Los Angeles County Grand Jury
1990-1991
Findings and recommendations not yet extracted.
Findings & Recommendations
16 findings
F1:
hospitals show substantial and increasing incidence of drug addiction, alcoholism, and STD, including AIDS. Incidence of AIDS is increasing steadily. The number of AIDS cases in the county is increasing in a linear fashion as shown in Figure 1, including new female cases of about 100 per year. Of the pregnant females admitted at Harbor-UCLA Medical Center for drug abuse, 29 percent are found also to have at least one sexually transmitted disease. AIDS CASES IN LOS ANGELES COUNTY TOTAL ADULTS AND ADOLESCENTS 200'01 000'01 450 024Y FEMALE AIDS CASES L.A. COUNTY 150 1987 1988 1989 1990 1991 1992 1993 TOTAL ADULTS AND ADOLESCENTS: FEMALE AIDS CASES: - SOURCE: L.A. COUNTY, DEPARTMENT OF HEALTH FIGURE 1 In Los Angeles County cocaine abuse is the principal drug problem; 70 percent of neonatal urine toxicology screens revealed cocaine. A dramatic increase in ICE intoxication, a new problem with a smokable form of methamphetamine, has been observed. Similarly, at Harbor-UCLA Medical Center tests of pregnant women who are admitted using illegal drugs or methadone or subject to alcohol addiction show that 27 percent are found also to have at least one STD: syphilis, gonorrhea, chlamydia, hepatitis B, or are HIV positive. Cost effectiveness. From our investigations and the literature, we have found:
F2:
National surveys indicate that the median charge for perinatal hospital care of drug exposed infants was $5500, compared to $1400 for non-exposed infants (GAO Report HRD-90-138). About 30 percent of drug exposed infants are placed in foster care which generates additional costs of $6000 per child per year. Dr. M.L. Yonekura's program at Harbor-UCLA Medical Center, a pilot program for pregnant and parenting chemically dependent women, was instrumental in avoiding the need for critical care for two infants by adequate prenatal treatment. This saved about $120,000 in one year, which covered the entire budget for the pilot program, a degree of cost effectiveness which suggests that such programs should be expanded. Estimates developed at LAC+USC indicate that the representative cost for one AIDS infant, from diagnosis to death, was $75,000. In 1986, $9,743,000 was spent to treat 152 patients in Los Angeles County. Using the estimate above, the current increased rate of HIV, 109 new AIDS mothers per year, would increase the patient load by about two-thirds at a total cost of about $15,000,000 (equivalent 1986 dollars). The increase in numbers of drug exposed mothers and infants is currently
F3:
underestimated. The Table below (derived from the GAO study which includes Los Angeles and four similar large cities) shows that 25 percent of infants tested showed drug exposure. Hence the number of drug-exposed infants in the total population is presently underestimated by approximately a factor of three because of inadequate test procedures and patient refusal. Infants Tested Drug Exposed by Test Infants Not Tested 594 78 306 Percent drug exposed of those tested = 78/306 = 25%; Underestimate in the total population number which would be detected if every infant were tested = number which were actually detected .25 X (306 + 594) = 225, about 3:1 78 78 99
F4:
Drug-exposed infants have more costly problems than non-exposed infants. In a pilot preschool study performed by the Florida Department of Health and Rehabilitative Services, drug-exposed infants with significant neurologic and physiologic damage were found to require special services that cost up to $75,000 by the time the individual reaches age 18.
F5:
Drug-exposed infants are more likely to require foster care than others. Cost of basic per capita foster care, according to studies, ranges from $3600 to $5000 annually. On the other hand, specialized foster care required for prenatally untreated drug-exposed children may cost in the range from $4800 to $36,000 annually. Drug abuse and STD are linked. Program funds and research projects that we
F6:
reviewed were oriented toward either drug abuse or STD, but almost never to both simultaneously. Even in the well-written 48-page GAO report we found no mention of STD, only of drug abuse. During our meetings with Dr. M.L. Yonekura and in her letter report, drug abuse was strongly emphasized with little mention of STD's relationship to the medical needs of infant and child. A similar study provided by Dr. Judy Howard, Department of Pediatrics, UCLA, notes that of 1986 medical care costs "drug related AIDS cases" account for almost as much money as "emergency room and related hospitalization," $9.7 million versus $11.8 million. One estimate states that eight percent of drug addicted newborns in Los Angeles suffered from congenital syphilis and that at least 29 percent have at least one STD, and about the same percentage aso applied to alcoholics. The effectiveness of the drug abuse programs and that of STD projects would be improved if they were not funded and evaluated by separate bureaucracies, since the medical problems occur together in many patients. Lack of prenatal care is partly due to government policy, ignorance of the 7, magnitude of future financial and human costs, and lack of leadership and social responsibility in all levels of our society. Government policy — Starting about 15 years ago, funding problems due to Proposition 13 compelled the State to provide "matching" funds to counties for the cost of indigent health care. Although the original commitment was to fund 70 percent of what the State would have spent if medical funding would have been continued, the promise was not kept. By the end of the last gubernatorial administration, funding had fallen to 55 percent with an additional hidden loss due to inflation. The Board of Supervisors has allowed the county's contribution to the Department of Health Services to decline to 50 percent of the resources allocated in 1981 in 100 current dollars. That this could happen in the face of a large increase in the number of medically indigent (due to immigration and the beginning of a new baby boom) exemplifies the neglect of our social responsibility.
F7:
and walk-in/emergency teams. Encourage the DHS to implement urgent care programs at the CHCs such as the
F8:
Human costs are high. We have a moral obligation, and a harder-to-define legal obligation, to educate children with learning and physical disabilities and poor skills to make them productive members of society. If they are unable to cope with the complexity of modern life, these costs may be exorbitant. Infants born with drug exposure problems suffer from drug withdrawal seizures in the crib. They have respiratory distress syndrome, birth defects, poor motor skills, poor language and learning skills, and many are seriously handicapped for life. The human cost of a lifetime as a drug handicapped person who is unable to function in society and is victimized by others, victimizes others, or is institutionalized, may be as great as that from prenatal AIDS infection, since drug abused infants have greater life expectancy.
F9:
charitable organizations and service clubs in providing much needed services, resources and money for VCR's, cassettes and books for the CHCs.
F10:
Provide additional space or trailers needed to alleviate overcrowding at North Hollywood Health Center and Tujunga Sub-Center.
F12:
Continue contracting with physicians and private hospitals to provide for the obstetrical overload.
F13:
Institute more no-smoking programs in the CHCs and health centers similar to the Wilmington Subcenter Program funded by the Tobacco Tax Program.
F14:
Evaluate the Ability to Pay Program so that it can better serve the needs of the community in terms of simplified qualification procedures.
F15:
Form a coalition of members of the community and experts in health service to begin to plan to meet the future needs and problems facing the county health care system.
F16:
Request more state and federal funds to offset the increased cost of health care due to amnesty, immigration and subsequent obstetrical crisis.
F17:
Subsidize Medi-Cal reimbursements or cover insurance costs of private hospitals and doctors who will accept county patients.
Additional Recommendations
7
Not linked to specific findings.
R1:
Regularly monitor and provide adequate resources for the timely implementation of corrective actions required by JCAHO and HCFA accreditation authorities. Periodic reports on the status of implementation should be provided to the Board with the review and comments of the Chief Administrative Officer. Where a corrective action recommended by accreditation authorities is deemed infeasible, the Board should receive a complete report on the matter and determine whether to appeal for relief from the appropriate authorities.
R2:
Regularly monitor and continue to support implementation of recommendations of the 1990 Health Facility Replacement and Improvement Plan including construction of new hospitals at the LAC+USC site, the San Gabriel Valley and other recommendations as presented.
R3:
Direct appropriate county staff to prepare a comprehensive financial plan to: Support implementation of interim corrective measures required by accreditation authorities. Financial support for corrective measures, including a reserve for costs that may arise from changes in accreditation requirements, should be considered in the county's capital planning and budgeting process. Present a more detailed discussion and analysis regarding the costs and benefits of constructing new hospital facilities versus rehabilitation of existing facilities. Prepare a detailed analysis of alternative plans to finance the construction of new hospitals at LAC+USC and the San Gabriel Valley. This analysis should cover a variety of specific financing options under a variety of economic and operational assumptions. A recommended financing strategy should be presented, based upon a "most likely" scenario. Particular attention should be paid to assumptions concerning the source of revenues to retire bonds. Develop a process to more precisely estimate, track and document operational cost savings related to the new facilities. Determine the reliability and alternatives to funding provided by SB1732. Prepare a detailed discussion and analysis regarding the feasibility, costs, and benefits of contracting selected segments of the county's health care provision. Request the Southern California Rapid Transit District to guarantee adequate bus service
R4:
to any county hospital site that is selected to serve the San Gabriel Valley. Investigate the feasibility of programming flexibility into the architectural plans for the
R5:
new hospital to allow for conversion of space from inpatient to outpatient use. The ability to convert will allow the county more flexibility to respond to future trends in health care service and hospital utilization. Develop a process to periodically reassess key assumptions relating to the design
R6:
and construction of the new hospital facilities since the proposed construction program will take eight years. The process should include a mechanism for altering plans to respond to changing environmental and economic factors. Implement an effective program to communicate to the county voters the benefits
R7:
to accrue from passage of the 1990 Health Facilities Replacement and Improvement Plan which incorporates the Master Plan update. B. GRAND JURY COUNTY HOSPITAL STUDY
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Additional Recommendations
3
Not linked to specific findings.
R2:
representatives from the DHS, Probation, and health care contractors to resolve potentially costly cases which are not discussed in the procedures and protocols. Instruct the Director of the DHS to develop a health education curriculum and teaching
R3:
methodology to be followed by all health care providers including contractors. Compliance with the curriculum and methodology should be regularly monitored by the Chief Probation Officer with financial penalties imposed upon contractors for non- performance. Instruct the Director of the DHS to review the current procedures followed and services
R4:
provided by health care providers at the time of a youth's discharge from the probation system. The Director of the DHS should consider this an opportunity to improve the health status of this population and determine if additional health care services should be provided. Examples of services to be provided would include giving a toothbrush, 121
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* This report's PDF did not contain easily extractable text and required Optical Character Recognition (OCR) for analysis. There may be minor errors in the extracted findings and recommendations due to OCR limitations with scanned documents.