‘People will die’: Local doctors, clinicians say Santa Cruz County health cuts pose big risk

For the layperson, it might be difficult to understand the precise impact if Santa Cruz County lawmakers vote Tuesday to shutter the public health agency’s lab and radiology services as part of a larger budget-slashing measure. 

However, for the local primary care doctors and physician’s assistants who spend their lives on the front lines treating Santa Cruz County’s poorest, sickest and most unstable people, those consequences are obvious. Some even view them as fatal. 

“More patients will get sick and more patients will die,” Jason Johnston, a physician’s assistant in Watsonville working as part of the Homeless Persons’ Health Project, told Lookout. “The illnesses that are the highest risk among those populations we serve will be untreated, will spread further, and will cause organ damage and death.” 

If the county closes its labs and radiology services, doctors and health care workers within the county’s Health Services Agency say they will have a tougher time managing patients with, and thus the spread of, chronic diseases such as hepatitis C and HIV. That prognosis stems from a practical understanding of what the labs provide, as well as a behavioral understanding of the HSA’s vulnerable and high-risk clientele. 

Doctors say throwing new obstacles at a population that already struggles to seek care could have serious ramifications. As Johnston puts it: “We are the safety net’s safety net.” 

The lab services in question are county-funded operations within or near county health clinic offices that draw blood or take urine samples for testing. The radiology services, similarly situated, provide X-rays. Neither service requires an appointment, which means a doctor who decides a patient needs a blood test can send them straight from their office to the phlebotomy chair and the tests can often take a day to turn around. 

Doctors say the convenience and efficiency offered by these services are key factors of adequate health care for an already difficult-to-treat and insecure population that struggles to make and keep appointments. 

Without the county-run labs on or adjacent to their health campuses, county health care workers say patients will have to schedule their appointments with private labs, such as Quest Diagnostics. Quest serves a broader population, and even though its labs sit only 1 and 2 miles away from the Watsonville Health Center and Emeline Avenue campus, respectively, doctors say the change presents distance and social barriers that might be too high for some of the more unstable patients to overcome.

If patients do not get those tests, it leaves their doctors without precise information. When a doctor finds they are operating blindly, they send their patients to the emergency room, said Dr. Jacob Ginsburg, a family and primary care doctor who works out of Santa Cruz’s Emeline campus. 

Quick turnaround blood tests that can be conducted on the same day as a visit to the doctor’s office, Ginsburg said, allows a doctor to better manage chronic conditions, such as hepatitis C, HIV or diabetes. But if a patient is ailing, and Ginsburg senses they need medication but doesn’t have blood test information, the best thing for the patient is to send them to the emergency room. In a future without nearby, quick-turn blood labs, Ginsburg foresees this scenario becoming more common. 

“If they actually cut lab services, it will definitely limit my ability to manage and control chronic conditions,” Ginsburg said. 

Johnston said asking already insecure patients to not only travel across town for a blood test, but requiring them to schedule and keep the appointment — which could be weeks away — creates the kind of barriers that will worsen health outcomes for a population that the county clinic system exists to serve.

“The more barriers you put to obtaining the next step in their treatment, all the sudden, their regular doctor visit has no impact because we’re blind,” Johnston said. “We don’t know the precise diagnosis, we don’t know how to treat it, and so we’re unable to care for those patients.” 

In a May 14 letter sent to the Santa Cruz County Board of Supervisors, signed by 26 health professionals in the county Health Services Agency — from doctors to nurse practitioners — local medical experts urged elected officials to reconsider the cuts, and listed 22 specific concerns they had raised to HSA management.

At the top of the list is a concern about a worsening budget crisis. If clinics lose lab and radiology services, the doctors fear the quality of care will drop to a point that they no longer qualify for care-based incentives from the Central California Alliance for Health, which the letter cites as a “major source of income” for the system.

The second listed concern deals with the impact of adding barriers to patients in the county’s Homeless Persons’ Health Project.

“The vast majority of these patients will not go to another site for urgent lab work, or labs that need special handling, and therefore can’t be drawn by one of our phlebotomists and sent over to Quest,” the letter reads. It goes on to say that doctors at the Homeless Persons’ Health Project already have a difficult time getting their patients to get an X-ray next door. 

In talking to doctors and medical professionals in the county, there is a clear sense of resentment that HSA management made the proposal for cuts without first consulting the front-line workers who would most feel the impact. 

“Why are we cutting people who are providing clinical care when maybe there are bigger administrative positions that are more costly and not providing revenue?” Dr. Anniken Hansen, a family doctor at the Watsonville Health Center, told Lookout. “I get they are trying to do the best they can but it could have been done in a more open way and maybe using everyone’s ideas to figure out how to improve the system.” 

Last week, Santa Cruz County Executive Officer Carlos Palacios presented a last-minute option to slow the health agency’s bleeding. Among his $1.4 million budget reshuffling to save a peer-run mental health day center and full-time mental health client specialist position, Palacios proposed extending the county’s blood lab services to Sept. 30 to “allow more time for the transition to community providers.” Palacios did not make the same play for the radiology lab, which will close if the existing budget proposal is adopted. 

The board of supervisors will meet on Tuesday at 9 a.m. for a final vote on the budget.

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