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Los Angeles Schools Brace for Shutdown of Public Health Clinics

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Schools in Los Angeles County are bracing for what officials see as a devastating situation if the county makes good on a promise to shut down most of its public health clinics at the end of this month.

School and health officials said the closures would leave them few options for referring hundreds of thousands of impoverished students in need of nonemergency medical care.

The California county's health department, facing a $655 million deficit in its $2.5 billion budget, has announced plans to close 35 of its 45 public health clinics. The remaining 10 would offer only reduced services, focusing on immunizations and the prevention and treatment of sexually transmitted diseases and tuberculosis. No longer would they provide prenatal care or pediatric services.

"It is a public-health tragedy," said Dr. Patricia C. Hassakis, the medical director of public health programs and services for the county health department.

Dr. Hassakis estimated that perhaps as many as 600,000 school-age children may rely on the clinics for medical services. Each year, she added, the county clinics conduct about 20 percent of the physical examinations required of children entering school for the first time--about 180,000 exams.

A Possible Reprieve

County officials, hoping to avert the crisis, last week were considering applications from private health-care providers to run the clinics. But it was unclear what effects such a move would have on schools or poor families.

Sally Coughlin, the assistant superintendent for student health and human services in the Los Angeles Unified School District, said closing the clinics would be devastating.

In an effort to respond to the coming crisis and provide better access to immunizations, Ms. Coughlin said, the nation's second-largest district was planning to have school nurses run immunization clinics. By November, nurses could be holding the clinics at least once a month.

Schools refer children to the public clinics for a variety of ailments or medication needs. If the clinics shut down, "Where do we send that child now who has a middle-ear infection or the child who has inflammation in the chest?" asked Sharon Goodrich, the coordinator of health services in the Pomona Unified School District. "There's not going be any place at all to send this child."

Distant Alternatives

Ms. Goodrich, who is also the state president of the California School Nurses Organization, said that if the clinics close, the closest source of treatment for some children will be at a county hospital 33 miles away. Her nurses in Pomona, on the eastern edge of the 4,070-square-mile county, are part of a new local health-care coalition that has submitted a bid to run the nearby county clinic.

Dr. Hassakis said she hopes all children who need one of the health screenings for school, known as the childhood health and disability screening program, will be able to get one. In the absence of the clinics, such screenings could be performed by private providers who are reimbursed by the state.

More than 1,000 medical providers in the county are eligible for such reimbursements, but Dr. Hassakis said she did not know how many could accommodate new patients. In any event, she said, those children will not be turned away from school because they could not get the exam.

Few Options

Experts said the reality is that sick children without insurance could go to one of the remaining clinics or to community or free clinics. Or they could wait in a hospital emergency room.

But emergency rooms are "not the appropriate place to receive that kind of episodic care," said Dr. Hassakis.

Ms. Coughlin of the Los Angeles school district said she is worried that parents will wait too long before taking a sick child to the emergency room. Those children could become sicker than they would have been had they been able to go to a clinic, she said.

Dr. Hassakis said she fears not only that sick children would miss school, but also that untreated asthma--a common affliction--could result in chronic lung disease or even death.

The loss of the prenatal and well-child care the clinics provide may also have a long-term effect on schools, Ms. Coughlin said. The loss of such care could result in "youngsters with really severe problems later on that will affect their ability to learn."

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