Pasadena’s Public Health Department will stop offering HIV/AIDS and prenatal clinical services by the end of the year to reduce a projected $2 million deficit.
The decision made Monday leaves more than 100 HIV patients uncertain of who will provide their care after the final service date of September 30. Officials say they’re committed to keeping the HIV clinic open at its current location on North Fair Oaks Avenue — if they can find another operator, whether a private company or a nonprofit.
“The city was the safety net when there was nobody else out there to provide these important services,” said Steve Mermell, assistant city manager and acting public health director. “There’s now people who are better placed — and financially incentivized by the federal government — to provide these services and do it much more cost-effectively than we can.”
Pasadena is one of three cities in California, including Long Beach and Berkeley, that maintain its own public health department.
Like those, Pasadena wants to focus more on education, disease detection and community wellness, with less money and time spent on providing medical treatments, according to Mermell.
At its meeting Monday, the council approved slashing the health department’s budget — including the elimination of 27 employees, some of whom have been moved to other departments. The city hopes to secure jobs for the others with whoever takes over the clinic.
Pasadena has formed an ad hoc committee of council members to determine who that operator may be. Roughly $1.3 million in savings will come from closing the HIV and prenatal clinics, officials said.
“Our responsibility is to the clientele, who currently rely on these services, and assuring them that they have some level of assurance that these services will continue to be provided by someone,” said Councilman Victor Gordo.
A decision on the clinic’s operator could be more than a month away. The health department’s next-door neighbor, ChapCare Medical and Dental Health Center, has committed to taking over the prenatal clinic, but its board has yet to sign off on managing the HIV/AIDS side.
The city gave the center until July 15 to submit a proposal, though in the interim the council committee is investigating other federally qualified health centers as contenders.
“We would just like to be given a chance, we think we can do it,” said Margaret Martinez, CEO of ChapCare, who noted the health center sees more than 15,000 patients annually.
One problem is that ChapCare, which receives free rent to operate out of a city-owned building, does not have enough experience in operating an HIV clinic. That lack of history disqualifies them from receiving Ryan White grants, federal dollars given out by county health departments to support HIV services.
Pasadena opened the health department’s Andrew Escajeda Clinic in 1991 because of a growing need for HIV services in the San Gabriel Valley. The clinic provides HIV and AIDS outpatient services, mental health treatment and HIV education free of charge to low-income and uninsured patients throughout Los Angeles County, largely thanks to the grants from the Los Angeles County Department of Health.
For some, the facility meant a difference between living and dying.
“Twenty-five years ago, I was diagnosed with HIV. I was told I only have six months to live,” said Eduardo Martinez, hoping his plea will persuade the Pasadena City Council to maintain the clinic. “Today, I am a living example that early diagnosis, staying on treatment and access to HIV medication saves lives — it saved my life.”
Like the prenatal care center, the HIV clinic benefited patients but could never make back its costs. For years, the health department lost money on the endeavor, with more than $2 million needed to get ahead of 2016’s predicted shortfall.
As more people became insured through the Affordable Care Act, the clinics served fewer and fewer people, according to Mermell. The health department cannot receive insurance reimbursements because it is not a federally qualified health center.
While the city does not have the resources to become one, the expansion of health care has made it so an increasing number of agencies can receive reimbursements, officials said.
Still, some worry that any change in providers hurts patients. Victor Wu began receiving treatment for HIV at the health department clinic 15 years ago, and he is worried the city may choose a less experienced provider.
“It just isn’t easy if you’re disabled and need services,” Wu said. “If you’re living with HIV and poor, it’s even more challenging.”
Michael Weinstein, president of the AIDS Healthcare Foundation, criticized the city for giving patients little warning and for not reaching out to organizations like AHF prior to Monday’s decision.
“The implications are not just for patients but the spread of the disease,” Weinstein said. “There’s been dozens of studies that say people who go to unqualified or less qualified providers do worse.
“You’d think that based upon what is happening, that the AIDS crisis was over in Pasadena and Los Angeles — which it is most definitely not.”
