3 December 2009
California Edition
Calendar
December 10
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published in the Calendar section,
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STD Programs Meet Funding Crunch
Cuts Could Impact Overall Health of Californians
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 one-
third 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.
www.lakesidecommunityhealthcare.com
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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
 Payers & Providers
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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
Continued on Page 3
NEWS
STD Programs
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
Poor Women At Greater Health Risk
UCLA Study Does Not Include Effects of Recession
A new study by the UCLA Center for Health
Policy Research indicates that California’s
low-income women are
far more likely to
Health Measurements Among Women, By Percentage
experience health
problems and less likely 40
32
to access timely medical care
than higher earners. 27
16
The study, based on the
California Health Interview 13
Survey data from 2007,
0
concludes that
Fair or Poor Health
women whose
incomes are at or 0-199% FPL
below 199% of the federal 200-399% FPL
poverty level are four times 400+ FPL
Source: UCLA Center for Health Policy Research
more likely to report
being in fair or poor
health. They are also twice as likely to report
a health condition that impairs their ability to
function on a daily basis, such as climbing
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Page 2
(Continued from Page One)
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.”
stairs or lifting objects.
Roberta Wyn, the UCLA Center’s
associate director and
the lead author of the
study, observes that
many women sacrice
their health to provide for others.
19
“Women are the primary organizers
14 in their families, and they tend to
11
8
priortize their kids’ (healthcare)
needs over their own needs,” she
says, adding that money
Condition Limits Basic Activity
problems can
exacerbate the
phenomenon.
Partly as a result, 20%
of low-income women had
not seen a physician in the
past 12 months, compared to 13% of those
with incomes between 200% and 399% of the
Continued on Next Page
Payers & Providers NEWS Page 3

Longer ALOS!* Health Disparities (Continued from Page Two)

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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
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 low-
income 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
Kaiser Pledges $1.25M Toward AIDS
Many Norcal Programs Receive $75K Grants
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.

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 rate-
hospital 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.
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.
entirely different formulas. Kaiser AIDS Grants Kaiser’s Northern
Kaiser’s Southern California region made
California region pledged Whittier Rio Hondo AIDS Project only seven grants
$22,874
$750,000 to more than 60 averaging $75,000
organizations. None received Project Angel Food apiece, with most
more than $40,000, and many $20,000 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.
Expert Healthcare Communications
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Payers & Providers
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OPINION
Mental Healthcare’s Own Breakdown
Without Attidunal Changes, Hasan Won’t be Alone
Less than 24 hours after Army Maj.
Nidal Hasan inflicted a horrendous and
senseless tragedy on Ft. Hood and the U.S.
Army, I began hearing television reports
refer to him as a “Muslim fanatic.”
This portrait seemed moderated by
reports emerging in the days ahead that
painted Hasan as someone any competent
healthcare professional would have
recognized as mentally ill. He wrote
rambling, nonsensical reports,
inappropriately proselytized and lived in
utter isolation. Even though his Army
colleagues – many of the psychiatrists like
Hasan –speculated that he might be
psychotic, they treated him as a problem
to be disposed of rather than someone in
need of assistance. Hence, his transfer
from Walter Reed Army Hospital to
Ft. Hood, where it was hoped he
would anonymously blend into one
of the world’s largest military
installations. Shinkman That’s a virtual non-starter when
Yet politicians on both sides of
the aisle grumbled that “political
correctness” prevented Hasan’s colleagues
from trying to get him help, rather than
callousness or even incompetence.
Not once have I heard that Hasan’s
overt devotion to Islam may have been a
manifestation of his mental state, even
though religious fantasy is a common
symptom among those with mental illness.
The coverage of Hasan has died down
in recent days, but his case should not. It
is a microcosm of how the military
specifically and our nation in general
treats mental health issues: by pretending
they don’t exist.
Despite putting tens of thousands of its
personnel in harrowing front-line action
this decade, the U.S. military treats the
mental health of these troops with the
same indifference Cpl. Klinger’s cross-
dressing drew on “M*A*S*H*.” Legitimate
disability claims based on post-traumatic
stress disorder are routinely denied.
Mental health counseling appointments
are often deferred, sometimes for months.
In July, Army Staff Sgt. Justin Lee Garza
took his own life when his therapy session
was canceled and not rescheduled. Like
Hasan, he was stationed at Ft. Hood,
where violent crime in and around the
base and the adjacent town of Killeen,
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Page 4
Texas is up by nearly a quarter since troops
began deploying in 2001. By comparison, the
national crime average has dipped by nearly
10%.
But the mental health of troops remains
an issue even after they leave the service.
Former Army National Guardsman Jesse
Bratcher, who was deployed to Iraq in 2005,
was recently found legally insane by an
Oregon jury when he shot and killed a man
alleged to have raped his fiancee. Bratcher
had been diagnosed with PTSD and was
eventually considered 100% disabled by the
Veterans Administration. The VA’s course of
treatment: sleeping pills.
Unfortunately, the private sector treats
mental health issues with much of the same
indifference as the military. Health plans have
chipped away at the number of days
they will pay for mental health
By counseling, with many offering to
Ron cover fewer than five sessions a year.
treating someone with a major mental
health condition. By contrast, the use
of prescription antidepressant drugs has
increased nearly 50% between 1995 and
2002. That’s despite the fact that most of the
drugs treat mental health symptoms, rather
than any underlying conditions.
This trend is unlikely to be addressed by
the healthcare reform proposals being
debated in Congress. The Senate version of
the bill deliberately omitted Medicare
payments for mental health counseling.
Neither the House or Senate versions of the
bills set any minimum guidelines for mental
health benefits covered by insurers. State
mandates could be eradicated if insurers are
permitted to sell coverage over state lines.
Given both the American military and
civilian culture wholeheartedly encourage the
use of firearms, their failure to address mental
health issues is a recipe for continued
disaster. Hasan was among the first military
personnel to go on a bloody rampage. If
things do not change, he won’t be the last.
Ron Shinkman is the publisher of Payers & Providers.
Op-ed submissions of up to 575 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com, or call
(877) 248-2360, ext. 3.
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INTERNAL AUDITOR – The Internal Auditor ensures that L.A. Care

and its subcontracted entities are compliant with state & federal
claims adjudication and financial administration requirements.
This is achieved by performing financial and operational audits,
risk assessments, and continuous oversight of internal controls and
systems.! Additionally, developing audit work programs that
appropriately address areas of risk, and identification of internal
control weaknesses are an essential function of the job.! Will
collaborate with L.A. Care staff to correct identified performance
deficiencies and help mitigate risk by identifying areas of needed
improvement.! Finally, will serve as a resource to internal staff on
compliance matters within their subject matter expertise; will
perform internal audits and/or investigations as needed or
required; and will collaborate/participate in work groups,
activities, or special projects, as required and assigned.
For complete job description, qualifications/requirements, and
additional opportunities, visit our website: www.lacare.org.
!
To apply, email resume with salary history/requirement to
recruiter@lacare.org, referencing “Payers & Providers Ad.”

It costs up to $27,000 to fill a

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Call Ron Shinkman at (877) 248-2360, ext. 2,
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