Senator: 'Incompetence' Plagues Vote Program

AUG. 4, 2010

By KATY GRIMES

Heated discussion took place in the budget committee on Tuesday about a public health program for women. Specifically: how much to fund it this year, setting off  the ire of Sen. Bob Dutton, R-Rancho Cucamonga, over apparent program mismanagement.

Dutton spoke out about what he considered the gross mismanagement of the “Every Women Counts” program. “People who really need the services aren’t getting them,” Dutton said during the hearing. “We can’t keep throwing money at the program. We’re not helping the people we want to help.”

Dutton then blasted program managers’ “incompetence” and demanded their firing.

Sen. Denise Moreno Ducheny, D-San Diego, and chairwoman of the budget committee, appeared resigned to Dutton’s remarks but said more than once, “I just don’t know what we can do about it.”

Governor Arnold Schwarzenegger has received the blame for decisions to freeze enrollment in the cancer-screening program for low-income women, and allowing routine mammograms only for women after the age of 50. But it was not Schwarzenegger who made the program changes.

The item of contention at the women’s health program, run by the Department of Public Health, is the large-scale funding that appears to have been spent within the first half of one year. The women’s health program received $51.62 million in fiscal year 2008-09 to provide free clinical breast exams and mammograms to California poverty-level women who lack health insurance. But by December 2009, the public health department announced that it was shutting down most of the woman’s health clinics as the money had already been spent.

“Declining funding” is cited as the reason by the public health department for the clinic closures. Tobacco taxes and federal grants have funded the women’s health program, and those fund sources have been declining. Tobacco sales are down, and even with the Proposition 99 surcharge of 25 cents on every pack of cigarettes, only a portion of the Prop 99 funding is allocated to the women’s health program.

Under mounting legislative pressure, in January 2010 the public health department requested that the Department of Finance perform a review and audit of the program. On May 25, 2010, the review confirmed that caseload figures had been overstated, duplicate billings had been charged and, because of duplicate billings, assessment fees were charged to the program.

In his January 2010 budget, Schwarzenegger allotted $42.4 million to the “Every Woman Counts” program. By the May revise, it was down to $41.6 million.

Reacting to the governor’s budget reductions and citing “lower-than-expected revenues,” the public health department announced reductions in the non-clinical programs such as education, contracting and training. They also reduced the number of women eligible for the woman’s health program by increasing the eligibility age from 40 to 50 for breast screening. Then they froze enrollment.

By June 2010, both the state Auditor and the Legislative Analyst’s Office conducted their own reviews about the women’s health program, recommending that the legislature adopt a modified version of the governor’s cost containment proposals and consider the long-term future of the program, particularly with federal comprehensive health care on the horizon.

The state auditor also found that the public health department incorrectly stated that their federal funding would be jeopardized if they were forced to cut outreach. But federal requirements mandated that only that certain amounts be spent in order to qualify for matching federal funds – not how those funds were spent. The auditor reported that the public health department has a great deal of flexibility in determining how to spend its program funds and recommended that the department stay focused on the core purpose of the program – breast screening services.

The LAO found that in 2008-09 the women’s health program experienced dramatic caseload growth. By May 2009 the program requested and received an additional $13.8 million from the Legislature. But the money was only a one-time infusion and ultimately led to the program age eligibility increases and caseload freeze.

The area of concern to both the LAO and auditor’s office was the program’s lack of accountability and transparency.  The auditor found that the public health department has not developed regulations for the women’s health program in the 16 years the program has been in existence, even though ordered by the state to do so.

Legislators at the budget committee hearing Tuesday were critical of the program for not providing any information about the numbers of women served on even an annual basis. The state auditor found only one such report in the 16 years the program has operated.