Feb. 10--Public care for Ukiah and Fort Bragg patients diagnosed with latent tuberculosis narrowly escaped cancellation during the Tuesday Mendocino County Board of Supervisors meeting -- at least until July.
"Due to some one-time funding that came in to Public Health this year, we are in a better financial position than we had anticipated," said Stacy Cryer, director of the Mendocino County Health and Human Services Agency's Community Health Services Branch.
The board had on its agenda a public hearing required before the county can cut public heath care. Cryer proposed to stop twice-monthly infection control services for patients suffering from latent tuberculosis.
The cut was expected to save the county $65,667, and was proposed because of falling revenue and lack of funding for nursing jobs.
The board followed County Counsel Jeanine Nadel's advice and pulled the hearing off of the agenda based on Cryer's remarks, but Cryer but cautioned the board that the reduction could come up again in budget hearings this summer.
"We continue to face budget challenges, and I cannot guarantee that I will not have to stand before you again for next fiscal year," Cryer said.
She told the board she had proposed the cut because state realignment money -- an increment of fuel sales tax -- was dwindling.
"Whenever we are faced with these types of decisions it is very difficult," Cryer said. "However, with realignment revenues continuing to decline, Community Health Services is forced
to look at what non-mandated services we currently provide," Cryer said.
Latent tuberculosis is diagnosed with a skin test that indicates the patient was exposed to the diseased in the past. The majority of patients diagnosed don't develop the active disease, according to the memo, but Cryer acknowledged that the reduction of case management would pose a risk.
"We know that over time, with no TB prevention efforts in place the incidents of active TB will increase. We also know it is more expensive to treat active TB versus latent TB. We are aware that many providers in the community are concerned about Public Health not continuing this service," Cryer said, noting that neighboring counties have eliminated latent TB services.
Supervisor John Pinches noted that through the 2003 passage of Prop. 242, voters diverted $1.4 billion away from education and public health for transportation.
"It was we the people, on a 2-1 vote, that diverted this money from public health programs, like we're talking about here," Pinches said. "It may keep brand new trucks out there on the road for Caltrans, but it has devastated some of these public health programs."
The board took public comment after informing people who came to speak on the matter that the board would not act on the withdrawn recommendation to cut the TB prevention program.
A man who identified himself as Mr. Ash spoke first, telling the board he has an immune deficiency because he had a liver transplant, and felt the threatened cut jeopardized his health.
"When you don't have the money, what do we do?" Pinches said.
"You die from TB, I guess," Ash answered, and board Chairwoman Carre Brown stopped the debate.
Physician Charlie Evans, CEO of Pacific Redwood Medical Group, called the proposed closure "very short-sighted."
"Ultimately the closure of the latent TB clinic would greatly increase the instance of not only latent TB, but active tuberculosis in our county would balloon," Evans said.
He added that there would also be more cases of resistant tuberculosis, which he said could cost between $250,000 and $500,000 per case to manage.
He said patients with latent TB usually undergo a nine-month treatment course of antibiotics.
"If no treatment is pursued, about 1 percent of these patients go on to develop active tuberculosis," Evans said, adding that the one or two new cases expected in the first year after impending cancellation could grow to as many as 16 to 20 new cases in the next generation.
Tiffany Revelle can be reached at udjtr@pacific.net, or at 468-3523.
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