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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

4-18 F. Visits to the DHS Health Care Facilities

193 pages
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Note: Missing finding numbers detected: F11

Findings 16 findings

F1 Page 120
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 Page 121
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 Page 123
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 Page 123
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 Page 123
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 Page 137
charitable organizations and service clubs in providing much needed services, resources and money for VCR's, cassettes and books for the CHCs.
F10 Page 137
Provide additional space or trailers needed to alleviate overcrowding at North Hollywood Health Center and Tujunga Sub-Center.
F12 Page 137
Continue contracting with physicians and private hospitals to provide for the obstetrical overload.
F13 Page 137
Institute more no-smoking programs in the CHCs and health centers similar to the Wilmington Subcenter Program funded by the Tobacco Tax Program.
F14 Page 137
Evaluate the Ability to Pay Program so that it can better serve the needs of the community in terms of simplified qualification procedures.
F15 Page 137
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 Page 137
Request more state and federal funds to offset the increased cost of health care due to amnesty, immigration and subsequent obstetrical crisis.
F17 Page 137
Subsidize Medi-Cal reimbursements or cover insurance costs of private hospitals and doctors who will accept county patients.

Recommendations 7