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Erie County Medical Center will not ask for more subsidy money from the county next year, but the price will be high -- job cuts and the closing of a clinic in the City of Buffalo.

A total of 136 jobs will be eliminated, including 73 that are currently vacant, said Sheila K. Kee, chief executive officer at the medical center.

"We are facing extreme financial issues. We have to make tough choices," Kee said. "Laying people off is not what we want to do. But we need to protect our hospital."

How many ECMC staff members will end up out of work will become clear after a 10-day "bumping" period, when medical center employees can use their seniority to "bump" employees in other county departments and take their jobs, Kee said. The remaining dismissal notices will likely be mailed out in October, she said.

The job cuts are included in the 2002 budget proposal, which squeaked by ECMC Board of Managers this week. The vote was 7-4, with one person abstaining.

The job cuts were the most unpleasant part of a sticky budget process, said David P. Rutecki, chairman of the board.

"The board was very saddened by what had to be done," Rutecki said. "It was a very difficult process this year. But the majority felt . . . it was better that we made the cuts than that the Giambra administration made the cuts."

The ECMC budget proposal of $300 million, including $20.3 million in subsidy money from Erie County, will now land on the desk of County Executive Joel A. Giambra.

Giambra, a Republican, can change the budget or send it, as is, to the Democrat-led county Legislature for consideration as part of his overall 2002 budget message for the county.

Kee said the primary focus of the budget was keeping the county subsidy steady at $20.3 million.

The medical center has been warned -- primarily by Giambra -- that it must begin to wean itself off of the subsidy.

None of the job cuts affect nurses or other employees that are involved in direct patient care, Kee said. The cuts are in areas like maintenance and clerical, she said.

The clinic slated for closure is the Bailey-Gerald clinic, one of three primary-care clinics operated by ECMC, Kee said. It is a mile or two from the medical center and has been open since 1996.

Kee and Rutecki said the clinic has not performed well enough to justify keeping it open during the current budget crunch.

"It just never attracted the kind of traffic we needed to make it work," said Rutecki. "It's unfortunate, but people are still walking into emergency rooms for their primary care."

The clinic will be closed in December, Kee said.

Fiscal problems for the medical center include additional costs associated with Medicare; growth in salaries and fringe benefits under a long-term contract that cannot be changed; and increasing costs of pharmaceutical and medical supplies, Kee said.

"We have major issues to deal with," said Kee. "Having to do a job restructuring -- like so many hospitals have had to do -- is never an easy thing. But it's necessary to the future of this hospital. These are difficult times."

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