Knock LA

In February, Los Angeles County’s Department of Public Health announced the ending or consolidation of clinical services at seven of its 13 public health center locations, citing more than $50 million in federal, state, and local funding cuts. Vaccinations, sexually transmitted infection testing and treatment, and tuberculosis care were among the services offered at the affected sites. 

Clinical services ended on February 27 at locations in Antelope Valley, downtown LA, Inglewood, Hollywood, Pomona, South LA, and Torrance, with most of the buildings remaining open for other public health programs. Such a shift can obscure what actually changed, as a resident could still go to a county office but no longer get the same care they were previously receiving. The county’s February 13 news release said the services would remain available at the six remaining clinics and at nearby community health centers, with other nonclinical programs continuing at most of the locations impacted by the cuts. 

The announcement told residents where they could go if they were previously being treated at one of the sites that ended or curtailed some services, but it didn’t explain how the transition would work in practice. How many patients had to be referred elsewhere? How many actually reached another clinic? Did they receive the same services at comparable quality? What additional work are community health centers absorbing?

The Community Clinic Association of Los Angeles County, which represents local community health centers, couldn’t provide aggregate service-use data when requested by Knock LA, with communications manager Taryn Burks saying CCALAC received no operational guidance regarding the closures. In her search for notices, she reportedly only found the county’s February 13th announcement to the public. Burks noted that community clinics near the impacted sites could have received some other communications directly, but CCALAC didn’t have a countywide picture of where patients went or which services were rendered. 

DPH director Barbara Ferrer said in February that there was work being done with community organizations and their clinical partners to connect patients with the services they needed. This leads to the question of what happened to referred patients, as referrals can lead to different outcomes. Uninterrupted care is different from a long delay, which is different from receiving a different service or none at all. Outcomes are patient- and clinic-specific, but the public is left guessing as to whether the referrals were effective. 

In the months since DPH’s announcement, the funding picture for the future changed drastically. County voters approved Measure ER, the temporary, half-percentage point sales tax increase beginning October 1, which is estimated to bring in roughly $1 billion across a year of collections. Since Measure ER is legally considered a general tax, the Board of Supervisors will be deciding how the money should be allocated in the county budget. 

Measure ER’s spending plan, released in March, is mainly dedicated to healthcare and related safety-net services, such as county hospitals and clinics, non-profit providers, school-based health programs, and care for the uninsured. The plan would direct ten percent — roughly $100 million — of funds directly to DPH for core public-health functions and health-equity-related grant funding, with other portions recommended for County Health Services, nonprofit health agencies, public hospitals, enrollment, school-based health, and in-home support such as caregiving. To understand exactly what changes for patients based on the tax funding, one must follow the money beyond the departmental allocations and into the actual clinics where services are being rendered. The plan does not immediately dedicate funds collected through Measure ER to reversing the service reductions at the seven affected sites. Any restoration would come through later budget proposals, grants, or contracts. 

The ordinance also created a nine-person citizens’ oversight committee, which will review receipts and expenditures alongside annual independent audits and annual public reports to track where the money goes. But the oversight cannot stop at receipts. Showing whether care continued requires published data on referrals, completed visits, and services delivered after the clinic changes. 

In addition to the Measure ER funding that will be coming in, DPH has affiliated itself with the Fund for Advancing Public Health LA, an independent nonprofit seeking private support for the DPH and its community partners. A May Board motion indicated the foundation had philanthropic funding commitments and that it was seeking more. The motion noted the tax would still leave some public-health needs without funding, presenting the Fund as another source of money for public health initiatives. 

In an August 28 email to Knock LA, DPH said the county and the Fund entered their official agreement on August 19. The agreement, obtained through a California Public Records Act request, permits the department to provide technology, staff, space, supplies, and other resources when to support its operations, though these costs would be tracked separately. The agreement also gives the county access to the records needed for auditing the affiliation’s work. There is no indication, however, that the money will be used to reopen or restore services at locations impacted by February’s announcement. 

In a September 24 email to Knock LA, DPH said county employees were currently providing “minimal staff support” to organize the Fund’s board meetings, as well as to prepare materials for review as the board continues to deliberate priorities. The response clarifies some of the work being done by county employees, but does not explain whether the Fund has hired on its own staff, how county time is being recorded, or whether the county is being reimbursed. Once the Fund starts spending, payroll and expenses for it should be distinguishable from public resource support. 

The Fund itself is still nascent. Its published email address bounced in July when Knock LA attempted to contact the entity, and its domain stopped resolving for part of August. The website has since returned with a contact form, a page describing the leadership team and their mission, and their pledge page. Still missing is an explanation of how funding will be spent, how grants will be awarded, or concrete details about what the Fund is currently working on. 

The Fund’s pledge page says that the board will be deciding how money is allocated to community partners, directing organizations to keep an eye out for updates on funding opportunities. As of writing on September XX, the site has no application process, awards, donation totals, or plan for restoring services. The page itself appeared after DPH’s August 28 reply to Knock LA’s questions, the site now describing a Fund that is still bringing on staff and has not started soliciting donations. There is still no indication of whether the Fund has received pledges or awarded money to any groups. 

The impacts of Measure ER and the Fund will require close, parallel tracking because they will leave different paper trails oriented toward similar goals. Measure ER receipts and expenditures should be easier to trace because they are subject to public audit. The Fund is another story, with the board driving the grant process and DPH being required to record county staff time and resources supplied under the agreement. Reconciling the two funding streams at the level of a single service could require matching county budgets, nonprofit grants, and service data, and existing no public process guarantees that those records will line up. 

The department’s September records document some of the Fund’s startup work, with calendar entries scheduling board, banking, grantmaking, and introductory meetings from late May through August. The records do not show who attended or what was discussed. The April corporate action naming the Fund’s directors listed bylaws as an attachment, but the documentation included only a title page. When Knock LA requested updates, the county said it was still searching and would determine by October 1 whether it could identify additional records for release. 

Months after the February announcement, the public still has no public countywide indicator of how many patients were referred from those seven affected clinics or how many received replacement care or were lost in the transition. For now, the consequences of the incomplete handoff are taken on by the patients. James An, director of Kheir Clinic’s Patient Resources Department, described in a call to Knock LA that staff are helping patients with tasks such as reversing erroneous Medi-Cal denials and navigating application waits that can often last thirty to forty five days. Kheir sometimes provides primary care of assistance with maintaining a prescription while coverage is still pending, he said, but specialty care often has to wait until patients are enrolled in the health plan, leaving those with worse comorbidities waiting longer to address them. Dr. Cárdenas, chief medical officer of Via Care, described that even when a Federally Qualified Health Center is able to waive or reduce costs of an office visit, there may still be bills for medications, laboratory tests, imaging work, and specialty care. He also said that Via Care was encountering patients that had delayed or avoided care amid immigration enforcement concerns.   

Until the county provides a full accounting of services delivered and restored, its assurance that care continued remains a promise the public cannot verify.

Devin Teichrow is an epidemiologist and science writer based in Southern California. He writes The Edge of Epidemiology, a publication focusing on outbreaks, disease geography and ecology, historical epidemiology, and how societal decisions influence population health. His work follows disease through war, migration, trade, climate, infrastructure, and ecology, combining historical and scientific analysis. He is also interested in how public health institutions make decisions under uncertainty, how those decisions are communicated to those they impact, and whether the systems being built work as intended. His reporting looks at the difference between official plans and their implementation, while his historical writing draws on history, literature, genetics, and anthropology to build a fuller account of disease through a Big Epidemiology lens