California: Is There a Doctor in the House? The Economic Crisis Is Creating a Public Health Disaster, and Health Officials Warn the Worst Might Be Yet to Come

In the central San Joaquin Valley, local health department budgets are shrinking with the economic crisis, leaving many agencies struggling to fulfill their public health mission. Across the state, health departments rely on vehicle license fees for a large portion of their budgets. But car sales have plummeted, and the newly unemployed and uninsured are increasing patient loads just as fewer staff are available to meet the demand, officials said.

Fresno and Madera counties have cut mobile immunization clinics for children and teen pregnancy prevention services. In Fresno County, TB patients who need monitoring for treatment adherence are visited twice a week instead of twice a day; others are monitored via a video link in their homes. The county no longer offers precautionary treatment for asymptomatic patients whose TB skin test is positive; instead, they must now seek treatment by a private physician. Those who have had close contact with active TB patients still receive treatment.

Reducing home visitations to patients with active TB and eliminating preventive TB treatment could lead to more TB cases in the future, said Dr. Kenneth Bird, head of the county's chest clinic. After declines over four years, Fresno County had 73 TB cases last year, up from 42 cases in 2007. The county also recorded one extensively drug-resistant TB case.

More services could be cut if budgets continue shrinking, health directors said. Last month, Fresno County supervisors cut 35 positions in public health. It is unclear whether a newly passed state budget to increase license fees will shore up departments' revenue gap, but health directors are not optimistic.

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