JACKSONVILLE, Fla. -

Barbara White says that without assistance from Shands Jacksonville Medical Center, she would not have any medical care.

White is far from alone. Many of the patients who go to Shands get some sort of assistance. To them and the hospital, it's no surprise the funds are running in the red, with a $20 million deficit last year.

With still more cuts looming, the hospital may be forced to cut some programs just to get by.

"That could be the end of care for a lot of people just like myself," White said. "If they close down programs like that, it means I would not have any health care. I would not have care for my heart or my seizures or anything like that."

In the last eight years, Shands has lost nearly $30 million in legislative cuts. During that time, Shands estimates it has handed over $300 million in care to the poor. Now with more cuts coming, the hospital sees a problem.

"We have a crisis in this community and it's the under an uninsured population," said Shands President and CEO Jim Burkhart. "How are we going to care for them at the same time reimbursement for funded programs like Medicare are being cut?"

It does receive $23.7 million a year in funding from the city, but that has not increased in 10 years.

Tony Carvalho, who heads up the Safety Net Hospital Alliance of Florida, said Shands is in a crisis due to reduced revenue coming in from the state and the federal governments, and rising health care costs.

"They will have to do everything to protect the patient quality inside the hospital, with some of the services they provide to the community outside the hospital may have to be reduced or eliminated," Carvalho said. "They will have to look at ways to reduce cost if their reimbursements continue to decline. And they will have to look at programs like Level I trauma centers, which Shands Jacksonville is the only Level I trauma center in your community. Those are expensive to maintain."