California is once again in the midst of a budget crisis, with state lawmakers wrangling over whether to borrow more money, raise taxes and fees or continue to cut programs and services.

For those on the front lines of dispensing care and assistance to the disadvantaged, whether it is healthcare, social services or both, more reductions to their already sparse budgets could soon begin to have a domino effect of undesirable consequences to the thousands of local families who depend on them.

Doctors and healthcare executives from local hospitals and clinics spoke with The Argonaut recently regarding the proposed cuts by Sacramento legislators and about the broader picture of the state of healthcare locally and nationally.

And with the news of the state freezing Medi-Cal payments to thousands of medical providers due to the failure of Sacramento lawmakers to pass a budget, the current predicament becomes even more stressful for healthcare providers and the patients who need them.

Two local executive directors of well-known health and social service centers reflected the mood that appears to be prevalent among many who work with the disadvantaged in the face of what could be drastic financial reductions to these clinics.

“There’s a state of high anxiety right now,” said John Maceri of OPCC, formerly known as the Ocean Park Community Center, in Santa Monica.

And Venice Family Clinic head Elizabeth Benson Forer says, “The cuts that are being proposed are much worse than I’ve seen in the 14 years that I’ve been here.”

Medi-Cal makes up 34 percent of clinic funding in Los Angeles County. For every minute that the California state budget goes unsigned, it is estimated that clinics will forego approximately $385 in Medi-Cal revenues, totaling nearly $3.9 million per week, according to the Community Clinic Association of Los Angeles.

Dr. Rishi Manchanda, who works with Benson Forer at the clinic, sees dozens of patients who will be adversely affected if Sacramento proceeds with its budget-cutting plan.

“It’s clear that this is another wave in a long, continual tsunami that hits community clinics, but we know how to surf this wave,” Manchanda told The Argonaut. “We’ve done it before.”

Local legislators pointed to their counterparts in Sacramento and the fiscal showdown that is under way as being the main culprits of the crises that are taking place in local clinics and service centers.

“The state budget impasse is holding hostage our safety-net clinics and threatening their ability to deliver critical care to our uninsured working families,” said Los Angeles County Supervisor Zev Yaroslavsky, whose district includes Santa Monica.

His colleague, Yvonne Braithwaite Burke, whose district includes Mar Vista, believes that because of the budget wrangling, those who depend on local clinics like the Venice Family Clinic and the Westside Family Health Center in Santa Monica are the ones that suffer the most.

“This budget impasse will only make it more difficult for Los Angeles County’s clinics and overall health system to care for the many thousands of residents who depend on it for care,” Brathwaite Burke said. “It is absolutely critical that the state Legislature come to an agreement on a fair and responsible budget as soon as possible.”

State Senate majority leader Don Peralta of Oakland said that a scheduled July 29th vote on the budget would be suspended until further notice, leaving physicians, administrators and personnel of local clinics and social service centers in limbo regarding how deep the cuts will eventually be.

But he said, “Negotiations are continuing daily and we are making progress. It is clear that a floor vote on Tuesday would disrupt that progress.

“I know the state is facing a cash crunch, and I am doing everything possible to pass a budget that fixes the state’s fiscal problems, which every year get worse.

“It’s painful — but it’s time to stop shunting our responsibility off to ‘next year’.”

Ray Sotero, communications chief for State Senator Jenny Oropeza, whose district includes the local area south of Santa Monica, said that Oropeza was firmly against harming those who need vital services the most.

“The senator believes that slashing much-needed programs is not the appropriate way to solve the budget crisis,” said Sotero.

At OPCC, one area that will be affected will be the center’s domestic violence program.

“That’s one program that we really don’t like to see impacted because it involves both women and children,” Maceri noted.

Benson Forer said that “hundreds of thousands of people can potentially fall off the Medi-Cal rolls” due to the inability of Gov. Arnold Schwarzenegger and state lawmakers to solve the fiscal crisis.

“At the Venice Family Clinic, we could lose as much as $300,000, which is difficult to sustain,” said Benson Forer.

Private donations have not tailed off dramatically, she said. “And we thank our donors for that,” she added.

Manchanda said that despite the projected cuts, he and many of his colleagues will continue to serve indigent populations and the working poor.

“As community clinics, we have experience seeing constant budget shortfalls and how to make the best of it,” the doctor said. “We are committed as we always have been, to deliver the services that our patients need, and we’ll find a way to make sure that our patients get the care that they need, whatever happens with the budget shortfall.”

Not knowing how deeply their budgets will be slashed is one of his biggest worries, says Maceri.

“If the economy continues to go down, the demand for our services will go up,” OPCC’s director said. “And the hardest part is not knowing how much we’re going to lose so that we can adjust the best that we can.”

Business organizations have also begun to weigh in on the state’s fiscal crisis and the repercussions on the public at large.

“When community clinics lose, we all pay the price,” said Gary Toebben, president and chief executive officer of the Los Angeles Area Chamber of Commerce. “The budget stalemate is costing our community clinics $385 per minute in lost Medi-Cal revenues from the state. These losses will ride entirely on the backs of our community clinics resulting in layoffs of critically needed doctors, reduced patient services and higher healthcare costs for everyone.”

As they wait until the final numbers come in, Maceri, Benson Forer and other administrators of community clinics and social service centers are forced to become more creative with less funding, while keeping morale up as much as possible.

“We all recognize that without us here, there would be nowhere else to turn for the majority of our clients,” said Benson Forer, whose clinic serviced 23,500 people last fiscal year.

Maceri dreads the day that he may have to turn clients away.

“It’s hard when people are coming in and the resources just aren’t there,” he said.

Manchanda says his patients are often the ones who keep his spirits up during the down times.

“A smile or a thank-you from a patient after a very long day is the sustenance that keep us going,” he said. “The camaraderie and knowing that we’re among a group of healthcare providers who share a commitment to providing quality care to those who need it the most, the feedback from our donors and the community at large, is also really important.”

Manchanda feels that eventually, policy makers and the electorate will reach a crossroads regarding diminishing budgets for healthcare that is provided to disadvantaged families and individuals.

“At some point, people across the state are going to have to ask themselves, how long can we continue to allow this healthcare crisis to go?” Manchanda believes. “And that time is not very far away.”