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Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Los Angeles County Grand Jury • 1981-1982

Subcommittee on Gang Violence

Published: February 16, 2010 113 pages
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Findings 6 findings

F1 Page 50
No specific impact studies regarding the consequences of the intended cuts were made prior to the abrupt curtailment of services in July 1981; only broad, descriptive generalizations of services to be cut were provided. The Grand Jury realizes that the Board was responding to abrupt reductions of funding; however, STATE OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE P the Department of Health Services had been warned to prepare projections for various anticipated levels of cutbacks at least six months in advance. A STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE STATE OF THE Los Angeles has a large population of immigrants from countries where diseases such as amoebic dysentery, malaria, typhoid and salmonella are endemic. The Jury believes that a curtailment of services could have a serious impact on the . health of the entire community. For example, it should be noted that Los Angeles County is experiencing a rise in the rate of tuberculosis while other major urban areas are experiencing a decrease. The CAO has twice recommended elimination of the requirements of the
F2 Page 50
Beilenson Act, which calls for a 90-day notice of hearing and 60 days concurrent waiting period prior to closure or reduction of facilities and level of care. The Act gives those who would be adversely affected an opportunity to give vital input about where and how much the level of services would be decreased. The CAO recommended that the County seek repeal of the Act "so that counties can The state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of the state of t have needed flexibility in their allocation of limited resources among all service programs," (letter dated December 5, 1980). In another letter dated June 25, 1981, it once again referred to side-stepping the specifics required under the Beilenson notification requirements. The Grand Jury believes the Board must STATE STATE OF fulfill its legal obligation to the community to provide adequate warning and opportunity for review by meeting the Act's requirements. PERSONAL PROPERTY.
F3 Page 50
The Jury has been unable to obtain an explanation of conflicting budget figures. The final budget adopted by the Board on July 3, 1981, shows a final figure of $4,595,599,459 with 72,300 positions budgeted. Yet in a letter dated July 23, 1981, to Assemblyman Art Torres, the CAO shows 1981-82 adopted figures STATE OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE PARTY OF THE P totaling $4,717,248,750 with 73,788 positions. This represents an increase of $121,649,291. Considering that the Health Services budget was cut by $56 million, to what extent was this additional amount allocated to restore the . health cuts? A document received from the CAO's Office showed the total number of people A CONTRACTOR on the payroll in September 1981 was 74,432. A second document from the Auditor-Controller showed the County payroll for the October accrual was 77,293. Since we understand a freeze had been put on County hiring, we are puzzled by the addition of 2,861 workers in one month's time. SUPPLY OF STREET Health care is generally considered a right of every citizen, whether privately or
F4 Page 50
publicly rendered. Medi-Cal was supposed to provide equal access for all; how- 1 ever, many private providers are unwilling to accept Medi-Cal patients because they are considered "unprofitable." In the past, the County has filled the gap for those unserved by the private sector. The current trend is to contract out these services in an effort to save money. The Jury has some serious concerns about the effects of contracting out health services. One university professor of Public Health states, "The history of contracting out has been miserable." He has said the cost of regulating the contract, added to the cost of the contract itself, can cost the County more than providing the services in its facilities. According to him, the cost in California and and a 49 1000000 of delivering services at a private hospital is greater than the cost at a County facility. The Jury's fundamental concern is: Who will ensure that the private contractor will provide services to those unable to pay, who receive services in County- operated facilities? The Jury believes contracting out health services might make them financially inaccessible for many, and could result in higher costs to the County. As the professor put it, "The overwhelming motive can't be -- what can we get rid of that no one will see... County facilities were set up to provide services no one else wants to provide. The people provided for in County facili- ties are historically those not profitable for the private providers."
F5 Page 51
The Jury believes that certain cutbacks in services could be short-sighted, result- ing in increased costs later on. For example, the elimination of health educators, nutritionists and social workers could pose a serious problem. These three occupations are crucial in helping people learn how to take care of their health problems before they become serious. Preventive medicine is the most cost-effective and efficient way of serving the community. Curtailing or eliminating health prevention programs results in hospitalization later, at much greater cost to the County. The Jury finds particularly alarming the elimination of pharmacy services at all but the comprehensive health centers. Almost all out-patient pharmacy services have been eliminated at hospitals, and drug dispensing at health centers is now limited to public health drugs only. Medical facilities and physicians serving the poor find it essential to supply medications. A patient with no definite symp- toms, such as one with hypertension, is not likely to purchase expensive medi- cation until he becomes acutely ill and requires hospitalization. The Grand Jury has learned the County can provide medication at a substantially lower cost than that charged by private pharmacies. Medication has been provided either in a lump sum Medi-Cal billing (under the Los Angeles County waiver which waives the necessity for itemized billing) or is included in the all-inclusive clinic fee. Rather than eliminating the dispensing of medication, the Jury believes the County should explore the feasibility of charging pharmacy fees somewhere between the actual County cost and the much higher fees authorized by Medi-Cal. The result would be a savings for the taxpayer, and the markup could be used to fund medication for those unable to pay and ineligible for entitlement programs. In addition, the Grand Jury has information that a gap in service has resulted because many medications pre- scribed at County facilities are not available in community pharmacies. For example, cancer patients cannot get the narcotics they need in many areas of the County because the pharmacies do not stock them.
F6 Page 51
Clinic fees as currently structured are exorbitant and unrealistic. Patients have been billed for later collection with extremely low collection rates. The experi- mental program of collecting a $20 up-front cash fee, instituted in April 1981 has reportedly been extremely successful. The vast majority of patients have been willing to pay the fee, and substantially higher revenues are being generated. Therefore, the Grand Jury recommends:

Recommendations 8