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by Lynda Carson
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 the proposed
closure of two county medical clinics 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 health care 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 were
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 the 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 opposing the
clinic closures 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 to 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 there appears to be around a 10 percent increase
in patients being admitted to Highland Hospital via
the Emergency Room since the closure of the two
clinics!
According to Dr. Geneve Allison MD, a physician at
Highland, the staff and physicians of Highland
Hospital are noticing an alarming trend in cuts to
prevention programs which cannot be sustained in the
long run, Dr. Allison said.
In all candor, Dr. 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 Dr. Allison, "there have been
out-patient clinic closures in Alameda County 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," Dr. Allison said. "It's hard to
tell what the true numbers are at this point," said
Dr. Allison, but there appears to be at least a 10
percent 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, Dr. Allison said; "despite the 10
percent increase in admissions at Highland I am not
aware of any increase in funding made to accomodate
the extra patients nor have extra provisions been
added to the existing resources for the patients. The
resources available appear to have been spread thinner
among more patients."
When asked if those with private insurance need to be
worried about the cuts and closures at Highland
Hospital, Dr. Allison responded: "First of all, as
we've all seen with the dot-com boom and bust, no one
can take their jobs for granted. With loss of job
comes not only loss of income, but loss of health
insurance. I've seen people show up at Highland who
used to be very wealthy, but with the recession and
loss of jobs, they have nowhere else to go for health
care. Second of all, any of us, any day, could wind up
in Highland Hospital's Emergency Department as a
trauma patient. Sadly, motor vehicle accidents take
their toll, and any of us could wind up a patient in
need of emergency trauma services. If Highland's
Trauma Center closes, we lose a major area of
expertise and care that affects every resident of
Alameda County, rich or poor."
On Thursday August 14, 2003 I was connected with Lara
Bice when I called the office of County Supervisor
Keith Carson after being told that Mr. Carson was in a
meeting at the moment. Although Ms. Bice is a staffer
in Carsons office and advised me that I needed to get
my quotes from her boss, she was very helpful in
clarifying a few things.
According to Ms. Bice, she said that in 1996 the
county handed over control of the ACMC to a newly
formed Board of Trustees to run the Alameda County
Medical Center, including Highland Hospital.
When I asked if it was true that no extra funding was
provided to cover the expenses for the over flow of
patients from the two recently closed clinics into the
other clinics of the ACMC or Highland Emergency Room,
Bice said; "it's true about the lack of extra funding
for the clinics or Hospital, no extra funding was
provided" said Bice.
"We are having discussions about some Bridge Funding
for the ACMC, but the Trustees have not yet created
such funding" said Bice. Ms. Bice went on to
immediately say that the ACMC gets one third of it's
funding from the county, a third from the state, and
another third from the federal government to explain
the funding mechanism of the medical center.
According to Dr. Avrum Gratch MD, a member of the
California Physicians Alliance who is an orthopedic
surgeon and has been practising medicine in California
since 1961, says that hospitals and clinics take cuts,
but under the circumstances the physicians and staff
do the best they can with what has been dealt to
them.
Dr. Avrum said; "everyone practising medicine in
California realizes that there have been cut-backs in
medi-cal and medi-care funding, and the county
hospitals become even more important to fill the gaps.
People will try to give the best care possible despite
the shortages, but we really need a just and fair
health care service such as the kind a single payer
health plan may provide. It's unfortunate that the
Alameda County Supervisors do not have it together to
provide enough money to keep the clinics open," Dr.
Avrum said.
Shortly later I connected with Alameda County
Supervisor Keith Carson who has been a County
Supervisor since 1992, and I asked if there was any
hope of saving the ACMC? "Despite the county budget
problems," Carson said, "the Board of Trustees and
supervisors are committed to keeping as much of the
ACMC operational as possible and at this point we are
providing $13 million dollars every two weeks to keep
the medical center open. We in the county know that
people in the medical center realize that a lack of
funding exists to cover the needs of the clinics and
hospital" Carson said.
According to Supervisor Carson, as of August 14 2003,
"The latest developments are that the Board of
Trustees and County Supervisors are trying to figure
out ways to shave the existing programs in the ACMC,
rather than to close any more clinics," Carson said,
"and we hope that someday we will be able to re-open
the clinics that have been recently closed."
Supervisor Carson says that the County Supervisors
number one priority is to keep the problem from
becoming worse. "We need to stop closing clinics" said
Carson, "because the problems become worse when the
out-patients from the closed clinics end up becoming
the in-patients in the hospital and it costs alot more
money in the long run."
When I asked if theres a problem with the county
spending large amounts of tax funded money for
entertainment venues such as the costs associated with
the Coliseum, Warriors, Raiders and Athletics sport
teams rather than to spend it on the needs of the
county health care system, Carson said; "the county
still has to service the original debt from 20 years
ago to pay off the Coliseum and the more recent
remodeling that was done, and presently the debt is
somewhere around $60-$70 million that is still owed on
the Coliseum".
In actuality, since 1995 through 2003 it reportedly
has cost the East Bay taxpayers in Alameda County
around $152 million to bring back the Raiders to
Oakland and costs will continue to rise until the
debt service cost is payed off some time in 2025.
Based upon reports describing the public subsidy of
the Raiders deal; $130 million was spent on a
renovation of the Coliseum, $63 million in cash was
given to the Raiders, $22 million was spent on a new
training facility & practice field plus relocation
expenses
of the team, and the report states that the
municipality
subsidizing the deal may get stuck oweing $147 million
at end of the 16 year contract with the Raiders.
Hundreds of millions more may also be owed by the
municipality due to a pending law suit if a former
Coliseum commissioner being sued by the Raiders for
fraud loses in court because of a peculiar indemnity
clause that was signed off on by local authorities a
few years ago. For more info on that fiasco go to the
web site below.
http://www.bayarea.com/mld/cctimes/sports/football/nfl/oakland_raiders/6...
For years, many local activists have expressed alarm
that scarce tax revenues needed for health care
programs are being bled away by the public subsidy
being used for the Coliseum boondoggle.
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 or shave the
existing health care programs.
As recent as late night Tuesday August 5, 2003 it was
announced that the proposed closure of major resources
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.
California has an estimated 6 million people that are
uninsured which equals about 17 percent of the
population, and Alameda County public health systems
have had multimillion-dollar cuts that are
devastating to the poor, homeless and disabled
populations.
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.
Other draconian solutions being considered include two
tiers of reduction in the latest ACMC fiscal budget
which include $11.5 million in operational changes,
and $34.2 million in program reductions and service
closures affecting, Newark, Winton, and Eastmont
Medical Centers. Programs considered for termination
include the Fairmont Skilled Nursing Facility,
elimination of trauma services, closure of an out
patient pharmacy, and elimination of Womens Urgent
Care, dental, and optometric services.
Furthermore, recomendations also exist that if
implemented would turn away people that cannot pay a
fee for services unless they are admitted through the
emergency room. Presently, Highland Hospital treats
70,000 patients annualy through their emergency room.
Already, the Finance Committee and the Board of
Trustees have adopted the Fiscal Year 2003-2004 budget
and then at that point deferred action on the
draconian budget cuts in anticipation of the expected
report from Price Waterhouse Coopers.
If adopted and no new long-term funding sources are
found, the above mentioned proposed policy changes
will drastically affect the disabled and working poor
patients in Alameda County and will result in a loss
of access to desperately needed programs and services.
At this point everyone is waiting to hear back from
the County Board of Supervisors and the Board of
Trustees in hope that a new funding source may be
found to keep Highland Hospital and the Alameda County
Medical Center alive.
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