The first cut won't be the deepest.
On Monday Kern Medical Center CEO Russell Judd announced plans to terminate the home health care and outpatient physical therapy departments at the county hospital in August.
It's only the first cut this month at the troubled facility.
Kern County supervisors will consider formal approval of the program cuts -- expected to save KMC $1.67 million a year -- on June 17.
Services would be shifted to private health care providers who, Judd said, can provide KMC patients the same care at a lower cost.
"We do not anticipate other program closures in the near future," he said.
Nevertheless, more pain is coming; KMC has been losing an average of about $3 million per month.
On June 12, the hospital plans to release a list of across-the-board KMC layoffs for supervisors to discuss and possibly vote on during the June 17 meeting, Judd said.
"To maintain the financial viability of KMC and to support the financial needs of other county departments," said Supervisor Leticia Perez, "we have to make these very difficult decisions."
Judd was tight-lipped Monday about the size of the layoff because the number isn't final. He and his staff have been working for months to determine the optimal staffing complement for each KMC department.
Currently, the hospital provides basic physical therapy services helping people with serious injuries build the strength and flexibility needed to regain full use of their bodies.
"To staff this we have had to use contracted physical therapists which are even more expensive than county employed staff," Judd said. "On an annual basis we lose about $670,000 on this service."
The hospital has developed a letter of agreement with at least one private local physical therapy firm that has agreed to take KMC patients. And the hospital is seeking agreements with other businesses.
In the past 12 months, KMC provided about 200 patients with physical therapy.
"We have made arrangements with other physical therapy providers in this community for every patient in the community who needs this service, regardless of ability to pay to receive this service," Judd said.
The key to the deal, he said, is the fact that the "vast majority" of the patients are now insured under the Affordable Care Act. Nobody would have accepted the patients if most couldn't pay, he said.
The other cut announced Monday was to KMC's home health care service.
Around 50 discharged KMC patients currently receive visits two or three times a week from nurses who check their medications and bandages, provide follow-up care and make sure their recuperation is progressing well.
After August -- if supervisors approve the cuts -- those services will be provided by private home health care businesses, Judd said.
Those home health care clients, like the physical therapy patients, are "all eligible for care under the Affordable Care Act," he said.
Judd said the hospital loses $1 million a year on home health care.
"We should all recognize that this board is making the tough calls in order to preserve essential services at KMC and all other county departments," Perez said.
She believes the impact of inaction on the rest of the county's services would simply be too high.
"Each department has already been asked to cut 5 percent for fiscal year 2014-15. The longer we put this off, the worse the problem becomes and more we have to cut elsewhere," Perez said.
In a statement released by Service Employees Internation Union, Rosie Kidwell, a program specialist at KMC, said that the union is focused on continuing improvements at KMC.
"Kern Medical Center is in much better financial shape now than we were a year ago thanks to everyone's willingness to work together," she said in an email statement. "SEIU members will continue to make sure that every change at KMC puts our community first and that critical services are protected."
Fewer than 10 union members would be impacted by the cuts and the union did not take a formal stand on the proposal.
"We're realistic about the fact that KMC needs real change," Kidwell stated in the email.
Clinica Sierra Vista CEO Steve Schilling said the "disaster" at the county hospital cannot be ignored.
"If there is a private sector service that can do it cheaper and quicker or better," he said, the county has to seriously consider cuts like those announced Monday.
Monday's cuts come on the heels of other efforts to stem KMC's chronic financial losses.
Since April the hospital has reduced unnecessary overtime, decreased staffing by attrition and sent people home on days when there wasn't available work, effectively reducing staffing by the equivalent of 60 full-time jobs.
Judd said his team will be working to save positions right up until June 12.
"These are people we are talking about," he said. "We are being very cautious."