OAKLAND, Calif. – A years-long simmering crisis threatening the existence of the Alameda County Medical Center (ACMC) is heating up again, as a “turn-around” management firm’s drive to cut hundreds of workers is challenged by a labor-community coalition struggling to save the only public health care safety net for thousands of poor, sick and uninsured residents.

During a July 19 public hearing on the fiscal 2005 budget held at Highland Hospital, the medical center’s anchor facility, trustees got an earful from union representatives and ACMC staff about the dire consequences of the proposed cuts on patient care, already stretched razor thin by previous cuts in funding and staff. Unions and staff also pointed out that instead of a deficit, the medical center actually anticipates a modest surplus based on new funding from county ballot Measure A. This proposition, passed in March, raised the county sales tax by 0.5 percent, with most funding going to ACMC.

The medical center operates three public hospitals and three clinics, and serves 125,000 mostly poor and uninsured patients a year. It also runs an outstanding trauma center serving the entire region.

The proposed budget, prepared by Cambio Health Solutions – consultants hired last year to run the center – would lay off 10 percent of ACMC’s total workforce and 21 percent of outpatient clinic staff, said Fred Seavey, research director for SEIU Local 250. The new reductions, coming on the heels of last year’s sharp cuts, would slash staffing in obstetrics and neonatal services, the emergency department and other areas to a dangerous level, he said.

“It’s time to heal the wounds of last year,” declared Bradley Cleveland, spokesperson for SEIU Local 616, as he pointed out the modest surplus in next year’s budget. “We need to address the health care disparities in this county.” Measure A offers a chance to fix medical care, reduce the waiting time (reportedly as much as eight months for routine appointments), “and get people into the clinics so the Emergency Department doesn’t become necessary,” he said.

Citing a large discrepancy in the budget’s expense side, pointed out in earlier testimony, Cleveland said, “Since that $10 million went away, maybe the layoffs should go away, too.”

“This is the time to undertake a long term evaluation of the medical center, to go through the budget and consider what the future of the complex will be,” said Vote Health chair and former ACMC staff member Kay Eisenhower.

“It’s very difficult to ask patients to come here when we don’t have staff to care for them,” said Dr. Linda Price, who heads the maternal and child health department.

The hearing room was packed to overflowing with concerned staff and community members, who responded to union and community speakers with vigorous applause.

In a telephone interview before the hearing, former medical center trustee Robert Phillips, who resigned with four others last fall and now coordinates the Citizens United to Restore ACMC coalition, said the current budget proposals will impact the sickest Medicaid and Medicare recipients and the uninsured most sharply. He called for capping consultant spending and taking time to evaluate Measure A’s impact before making further cuts. The coalition includes SEIU locals 616, 250 and 535, as well as the California Physicians Alliance, Vote Health and other community organizations.

A scathing Alameda County Civil Grand Jury report released last week was the backdrop for the July 19 hearing. In it, the Grand Jury sharply criticized ACMC’s fiscal management, including failure to bill Medicare and Medicaid for a large number of services. The Grand Jury warned ACMC’s trustees to scrutinize Cambio’s recommendations to see if they would harm patient care. It also called Cambio’s $3.2 million, 18-month contract “extremely expensive.”

The author can be reached at mbechtel@pww.org.