County cuts in health service ill-considered
Times are tough in California, forcing individuals and institutions to re-evaluate economic priorities, commitments and obligations. The administrative priorities for our county are reflected in the 2004-05 budget adopted last week. The county has been challenged to reduce expenditure and has responded by eliminating clinical health services for vulnerable populations.
During this last year, the Nevada County Health Department has terminated clinical preventive care services for low-income babies and has planned to eliminate state-funded reproductive care, including women’s health exams, contraception, and sexually transmitted infection diagnosis and treatment. These services were a vital source of support for some of the most at-risk citizens in our county.
The administration’s rationale for these cuts was to “eliminate duplicate services” within the region. This faulty reasoning was constructed simply to justify a quick-and-dirty method to align the budget at the expense of vulnerable populations who lack the ability to advocate for their own needs.
Duplicate reproductive care services did not exist until the county conspired with the administration of Miner’s Clinic to create them. Last week, after a lengthy application process, Miner’s Clinic received approval to provide state-funded reproductive care services, months after the goal of eliminating “duplicate” services was composed. This was a calculated action by county administrators to deflect commitment to vulnerable populations and create a monopoly of indigent care services at Miner’s Clinic.
These plans were not devised with the best interest of the client as a priority, and they did not include any consultation from local medical providers, professionals who work with at-risk populations, or the community. The plan was orchestrated by two administrations attempting to reconcile budget deficits using funding for vulnerable populations as barter.
Should Miner’s Clinic, with a history of financial instability, eventually succumb to economic stress, what will happen to the health care for vulnerable populations in this county?
Miner’s Clinic is not a substitute for Community Health Services. Staff at the Nevada County Health Department are experienced and committed to the care of this challenging population, working arduously to promote the stated mission “to safeguard and promote health in our community.”
Health Department employees routinely provide excellent, compassionate service to clients who present with needs ranging from disease, to rape, hunger and addiction. Last week, as a reward for their dedication, the staff of the Health Department earned pink slips while the administrative layers at the county remain untouched. The current plan will preserve facility overhead and administrative costs while eliminating services that could generate over $100,000 of county revenue.
Community Health clients have persistently and vehemently expressed the perception that Miner’s does not effectively address their concerns. Now Miner’s Clinic intends to assimilate the highest-risk citizens into an institutional structure that is unprepared to meet their needs and is already plagued with significant staffing issues. Critical services, such as confidential HIV counseling and teen clinics, will now be fragmented between systems.
The Miner’s facility, visibly situated across from SPD in Nevada City, cannot offer high-risk clients the confidentiality they require, thus impairing access to sensitive services. The location of this site also encourages the developmentally questionable utilization of confidential reproductive care by the young adolescents in the Seven Hills School district. The overall effect of this “budget” decision will be an increase in sexually transmitted infections, unintended pregnancies and abortions.
Clients who have been alerted that their care has been “transferred” to Miner’s Clinic have responded with shock, disappointment, and frequently tears. Most clients, however, are oblivious that their previous service has been eliminated because the county staff was instructed not to disclose the information, an effort to subdue public opinion and a clear violation of patient abandonment regulations.
This ill-conceived “budget remedy” was enacted without clear announcement in the Board of Supervisors’ agenda, adequate assessment, application of proper transitional process, or development of any program evaluation criteria. These activities reflect the worst of both business and government.
With indicators demonstrating that rural health is in decline with regard to substance abuse, HIV infection and AIDS, our community needs an accessible health department more now than ever. There are fiscally responsible methods to preserve the mission of the Nevada County Health Department, but it will require vision and commitment to our entire society, particularly to those who lack opportunity to advocate for themselves.
Alexa Curtis of Nevada City is a family nurse practitioner and a doctoral student in community health systems, with a specialty in at-risk youth.
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