Modesto Bee Article

last updated: March 20, 2008 05:45:19 AM

The health safety net has holes, and when people fall through them, the ultimate social cost often is higher -- in dollars and other impacts -- than if treatment was provided up front. That's surely the potential with a safety-net issue before Stanislaus County supervisors this week.

The board voted 3-2 Tuesday to stop paying for psychotropic medications for medically indigent adults suffering from serious mental illnesses and being seen by family practice physicians in county health clinics. The board should not have taken this action without a backup plan in place.

Instead, there was a direction to county staff to try to work out a way for these patients to be treated by psychiatrists working for another county department, Behavioral Health and Recovery Services, aka mental health.

The issue immediately affects about 160 of the 6,100 county residents who are eligible as medically indigent adults. That is a specific definition, not a generic term for poor people. Medically indigent adults are not covered by Medi-Cal or Medicare, but don't have private insurance or enough money to buy it. Under state law, the county is directly responsible for providing medical care for these adults -- either through its own clinics or under contract. Stanislaus provides most of the care through its clinics and pays for hospitalization at Doctors Medical Center. But the state law does not mandate mental health treatment, and Stanislaus, like many counties, does not provide it. Contributing to the problem are state cutbacks in mental health programs and the overall budget outlook for the county.

For several years, these 160 patients have been seeing county family practice physicians who are not trained to deal with serious mental illnesses such as severe bipolar disorder and schizophrenia.

Dr. Del Morris, medical staff chief for the Health Services Agency, did a good job Tuesday explaining why this is beyond the scope of family practice doctors. He suggested the family doctors would be willing to work with a psychiatrist to see that the patients are getting the right meds at the right doses. Psychiatrists also are needed to document mental illness that might qualify a person for long-term coverage under Medi-Cal.

Mentally ill indigents don't have any place else to turn. The valley is short on medical specialists, including psychiatrists, and most limit the uninsured patients they will see.

And if the county cuts off prescriptions, stable patients could deteriorate quickly -- even to the point of becoming a danger to themselves or others. They could end up in jail, the psychiatric hospital or the emergency room. In any of those places, the county would have to foot the bill and it quickly could rise above the $300,000 the county anticipates saving by eliminating the prescription coverage.

The dollar-and-cents reality of this situation persuaded Supervisors Bill O'Brien and Jim DeMartini to vote against ending the psychotropic prescriptions. Supervisor Jeff Grover suggested the county look for Plan B through mental health.

Informally, supervisors said they'll continue providing the psychiatric meds for 60 days. That's not enough; they need to commit to a longer term solution. It would be penny wise and pound foolish to eliminate a $300,000 program that could cost many times that in hospitalization and, in a worst case scenario, could include violence.

This is a matter of money, compassion and common sense -- and closing a recognizable hole in the health safety net.

Our Point

The definition of penny wise and pound foolish: For the county to try to save $300,000 in prescription costs when the patients likely would end up needing hospitalization costing much more.