County weighs health cuts

Stanislaus County supervisors could approve more cuts to health care services for the poor today, including the elimination of clinical laboratory and radiology services that appeared to be profitable in the past.

Among the cuts intended to address a $16.6 million operating deficit in the Health Services Agency for 2007-08 are a 57 percent reduction of urgent care hours, elimination of in-house lab services and most radiol-ogy services, and lowering the maximum income eligibility for the medical indigent adult program.

County supervisors will consider the cost-saving measures after a public hearing tonight. The changes could take effect as soon as Dec. 1.

According to HSA officials, the laboratory and radiology departments are operating at a significant loss, and those kinds of services are available to patients at other facilities.

From 2005-06 to 2006-07, there was a 20 percent decline in patients using radiology services and a 13 percent decline in clinical lab patients.

The agency's official line is contested by some former health services employees who left in the wake of a managerial restructuring in December 2006. They said laboratory and radiology services were moneymakers but patients stopped using radiology services early this year because of staff shortages after five key employees resigned.

For a few months, the department lacked technicians to do ultrasounds, CT scans and nuclear medicine procedures, which resulted in a sharp decline in patients, the former employees said.

"They had no coverage for ultrasounds until they hired a rent-a-tech," said Mike Owen, an ultrasound technician who resigned early this year after more than 20 years with the HSA. "They were losing patients because no one was there."

Ruth Nall, a former ultrasound technician, said that before the poor financial showing in 2006-07, the financial reports were positive.

"Nuclear medicine was profitable; CT (scanning) was profitable," she said. "Ancillary services made a lot of money that was helping to carry those clinics."

Former employees also said nuclear medicine diagnostics were out of service for nine months because of what they thought was foot-dragging in keeping the equipment licensed. While the service was down, the agency was making lease payments on the equipment. The equipment was put back in service in May.

Mary Ann Lee, director of the HSA, said the lab and radiology departments lost money in 2006-07 and that net income in the two departments was overstated in previous years.

In fiscal year 2006-07, which ended in July, the HSA lost $872,000 on lab services and $664,000 on radiology, partly because of the decline in patients, Lee said.

In 2005-06, radiology services showed a profit of $662,000, and lab services also showed a profit in previous years, Lee said.

Lee said, however, that she believes the net income was overstated. County financial staff has not done an analysis to find out how much accounting errors skewed previous financial reports for radiology, she said. They have found inaccuracies in the lab services accounting.

The agency is looking for ways to keep from losing money, Lee said. "When we look forward at what we think is a reasonable forecast for these services, it still shows it will lose money," she said. "We have to make changes if we want to save the clinic system. Those services are available in the market from external vendors."

The former county employees said they are skeptical of Lee's explanation. Even at the Medi-Cal rates of reimbursement, the more advanced imaging technology such as ultrasound and CT scanning can generate significant revenue, they said.

Lee said changes in management were made across the agency in fall 2006 to improve operations. In the case of radiol-ogy, there was no manager specifically over the operation and she wanted more focused management, she said.

The director said the managers she appointed have made improvements.

"Whenever there is change, there may be some individuals that like the changes and some that don't," she said.

Dr. Del Morris, medical director for Scenic Faculty Medical Group, which sees patients in the county clinics, said radiology has suffered from staff departures. He said other departments in the HSA have lost staff because of the financial uncertainty of the clinic sys- tem.

On Monday, the line of patients ex- tended outside the waiting room door of the lab on Scenic Drive in Modesto. Patients said the lab should stay open for the poor and uninsured.

"When you don't have transportation or someone to bring you, you have to walk," said Maria Weatherford, a resident of the Marple Manor retirement complex.

Karen O'Brien of Modesto said she went to the lab twice in the past month to give samples for testing. Her doctor monitors how the potent drugs she takes for multiple sclerosis and lupus are affecting her organs.

O'Brien said she is concerned that commercial services won't accept all the Medi-Cal patients who would be turned away from the county lab. The clinical lab processes tests for about 26,400 patients a year.

The HSA still would provide in-house film X-rays for its orthopedics clinic and make arrangements with outside labs to serve medically indigent adults. Medi-Cal patients, which make up the largest portion of county clinic patients, would have to go to commercial labs.

Under the cost-saving proposal, hours for the Scenic Drive urgent care center would be reduced from 84 to 36 a week. Instead of being open 12 hours daily, the urgent care center would be open from 5 to 9 p.m. weekdays and noon to 8 p.m. weekends.

The maximum income eligibility for the medically indigent adult program would be 200 percent of the federal poverty level (up to $27,380 for a family of two; up to $41,300 for a family of four), down from 250 percent of the poverty level.

With the proposed cuts, the Health Serv-ices Agency expects to eliminate 19 positions. About half of those employees can be offered other positions, Lee said.

The Board of Supervisors will meet at 6:30 p.m. today in the basement chamber of Tenth Street Place, 1010 10th St., Modesto.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.