Pharmacy fights to save California's poison control centers

Record budget problems have pushed California to eliminate funding for the largest poison control system in the nation. Faced with a $24 billion budget gap, Gov. Arnold Schwarzenegger has proposed massive spending cuts for education, healthcare, and other social services.

Cutting the California Poison Control System (CPCS) would save the state $5.9 million. Eliminating CPCS would also cost the state an additional $70 million in additional emergency department visits, 911 calls, state Medicaid services, and other demands currently handled by telephone triage.

CPCS executive director Stuart Heard warned that closing CPCS would result in an additional 164,000 emergency room visits yearly. Heard is also assistant dean and associate clinical professor of pharmacy at the University of California, San Francisco.

“That $6 million in state funding is the foundation for federal matching funds and other funding,” Heard said. “We can keep the phone lines open through September, but the minute we start issuing 60-day layoff notices, we start losing staff. There is a good chance that we wouldn’t even have the people to stay open into September.”

In early June, Heard convened an informal coalition of advocacy groups and pharmacy, medical, and nursing providers to chart strategies to maintain funding. The problem, noted Fred Mayer, president of Pharmacists Planning Services, Inc, is that the proposed budget slashes almost every health, education, and social program.

“I can’t say that child health or senior health is more or less important than poison control,” said Mayer, a member of the Drug Topics editorial advisory board. “They are all vital. If poison control goes away, we are just going to see higher costs in every other part of the healthcare system, along with massive cuts to access and services. Litigation may be the only way to keep poison control functioning.”

The current threat stems from longstanding political and financial problems that could bankrupt California by mid-July. The state constitution mandates a balanced budget. It also requires a two-third vote of both houses of the state legislature to boost taxes. Schwarzenegger, a Republican, was first elected on promises of fiscal reform when former Governor Gray Davis, a Democrat, was recalled in 2003 over budget problems. The 2009 crisis was trigged by a sharp drop in tax revenues caused by the recession. Republican legislators, in the minority, habitually refuse to approve tax increases.

Democrats, in the majority, insist on some combination of spending cuts and tax increases. The governor attempted to cut through the legislative standoff with a package of six fiscal changes submitted to the voters in May. Supporters called the changes vital; opponents called the package muddled, contradictory, and unworkable.

After voters defeated the package by more than 60 percent, Schwarzenegger released budget proposals that slashed spending on healthcare, education, state parks, and other areas but included no new taxes. Legislative budget committees are currently examining Schwarzenegger’s budget in detail.

Proposals include laying off 5,000 state workers, shortening the public school year, cutting college funding and boosting fees, eliminating health coverage for 250,000 needy children, eliminating CPCS, and withholding at least $2 billion in revenue from local government, which would trigger layoffs in public protection and other areas. Other proposals would release up to 38,000 prison inmates and transfer all undocumented prisoners to federal custody.

The nonpartisan Legislative Analyst’s Office has recommended against suspension of funding for the CPCS, but LOA recommendations are not binding on either legislators or the governor. “People all over the country rely on poison control centers,” Herd said. “Parents, teachers, emergency responders, hospitals, physicians, 911 operators - they all expect to pick up the phone and get an answer. If we aren’t there, there is nowhere else for them to go.”

CPCS responds to about 900 calls every day, Herd said, more than 330,000 calls annually. Other states lack the funding to pick up CPCS calls.

The long-term solution, he said, is to move CPCS out of state funding, which is threatened with every budget. The short term calls for more dramatic actions. The California Pharmacists Association and the state’s nine pharmacy schools will be asked to contact students and alumni to flood legislators’ district offices with personal pleas for CPCS. Public relations groups are planning a quick campaign featuring children whose lives were saved by CPCS.

And PPSI is preparing legal action to preserve funding. “Poison control is a public health issue,” Mayer said. “When it comes to public health, we don’t care whose toes we jump up and down on.”