No one knows what is to be done with the patients who currently depend on the community clinics run by Natividad Medical Center. But their options for medical care are running dry.

Beginning in a few months, more than 6,000 patients could be turned away from the clinics, leaving the county desperate for hospital space.

On Tuesday, June 10, the Board of Supervisors balanced its budget by slashing $8 million from Natividad''s health care services. The county hospital will close its outpatient clinics and reduce the subsidies it gives to uninsured and low-income residents. Natividad will also lay off 60 employees.

The 5,000 patients receiving care at the Family Medicine Clinic at Blanco Circle "are at risk of not having a doctor," says medical director Dr. John Clark. The clinic, which primarily treats patients with diabetes and high blood pressure, will close in mid-August at the latest.

The closing of the clinics will lead to the "overloading of our whole health care system," Clark says. As soon as the clinics close, the patients will turn to other health care providers--who may not be able to accommodate them.

There is talk of sending the patients to Clinica de Salud, a nonprofit health organization, which has several sites in the county. The patients may also find care in centers run by the Monterey County Health Department.

Then again, according to statements by county administrative officer Sally Reed and others, a change in Natividad''s administrators could keep the clinics open-- bookkeeping and billing problems have been blamed for the hospital''s fiscal woes.

Fernando Armenta, chair of the Board of Supervisors, says that half of the patients will be transferred to Clinica de Salud. The rest of the patients will have to "make their way to the front door of the [Monterey County] Health Department or the emergency rooms at Natividad," says Armenta.

"There is no certain plan to pick them up anywhere," Clark says.

The 1,200 patients in a pain management clinic at Alvin Drive are also at risk of losing their medical treatment. Armenta says that clinic may be taken over by the Monterey County Health Department, but it still needs recognition from the federal government. The supes are trying to find "short-term funding for Alvin" and extend its life until February, Armenta says.

Dr. Pedro Moreno, another physician at Natividad, says the county hospital is the "last resort for patients" who are uninsured or on government insurance. "As a consequence," he says, "patients will have to use the emergency room. Little by little we are going to have a saturated emergency room."

Also losing out on medical service will be 200 patients receiving treatment for neurological disorders such as multiple sclerosis. Dr. Murtadha Al-Marashi at Natividad is the "only neurologist who takes patients with government insurance," Moreno says.

Before the cuts, Natividad was generous with a program to serve poor and uninsured patients, subsidizing the care of those who were technically above the poverty line. Now patients who are not at or below the poverty line will have to pay more for health care, says Steven Slack, assistant medical director.

As for the medical staff, 60 pink slips will be handed out this week to meet a 10-percent reduction.

With the large deficit plaguing the county and reduced medical services at the federal and state level, some say the cutbacks were unavoidable. They "are driven by the lack of government resources for Medi-Cal, Medicare and indigent patients," says Susan Matcham, chair of the Board of Trustees.

Moreno believes the county could do better by its needy residents.

"If there was a political will to maintain [medical] services, the money is there," he says. "Our county is not poor, thanks to the workforce that we have."

Political support for Natividad will be tested on Oct. 7, when county residents will be asked to vote on a mail-in initiative to increase the sales tax by a half-cent. If passed, the initiative will provide a steady stream of revenue to "perform basic service in the future and restore some of the services we are cutting," Matcham says.