Features

L.A. County Department of Health Services: A System in Crisis

Faced with an $800-million budget deficit, the Los Angeles County Department of Health Services (DHS) confronts the daunting task of restructuring the county’s health care system. There is no question that the county lacks the money to continue with business as usual. The Board of Supervisors’ current plan is to close all but the seven comprehensive clinics, convert High Desert Hospital to an outpatient facility, and combine administration at Harbor UCLA Medical Center and Martin Luther King/Charles R. Drew Medical Center.

Even without this budget deficit, the potential for a medical disaster is present: a high percentage of uninsured, limited hospital bed space countywide, and already overworked emergency departments. But the shuttering of key facilities and the restricting of essential health services will cause an access-to-care crisis for low-income and uninsured patients. The closure of public facilities also threatens to overwhelm the private sector, jeopardizing access to care for all citizens, not just for low-income or uninsured patients.

As the crisis builds, it won’t matter whether you have an insurance card in your pocket or a large stock portfolio. Rich and poor alike—heart attack and car accident victims—will ride in ambulances past hospitals with shuttered emergency rooms or trauma centers on diversion. The middle class will find that their office appointments are scheduled farther into the future, that they have to wait even longer in doctors’ offices, and that even urgent care is difficult to get.

The DHS is attempting to save money by consolidating and reducing services. Even if funds are found, some of those programs must become more efficient and redundancies must be eliminated. In the following article, "Race, Medicine, and Health Care," Robert A. Beltran, M.D., Vice-Chair of the California Latino Medical Association, makes some interesting points and thought-provoking suggestions that might help the Los Angeles County health system get back on the right path.

The DHS’s Redesign Plan can be viewed online at www.dhs.co.la.ca.us. They are seeking comments on the proposed plan until August 2, 2002. Comments can be emailed to comments@dhs.co.la.ca.us or mailed to DHS Planning Office, 313 North Figueroa, Room 704, Los Angeles, CA 90012.

Ilena Blicker, M.D.
Past President
Los Angeles County Medical Association

 

Race, Medicine, and Health Care

By Robert A. Beltran, M.D., M.B.A.
Vice-Chair, Governing Board
California Latino Medical Association

Our country faces a War on Health Care and a major battleground is Los Angeles County. What happens here will foreshadow how our country faces the commitment to provide health care for all.

On June 26, 2002, Los Angeles County’s new health director, Thomas Garthwaite, M.D., released his strategies for system wide reform. This is a thoughtful and comprehensive document, but it is flawed, perhaps because it was put together do quickly. Dr. Garthwaite took office just five months ago. And while, he and his staff have spent many long and sleepless nights crafting it, the plan causes grave concern for community advocates, health service researchers, and health policy experts. They find flaws in the methodology, in the process, as well as in its conclusions.

Some critics of the Garthwaite plan have said that he has used a “chainsaw” instead of scalpel to make cuts and consolidations, leaving many jagged edges. One of these jagged edges exposes sometimes hidden inequalities in how our nation dispenses health care. In 1999, Kevin Schulman, M.D., then of Georgetown University Medical Center, documented how racial and gender bias distorts clinical decision-making. This sent shock waves throughout the health system, reminding us of how pervasive discrimination is in health. One year prior, then-President Clinton issued his Executive Order on “Eliminating Racial and Ethnic Disparities in Health.”

Our own Los Angeles County Department of Health Services documented the same disparities two years ago in a report called, “The Health of Angelinos.” This report showed disparities in health status, health risks, medical access, and other health determinants for our multiethnic population in Los Angeles County.

And there is more evidence from private foundations and federal agencies. The Institute of Medicine report on “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,"released in March, discusses strategies to eliminate ethnic and racial disparities in health. The work of the Commonwealth Fund concentrates on two major areas related to improving health insurance coverage and access, and improving the quality of health care services.

Many in the healthcare arena find it incongruous that Los Angeles County can propose a major redesign of its health care system, yet downplay strategies and programs to reduce bias in the delivery of medical care.

This is a major short fall in the proposed redesign and it must be corrected if the Garthwaite plan is to be credible, successful, and sustainable.

Furthermore, many stakeholders in our county healthcare system hope politics as usual will not prevail; that Garthwaite will rethink his plan and in doing so provide a more inclusive process that utilizes the resources and intellectual capital of our multiethnic physicians and their medical associations.

After all, it is this group of healthcare providers who have the cultural/ linguistic and relationship expertise to communicate with the impacted populations. They are the physicians, nurses, and other professionals whose task it will be to mitigate the pain and suffering that is inevitable when drastic change occurs.

Let there be no doubt. The scenario, which our Board of Supervisors has constructed, will cause the crippling and collapse of our countywide healthcare delivery system. The Hippocratic Oath has a primary tenet: “First do no harm.”The supervisors should embrace it.

Surely, combining the county crisis with the existing nurse shortage, increased delays in emergency room care, physician group failures, and the instability of healthcare finances is a recipe for terminal failure. What can be done to avert this disaster and the consequences that follow?

Our only salvation is the full force and leverage of community participation and advocacy, which will allow for wiser and more inclusive input. This, in combination with more flexible, efficient use of state and federal monies, will avoid full system collapse.

Short of this, no medicine, no bureaucratic magic, no surgical procedure can restore life to an already ailing healthcare system so badly in need of coordination, integration, and collaboration of services and healthcare providers both public and private.