SR-306-001-01 (2)
.
Santa Monica, Cal~nia
July 28, 1981
306--00/-10/
/I-c..
To:
Mayor and Clty Council
JUl 2 8 1981
From:
City Staff
SubJ ect.
Report on Los Angeles County Fiscal Year 1981-81 Budget Curtailments
in Health Service
Introductlon
This report presents lnformatlon concerning the recent budget cuts i~ple~ented
by the Los Angeles County Board of Superv1sors relat1ve to Health Services.
Background
At their regular meetlng on July 14, 1981 the City Councll directed staff
to prepare a report concernlng Los Angeles County Budget cuts in health
services The Los Angeles County Board of Supervlsors recently passed their
1981-81 F,scal Year budget which contains curta,lments ln fundlng for County
Health Serv1ces. Most of these cut-backs will take effect August 1, 1981.
The areas affected generally impact two segments of the County health care
system - the County hospltals and area health care clinics. Fees for Para-
medlc Tralning wlll also be established as a result of County cutback.
Total cutbacks wlll amount to approximately 79 mlllion (that is curtallment
of ap~roprlations authorlty) from a total County Health Services budget of
$989 '1ll1llOn.
Los Angeles County 1981-81 Hospltal Budgets
Overall hospital service cuts are shown on Appendix I. Los Angeles County!
use Medlcal Center budget will experience a gross expendlture reduction of
521.8 mllllon with layoff of 603 employees. Areas to be affected are summ-
arlzed ln Appendlx II. Harbor/UCLA Medlcal Center program reductions wlll
equal $3.7 mlllion or about 10~.
Programs to be affected are SUmMarized in
AppendlX III.
II-C
JUl 2 8 1981
.
To:
Mayor and Clty cou~
.
July 28, 1981
-2-
Martin Luther Klng, Jr. General Hospital wlll experlence curtallments when
the budget cuts are implemented in the amount of 54.8 million. The cuts
appear in Appendix IV. Long Beach General Hospital will have program cut
backs of ~8.2 m1ll1on. These appear ln Appendix V.
Also, Rancho Los Amlgos Hospltal and Ollve View Med1cal Center will exper1ence
slmllar program cuts and personnel layoffs as a result of Los Angeles County
cutbacks. (see Appendlx VI).
10s Angeles County Health Center Cutbacks
Several major curtailments wlll occur in the Health Center network of district
health centers and subcenters as a result of County budget cutback Eight
health centers will be closed wlth a net reduction of $11.6 mllllon In the
cost of health center operatlons Budget cutbacks will result in severe
cutbacks In ambulatory care, eli~inat1on of med1cal soc1al worker, health
educatlon and nutrltionist programs and reduct10n in pat1ent transportat1on
serVlces.
Health Center Closure
Health subcenters to be closed are Santa Fe Springs, Norwalk, Culver City,
North Enterprlse, Vllla Carson, Bell Gardens, Dollarhlde, and Pacolma.
Dlstrlct Health Centers where publlC health care wlll contlnue to be ava1labe
are Whittler, Bellflower, West - Santa Monlca, South Torrance, San AntonlO ,
Compton and San Fernando The public health activlties conducted in clinics
to be closed wlll be relocated to the health center ln the same health dlstrlct
in WhlCh the subcenter ln located. (Appendlx VII)
To: Mayor and C1ty cou~
.
July 28, 1981
-3-
Ambulatory Services
Ambulatory care services wl11 be ellminated at the elght subcenters to be closed
and at th1rty-two other health center 10cat1ons. (see Append1x VIII) These
cl1n1ca1 serV1ces include adult and ch1ldren's ambulatory care serV1ces 1nvolving
tr1-age screening, treatment for bas1c health care needs, and referral for
secondary and test1ary treatment serV1Ces.
N1ne health c11nic facil1t1es w1ll cont1nue to prov1de ambulatory care
They are EJ Monte, Pomona, West - Santa Monica, Compton, El Cerr1to, Glendale,
Canoga Park, San Fernando and Antilope Valley.
Medical Soc1al Worker, Health Educator and Nutritionist Programs
Social Worker, and Nutrit10nlst programs w1ll be eliminated in Co~munlty Health
and Comprehensive Health Centers. Health Education wlll also be eliminated
except for elght Health Education posit1ons to be ma1ntained to conduct immlnlzation
p~ogram activ1ties. (The rema1ning several pos1tions will prov1de.consultant
services in the area of tuberculosis, venereal d1sease, and 1m~unizatJon
programs to satlsfy Callfornla Admin1stratJve Code requirements for Health
Departments in California).
The elim1nat1on of 50c1al Workers, Health Educators, and Nutrltionists w1ll
stop aSSlstance to patients and fam11ies, health promotlon and d1et counseling.
Medlcal, Soc1al Service programs to be eliminated lnclude:
Chlld Abuse Referral Team
Sudden Infant Death Syndrome Counseling
Battered Women Counseling and Referral
Wlfe Abuse Probationer Counsellng Program
Premature Infant Counsel1ng Program
Emergency Family A1d and Referral
Famlly Counseling Progra~
Adult Therapy Counseling
To: Mayor and Clty cou~
.
July 28, 1981
-4-
Avallable nursing staff (which is experienclng a 30% shortage) wlll be
expected to absorb:
Prenatal Soclal/Economlc Screenlng and Counseling Service
Electlve Abortion Counsellng
Sterilization Counseling
Referral to Outslde Resources
Parenting Counseling
OB Contract Referrals
Health Education includes health promotlon, inservlce trainlng, and community
outreach. The ellmination of this program will affect health information
dissemlnatlon and coordination, and communlty health outreach lncluding
immunlzatlon, screening cllnics, health fairs, and health demonstratloPs.
The ellmlnation of Nutrition as a health serVlce will lmpact about 16% of
the current patlent workload lncluding patlents who are obese, diabetic,
hypertensive, need special dlets (malnutrltlon) and need school counsellng
programs. Nutrltion programs relleved nursing staff of nutritlon counsellng
and follow-up these are important aspects for the treatment of preventable
dlseases. Upon ellmination, these serV1ces wlll be absorbed by nursing staff
where possible.
Other Cutbacks
In addltlon, other cutbacks at Comprehenslve Health Centers will result In
increased turn-around tlme for laboratory and radiology services, reductions
In dental services, famlly medicine, medical walk-ln, pharmacy and women's
medlclne. Waitlng time for new and return appointments wlll probably lncrease
from the present 1-2 week wait to 4 or more weeks. (See attached IX for other
cutbacks).
Patlent Transportation SerVlce
Patlent Transportatlon Service (PTS) curta11ments will result in a 77~ reductlon
To: Mayor and Clty Cou~
.
July 28, 1981
-5-
of PT5 staff. The effects of thlS wlll be to dlsco~tlnue transportation of
patients from private hospitals and nursing homes to County hospitals, and cease
transportlng outpatlents to County hospltals. Remalnlng PTS wlll enable move-
ment of patlents withln the County system only.
ParamedlC Tralnlng Institute Fees
The County budget for next year lncludes several program modlflcations.
These changes include establlshment of fees for tralning at the County
Paramedic Training Institute. The proposed fees will be as follows:
Primary Trainlng $1,750
Contlnuing Educatlon 100
Certlficatlon and Recertiflcatlon: 100
Paramedics 100
Paramedics - Challenge Exams 300
MICN 50
MIeN - Challenge Exams 150
The Clty of Santa Monica Flre Department personnel wlll be directly affected
by the establishment of fees for paramedlc tralnlng. The City will now have
to pay a fee for tralnlng, certlflcation and recertification of our flre-
fighters. There currently are no monies budgeted in the current Clty budget
to fund fees for these tralning actlvitles.
Summary
The cuts in County Health SerVlces may have several effects on Santa Monlca
resldents who use the County Health care system. The West - Santa Monica
Health Clinlc located at 2509 P1CO Boulevard, Santa Monlca, wlll contlnue to
provlde full-scale medlcal care. However, the Culver City Health Subcenter
wlll be closed, and ambulatory care at Venice Cllnic dlscontinued. The West-
Santa Monica Cllnlc wlll recelve an lnflux of patlents from these areas,
without added personnel to compensate for the lncrease. (See Appendix X
To. Mayor and City cou~
.
July 28, 1981
-6-
for l'St of affected Health Centers). For example, the nlne Health Centers WhlCh
wlll contlnue to provlde ambulatory serVlce (including Santa Monic~ have
experienced 125;000 ambulatory clinlc V1Slts per year. The total system-wlde
visits were 460,000 per year. Because of the serVlce cuts, the nlne remalnln9
clinlCs will be expected to absorb some of these excess clients needing
ambulatory care. The ellmination of medical soclal worker, nutrltionist and
health educator programs will affect all Health Clinics. As a result, clinic
patients will no longer be able to obtain serVlces such as counsel lng, health
educatlon and nutrltion programs.
The Los Angeles County Health Servlces budget cuts affect a Wlde spectrum of
Santa ~bnlcaand County area resldents. Those who wlll be severely lmpacted
are indivlduals and families who use the County Health Care system; many
of these are low lncome and minorlty individuals.
The cuts in comprehensive health center programs will produce a shift in
medlcal services to the acute care facilitles where costs are higher for the
same service. County hospltals also wlll experience cutbacks in serVlces and
compound the effects of health service curtailment to the cllent.
Recommendatlon
It is recommended that Council direct the City Attorney to draft a resolution
expresslng thelr concern regardlng the Los Angeles County Health Servlces
budget cuts, and d,rect Staff to manltor the Health Serv,ces cutback effects on
health serVlces provided by the County to Santa Monlca resldents.
Prepared by Jacquelyn M. Kelly
Admlnistrative Assistant
JMK: mmm
Attachments
B'"J1IRD hOOPl'ED aJR'rAIUiiJm Q)>ITAIr~D IN 1981-82 ms B;ljJur.T
HOS; 'ITALS
.
.
;Z.
A ten p:.'rcent (10%) reductlOn at IACjUSC Hedlcal Center, Harl::or-U:"U, :letllcal
Center, HartIn wther Klng, Jr., General ,iOspltal, F.ancho Los Airllgas HOspItal,
olive View MeDIcal Center, and MIra Lorna HOSpItal.
Inpatient ServIces
- ReductlOn of beOs at IJ\CjUSC r.lechcal Center, including prCXjra1\S such as
Renal Transplant, IX>r;~atoloTI I ?regn,mcy Terr<lnatlon, OJstetncs/JlJ'ltepartwF
and Alcohol D2toxiflcatlOn.
Reduction of beds at RanQ~O Los A~i9os Hosp1tal, IncludIng cardIology,
Neurology, OlronlC Back: PaIn anD Liver Service.
El1r.unatlon of Acute j.ledlcal and SurgIcal ServIces at w~ Beach
General Hospita~.
OJtpatient SerVIces
Curtailment of services mcluduJ] lAltpatient Pharmacy, Dental, Renal
DIalysIs (except IACjUSC ~ledlCal Center) and, Specialty and General ClInics
?ther Programs/ActIvlqes
ElImInatIon of patient appbances except t::yr:€s provld~ !:y NedlCal Program.
Dlsoo~tinuatlon of certaIn contract laboratory servlce~.
- MedIcal school contracts held at 19RD-8l level {no prOVIsIon for cost
increases due to Inflation).
- Q.lrtaI1ment of supp:>rt servIces related to the Board Adopted program
cuts.
AddItIonal 10% cut In AOrrunlstratIve Staff.
PERS9~~l.L/A'1BtY,-,l;TORY CARE SERVICES
MaJor reductiOns in Personal/A~ulatory Care ServIces and closure of
eIght health centers.
A 10% reductIon at the COmprehenSIve Health Centers.
EliminatIon of the HealL~ Education, SocIal Worker and l~utrItlonIst serIes
In Health Centers and CanprehensIve Health Cente::-s except eIght Health
L~ucators maIntained to conouct ~~~lzatlon prD9ram actIvltIes.
- ~~dItIO~al a~~lnIstratlve curtalLTent of 10%.
OIlIER !",0?A"1 CURl'AIU-iENTS
- l, 30% reouct1on In [)?p::rb:-r::mt 4:a5~,Elrters staff.
- A servIce level d~crC2se at C~11~O~1l1a C~Ilcren S=rvlc~s.
'I'ra:1S[er of Certain staff fro, t:le Ca-?3ratlve ';::chcal a'1d V.::~erHl3.lY
S":nnce to the t>-"part::.?nt of 1-_'11--.31 Care and Co"1trol.
- S..,.::!::r3t..3:'1tlal reductlofl of Lr'IC ~3.~~CT1t 7=--a""'.5;X:H.-t2t~~-; ?!. _':~-~"T).
/....Ac/osc
Ht>.s P IrA- ~
. Chunty Cost
Reduction
Prograrn
lKPATIENT &iliVlCES
$1,663,309
, .
Budgeted Po~h t ion
Reduction
ATTACIIIYJEIVT :1L
l2.yoff
145.75
145.75
68 reds wi.l1l:e closed July 15, resulting in a loss of revenue of ~;2,601,580 and
decreasing expenditures by $4,264,895. Closure of these beds will necessitate
laying off 1<~6 i?';lloyees. Services will either be consolldated with other 2.::-e2S
or patie.'1ts :::eferred to other service resoClrces, such 2S outpat~ent cli..'lics and
private hospitals.
Net County Cost
ILoduction
OUTPATIENT ::i.t;.IiVICES
$2.575,205
B-..1dgeted Position
Reduction
layoff
86.3
86.3
All primary care clinics aIld select specialty clinics will be closed Julv 15, 1981,--
decreasing revenue by $384,801 and gross e"'-p"'-llditures by $2,960,006. Patients will
be referred to Cbnprehensive Health Centers or private facilities. All outside
clinic refe:7'als from health centers, \miversities, or private physicians will not
be accepted. Approximately 86.3 direct patient care errployees will be layed oU.
Net Chunty Cost
Reduction
OUI'PATIENT
DENTAL S".t.RVIITS
$ 254,900
Budgeted Position
Reduction
\
f-ayoff
6
6
Dental services vdll be discontinued July 15. A letter will be sent to all scheduled
patients advising them of the dlscontinuance of the dental program. Alternative
..sources which will be recoi'rrIBnded are private dentists and University dental sc..rlOols.
ApPrDKimately six iterr.s, including dentists and dental assistants, will be deleted
fro."!l the budget.
Net County Cost
Reduction
PATIENT A.P?LIAt'\cr.s
$ 278,000
Budgeted Position
Heduction
Layoff
o
o
A letter has been forwarded to Purchasing and Stores requesting the cancellation
of contracts for vendors to supply eyeglasses, orthopedic shoes, liquid oxygen,
and hear:in- aids effective July 15. Patients will be advised of alternate sources
:for purc~e and will be provided appropriate prescriptions. There:are no
layoffs associated v:ith this program, which will decrease revenue by $42,000 and
gross appro;:Jriations by $320,000.
Net County Cost
IL.<=>duct ion
OUI'PATITh'T P?.P.R\ti\.~
$3,250,390
Budgeted Position
Reduction
;Layoff
25
38
Elimination of outpatient pha..'TClacy will result in a loss of $485,600 in revenue
and decrease gross appropriations by $~,736,080.. Qltp~tients.will be ~ef~rred to
- their COITIr'.-mity pha...."'!facist for rremcabons. Pat~ents wlth l.Iedl.-Cal or },Jedlcare
vd.ll re liable for deductible levied on prescriptio:1 items; non-covered patients
will P3.Y full charges. 38 positions will be delet~d. ~c1uding P~arr..acists, . .
Pha.:nracy Helpers and Teclmic~a!1s, and var~ous cler~cal ~telIE. TIus program wl11
be eliminated July 15. 1981.
. County Cost
Reduction
Budgeted Ation
Reduction
.w..yoff
LAB ro.~l'R..4.cr
ELIMlliATlo..~
$ 88,000
o
o
. Effective July 15, the Medical Center will no lo.'1ger utilize contract lab services
for tests unable to be processed at the tirre ordered. Tests v.-"ill be held U11til
staff and eq't!l~nt are available or will supercede the processing of pending tests.
Net County Cost
Reduction
Budgeted Position
Reduction
Layoff
VISITING NGR.::;""E
J,.SSOCIATICN (\/NA)
$ 975,000
o
o
'!he VNA provides hane health services to patients as an alternative to hospitali-
zation Or specialized outpatient services. The Medical Center contracts with
eight (8) area \WA's to provide these services on a direct referral basis.
l.bdification of the contracts will refocus VNA - provided services primarily to
patients with third party coverage. The Medical Center's Hare Care Program will
_ attempt to provide substitute services for Cbunty resp:Jnsible patients to the
extent p:>ssible. A contract IlOdification letter will be sutmitted to your Board
by September I, 1981, There are no layoffs associated w1th this reduction.
Net Cbunty Cost
R-<>duction
Bu~~ted Position
R..<>duction
!-ayoff
PARr-Tr:.~ Pni"SICIAL'l"
SERVICES
$ 747,000
o
o
Toe Medical Center currently utilizes part-tiIre physician services for v,-eekend and
erergency room coverage. 'The Service O1.iefs have a.,areed to change the training
program of Residents to include a one rronth rotation in the Err.ergency Roan. Pending
notification to the Interns and Residents Association Wlder terms specified in
their }.K>U, this action will provide over 80,000 hours of Resident cover20ae. The
effective date is scheduled for August 1. 1981 and win result in the elimination _
of associated paid coverage.
Net County Cost
Reduction
Budgeted Position
Reduction
layoff
A!Y.,!INISTR.f,.'l'Za, MTJJ
AIl.UNISTRliTI\'E
SU.<>l-ORT SER-{I0':S
$3,622,196
32:7.25
327.25
An 111 percent cut will be taken by General Services, Medical Social Services. Pay-
roll, Perso:l!",el, Medical Records, Finance, Maintenance :i.Tld Po.,'ler. laundry, SeCUTity,
,Dietary, and llcrn:inistration. This curtailrrent, which will re abs::>rbed in addition
to the program redcction, will reduce revenue by $4,374,754 and gross e)..-penditures
Uj $7,990,950. '!be layoff of approximately 327 employees in these areas is
scheduled fo::' August I, 1981.
'These action.'s v.i.11 be taken it1 accordance with provisions of the 1981-82 adopted
badget. I will continue to keep your Board infonred of significant budget
implementatio:J. events.
H/llWal<./ (/(!.Vf
I
Total ?~ogram Red~ions:
11[;/)/441- C~Nr6P-
$ 3.7 .
AtTACHMeNT 7iT
FT:S's Impacted:
76.0
?.::-oa~ams ane Patient~", ImoC!cted:
I. OULD2tient Phar~2~Y
A. 100% elimination; minimal pharmacy stock on hane for
emergency needs will be on band in an outpatient
area.
B. 208,305 patient prescriptions curtailed.
C. Program Alternatives:
1. Medi/Cal, Medicare and cash patients will be
referred to p~ivate pharmacies.
2. ~on-Medi/Cal and indigents to be referred to
comp~ehensive health centers.
II. OU~D~Lient Dental Service
A. Total elirnina~ion with the exception of Oral Surgery.
B. 7,916 patient visits impacted.
C. ?~ograrn Alte~natives:
1. Medi/Cal, Medicare and cash patients will be
referred to private dent~sts.
2. Non-Medi/Ca1, non-insured and 1ndigents will be
referred to comprehensive health centers.
III.
r2.r:lil Y' Nedicine
A. 100% reduction during 1981-82. After final budget
passage, funds were acquired from UCLA (approximately
6 FTE's) and from temporary f~eezes on FTE's in
va~ious medical departments at HarDor/UCLA to soften
the impact on patients and st2.=f. The p~ograrn will
be to~ally gone by June 30, 1982. -
B. A gradual reduction of visits from 800 per month to
zero. The major reauction will be in August and
Septenber as the Family Med~cine Depa~tment squeezes
~nto the already crowaed hospital cl1n~c area.
C. Patients will be referred to our existing medical
c1~nics, comprehensive health centers, the private
sector and univers2ty health =aci11ties.
IV.
C1}rontc Renal.clvsiS - I<'JD~~Y ,Z)1.'/$/5
A. lOO~ elimination.
B. l,2~8 patient visits ~mpacted.
c. ?rogram Alternatives:
l~ Patients requiring ch~o~ic d~21ysis ~~ll b2
re=erred ~o otbe~ loc~l =aclllLles capable 0=
prov;.ding tbese services and to the Los F-<"1geles
County/USe Medical Center.
v. ~o~~unicatio~ Disorders
A. A reduction of approximately 80~.
B. The reduction will be from 1248 visits per year to
approximately 250 per year. After final budget
passage, runds were acquired from UCLA (one FTE)
and one hospital position was deleted as a substi-
tute so one audlo10gist could be retained to provide
minimum support for the inpatient program.
VI. Chest Clinic
A. 100% elimination.
B. 1,932 patient visits i~pacted.
c. Program Alternatives:
1. All patients neeai~g this service will be referred
to Acute Care Publ~c hospitals rendering this
service and to the private sector.
'To-::al
f"'II1F<lIN J-U7}iE:;P." I')IN6 I V/1" '-"C4VC.fqf"~
progra::n Re.tions: $ _816,566
'Iv.:.rl(~'-
FTE's
Impact.ed:
127.5
/!?!" ACHIn QJr
:L
?,::-oc!"a;;:s anc ;?ct~ents lr.",?~ctec.:
I. OU~~2Lle~t Ph2r~acv
A. 100~ elimination of ou~patient phar~macy services;
retain minimal drug/medication stack in Outpatient
Pharmacy area for emergencies only.
B. 240,000 patient prescript.ions curtailed.
c. Program Alternatives:
1. Refer Medi/Cal, Medicare and patients able to
pay cash to private pharmacies.
2. Refer non-Medi/Cal/Medicare and indigent patients
to comprehensive health centers.
II. Rutpa~ient Rena~ Dialvsis
A. 100% elimina~ion of outpa~ient renal dialysis
service; provide acut.e renal dialysis service for
e~ergencies o~ly on the inpatient medical service
c~ly .
3. 2,1~0 pat~ent visits curtailed.
c. Program Alternatives:
1. Refer Medi/Cal, Medicare and private insurance
patients to commununity renal d~alysis centers.
2. Co-ordinat.e referral 0= ~ndigent pat~ent re-
qu~ring outpatient rental aialys~s services
through the End-steoe Ren~l D1alysis ESRO
Serv~ce Co-ordinat~ng Netwo=k.
3. ~efer u~doc~~ented p~tients to Kloney Specialist
!~)ea.i eal G=oup.
..:..J....!...
Den"C2.l Clinic
A. 30~ ellmlnatlon on ae~~al outpatle"'t serV1ces 2550-
c12tec ~l~h general p~actlce aen"Cis"C~y and pec1atr~c
den"Cis~ry. Note: T~e O~~~ Su=gery ouc:pct:enc: se~-
vice will be retained.
B. 3,100 dental outpat1en~ vis~"Cs curc:ailed.
\.... r.!..U~.L-c:.l&l nJ......t:'1..L&d.'-.LVt:~::
1. Re=e~edi/cal, Medica~e. prittte insurance and
patients able to pay cash to private dentists.
2. Refer non-Medi/Cal, Medicare and indigent
patients to comprenensive health centers.
3. Re=er patients to University Dental Schools.
IV. baul~ W21}~-In Clin~~
A. 100% elimination of the Adult Walk-In Clinic (A.M.,
and P.M. shifts).
B. 29,679 outpatient visits curtailed.
c. Program Alternatives:
1. From 8 to 5 p.m. (Monday through Friday) refer
patients to General Medicine and Family Practice
clinics.
2. A=ter 5:00 p.m., weekends and holidays refer
patients to the Emergency Room.
3. Re=er Meei/cal, ~edicare. private insurance and
patients able to pay cash to private physicians
or medicare groups.
~. Refer treatment 0= pa~ients requiring non-emergent
care.
5. Re=er indigent pa~ients to comp=ehensive health
centers and health centers.
v. ?ea~a~ric,hcute Care Cli~ic (P.K. Shift)
A. 50% elimination of the Pediatric Outpatient Clinic.
B. 13,304 Pediatric Outpatien~ visits cu=tailed.
c. Program Alternatives:
1. Pediatric patien~s =equiring emergency care after
5:00 p.m., weekends and ho1id~ys, refer to
Emerge:1cy Room.
2. Defer treatment o~ non-emergency patients until
they can be seen ~n the Ped2a~ric Clinic from
8 to 5 p.m.
3. Refer Medi/Cal, Mec~care, private insurance and
pa~~en~s able to pay cash ~o pr~vate physician
or private hospitals.
~. Re=e~digent patients to otl" County faci-
lities (i.e., comprehensive health centers, etc.).
VI. Co~~u~itv ~ecicine
~. lOO~ elimination 0= the Department of Co~ounity
Medicine as a hospital service component.
3. Con~u~ity Mec~cine s~c=f does no~ p=o\~de d~~DC~
patient care service.
c. Program Alternatives:
1. Transfe~ data collections, health education, and
health system analysis (i.e. demographic,
mortality/morbidity studies, etc.) to tne Medical
School.
2. Absorb Community Medicine functions in other
hospital services (i.e., Fiscal Services,
Management Services, Medical Funds, etc.).
VII.
~~ci~la~y Suoport
A. .~cil1ary support services will be reduced accord-
~ngly, e.g., the propo=tion 0= ~he support to
curtailed service pro~ra~s.
B. Reduce in relation to curtailment 0= clinics.
C. Prog~cm Alte=~atives:
1. '{orkload to be a~sorb by remaining staff after
curta21rne~t 0= posi~ions.
2. Contracti~g out for services required.
~N6 !36AC# G&N&ML. f/DSPITAt.
Total ?ro~ram Re~tions: $ 8.~
/f'TI./IC/yUI17,vl ~
FTE.s Impacted:
221. 0
P~oa~2ms and Patients Imo2ctec: Option III
hcute Neclccl/Surqiccl
A. 100% elimination of hcute ~edica1 and Su~gical services.
B. 3,600 patient a~~issions impacted.
C. Program Alternatives:
1. All Medical and Surgical patients will be referred
to Harbor Hospital where th~se services will be
absorbed.
II. Alqoholism proarams and D~v Care
A. Moaification of Alcohol Progr~~ from a Medical Model
De~ox to a Modified Mecical Model Detox, plus elimi-
nation of the Cay Care Compo~ent.
B. Nlli~~e~ of patie~ts should remain the same, but the
patient mix will be di==erent with the elimination
of Acute Detox and the Day Care Component.
c. Prog=am Alternatives:
1. Acute Detox will go to Barbor liospital.
2. contracting with the private secto~ for these
Alcohol Progr~~s will be an ongoing plan for
eventual conslli~~ation.
III. ~~cillary and SUDport Se~vices
A. App=oximately 40~ reduction in ~~cillary and Support
d~visions in proportion to the ?rogram Curtailment
0:: Option III.
~
J'l,ANCHt) Los /11'11100$
7ot21 ?~ograffi R~tions:
H{)SPI7/fL.
S 2.
/f7TACHmIf,N7
;JZL
?7Els Iw?acted:
129.1
?~ocrams ana ?at2ents Imoactec:
J-~ ~,"~2~
A. 50% reduction.
B. 27 beds impacted.
c. Program Alternatives:
1. Beas that are retained will be su==icient in
number to accept all cases of infectious hepatitis
that are referred to Rancho Los ~~~igos Hospital
annually.
2. The pat1ents thaL would be referred elsewhere as
a result of the 27 bed reduction, would include
cases o~l~ of no~-infectious liver disease and
these would be re=erred to other County or co~~u-
nity hospitals.
II. T,. :3 .
A. 50~ reductio~.
B. 22 beds impacted.
c. Program ~lte~uatives:
1.
Because of Droaram reoroa~izatio~, it w111 be pos-
sible to reduc~ the hospital census at Rancho by
referri~g patients to the ambulato~ care services
and treated unoer d1rect supervis1on. By 002ng so,
the remain~ng 22 beds at Rancho w111 be su=ficie~~
to acco3odate all of the T.E. pat1enLs referred to
Rancho dur1ng the coming year.
II:i:..
ca::-c..:.oloav
~. lOO~ eliminat2on.
B. 10 beds impacted.
C" ?rogrc.ffi J.lternatives:
1. PaLients w211 be ~e~e~rec ~o COUDty =acil~ties.
Addit1onally, patlents way be able to obtain care
at aCULe care fac11ities in the co~~unity o~ flnc
alternate treatme~t ~lans.
~
IV.
Neu~oloav
.
.
A. 50% reduction.
B. 13 beds impacted.
c. Program Alternatives:
1_ Keu~ology ?a~len~s re~ui~ing reh2b~li~~tion wo~ld
be referred ~o publ~c or County o~ co~~un~ty
hospitals.
v. Stroke
A. 50~ reduction.
B. 13 beds impacted.
c. Program Alternatives:
1. Same as Neurology.
VI. Pulmo~ary
A. 50% reduction.
B. 15 beds impacted.
c. ?rogr~~ Alternatives:
1. Patients requiring care of this type would be
referred to the County or cO~uunity hosp~tals
since there are many excellent respiratory care
units throughout Los ~~geles Co~,~y.
VII. ?Di~al_Pain
A. lOO~ elimination.
B. 16 beds im?ccted.
c. ?rogram Alternatives:
1. These pa~ients with chronic back pain will be
referred to other hospitals for evaluation and
treatment.
--~-
PLIVE VIEW M~DICAL C~NTER
.
.
$ 1.8
Tot~1 Program Reductions:
FTE's lfilpacted:
39.0
Pro~r~~s 2~d Patients ~F~actee:
, ?h~~j';iacy
A. 18~ reduction of outpatient pha~macy services.*
B. 18,000 prescriptions impacted.
*?harmacy services to outpatients in the E.R. will not be
impacted by this curtailment. The 18:,; reduction will occur ---
in the Primary, Secondary and Specialty Clinics.
c. Program Alternatives:
1. Will develop a plan for referral of Med~/Cal
patients to private pharmacists with the Director's
2.p.?roval.
2. Non-cove~ed patie~ts rr.ay possibly use some of the
re:r.c.ining 82%.
II. De~ta~,Servi~e
A. lOO~ elimina~ion of all Dental Progra~s inclu6ina Oral
Su!"ce=y'.
B. 9,500 patient visits impacted.
C. Prog=~~ Alternatives:
1. Dental members on the attending sta=f w~ll be
available for emergencies on an ., as neeaed basis".
2. Nedi/Cal patients "-2-11 be referred to the pr2- va-te
secto::::-.
3. Non-coverec patlents will be ::::-e=erred to heclth
centers.
-T~
.L_.L.
~enc.l
A. lOO~ eliminat~on_
B. 20 p2t~ents three times per week irr.pccteo.
.....- -.
,
c.
Prog~am ~rnatives:
.
1. Placement - private renal programs for tnose ~ho
have coverage.
2. No coverage - refer patients to the Medical Center.
ZV. ?rl~2~V ana Secor-aarv Clir-ics
:P--. .
1 ') e.-
_.... '0
recuction of the OU~p2t~en~ SerVIces.
B. 8,200 patient visits impacted.
.c. Program Alternatives:
1. Longer waiting periods to be serviced.
2. Negative impact on the E.R.
3. Possible referral of Medi/Cal patients to the
private sector.
MI/{A
.
Total Program Recuctions:
{...OMI1 ltosPl1"AL
.
$ 607.951
FTE's Impacted:
2.0
?~oc~cms ana ?2tients Im~acted:
1.
Patien~s Impac~ed
o
Progr~~s Impacted 0
A. Reduction of UR ( 2 positions) has no impact since
Mira Lorna was exceeding UR requirements by 50~.
B. Based on the program reductions listed for Mira Lorna
Hospital, impact on patient care is minimal.
Due to the ability to increase revenue and share
facility costs with the Probation Department. the
only program reduction that significantly impacts
o~ patient care is the elimination of non-emergent
patient transportation.
Although this poses some hardship in this large rural
a=ea, alternatives such as volunteer agencies and
fa~ily friends do exist to allow those requir1ng
non-emergent care to get to the hospital.
Othe~ reductions in equi?me~t and supplies will
req~ire tighter manage~ent, but not directly impact
o..."'l patient care.
;
.
.
HEALTH SUBCENTER CLOSURES AND
RELATED DIST~ICT HEALTH CENTERS WHERE
PUBLIC HEALTH CARE WILL CONTINUE
TO BE AVAILABLE
He21~n SUDcenters
To Be Closed
Dlst.cIC~ He21t'h
Centers
1- Santa Fe Springs Whittier
2. Norwalk Bellflower
3. culver City West-Santa Monica
4. North Enterprise South
5. V~lla Carson Torrance
6. Bell Gardens San Antonio
7. Dollarh~de Compton
8. pacoima San Fernando
,,'/ /fC/Yme,u I
:1JI-
HEALT~CENTERS AND SUBCENTERS ~WHICH
PUBLI~LTH SERVICES WILL BE ~TINUED
AND N1BULATORY CARE SERVICES TERMINATED
1. Bellflower
2. Hawaiian Gardens
3. Imperial Heights
4. Bald'nn Park
5. Paramount
6. Monrovia
7. Pico Rivera
8. Florence-Firestone
9. Burbank
10. Harbor-San Pedro
11. 'Nllmington
12. Montebello
13. La\-:nda1e
14. Alhambra
15. Avalon
16. Azusa
17. Central
18. East Valley
19. Ho11ywood-W~lshire
20. Inglewood
21. La Puente
22. Northeast
23. San Anton~O
24. South
25. Southwest
26. Torrance
27. Tujunga
28. Valencia
29. Van Nuys
30. Venice
31. West Hollywood
32. ~1hi ttier
/177 /f~1I m [:;1"';7
Y/lL
c_S_~~~9~;:'.n<;:eles Cmfd ano Youth Clinic r",rr'-Tl""""''''' ...s.--
~Ar;;:i1icry Services: ine LeaOS f..ngeles Child and Youth _Die curren~ly receives
laboretory and radiology services from the Roybal ComprehensivE Health Care Center.
Due to the reductions at Roybal, turnaround time is expected to incrEase as follOl.'s:
a) Laboratory - From three to seven days, affecting 10,000 laboratory tests per year.
b) Radiology - From two to five days, affecting 1,800 encounters per year.
~. Cl~~~e Pudson Co~~reh2n5ive HEalth Care Center
c Dental Services: Reduction in the dental program will affect the outreach and dental
hygiene programs, which provide dental assessment for about 1,000 senior citizens
and school children.
. Family Medicine: Reduction of a physician assistant treating patients at Women's
Hospital. This position provided for 2,500 encounters at Women's Hospital.
G Medical Walk-In: Reduction of two nursing items which provide triage services will
decrease the service capacity by 50 percent, or 4.800 triage encounters per year.
. Pharmacy: Currently, Hudson provides three health centers with drug inventory
control and drug purchasing service. This activity has been effectively handled
by a clerical item. Elimination of that item will require the pharmacist to assume
these duties which in the long run is less cost effective. This will also create
an estimated two-week backlog in drug purchasing.
D Women's ~edicine: Reduction of two nursing care specialists in the Women's Medicine
Program will decreese ambulatory nursing supp~rt provided to the health districts
by an estimated 2,400 patient encounters per year.
~ubert H. HU~Dhrey Comorehensive Health Care Center
. Dental Service: A 48 percent reduction of the dental program which is expected
to provide 11,232 patient visits. This reduction will result in a loss of approximately
5,400 billable visits with the elimlnation of dental specialty services such as
endodontia. periodont1a. pedodontia, orthodontia and minor oral surgery, hygienist
services including topical fluoride treatments, oral prophylaxis and oral health
education.
Restorative dentistry for children and adults will be eliminated and prosthetics
will be limited to emergency cases only with patient referrals out of the facility.
Patients requi~ing dental specialty services and pa~ients who must be deferred will
be referred to the Hudson and the Roybal Comprehensive Health Centers.
Walk-in patie~~s, comprising approximately 36 percent (1,944 visits) of all dental
visits would be limited to dental emergencies only, with the referral of tne major
pDrt10n of those emergencies to H. Claude Hudson Comprehensive Health Center and
other facilities. Those dental emergencies WhlCh would be seen would have to \~ait
until the end of the clinic session, 2ssuming there were broken appointments. Waits
-could vary from ~-6 hours, depending on the availability of a dentlst.
Wa;'~ln; time for new and return appointments is expected to incre~se from the present
1-2 weeks wait to 4 or more weeks.
.
.
Eci~ard R. Rovbal Comurehensive Health Care Center
___ W' __~_
o Laboratory Services: This will affect turnaround time for 16,000 monthly tests
provided for the Northeast District Health Office, the Child and Youth Clinic, and
the Hudson Com?rehensive Health Center. Turnaround time will increase from three
Gays to seven days. The resultlng delays 1n di3gnosis may cause aQgravated medical
cOri'Dllcations.
o Radiology: Reduce radiology services to the Northeast District Health Office
representing 3,120 patient encounters per YEar. and to the Child and Youth Clinic
in the amount of 1,800 encounters annually.
e Pharmacy Services: Reduce pharmacy services support to Northeast District Health
Office thereby increasing waiting time for prescriptions from 15 minutes to 45
minutes.
Bf1A: pm
.
4 :v
. rr.4~HfJ1tNr _L~
HEALTH CENTERS TO BE AFFECTED BY L.A. COUNTY BUDGET CUTS
Health Subcenter to be Closed'
Santa Fe Springs, 9255 Ploneer Blvd., Santa Fe Sprlngs; NOrYtalk, 12360 E.
Flrestone Blvd., Culver Clty, North Enterprlse, 638 E. El Segundo Plvd;
Los Angeles, Villa Carson 23233 S. Avalon Blvd., ~llmington Bell Gardens,
6912 Ajax henue, Bell Gardens, Dollarhlde, 1108 N. Oleander ~ve., Compton,
and Pocoima, 13300 Van Nuys Blvd, Pacolma.
Health Center and Subcenters In Whlch Full-Scale Health Care will be
Ellminated and only Public Health Care Such as Inoculatlons Will be Provlded'
Bellflower, 10005 E. Flower, Bellflower, Hawallan Gardens, 22101 Norwalk
Blvd., Hawaiian Gardens, Imperlal Heights, 10616 S. Western Ave., Los Angeles;
Baldwin Park, 4640 N. Malne Ave, Baldwin Park: Paramount, 15312, Paramount
St., Paramount; l"ionrovla, 330 W. Maple Ave., r.1onrovia, P1CO RlVera, 6336 S.
Passons Blvd., Pico RIvera; Florencp-r- '-2stone, 8019 Compton Ave., Los Angeles,
Burbank, 1011 1.1. ~1aqnolia Blvd. Burbank; Harbor-San Pedro, 122 \~. 8th Street,
San Pedro, Wilmlngton, 1325 Broad Ave., Wllmlngton.
i'1ontebello 1221 W. \~hittier Blvd, !~o;it-",iJell(l Lal'mdale, 14616 S. Grevlllla
Ave., Lawndale, AI~ambra, 612 W. Shorb Street, Al~aMbra; Avalon, 215 Sumner
Ave., Catalina Island; Azusa, 150 N. Azusa Ave., Azusa, Central. 241 M. Figueroa
Street., Los Angeles, East Valley 5300 Tujunga Ave., North Hollywood; Hollywood-
Wllshire, 5206 Melrose Ave., Los Angeles; Inglewood, 123 W. Manchester Blvd.,
Inglewood.
La Puente, 15930 Central Ave., La Puente; Northeast, 2032 Marengo St.,
Los Angeles San Antonlo 6538 Miles Ave., Huntington Park; South 1522 E. 102nd
Street, Los Angeles; Southwest, 3834 S. Western Ave., Los Angeles; Torrance,
2300 Carson St., Torrance; 7747 Foothl11 Blvd., Tujunga, Valencia 23763 W.
Valencla Blvd., Valencla; Van Nuys 14340 Sylvan St., Van Nuys; Venice,
905 Venice Blvd., VenIce West Hollywood, 621 N. San Vicente Blvd., Hollywood,
and Whittler, 7643 S. Painter Ave.,
~Jhittier.
Health Centers and Comprehensive Health Centers that will contlnue to Provide
Ful-Scale Medlcal Care:
El Monte, 3550 N. Johnson Ave., El Monte, Pomona, 750 S. Park Ave., Pomona;
Yvonne Brathwalte Burke (formerly West). 2509 Plea Blvd., Santa Monica;
Compton, 300 E. Rosecrans Ave., Compton; El Cerrito, 1401 Chestnut, Ave.,
Canoga Park; San Fernando, 604 S. Maclay Ave., San Fernando; Antelope
Valley, 4485 V. Cedar Ave., Lancaster; H. Claude Judson CHC, 5850 S. Maln
~t., Los Angeles. Edward R. Roybal CHC, 245 S. Fetterly, Los Angeles, and
ELA Chlld & Youth Clinlc, 929 N. Bonnle Beach Pl., Los Angeles.
e
.
(lL7 2 f
fcrJ~
DATE: July 15, 1981
TO: City Manager
FROM; Ci ty Clerk
SUBJECT: Medi-Cal Fees and Cuts in LA County Health Care
SerVIces (Item lO-B, CouncIL Agenda of July 14, 1981)
The Council, at its meetIng of July 14th, passed a motIon re-
questing staff, to the best of their abllity, to give CouncIl
a report on the impact on Santa Monica citizens of proposed
legIslation to implement fees for MedI-Cal and MedIcal Emergency
SerVIces and cuts proposed by Los Angeles County for Health Care
Services.
DurIng dISCUSSIon, Councllmember Edwards suggested that copies
of the bill be obtaIned from leg~slators, It was requested that
staff return w~th a report at the July 28th meetIng, and that
the Commission on Older AmerIcans be advised of CouncIl actIon
so they can add Information if they wish to do so.
Mayor Yannatta Goldway requested that I transmIt to staff the
attached note from Cheryl Rhoden addressed to the Mayor gIVIng
Information regard~ng County Health Services budget reductIons.
All of the above IS for your ~nformation to assist in preparing
the staff report.
aJ
At tachment
cc: Mayor Yannatta Goldway
H~>").F-IT;\LS
}~~;1.J .:) ..\II)J.LtD ll' ..~~~~..': ~.~.:'S Q~.,lr""'i'~~D IN lj~l-rL n.=, ,h.I___.....-H.....a.
e .
h ten percent (10%) reductIon at LACjVSC )jedIcal Center, Harbor-U:LA ~~jlca1
Genter, MartIn Luther KI~g, Jr., General H0spItal, Rancho Los l~rlgas HospItal,
Olive VIew l-ledlcal Center, and thra lDrra. HOSpItal.
Inpatient Services
Reduction of -b-.-.as at TAC;VSC lie(llcal Center, lncluchng prCXjrams such as
Renal Transplant, rRr,~''3tology, Pregna..cy TennnatIon, Os'Stetrlcs/Antepartli.
and JlJ.cohol DetDxIfH'..atIon.
- Reduction 0: beds at R3nG~O Los A~igos HOspItal, IncludIng Cardiology,
,.Je.Jro:!o31', OxonlC Back ?a~n a;ia TJi'Jer ServIce.
EliiTnniJtlon of ACclte '~echcal G.'-IO SurglG.=ll Ser-'>lc2s at L.::ng Beach
Ce.'1eral HOSpIta~.
..:;
OJt?G~lent SerVICeS
CurtaIlr.ent of servIces Inclucug Outpatient Pharr..acy, DEental, ?:enal
DIalYSIS (except l.l:I.C/USC r~edlcal Center) and, Sp2Clal t:1' and General Chmc",
Otl,e r Progr 2lT1S/Ac ti VI ties
Elwilnatlon of patIent a?pllances except c.I'pes P::-OVlo":'d by'\oDlCal ?r~r:aT)l.
Dlsco~tlnuation of certaIo co~tLact 12Cor:atory S~~l~S.
MedIcal school contracts held at 1980-81 level (~O ~rOvlSlon for cost
Increases due to In:latlo~).
- Curtailment of s:.J?;Drt setvlCes related to the Soard kj.J?ted prC>:Jrarn
cuts.
AddItIonal 10% cut In ~iL~nlstratlve Staff.
PS.P5:)"<llL/;':SULlI.1DRY O.RE SERVICES
~BJor reductIOns In ?er5onal/A~h:.J]atory Care Serv10es ana closure of
eIght health c~nteLS.
,., 10% reductIon at ilie c:a.pr'~~en5Ive He-aJ th Centr::-rs.
Elumr,atlon of the Health 2dJcatlOr" S::>:::lal ~;.:J~~,er elld ::utrltlo;11st senes
In Heal th Centers and CO".:Jreher-51 ".Ie Heal th O:~rJt~~-s except eIght Health
L-JLJCators ;ralntalned to =r.CJuct li-~,:nlZ1tJo'l pLO::;:-2:n actIVitIes.
A:jJl tlO,a} a:i-nlOlstratlve CLJ~-tall.~e;1t of lO'L
OiliER ??:X;?",,!.! CU-r"..I'i"JU.2NIS
~ h 30% reOLlctlon In D:?;'-~rL-.~nt ~=-.~~~~'-'3l~~!..-S 5~2f:..
n s~rvlce ]e~21 ~2rC2c~ 2t C?1::0~nJc ~Jllcr~~ S=~V)C0S.
:Ya"lS~er of C..:t--tcln s~~f :tCl~. tOll? CO-?~ratl'''~E:' H:::<~lcal 2"'l:5 V.:~C'rlrJ3ry
~-:-r\l)Ce to the: D-~.?C;.!-L~I~'lt 0: ;-....')~ -.~l D.re 21":-.3 Co~t~ol...
S.;~;t.3rltlal r.....: JC"_!CY' 0: ~ -=-- --~~ _'-It
_-,: I.): ~ -::: t ~::. ~