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Judges Order Sacramento County to Pay Up

The showdown in court is over for now, and Sacramento County will need to come up with a better way to fund and manage its responsibility to care for the indigent and mentally ill.

That’s the word from three recent court decisions. At the end of last week, Sacramento County, which had already been hit with a temporary restraining order, accepted a longer-binding preliminary injunction to halt cuts and closures at its three public clinics, until a new plan can be worked out — one that offers better care to the county’s indigent patients.

That legal move came just one day after a U.S. District Court judge ruled last week against the county in a different court case, ordering Sacramento County to stop its plan to scale back some mental health services.

The county also recently lost a third case, when a judge ruled that UC Davis Medical Center was entitled to reimbursement from the county for indigent care provided by the hospital. (And on top of all of that, another lawsuit over mental health cuts is pending in Superior Court, as well.)

The three legal decisions have rocked the county’s cash-strapped Health and Human Services department and heartened advocates for the poor.

“We’re happy at this point, because we have an injunction until something else happens,” lead attorney Stacey Wittorff of Legal Services of Northern California said. “We assume the next step is we’ll have talks with the county. And certainly we’re open to those.”

Stuart Seaborn is the managing attorney for the Sacramento Regional Office of Disability Rights California. He’s the one who argued the lawsuit to maintain mental health services.

“This ruling sent a huge sigh of relief throughout the mental health community,” Seaborn said. “They would have ended up cycling in and out of institutions, emergency rooms, and that’s something we wanted to avoid.”

The county’s Department of Health and Human Services has seen its share of general fund money drop in the past two years from $40 million to $18 million.

“We know the county is facing significant cuts to the general fund,” Seaborn said. “But this top-down, one-sided approach just won’t work.”

Those budget cuts over the last two years are just a portion of the money forfeited by Health and Human Services, director Ann Edwards-Buckley said. “Many of our programs draw down state and federal revenue,” she said. And that means that whenever services are cut, the department loses additional matching money. What do you cut, she said, when every service provided by the department is vitally important?

“I call it a Sophie’s Choice,” she said.

“You know, in the past I’ve been an outsider looking at what government is doing, and you think, ‘Wow, how could they do that?’ But when you have limited resources and you have to spread that money around, you’re looking at some really difficult choices.”

The county has been trying to reorganize the way mental health and indigent services are delivered. And it has started talks with UC Davis to arrange a fair payment level. The next big step in mental health and indigent care likely belongs to the Sacramento County Board of Supervisors, which has control over the budget.

Decisions need to be made quickly, Seaborn said.

“We’re looking at Aug. 1st as a key date. That’s the crucial end-of-the-status-quo date,” Seaborn said. “At that point, we’ll see whether the county has complied or not. The ball’s in their court.”

Everyone knows the county has a lot of balls on that court. And while all of these court cases have gone against the county, it’s anxiously waiting to see what further cuts might come from the state.

“The county has had its hands full,” Wittorff said. “Right now, the system will remain the same until something else can be worked out. But we’re hopeful we’ll reach an agreement.”

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