John Howard is the editor of Capitol Weekly. You can read more at the Capitol Weekly Web site.

Tomorrow, after 27 years, the Potter Valley Community Health Center east of Willits will shut its doors, a victim of the state’s budget meltdown. The rural medical office, which serves all patients regardless of their ability to pay, is the third clinic to close down within a month.

“More closures are coming,” said Dr. Toni Mann, a dentist at Potter Valley. The center’s announcement to its patients was direct: “Effective August 21, 2009, we will be closing our doors and will no longer be able to provide health care services to you or your family after that date.”

The reason is that the state, grappling with a $23 billion budget hole and facing the likelihood of another multibillion-dollar shortage within months, has cut, directly or indirectly, about $120 million in support to the non-profit clinics, a figure that includes federal money. The clinics serve the uninsured and the poor, and in many rural areas represent the only readily available medical care. About 4 million people – about 2.5 million of them below the poverty level — use the clinics each year in about 12 million visits. Nearly two-thirds of the patients are white, about 1.4 million patients are 19 years of age or younger and about 440,000 are four years old or younger.

There are more than 800 community clinics in the state.

About half the clinics are federally certified, and about 120 others are either “look-alike” – like Potter Valley — or rural health care sites that receive financing from state and other sources. Still other clinics are financed largely by donations.

More than half the state cuts, about $57 million, went to the adult dental care program that handles 1.1 million patient visits.

Numerically, the number of people making use of adult dental services is smaller than the 10.1 million visits for general medical care from clinic physicians, doctors’ assistants, nurse practitioners and others. But the dental care is more expensive.

“The clinics have to provide the services,” said Laurie Johnson of the California Primary Care Association. “It’s income based. But if you don’t have the money to pay, you don’t have the money, and clinics have to provide the medical services regardless.” Johnson noted that a number of optional medical services were eliminated at the clinics earlier this year, prompting a lawsuit – ultimately unsuccessful – to restore the money.

Senate Leader Darrell Steinberg is challenging the those cuts – and others – in a suite he filed Aug. 10 before San Francisco Superior Court Judge Peter Busch. Steinberg contends that Gov. Schwarzenegger overstepped his constitutional authority by vetoing, line-by-line, a multitude of health and social services. The first court hearing is expected next month. At least two other suits also have challenged the reductions.

“We are hoping that those line-item vetoes become null and void,” said Steinberg spokeswoman Alicia Trost.

The cuts come from several pockets, including a two-thirds, or $17.5 million, reduction in the Expanded Access to Primary Care Program, $6.2 million in the Rural Health Services Development Program, $6.9 million in a program for seasonal migratory farm workers and $6.5 million in an Indian health program.

Cuts to the Healthy Families program also affected the clinics, which provide about services to about 300,000 children enrolled in Healthy Families.

Although federal stimulus-package money flows into California, the funds do not necessarily supplant the state cuts, in part because of the structure and governance of the clinics, in part because of a rapidly expanding patient load – a 50 percent increase at some clinics — stemming from the recession, and in part because the money doesn’t cover day-to-day expenses. In Potter Valley’s case, for example, money could have been obtained for capital expansion rather than medical care.

In some areas, clinic closures will require that patients travel further to get care, a difficulty for the elderly in rural and mountainous areas. In others, other clinics with federal funding – such as clinics on tribal land – can provide services, although their first priority is to first accommodate tribal members.

Absent funding – which may depend on the outcome of Steinberg’s lawsuit – Potter Valley is going to hold tight.

“We’re going to close everything down and try to preserve the building in hopes that we will rise again,” Mann said.

John Howard is the editor of Capitol Weekly. You can read more at the Capitol Weekly Web site.