By Andy Furillo, The Sacramento Bee, Calif. Knight Ridder/Tribune Business News
Aug. 15--Maybe it will be the 1-year-old girl with the heart murmur. Or the anemic 2-year-old boy. Or the teenage girl with hepatitis. Or the 7-month-old girl with fluid coming out of her right eye. Or the 4-year-old boy who dropped in for a routine checkup.
Nobody knows specifically who will lose out. But three out of every five kids like those who visited Well Child health clinics the past two days can forget about receiving preventive treatment if a proposed budget cut being reviewed by the Sacramento County Board of Supervisors becomes a reality.
'At our Carmichael clinic, we found a child who had a cardiac disorder,' said Chris Bunn, a pediatric nurse practitioner in the program that serves low-income patients at eight locations around the county. 'We had him hospitalized that day, and he had surgery within a week. With Carmichael geographically being where it is, that parent probably wouldn't have made it to one of our other health centers with transportation being what it is. So we're going to be missing a window of opportunity to do screening.'
County budget writers put the $400,000-a-year Well Child program on the chopping block in preparation for what is shaping up to be a $26.1 million revenue shortfall.
If the money is cut, Well Child stands to lose about half of its funding, which officials said will eliminate a second nurse practitioner job and deny screening, immunization and other health services for 1,500 of the 2,500 children program workers treat annually.
On Wednesday, Maria Isabel Saucedo brought in her 7-month-old daughter, Maria, for a follow-up visit. The baby's eye had been oozing fluid on her previous trip to the South City Health Center on Bowling Drive.
Bunn checked the eye and noted improvement, then measured little Maria's head and checked her glands. She told Mom that she should ease the baby off the medication and see if the eye continued to heal, then come back next month.
'I wouldn't know what to do if they weren't here,' Saucedo said at the conclusion of the examination. 'They have very good intentions.'
Well Child has been a Sacramento County public health staple for more than 30 years. For a minimal fee, patients can receive shots, lab tests, vision and hearing checks and more at clinics such as South City and through mobile 'satellite' clinics that are brought to places such as Howe Park in Arden-Arcade.
Along with other services ranging from community policing to protecting seniors against scam artists, Well Child is finding itself in budget trouble this year because of slipping sales and property tax revenues, a decline in state support and the prospect of voters in November rejecting the county utility tax measure.
Department of Health and Human Services Director Jim Hunt said the loss of the $16 million in utility tax money would cinch the Well Child budget cuts. In turn, such reductions could compute to a more problematic public health equation.
'Any time you reduce the number of children who are vaccinated, the potential for vaccine-preventable illness increases,' Hunt said. 'Whether it's enough to make a significant difference is tough to tell. We haven't done that analysis yet. But for undiagnosed conditions, the clinics are immensely helpful. The conditions may worsen, which would require greater medical intervention.'
At the South City clinic Wednesday, Bunn bounced from examination room to examination room to examination room, whacking kids on the knees with the rubber reflex hammer, inoculating them with a variety of vaccines, prodding into their ears with infection-detecting lights and listening intently through stethoscopic headphones to the rhythm of young hearts beating.
'I had an ear infection, high cholesterol, a history of ear pain, a TB screening -- this child's behind on immunization,' Bunn said, thumbing through the day's medical charts, before sitting down to check out 1-year-old Cheyenne Freshour.
Tuning in to the toddler's heartbeat, Bunn stopped and listened even more closely to a faint swishing sound between the thumps. For Cheyenne's mother, Kristian Roubique, it was the first time anybody told her that her little girl had a heart murmur.
Bunn gave Roubique a referral to a cardiologist. Roubique came out of the examination with a renewed appreciation for the health program and a sense of revulsion over its proposed cutback.
'It's ridiculous,' Roubique said. 'There's always a glitch in the system, and it usually hits people who don't have the money.'
If and when the reductions go through, the 1,500 children turned away from Well Child in all likelihood will be forced to wait in line with other poor people at the county's scattered health clinics, with uncertain prospects for treatment.
'If you bring them into the clinics, guess what -- most of everything goes to the sickest adults,' said Sherry Mosley, who runs the downtown clinic at 15th and C streets. 'The children that come in here are going to be competing against real sick people.'
Bunn predicted that most will just forgo immunizations and checkups. For those who don't, county officials will be left with the unpleasant choice of deciding which of the 1,500 children will be vaccinated.
'It may well be who shows up first,' said department director Hunt.
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(c) 2002, The Sacramento Bee, Calif. Distributed by Knight Ridder/Tribune Business News.
