District residents who are screened or treated for venereal disease, drug addiction, lead poisoning or tuberculosis at the District's public health clinics may have to pay for those services after Oct. 1.
A funding bill approved last week by the City Council would allow Mayor Marion Barry to charge fees for public health services that now are free. The provision, which is part of the city's fiscal 1984 budget, must be approved by Congress.
Among the services for which fees would be charged are screening for hypertension and sickle-cell anemia and immunization for communicable diseases in humans and rabies in animals.
The city already charges for certain services at the clinics.
The city plans to implement the new fees Oct. 1 and expects them to raise $300,000 in 1984, said Dr. Ernest Hardaway, the city's commissioner of public health. The Public Health Commission is expected to decide in June whether any of the health services listed in the bill should be exempt from the fees.
Hardaway said one benefit of the bill is that it would allow the District to seek third-party reimbursement when providing services to Medicaid recipients or persons with private health insurance.
Officials at the Department of Human Services emphasized last week that nobody would be denied services at public health clinics if they could not pay.
But the idea of user fees, spawned by the mayor's transition team in its attempt to increase revenues, has drawn sharp criticism from Barry administration health advisers, who fear the plan would have an adverse effect on public health and may not raise the expected revenues.
"We're not optimistic this is going to be a good thing," said Norm Linsky, chairman of the Mayor's Advisory Committee on Venereal Disease. "We don't think it's going to generate the money. We think it's going to discourage some people from seeking services, and we just really don't see anything good about it."
The District ranks in the top five among major cities in terms of reported cases of gonorrhea and syphilis, said John Heath, chief of the city's venereal disease epidemiological services.
The Mayor's Advisory Committee on Tuberculosis also opposes user fees. "Basically, the committee questions imposing fees on a public health problem like this because it might discourage utilization," said Dr. Hazel Swann, chief of the Bureau of Tuberculosis Control.
"Most of the clients are poor people, and if this process involves billing, the committee is afraid people won't continue treatment if they fall behind in their payments," Swann said.
The D.C. Lung Association said that in 1982 the District had the fourth highest tuberculosis rate among the nation's major cities.
Members of the advisory panels say the user fees are likely to bring in less money than the city has projected. Because the revenue already is figured into the fiscal 1984 budget, they are concerned that if the fees don't produce the money anticipated, the health programs could suffer.
"It is my understanding that 70 percent of the people who go through the VD program are men, many of whom are unemployed," said Wendy Wertheimer, cochairman of the VD advisory panel. "Frankly, if they had the money to afford services they wouldn't be in those clinics."
Jim Chamberlin, program director of the D.C. Lung Association and a member of the Mayor's Advisory Committee on Tuberculosis, said, "It doesn't make sense for the city to charge a fee for these services. If you collect cash, you have to pay for security, and if you use a billing system, you have that expense. It just adds to the logistical problems."
Health advisers complained neither the public nor the advisory panels were consulted about the proposed policy.
"There wasn't any consultation of the public or of those who have been asked to serve in the advisory program," Wertheimer said. "I was very disappointed."
However, Hardaway and other officials said the proposal is still in the planning stages and public comment and the advice of the advisory committees would be sought.