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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 • 1990-1991

County Health Care System

25 pages
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Note: Missing finding numbers detected: F11

Findings 16 findings

F1
treatment, and management strategies within the DHS system. Community-based organizations and local support groups have done the majority of the work. Good networking among most of the organizations is being done. Ten years ago AIDS was an unrecognized, non-identified, and misdiagnosed killer in the Los Angeles County health care system. Today, more is known about this disease and its effects than was thought possible. The sooner a treatment and management protocol can be established the greater are the chances of success in dealing with this disease. Currently the DHS has too few effective early intervention programs. Early intervention depends not only on testing sites but also on effective educational and community outreach programs. Early intervention, a multi-faceted, greatly needed service, includes medical screening (antibody testing), and case management services. The highly publicized long waiting time for new outpatient appointments at DHS is a fact. A 20 to 22 week waiting period is not acceptable by any standard. We found from our site visits that the majority of county health care centers have few or no HIV/AIDS related programs functioning at a level necessary to meet the demands of the community. The DHS needs increased funding and grants from appropriate state and federal agencies in order to provide funds for community-based programs. Because of the high turnover rate and less than adequate numbers of staff personnel, the various DHS HIV/AIDS programs fail to meet the need. Special wage and benefit incentives to HIV staff would assist in recruiting personnel and reduce the shortages. HIV/AIDS education, prevention, and community outreach programs are essential. Literature and video education materials on the benefits of early intervention are not available in culturally appropriate language. The number of HIV/AIDS patients seeking care at county hospitals is increasing because fewer private hospitals accept Medi-Cal and medically indigent patients. Annual increase of AIDS is 23 percent among women versus 15 percent for men currently. One out of every nine people diagnosed with AIDS this year will be female, making it one of the top five killers of women aged 15 to 44. The problems of AIDS in women are different from that in men because female diagnostic tests and symptoms differ from those in males. This results in delay of detection and treatment. Women are not included in most of the current research protocols. According to Constance Wofsey, M.D., Codirector of the AIDS Activity Program at the University of California, San Francisco, studies show that up to 50 percent of women who are infected do not even know they are at risk. The accompanying graph, cited from the source, "Centers for Disease Control" illustrates the dramatic increase of AIDS in women. CUMULATIVE CASES OF AIDS IN WOMEN 16,000 15,000 13,000 12,000 11,000 10,000 9,000 8,000 7,000 . 6,000 5,000 4,000 3,000 2,000 1,000 0 83 85 86 87 88 89 90 82 84 Source: Center for Disease Control Increase of AIDS among child-bearing women implies a future threat that there will be an increase in the number of babies born with the HIV virus. 104
F2
of us are exposed, those risks are so small that they have been impossible to detect in epidemiological studies to date." The study also presented data on the relative cost of various fluoride regimens which showed that community water fluoridation was cost effective especially in large cities. This data is tabulated below. Estimated annual cost of fluoride regimens per person served in public health programs Method Cost Community Water Fluoridation 200,000 Persons $0.12 - .21 .18 - .75 10,000-200,000 Persons .51 National Weighted = Average School Water Fluoridation 3.55 - 4.73 Fluoride Supplements .81 - 5.40 Fluoride Mouthrinse in Schools -.52 - 1.78 Children covered by Medi-Cal are less likely to use preventive dental services than other children because the system discourages the use of these services. The Child Health and Disability Prevention (CHDP) Program regulations require that all eligible children be examined by a dentist annually, but Medi-Cal, which is supposed to pay for this service, allows for only a single dental examination per dentist in the child's lifetime. Medi-Cal insured children do not benefit from dental sealants (a clear plastic material applied to the chewing surfaces of back teeth protecting these decay prone areas from plaque and acids), fluoride treatments or regular prophylaxis due to Governor Deukmejian's veto of legislation that would have added sealants. Sealants are available to privately insured children in California and to children insured by Medicaid in 22 other states. A Pedodontist Residency Program will be instituted at Roybal CHC with three residents and seven senior University of California at Los Angeles (UCLA) dental students. There is a great need for board certified specialists at the CHCs, especially oral surgeons, pedodontists and periodontists. Volunteer organizations such as Meet Each Need with Dignity (MEND), the Los Angeles and Venice free clinics, and dental hygiene and dental student participation in dental school-sponsored mobile clinics are not sufficient to meet the demands for dental care. 109
F3
services, and multiple entry into the county public health system. Replace outdated laboratory equipment to prevent duplication of tests first performed
F4
with obsolete instruments and to provide the tests more expeditiously. 113
F5
Offer primary care for HIV patients and dispensing of medication at all health clinics and/or CHCs to alleviate the overcrowding of county hospitals by HIV patients.
F6
Provide security guards at county health centers so that sorely needed evening services can be instituted. Provide El Monte CHC the funds to meet their needs for an ambulance, paramedic
F7
and walk-in/emergency teams. Encourage the DHS to implement urgent care programs at the CHCs such as the
F8
one at Hubert H. Humphrey to alleviate emergency care overload at county hospitals. Encourage the participation of private donors, small businesses, civic, social and
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. G. PEDIATRIC RESIDENT RECRUITMENT

Recommendations 9