Kaleida Health is closing or consolidating some well-known medical clinics in the city to reduce expenses, and others may close as a result of pending state budget cuts.

Planned closures this fall at the hospital system’s Buffalo General Hospital include the Wettlaufer Eye Clinic, which dates back to 1876, as well as the dental and oral surgery program.

The Wound Care Center at Millard Fillmore Hospital at Gates Circle already has closed, while the facility’s outpatient urology services will be split later this summer between Millard Fillmore Suburban and Buffalo General hospitals.

Unclear but in doubt are the fates of the Western New York Poison Control Center and the Shaken Baby Syndrome Program at Women & Children’s Hospital.

Officials at Kaleida Health attributed the changes to state reimbursement cuts and other financial pressures that have forced the organization to focus on core services, such as heart care and orthopedics.

“Rather than continue to provide duplicative services, we will concentrate on strengthening the services where we have special expertise and that more broadly meet the health care needs of Western New Yorkers,” James R. Kaskie, chief executive officer, said in a statement.

Kaskie defined core services as those in which Kaleida Health has a technological or market-leading position, the program is required to support another key service, or the service is considered a critical community need and not duplicated

elsewhere. He also said services should be financially viable.

The changes have stirred concern.

Patients like Louise Castro, a 75-year-old Buffalo woman with cataracts who has been going to the Wettlaufer clinic for about two decades, must now get services elsewhere.

“It would be nice to keep the same doctor,” she said.

Kaleida Health described the Wettlaufer Eye Clinic as moving to the Ross Eye Institute, a multispecialty group downtown run by doctors affiliated with the University at Buffalo. There is an agreement for Ross Eye Institute doctors to consult on hospitalized and emergency room patients, said Dr. James Reynolds, chief executive officer of the group, but no formal agreement to transfer the Wettlaufer’s patients.

“Kaleida Health has elected to close the Wettlaufer. We hope most of the patients will come to us, but we are just one alternative,” he said.

No job losses were expected, said John Klein, president of Nurses United, Communication Workers of America Local 1168, which represents many of the hospital network’s workers. But he criticized the actions for limiting services to residents in the inner city.

“It comes down to profitability. Kaleida Health seems inclined to close anything that doesn’t make money,” he said.

Kaleida Health officials characterized the closures and moves as part of efforts to reduce spending by $12 million to $15 million. They said discussions are under way that may result in dental services moving to another facility in the city.

The consolidations also come in anticipation of the closure of Millard Fillmore Hospital and transfer in 2011 of its services to Buffalo General Hospital and the vascular institute being built next to it.

The $291 million facility for vascular care and medical research — a collaboration with UB—will bring together Kaleida Health’s heart, stroke and vascular services and provide research space for UB.

The focus on core services at Buffalo General may turn out to be the right thing to do, but there are tradeoffs, including the loss of the Wettlaufer clinic’s 6,000 patient visits each year, said Dr. David Rodman, acting head of the Wettlaufer.

“Kaleida is engrossed in the vascular institute and doesn’t want Buffalo General to be a community general hospital anymore. That’s a problem when you are located in a neighborhood in the city,” he said.

Rodman said there is a need for same-day services in the inner city for subspecialties, the narrow fields within a larger specialty. Many of the indigent patients who frequent the Wettlaufer lack the transportation, finances or sophistication to be seen in a private office, he said.

Rodman said the clinic is the only location in Buffalo where inner-city patients can receive eye-related outpatient and surgical care under one roof.

“It’s a great service that is still a viable entity, and it’s sad that it will be broken up,” he said.

In his statement, Kaskie said Kaleida Health, like hospitals across the county, must make difficult decisions and reorganize to face enormous challenges posed by state budget crises, a difficult economy and health reform.

“These clinics, with excellent physicians and dedicated staff, have provided a high-level of care and service for many years,” Kaskie said. “But resources are limited, and we must use them where they provide the greatest benefit to the community. These services are available at other area health care providers that are better equipped to deliver this particular care than we are.”