SAN FRANCISCO – Each day, skeleton crews of doctors, nurses and pharmacists field almost 900 calls a day around California from people such as a mother whose child swallowed flea repellant and an elderly man who accidentally doubled up on his medication.
But the poison control centers that have been a lifeline for millions of residents could go dark this summer under the governor's plan for closing the state's $24.3 billion deficit. That would make the nation's most populous state the only one without poison control assistance.
The demise of the California program could have a domino effect throughout the country, officials say. Washington and Michigan centers already have been forced to downsize, and officials in Tennessee and Oregon also have proposed significant cutbacks. But here, the entire program sits on the chopping block, with some lawmakers hoping to reach a compromise to keep some of the money available.
Many states strapped for cash would like to see how California, which handles 10 percent of the nation's poison calls, fares without a state-funded system, said Jim Hirt, executive director of the American Association of Poison Control Centers.
"This could jeopardize the nation's entire poison control centers," Hirt said.
With cuts, the growing alternatives would be hospitals and emergency rooms. In California, the deficit situation is so dire that Gov. Arnold Schwarzenegger's office says they have to make tough choices, even if it means targeting important programs like poison control.
"While there were many incredible programs that we were able to fund in the past, like this one, we simply don't have the revenue to sustain them today," said Lisa Page, a spokeswoman for Schwarzenegger.
Poison control programs also provide data for health research.
Their reports, which are regularly fed to state health departments and the Centers for Disease Control and Prevention, alerted health officials to recent salmonella outbreaks in tomatoes and in peanut butter. Earlier this year, the CDC used the data to track a contaminated nutritional supplement distributed in about a dozen Southeast states.
The poison control database allows officials and researchers to better understand trends and the magnitude of an event, said Colleen Martin, a CDC epidemiologist in Atlanta.
"If certain states drop off the map, that's going to affect our ability to provide national surveillance," Martin said.
Closing California's call centers — in Sacramento, San Francisco, Fresno and San Diego — would save about $5.9 million annually, but program officials say the state could end up paying much more than that in emergency room and other doctor visits. In the worst cases, they say, not having access to a poison control hot line could lead to deaths.
"Without assistance, people may do inappropriate or deadly actions," Thomas Kearney, director of the San Francisco center, said noting that some common medications around the house can kill a child with only one pill.
Officials with the California Poison Control System, currently slated to close in September, estimate that eliminating the program would translate into $80 million in additional health care costs each year, as well as greater pressure on 911 call centers.
Page declined to comment on potential health care costs associated with a poison control shutdown.
In Washington state, lawmakers have pulled 35 percent of the poison control program's budget, forcing the layoff of its medical director. Without that position filled, the program risks losing its accreditation, which is needed to qualify for federal money.
For now, outgoing director William Hurley plans to volunteer to help keep it afloat while officials scramble for funding and consider filling the position on a part-time basis.
"We're hoping this is a temporary problem," Hurley said. "These cuts don't leave us in a long-term sustainable position."
Since California's statewide poison control system was established in 1997, it has faced several funding cuts, including a 15 percent budget reduction last year.
Before 1997, poison control services were provided through a combination of state, local and private funding. State finance director Michael Genest has suggested returning to a similar model.
"We did not have poison control centers some time back," Genest said during a May 29 budget conference call. "There is certainly a chance that the poison control center information will remain available to people privately, or get picked up by others."
But hard times have hit governments at all levels, meaning counties and cities are unlikely to be able to keep poison control afloat this time, program officials said.