Report Paints Grim County Health Picture : Medicine: The area’s problems in providing care for poor and uninsured residents go far beyond state and national norms, task force finds. It estimates that aid must be tripled to meet basic needs.

Los Angeles County’s problems in providing health care to poor and uninsured residents far surpass those of the rest of the state and the country, according to the long-awaited report of the county Task Force for Health Care Access.

The report paints a dire picture of medical deprivation affecting a third of the county’s residents, as well as significant waste of health care resources. The task force estimated that a threefold increase in county health services or significant new contributions from private doctors, clinics and hospitals are necessary to meet basic health needs.

The findings come as the financially strapped county Department of Health Services ponders clinic closures and other medical service cuts to cope with state funding reductions.

“This is not a time when that is tolerable,” task force Chairman Robert Tranquada said in an interview Wednesday.

Thirty-three percent of the county’s residents--about 2.7 million people--are uninsured and depend upon those facilities and a patchwork of privately funded free clinics, hospital emergency rooms and private physicians willing to take charity cases, the task force found. That is 50% higher than the proportion of Californians without health insurance and more than double the national rate.

Indeed, Los Angeles County emerged in the task force’s eight-month study as the most medically underserved metropolitan area in the United States--”by a wide margin,” according to Tranquada.

The vast majority--87%--of Los Angeles County’s uninsured are employed or are dependents of low-income workers whose jobs do not provide health insurance. This mirrors the national profile of the uninsured--an estimated 37 million Americans whose plight has become the driving force behind the nation’s health reform movement.

Among Los Angeles County residents who depend upon these public or charity health services are illegal immigrants. A new state law excludes them from coverage by the government’s Medi-Cal insurance program for the poor, leaving them and their families outside any organized system of preventive care. The task force cited evidence of high rates of transmittable diseases such as measles, tuberculosis, hepatitis and AIDS in this population, estimated to number 700,000 in Los Angeles County.

The task force also found that:

* Latinos, representing 37% of the county’s population and a significant proportion of its uninsured, have three times the typical rate of diabetes, many unimmunized children and rapidly rising rates of acquired immune deficiency syndrome. Latinos represented 26% of the reported cases of AIDS in 1991, compared to 15% in 1988.

* The rate of infant death among African-Americans is twice as high as that of other ethnic or racial groups in the county.

* Thirty-two percent of the county’s uninsured are children, compared to a national average of 17%.

* The number of county uninsured has doubled over the last 10 years, but public health funding has not kept pace--a major reason for the current overload on county health services.

The task force also concluded that county health officials could have used their resources more efficiently. The report criticizes them for wasteful duplication of health services, and urged greater coordination within the county’s hospital and clinic network and with private health-care providers.

Tranquada cited the example of tuberculosis patients, who represent a growing public health threat in Los Angeles.

If they are diagnosed in private charity clinics, there currently is no mechanism for sending them directly to the county’s special tuberculosis treatment programs.

Instead, the clinics must refer them to a county hospital emergency room, where doctors re-examine them and repeat X-rays and other expensive diagnostic procedures. Only then is it possible for the patients to get treatment for their highly contagious illness, according to Tranquada.

Even more frustrating, he said, is the lack of coordination among the county’s 46 health centers and six hospitals. Each facility assigns different identification numbers to patients and keeps separate medical records. Thus, a patient might be seen for the same condition at any or all of the facilities without anyone knowing that a diagnosis or prescription has already been issued.

Tranquada said the task force did not have enough time to calculate how much staff time and money have been squandered by such duplication, but he said the losses are significant.

“It is all hit or miss,” said Tranquada of how patients make their way through the county health system. “There is also no means for the emergency rooms to refer patients back to (private) clinics where they might be regular patients.”

Robert Gates, the county’s health director and a member of the task force, said his department was trying to improve the situation even before the task force spotlighted it. As evidence, Gates cited $4.6 million earmarked in this year’s departmental budget proposal for a computerized record-keeping system that would link all county facilities. But the state funding shortfall wiped out the project, he said.

The task force urged the supervisors to redouble their efforts to make up the funding gap and preserve existing clinic and hospital services. County representatives have been negotiating with Medi-Cal and federal officials for larger allocations to make up a $180-million funding shortfall.

In the meantime, Gates’ department has held off on clinic closures and other curtailments--a risky maneuver that could force the county to make even more drastic service cuts later in the fiscal year. Gates said his department may be forced to close a hospital.

The task force was created by the Board of Supervisors last February. Its 22 members represent consumers, labor, business, hospital and physician organizations, insurers, public health experts and county government.

The Board of Supervisors on Tuesday ordered Gates to report in 60 days on how he will implement the task force’s recommendations.