County doctors slam plan to cut clinic care
By Sandy Kleffman
CONTRA COSTA TIMES
Posted: 03/11/2009 06:12:42 PM PDT


MARTINEZ — Nearly 40 physicians warned Wednesday that a Contra Costa County proposal to eliminate basic health care services for 5,500 adult undocumented immigrants could backfire by severely harming people's health and driving up emergency room costs.

"As a doctor, I feel morally obligated to speak up," said Francisco Dorado, a resident family physician. "If these patients are dis-enrolled, they'll have nowhere else to turn."

The physicians, carrying signs reading "Stop Cuts to Health Care," gathered in front of Contra Costa Regional Medical Center, the county hospital in Martinez.

Stephen Weiss, a county surgeon for 20 years, said he has seen many budget cuts but "this time, we feel that the plans go against our beliefs ... that health care is a basic human right."

He and others urged county supervisors to reject the plan during a public hearing scheduled for Tuesday.

William Walker, the county health services director, proposed the cuts after he was told to recommend $13.2 million in budget cuts. Walker estimated the county would save $6 million a year by eliminating nonemergency care for undocumented adults in the county's Basic Health Care program.

If approved, Contra Costa would become the second county in the state to eliminate such services for undocumented patients. Sacramento County did so last month.

"I'm hoping that this is an interim kind of thing," Walker said Wednesday in an interview from Washington, D.C., where he was attending a meeting of the National Association of Public Hospitals. "This is something I would never have wanted to do.

"But the federal government doesn't pay for it," he said. "The state government doesn't pay for it and that leaves us holding the bag."

Walker said he hopes that health care reforms under consideration by the Obama administration will result in more federal money for the county and enable it to restore the services.

In the meantime, he urged nonprofit community clinics and private hospitals to help finance new models for serving the undocumented population.

Community clinics provide such care, but they have their own struggles as they cope with rising numbers of uninsured families. La Clinica de La Raza has a waiting list with 700 patients.

Undocumented children and pregnant women would continue to receive care at county clinics.

The county hospital will also provide emergency services for everyone, no questions asked, as all hospitals must do under federal law.

But physicians warned Wednesday that eliminating preventive care will result in more people arriving at the hospital with life-threatening conditions that could have been avoided, something they said they see far too often. They noted that hospital care is much more costly than a doctor's office visit.

Neil Jayasekera, who has worked in the hospital emergency department for 10 years, said he often sees patients arrive with strokes and heart attacks that could have been prevented if they had kept high blood pressure in check.

Last week, one such patient was brought in with massive bleeding in his brain, he said. The patient remains in the intensive care unit and may not survive.

The plan will require county clinics to verify a person's legal status before providing services. People who are illiterate, have transportation difficulties or are homeless may have difficulty obtaining and submitting the proper documentation, said Anthony Jones, a staff physician at the hospital.

Others argued that the proposal will violate the mission of the county health system.

"I believe that the cuts will force us to practice medicine in a way that makes no sense at all," said Julie Freedman, who works in the hospital inpatient unit.

An undocumented immigrant may arrive with a blood clot in her leg and need medication to prevent a recurrence, she said. But doctors will know if they send her home, she may not have access to medication or follow-up care. Doctors will then face the tough decision of whether to keep her in the crowded hospital longer or release her knowing her condition will probably deteriorate.

"As a doctor, I dread making these choices and I pray that I will not have to," Freedman said.

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