County Health Services Would Be Gutted in Budget Cuts

As we have reported more times than we bear, the county has around a 21 million dollar deficit that it will be cutting around March 25, 2010.  In order to get to that point, whole departments may be eliminated.  However, the worst impact will be on the residents who rely on vital services from the county, most particularly health services.

Departments have been asked to identify the possible impacts and develop worst-case scenarios in the event they have to absorb a 16 to 35% budget reduction target.  From the health department budget the county is contemplating a cut over a little over a million dollars.  The impact will be devastating on multiple levels.  In the fiscal year 2007/08 there were 130.3 FTE positions in the Yolo County Health Department, by 2010/11, that number could be down nearly in half to 67.4.

Some of the proposed cuts will be the elimination of the Children’s Medical Treatment Unit.  This is one of several cuts, that will result in the loss of Federal and State funding, this one would result in the loss of $227,898 in funding while saving a net amount of $327,000.  That means the cut is significantly more than advertised.  This action eliminates diagnostic, treatment, and therapy (DTT) and the medical, treatment unit (MTU), which provides physical and, occupational therapy services to children with qualifying conditions.  Eligible children however would still receive services through local providers and the school could pass some of the cost on to the county.

They would eliminate the Director/ Health Officer position.  This position is required under state law and for a county the size of Yolo, a full time Health Officer is required.  There would be no oversight of any Health Department program, and no or significantly diminished liaison with CDPH, and CDHS for health programs.

They would also eliminate the administrative assistant position.  This would eliminate the position that supports the Director/ Health Officer, and acts as a human resources liaison, and provides general administrative support to the department.

Furthermore they are eliminating the communicable disease control efforts, which would eliminate communicable disease investigation and control efforts other than those funded by the Tuberculosis Control Program.  The staff eliminated would be a halftime position for the public health nurse.

The position of Chief of Public Health Laboratory services would be eliminated.  Elimination of this position would require contracting with a nearby county for laboratory services in general or for the public health laboratory in its entirety.  This would cause significant delays in the diagnosis and intervention in diseases of public health significance including rabies, influenza, Novel H1N1, environmental health sampling and testing among others.

The elimination of the Senior Administrative Services Analyst Position would eliminate a position that provides fiscal support for several programs including those listed about, thus fiscal support would no longer be required.

The Children’s Health Disability program would also be eliminated.  This a program that provides care coordination for children from low-income families while providing outreach to physician practices for program participation while likely increasing indigent health or California Children’s Services costs.  While elimination of the program would save a net $77,682 it would result in a loss of State and Federal Funding to the tune of $371,188.  Staff eliminated include a supervising public health nurse, senior public health nurse, and senior community health assistant.

Finally they would eliminate a halftime position for the lead vital statistic technician.  Vital Statistics requires significant local funding to make up for the shortfall in fees received which are set by the State.  This action would reduce the hours from five to three.

The impact of the loss of these programs if difficult to estimate.  Certainly it will have a huge impact on public health.

Dr. Joseph Iser is currently the Director/ Public Health Officer whose position would be eliminated in the proposals here.  He laid out some of the impact in an email to the health council that was provided by one of its members.

According to his email, if the county were to lose Pomona funding.  The loss of Pomona funding would mean the County would not be able to complete any more tobacco cessation trainings and interventions.  It would also mean they would not be able to participate in the needle exchange program, those who need clean syringes to avoid infection by blood borne diseases will not have access; it also means that the County will not be able to do any interventions on the street to encourage drug users to get into treatment and to get trained to intervene in overdoses.

It would mean the loss of HIV counseling and testing including at high risk venues such as jails which means a likelihood of an increase in HIV/ AIDS cases.  The county would lose funding for immunization clinics.  It would lose funding for maternal child health meaning no more home visitations for high risk mothers.

Furthermore the Yolo County Health Council wrote a letter to the Board of Supervisors opposing the Governor’s proposal that would eliminate Adult Day Health Care as a Medi-Cal benefit.

They write:

Adult day health is a critical health maintenance program for chronically ill, low-income disabled Californians who have Alzheimer’s disease, schizophrenia, Parkinson’s Disease, traumatic brain injuries, severe cardiac conditions, and much more. The program is staffed with registered nurses, therapists and social workers; provides transportation, psychiatric services, and strongly supports caregivers.

Morevoer:

The Department of Health Care Services’ proposed savings are inaccurate and misleading as costs are simply being shifted to the Department of Developmental Disabilities, hospitals, physicians, skilled nursing facilities, and emergency rooms who will see an increase in need for care by the disenrolled adult day health patients.

Yolo County runs on bare bones services. We can not afford to lose adult day health. The State is forcing the hands of Counties and creating exorbitant cost shifting to our local hospitals and nursing facilities. Losing community-based long term care programs adds an unsustainable burden to what is left of our healthcare system. In addition, this County does not have sufficient nursing home beds for Medi-Cal patients to serve the numbers these service cuts will create.

The loss of Yolo Adult Day Health will have immediate catastrophic medical, financial, and emotional effects on the lives of many of the individuals who currently attend, and also on the lives of their families. It would also be a tremendous loss of an investment in a living laboratory that is a proving ground for future health care for all of us.

We have focused much time on these pages about the cuts to education and for good reason, as education is not only an expenditure but an investment in the future.  But the cuts at the state level filtering down to the county level in health care, especially for those who do not have their own private coverage will be devastating not only to those who lose coverage, but to the entire community.  It will result in the loss of productivity and expose those who do have health coverage to additional health risks.

Some of the most important services that the county provides are health services whether they are educational or preventative treatments and those will be the programs most impacted by these cuts.

While these are worst-case scenario proposals, it would appear at least reasonably likely given the magnitude of cuts that the worst-case scenario would play out.

—David M. Greenwald reporting