REFLECTIONS ON 2001: HEALTH
Promising Year Ends Up Leaving Health Care Advocates Heartsick;
Plans to insure more poor children and mend the trauma care system were dashed by an ailing economy.
Copyright 2001 / Los Angeles Times
Los Angeles Times...12/25/2001
In health care, 2001 was a year of great anticipation followed by dramatic disappointments.
It was supposed to be the year that millions of poor children and their parents in California received health insurance through an expansion of the federal Healthy Families program. An infusion of cash from Sacramento was supposed to be on its way to the state's beleaguered trauma care system.
But the economic crash--combined with fallout from the terrorist attacks--put an end to both the surplus and the dream. Nationwide, Medicaid programs were expanded early in the year, only to be cut back. Private health plans, fattened in recent years by a prosperous economy and a new generosity among employers, busily removed restrictions and expanded coverage, only to face reductions at year's end.
"This year started off with us thinking we could do anything," said Helen Schauffler, director of the Center for Health and Public Policy Studies at UC Berkeley. "We had so much money. There was such a huge surplus. And then it just vanished."
The Sept. 11 terrorist attacks, meanwhile, dramatically shifted the political agenda. Congressional plans for a patients' bill of rights and prescription drug coverage for seniors, as well as expanded coverage for the uninsured and mentally ill, were scuttled. Bioterrorism was the only health care issue to dominate political discourse after the attacks.
Public and private health care systems saw their weaknesses exposed.
In California, nonprofit hospitals continued to struggle financially in 2001. Henry Mayo Newhall Hospital, a key facility for the Santa Clarita region and the only trauma center between Northridge and Fresno, filed for bankruptcy protection in November. Daniel Freeman Hospitals Inc., the last nonprofit hospitals in Inglewood and Marina del Rey, were sold to Tenet Healthcare Corp. of Santa Barbara as a way to avoid bankruptcy and closure.
A shortage of nurses continued to plague both public and private hospitals, as RNs continued to flee the health care business and fewer students signed up for nursing programs. Those nurses who remained in the system found conditions so uncomfortable that they signed up for union membership in record numbers. The California Nursing Assn. won 11 representation elections, for 4,500 registered nurses.
It was the public sector, in many ways, that suffered most. Los Angeles County's massive hospital and public health system faces a loss of nearly $ 500 million in funding over the next two years, with the expiration of a Clinton-era bailout.
In addition, the Bush administration approved cuts in federal health financing that would reduce the budget even further.
Next year, predicted county Supervisor Zev Yaroslavsky, the county will have to consolidate services at some hospitals and clinics as a way to save money.
Supervisors were reluctant to make such moves this year. When County Health Director Mark Finucane proposed closing High Desert Hospital without consulting local constituents, Supervisor Mike Antonovich--who represents the area--objected and the proposal was quickly withdrawn.
Finucane, whose relationship with the supervisors had long been rocky, was forced to resign by the board in March, ending a turbulent tenure without resolving the Health Department's fiscal woes. A new health director, Dr. Thomas L. Garthwaite, a medical director of the sprawling Veterans Health Administration, was chosen at year's end to replace him.
Financial and administrative problems led to reports of poor treatment at the county's largest hospital. The Times reported in June that three patients at County-USC Medical Center died while waiting for emergency dialysis in late 2000 and early 2001. The hospital also was cited by the state for having an overburdened psychiatric emergency room.
The hospital's executive director, Roberto Rodriguez, resigned when Finucane did.
"We are not in a better position to deal with our problems in L.A. County today than we were six years ago," said Yaroslavsky. "Part of that is the county's fault. But the largest part of it is that the public health system . . . is on the slippery slope to financial calamity. And that will have an impact far beyond the county hospitals."
Nationwide, holes in the public health infrastructure--weakened after years of cutbacks and neglect--became particularly apparent after the terrorist attacks.
It became clear that leaner-and-meaner hospitals don't have the equipment or medications they need. The medical center to which victims of the attack on the Pentagon were sent, for example, had little of an expensive synthetic skin used to treat burn victims.
Public health officials were largely unprepared. Only 100 laboratories in the United States can process the test for anthrax infection, and before the attacks forced attention to the issue, most doctors did not know the symptoms of the deadly disease. There is a nationwide shortage of vaccines protecting against anthrax and smallpox, and laws governing the treatment of infectious disease are outdated in most states, including California.
Officials' reassurances were too optimistic and, at times, confusing or inaccurate. When an unknown bioterrorist sent envelopes filled with anthrax powder to media and political figures, health authorities were quick to assure the public that procedures were in place to treat and guard against anthrax, smallpox and other bioterrorism threats.
But they had to backpedal as the anthrax cases spread. Five people died and 13 were sickened nationwide as a result of the tainted letters.
In Southern California, most hospitals are unprepared for a large influx of patients, whether from a bad Saturday night on the road, an epidemic of flu or in the extreme case of a terrorist attack.
When two postal workers from Bell Gardens feared that they had been exposed to anthrax, they walked right in the front door of L.A. County-USC. Medical Center's emergency room, white powder and all, because there was no separate entrance for people who may have infectious diseases.
At Northridge Hospital Medical Center, doctors prepared to collect contaminated water used to rinse off victims of a bioterrorist attack using children's wading pools supplied by the county.
In the end, efforts to prepare for a bioterrorist attack overwhelmed all other health care considerations.
"Our lobbyists say they have to frame everything in terms of bioterrorism," said David Jansen, chief administrative officer for Los Angeles County. "That's the only thing anybody in Sacramento is interested in."
Times staff writers Charles Ornstein and Nicholas Riccardi contributed to this report.