So Wittorff’s legal aid organization filed a lawsuit and won a temporary restraining order to keep the last three clinics open, at least for now.
“They’ve been chipping away at the safety net over the last two years,” Wittorff said, adding, “With this round of cuts, the level of care does not meet what they need to provide, does not provide what’s medically necessary.”
The county has been squeezed by budget cuts. In the 2007-2008 budget, the county’s Department of Health and Human Services received $40 million in general fund money — and in the most recent budget for fiscal year 2009-2010, that general fund number dropped to $18 million, according to Ann Edwards-Buckley, director of Health and Human Services.
“We’ve made reductions in every single program, every single one, and there were just no good options,” Edwards-Buckley said, adding, “We’ve made reductions to public health programs, child protective services, senior and adult services, mental health programs and the clinics.”Â
So, earlier this year, the county Board of Supervisors voted to close the Del Paso and South City clinics, and cut back hours and the number of physicians at the county’s Primary Care Center.
Judge Allen Sumner, who issued the temporary restraining order, said the planned closures ignored the county’s responsibility to the indigent population. “The county acted arbitrarily in significantly reducing its medical services to indigent persons, without addressing what standards it was using, or determining if it would continue to provide necessary medical care as required by statute,” Judge Sumner wrote.
He added, “The court is well aware of the difficult budget decisions the county must make. However, the Legislature has required the county to provide medically necessary services for indigents.”
There are 22,000 patients enrolled in the County Medically Indigent Services Program in Sacramento County. The cuts would drop the number of physicians treating that patient population down to five. That’s slightly less than half of the current physician staff.Â
“People with chronic preventable conditions are not getting access to primary care, so conditions are becoming emergent,” Wittorff said. She said that, ironically, the county often ends up paying for care for those indigent patients in more-expensive private emergency rooms. “So not only are people getting sicker, or dying,” she said, “but the county’s paying more for it in the end.”
“In some situations, that is true,” Edwards-Buckley said, “in that some patients go to emergency rooms for conditions that aren’t emergencies.”
She hopes that recent changes in triaging patients at the remaining Primary Care Clinic will help keep patients from going to the emergency department for care. “We’ve been making operational changes to the clinic, putting better practices in place for triage. So I think thatâs going to make a difference,” Edwards-Buckley said.
In any case, she said, it’s about the limit of what can be done.
“This has been the most excruciating budget process of my career,” Edwards-Buckley said. She added, “These are not reductions I feel good about, none of them, not one of them. For me and my staff, it’s been very painful, and we spent many, many hours thinking about how to make things better for those we serve. This has not been a good time for any of us.”
Earlier this month, Sacramento County lost a different court case with UC-Davis Medical Center over indigent care. The county ended its indigent-care contract with the medical center, but the judge ruled that, since indigent patients still use the facility, the county is responsible for reimbursing the UC-Davis facility. The county is meeting with UC-Davis officials to determine just how much payment is necessary.
If Judge Sumner does rule that Sacramento County needs to provide better health care services for its indigent population, then the next decision will be up to the county Board of Supervisors. The board could pump a little more money into the Department of Health and Human Services or it could order the department to stay within its crimped budget and axe other services.
“It’s possible we’ll need more general fund money than we currently have,” Edwards-Buckley said, adding, “I have no idea where that money would come from.”