County Clinic Closures Hurt The Poor

County Clinic Closures Hurt the Poor

Unraveling of the County Safety Net

By Lynda Carson Aug 13, 2003

feed the hungry
give drink to the thirsty
welcome the stranger
clothe the naked
visit the sick
visit the prisoner
bury the dead

On May 14 2003, the Alameda County Medical Center (ACMC) announced that public hearings on two county clinic closures were set for May 20, 2003. As it turned out, by the end of the hearings, Fairmont Ambulatory Care Clinic at 15400 Foothill Blvd., San Leandro, CA, and Central Health Center, 470 - 27th Street Oakland, CA, were being scheduled for closure by the end of June 2003.

Expected annual savings from the closure of the two county clinics are $4,464,937 and it's expected to affect around 25,000 patients a year, including 11,000 of them who are not insured in the ACMC system. According to a statement from the official press release, around 8,301 patients may be able to recieve care in other ACMC systems, but, 17,378 adult patients would need to be accommodated by other health care providers to avoid delays in healthcare provision caused by the reduction of services at the Alameda County Medical Center.

There was no mention in the press release as to where those other needed health care providers may actually exist to accomodate those 17,378 patients that are about to get the bums rush out of the two county out-patient clinics scheduled to be closed.

The clinic closures are opposed by the community at large, plus the patients, advocacy groups, physicians, and affected staff in the two clinics.

In a move to stop the clinic closures, patient advocacy groups hit a brick wall after they filed suit for a request for a preliminary injunction which was denied on June 26, 2003 by Alameda County Superior Court Judge Steven Brick.

While making his ruling that could have stopped the clinic closures, Judge Brick said that he was not persuaded that the level of health care for the patients would fall below minimum standards even though some of the patients testimony was "compelling."

More than a dozen patients and their advocates appeared in court to offer testimony against the clinics closure before the ruling was handed down, and they were stunned by Judge Bricks decision. To no avail, the advocacy groups that filed suit to keep the clinics open argued that the county was neglecting civil rights codes under state welfare laws meant to provide care for the poor and disabled populations in accordance with it's mandate.

"I don't believe that the court's function is to require the respondents (the ACMC) to show that they will fulfill their duties," Brick said.

In hopes of quieting the frightened patients who showed up in court, attorney Stephen Parrish, who represents the ACMC and County Supervisors named in the suit, claimed that they have plans in place to make sure the patients needs are met.

Judge Brick decided to ignore the courts power that could have been used to require the county medical center to fulfill their duties to serve those in need. Especially the poor and uninsured patients as has been mandated by law. Barely more than a month later, the outcome of Judge Bricks ruling has already resulted in some immediate traumatic affects at the Alameda County Highland Hospital Emergency Room.

During an August 12, 2003 interview with one of the Chief Resident Physicians in the Department of Medicine at Highland Hospital, this reporter learned that based upon the observations of doctors and staff in the Emergency Room, there appears to be around a 10% increase in patients being admitted to the Emergency Room since the closure of the two clinics!

According to Genev'e Allison a physician at Highland, the staff and physicians of Highland Hospital are noticing an alarming trend in cuts to prevention programs which appear to be illogical and cannot be sustained in the long run, Allison said.

In all candor, Allison made it clear that by going on record for this story that she is not trying to attack any officials or administrators involved in the budget cuts, and that she is truly concerned about the welfare of the patients that are being affected by the clinic closures and program cut-backs taking place recently.

"As you know," said Allison, "theres been out-patient clinic closures in the ACMC as the result of recent budget cuts. Patients from those clinics are losing their primary care and their access to medication. Lately, patients coming into the Highland Hospital Emergency Room are very frightened, sick and being admitted as in-patients as a result of the recent out-patient clinic closures at the two county facilities," Allison said. "It's hard to tell what the true numbers are at this point," said Allison, but, "from the observations of staff and other physicians in the emergency room there appears to be at least a 10% increase in patients being admitted to Highland Hospital since the recent clinic closures took place."

When I asked if there has been a larger allocation of resources to make up the difference since the clinic closures took place, Allison said; "despite the 10% increase in admissions at Highland there has not been an increase in funding made to accomodate the extra patients nor have extra provisions been added to the existing resources for the patients, and the resources available have been spread thinner among the patients."

Doctor Genev'e Allison has been with Highland Hospital during the past 3 years as a physician in the Emergency Room, and also rotates as a physician at a local Kaiser Hospital, and she say's that she can see a markedly difference between the elderly patients she see's at Highland compared to those she see's at Kaiser. "The elderly insured patients of Kaiser Hospital seem to be in much better shape than the uninsured elderly patients showing up at Highland Hospital for treatment," Allison said.

Highland Hospital itself has just barely been spared from being bludgeoned by the budget axe, and may soon take a large hit despite the recent efforts by county supervisors to delay more budget cuts.

As recent as late night Tuesday August 5, 2003 it was announced that the proposed closure of major clinics at Highland Hospital such as the trauma center and more out-patient clinics have been averted for now, according to the ACMC Board of Trustees and the Alameda County Board of Supervisors after the supervisors agreed to provide short-term funding to keep these most needed crucial health services open to the poor or uninsured public.

For the moment, 700 jobs slated to be cut from the ACMC have been saved, and the clinics remain open for now, but, the financial outlook for the center remains bleak and the supervisors failed to advocate a permanent funding source for the long term.

Regardless of the stated policy mission of the ACMC, it's presently facing a $45.7 million budget deficit, and the local county officials have considered and delayed a plan to cut an already bad situation down even further to a dire straights type of emergency care system that would most likely hurt the poor and disabled to extremes while laying off many workers in the process.

Apparently, even if the authorities followed through with the above mentioned plan, it may not have been enough according to a July audit-report released by Price WaterHouse Coopers that found that the ACMC would eventually have to close completely unless a new funding source was found to keep it open.

The reasons given for the extreme financial problems of the ACMC include an increase in the number of poor and uninsured patients showing up at their door, while being exacerbated by fewer federal and state funding sources available to existing health care programs.

Among other solutions being considered by officials and advocay groups to keep the ACMC open on a long-term basis, a local political strategist was hired last April for nearly $25,000 to help determine if a ballot initiative was feasible to create a new tax based funding source for the ACMC, and authorities are awaiting the expected report.