3 December 2009

3 December 2009

California Edition

Calendar

STD Programs Meet Funding Crunch Cuts Could Impact Overall Health of Californians

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A new study by the National Coalition of STD Directors reports significant budget cuts to programs for curbing sexually transmitted diseases. California has been no exception, where cuts have taken their toll on both the state and county level. According to the NCSD, more than two-thirds of STD programs nationwide experienced budget cuts between 2008 and 2009, the height of one of the most severe recessions in decades. As a result, 39 clinics that have treated sexually transmitted disease have closed their doors. Nearly 40% of health departments reduced disease intervention services, while onethird of jurisdictions cut testing. “These cuts threaten our national ability to control both STDs and our entire public health infrastructure,” says William Wong, M.D., lead author of the study and an NCSD trustee. The California Department of Public Health has experienced cuts both over the long and short-term. Its funding from the federal Centers for Disease Control and Prevention has remained essentially unchanged since 2000, remaining at around $2.6 million. It has suffered 10% across-the-board cuts on the state level the past fiscal year. Additionally, the number of employees in its STD Control Branch have been reduced from 117 to 77 full-time and one part-time worker, according to Gail Bolan, M.D., chief of the branch.

Hit particularly hard has been staffing among California’s disease intervention workers, who go out in the field and encourage at-risk groups to undergo testing. There are now just 26 such workers, compared to 62 earlier in the decade. “That’s a 58% reduction in front-line public health employees,” Bolan says. The DPH also allocates about $1.8 million annually in funding to California’s 58 counties, but that grant has been slashed in the past year, forcing reductions on the community level. Bolan says STD clinics have been closed in both Santa Clara and Sacramento County as a result. Los Angeles County, which reports the nation’s highest rates of syphilis and Chlamydia, lost $295,000 from the CDC in syphilis prevention grants, part of an overall $20 million reduction in the county Department of Public Health’s budget. As a result, it cut its STD program staff from 164 positions at the end of 2007 to 106 now. Its program that distributed 1 million condoms a year has also been eliminated. Peter Kerndt, M.D., L.A. County’s STD program director, is concerned that the cutbacks will lead to dramatic increases in STDs, which can lead to Continued on Next Page

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In Brief King-Harbor Inches Closer to Reopening The Los Angeles County Board of Supervisors and the University of California Board of Regents have both approved a pact that would allow for the perpetually troubled King-Harbor Medical Center to reopen by 2013. The Supervisors voted unanimously on Dec. 1 to reopen the hospital, while the Regents cast a unanimous vote on Nov. 19. “This is going to be a good partnership for them and, more importantly, for the clients we serve,” says Supervisor Zev Yaroslavsky. The hospital would be operated by a not-for-profit entity with a seven-member board of directors appointed either individually or jointly by the Supervisors and Regents. King-Harbor closed in 2007 after the Centers for Medicare and Medicaid Services withdrew its funding after a series of safety violations that killed or threatened the lives of several patients.

Kerlan Jobe Pays $3 Million Settlement The Kerlan Jobe Orthopaedic Clinic in Los Angeles has paid the U.S. Justice Department $3 million to settle allegations of accepting illegal kickbacks from Birmingham, Ala.based HealthSouth Corp. Kerlan Jobe, which has treated some of Southern California’s most famous athletes, had received payments to its charitable foundation from HealthSouth, forgiveness on an equipment lease, stock option grants, and a high ownership interest in a jointly owned ambulatory service

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NEWS STD Programs

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more hazardous health effects as pelvic inflammatory disease, and potentially fatal conditions such as cervical cancer and ectopic pregnancies. “Every single one of those cases needs to be (handled with outreach workers),” Kerndt says. “That’s the only way to get people in for treatment.” Aside from the current budget cuts, department officials fear there could be another $10 to $15 million reduction beginning next July. That could spell cuts for the county’s vaunted STD laboratory, which conducts nearly 7,000 tests a week, including all those in the county jail and juvenile detention system – groups that have a much higher rate of STDs than the countywide average. “There has been no reduction so far, but there may be all kind of reductions in the future considering our situation,” says Jonathan Freedman, the department’s chief deputy. Freedman notes that the bulk of the STD testing in L.A. County is still performed by private sector providers. But Sara Cody, M.D., a deputy health officer for the Santa Clara County

Department of Health, notes that its STD clinic received many patients for testing who did want to go to their regular provider due to privacy concerns. “The niche that we filled was people who could be millionaires and had access to any kind of care they wanted. We certainly served that population,” says Cody, who adds that many private sector physicians are ill-equipped to handle STD care. Although Cody believes many patients have ventured to clinics in San Francisco and San Mateo County for testing since her department’s clinic closed early last year, she is concerned that underreporting of STDs will become a major problem. The Santa Clara County clinic routinely identified half of all the syphilis cases in the county each year. “Because of the erosion of the public health infrastructure, we don’t have a robust enough surveillance system to say what the fallout has been,” she says, adding that reported rates often go down after clinic closures. “That usually means cases are going unreported.”

Poor Women At Greater Health Risk UCLA Study Does Not Include Effects of Recession A new study by the UCLA Center for Health stairs or lifting objects. Policy Research indicates that California’s Roberta Wyn, the UCLA Center’s low-income women are associate director and far more likely to the lead author of the Health Measurements Among Women, By Percentage experience health study, observes that 40 problems and less likely many women sacrice 32 to access timely medical care their health to provide for others. 27 than higher earners. 19 “Women are the primary organizers 16 14 The study, based on the in their families, and they tend to 11 13 8 California Health Interview priortize their kids’ (healthcare) Survey data from 2007, needs over their own needs,” she 0 concludes that says, adding that money Fair or Poor Health Condition Limits Basic Activity women whose problems can incomes are at or 0-199% FPL exacerbate the 200-399% FPL below 199% of the federal phenomenon. 400+ FPL poverty level are four times Partly as a result, 20% Source: UCLA Center for Health Policy Research more likely to report of low-income women had being in fair or poor not seen a physician in the health. They are also twice as likely to report past 12 months, compared to 13% of those a health condition that impairs their ability to with incomes between 200% and 399% of the function on a daily basis, such as climbing Continued on Next Page

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In Brief center, according to a statement issued by the Justice Department. “This settlement serves as a reminder that federal healthcare program beneciaries' referrals should be based on quality of care for the patient, not the nancial benet for any physician or healthcare company,” says Assistant U.S. Attorney General Tony West. HealthSouth settled kickback allegations involving Kerlan Jobe and another sports medicine clinic for $14.7 million in late 2007.ore

Grossman Opens Burn Unit In Louisiana The Grossman Burn Center has opened up a new burn unit at Lady of Lourdes Regional Medical Center in Lafayette, La. It’s the first burn unit the Sherman Oaks-based Grossman has opened outside of California. The six-bed unit is being staffed by three physicians and is the only dedicated burn unit in southwest Louisana, which has a large concentration of industrial agriculture and petroleum production. “Our expansion strategy has been to identify markets where there is a demonstrated need for burn care as well as the existing quality medical infrastructure to support a dedicated burn unit,” says burn center co-director Peter H. Grossman, M.D. “In Lafayette we were able to fill a need for burn care and affiliate with a first ratehospital partner.” Grossman operates its primary burn unit at Sherman Oaks Hospital, but will be relocating to West Hills Hospital & Medical Center in 2010. It also operates units in Santa Ana and Bakersfield.

NEWS

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Health Disparities (Continued from Page Two) poverty level, and just 8% of women with incomes above 400% of poverty, which is about $66,000 for a three-member household. Similar numbers were reported for timely pap smear exams. Nearly a third of low-income women did not have a mammogram in the past two years – twice the rate of those with higher incomes. Those ndings tended to correlate with rates of insurance coverage: 41% of lowincome women lacked insurance at least some part of the year, compared to only 7% of women whose incomes are at or above 400% of the poverty level. Although a full

44% of low-income women surveyed did not have steady jobs in 2007, only 29% were enrolled in the Medi-Cal program. Those in Medi-Cal were far more likely to obtain regular doctors’ visits. Wyn believes the severe recession has added to the ranks of low-income women and likely pushed down health indicators. However, she believes that if federal healthcare reform is signed into law, the expansion of the Medicaid program and subsidies for middle-income earners to purchase insurance would help address some of the disparities.

Kaiser Pledges $1.25M Toward AIDS Many Norcal Programs Receive $75K Grants Kaiser Permanente announced $1.25 million San Fernando and the Saban Free Clinic in in grants for AIDS programs statewide earlier Los Angeles. Kaiser’s Southern California’s this week, although its Southern California grants were directed through committees and Northern California regions based at its regional allocated the funds through hospitals. Kaiser AIDS Grants entirely different formulas. Kaiser’s Northern Kaiser’s Southern California region made Whittier Rio Hondo AIDS Project California region pledged only seven grants $22,874 $750,000 to more than 60 averaging $75,000 organizations. None received apiece, with most Project Angel Food $20,000 more than $40,000, and many focusing on AIDS testing, of the recipients performed particularly among San Francisco AIDS Foundation support services rather than minority communities. Up to $75,000 provide direct healthcare “These grants are part of services. An example was a our long-standing Source: Kaiser Permanente $10,000 grant that went to Auntie commitment to prevention and Helen’s Fluff & Fold, a San Diego reducing health disparities,” organization that does laundry for AIDS says Yvette Radford, a Kaiser regional vice patients. president. The grants were made without the “Our grants in Southern California take a supervision of Kaiser hospitals in the region. much broader service approach,” says Kaiser Kaiser has provided more than $6.2 spokesperson Socorro Serrano. However, million in community grants to try and several community clinics received grants, prevent the spread of AIDS in California since such as the Northeast Valley Health Corp. in the late 1980s.

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OPINION

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Mental Healthcare’s Own Breakdown Without Attidunal Changes, Hasan Won’t be Alone Less than 24 hours after Army Maj. Texas is up by nearly a quarter since troops Nidal Hasan inflicted a horrendous and began deploying in 2001. By comparison, the senseless tragedy on Ft. Hood and the U.S. national crime average has dipped by nearly Army, I began hearing television reports 10%. refer to him as a “Muslim fanatic.” But the mental health of troops remains This portrait seemed moderated by an issue even after they leave the service. reports emerging in the days ahead that Former Army National Guardsman Jesse painted Hasan as someone any competent Bratcher, who was deployed to Iraq in 2005, healthcare professional would have was recently found legally insane by an recognized as mentally ill. He wrote Oregon jury when he shot and killed a man rambling, nonsensical reports, alleged to have raped his fiancee. Bratcher inappropriately proselytized and lived in had been diagnosed with PTSD and was utter isolation. Even though his Army eventually considered 100% disabled by the colleagues – many of the psychiatrists like Veterans Administration. The VA’s course of Hasan –speculated that he might be treatment: sleeping pills. psychotic, they treated him as a problem Unfortunately, the private sector treats to be disposed of rather than someone in mental health issues with much of the same need of assistance. Hence, his transfer indifference as the military. Health plans have from Walter Reed Army Hospital to chipped away at the number of days Ft. Hood, where it was hoped he they will pay for mental health By would anonymously blend into one counseling, with many offering to Ron of the world’s largest military cover fewer than five sessions a year. Shinkman That’s a virtual non-starter when installations. Yet politicians on both sides of treating someone with a major mental the aisle grumbled that “political health condition. By contrast, the use correctness” prevented Hasan’s colleagues of prescription antidepressant drugs has from trying to get him help, rather than increased nearly 50% between 1995 and callousness or even incompetence. 2002. That’s despite the fact that most of the Not once have I heard that Hasan’s drugs treat mental health symptoms, rather overt devotion to Islam may have been a than any underlying conditions. manifestation of his mental state, even This trend is unlikely to be addressed by though religious fantasy is a common the healthcare reform proposals being symptom among those with mental illness. debated in Congress. The Senate version of The coverage of Hasan has died down the bill deliberately omitted Medicare in recent days, but his case should not. It payments for mental health counseling. is a microcosm of how the military Neither the House or Senate versions of the specifically and our nation in general bills set any minimum guidelines for mental treats mental health issues: by pretending health benefits covered by insurers. State they don’t exist. mandates could be eradicated if insurers are Despite putting tens of thousands of its permitted to sell coverage over state lines. personnel in harrowing front-line action Given both the American military and this decade, the U.S. military treats the civilian culture wholeheartedly encourage the mental health of these troops with the use of firearms, their failure to address mental same indifference Cpl. Klinger’s crosshealth issues is a recipe for continued dressing drew on “M*A*S*H*.” Legitimate disaster. Hasan was among the first military disability claims based on post-traumatic personnel to go on a bloody rampage. If stress disorder are routinely denied. things do not change, he won’t be the last. Mental health counseling appointments Ron Shinkman is the publisher of Payers & Providers. are often deferred, sometimes for months. In July, Army Staff Sgt. Justin Lee Garza took his own life when his therapy session Op-ed submissions of up to 575 words are was canceled and not rescheduled. Like welcomed. Please e-mail proposals to Hasan, he was stationed at Ft. Hood, [email protected], or call where violent crime in and around the (877) 248-2360, ext. 3. base and the adjacent town of Killeen,

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