COLUMBIA, S.C. - Gov. Mark Sanford stressed a preventive and integrated health care system for South Carolina during a budget meeting Friday with five of the state's health agencies.

Citing statistics that show South Carolina as one of the unhealthiest states in the country, Sanford pressed agency directors to offer up programs to cut while encouraging them to tout essentials services.

In many cases, the answers didn't come easy.

Department of Health and Environmental Control Commissioner Earl Hunter said the agency should end tanning bed inspections, but Sanford continued, "What are other things that would be marginal?"

"I think in the last $25 million in state budget cuts, we've taken all the marginal stuff out, to be very frank," said Hunter, who praised his agency's immunization program and said the department has aggressively sought federal grants for disease prevention.

Sanford will use the input he receives from health and other state agencies during the next three weeks to craft his 2005-06 executive budget, which will be presented to legislators in a few months.

Some in the audience, which included advocates, board and commission members and Sanford's staff wanted more from the agencies, which make up about a third of the $15 billion in state and federal money in South Carolina's budget.

"When you look at their budgets, that's not where the dollars were cut," Sanford said. "There was not a lot of money spent in preventive care before, there's not a lot of money spent in preventive care now."

The governor wants to rank the more than 1,400 programs and services the state pays for, possibly cutting those at the bottom entirely.

"You're ... dealing with just a complex number of, in all too many cases, independent activities," Sanford said. "But as was acknowledged today, very little of it is spent treating prevention. It's largely a disease management system that we have."

Hunter wasn't alone in struggling to find savings after years of budget cuts.

Department of Disabilities and Special Needs director Stan Butkus said his agency faces a potential lawsuit because it hasn't been able to make any progress on a waiting list for residential services.

"We're getting some very desperate families," he said of the roughly 1,780 on the waiting list. "I'm afraid that we're going to be in a position that we're going to get sued."

He said the agency gets 200 to 300 eligibility referrals a month because of population increases, accidents and children graduating from high school special education programs.

Butkus said 25 other states are facing similar lawsuits.

"The situation makes us very vulnerable," he said. "We don't want to have a federal court tell us what to do."

Lee Catoe, head of the Department of Alcohol and Other Drug Abuse Services, said he has tried to "change the culture" at his agency, which had been using federal dollars for services that weren't improving health care.

Catoe said now the agency holds county services more accountable. His staff also suggested stronger tobacco possession and purchase laws to curb teen smoking.

Mental Health Department director George Gintoli said his agency has had success treating many people in community settings, including 34,000 children.

But "there's probably another 30,000 kids we should be reaching out to but we do not have the capacity or there's no access to them right now," said Gintoli, who has increased the number of mental health workers in schools.

He also said an adult day care program is not working and that the state should take a closer look at its sexually violent predator program, which some states don't even have.

Some people attending the meeting suggested increasing the state's cigarette tax, though lawmakers have balked at that proposal in recent years.

Sanford said he'll again push legislation to restructure the state's health agencies.

"The larger question is, some activities have more value than other activities," Sanford said. "The master gardener program at Clemson (University) is nice, but when measured against immunization, I think the master gardener program needs to go."