The Harbor-UCLA Family Health Clinic, which survived a brush with death three years ago and continues to provide low-cost medical care for thousands of the South Bay's poor and elderly, is having a relapse.
The clinic, whose staff is made up of 15 physicians in a UCLA family-medicine residency training program, was notified last month that the program's chairman will be replaced. The chairman, Dr. Fred Matthies, also heads the clinic.
Dr. Kenneth Shine, who recently became dean of the UCLA Medical School, said Matthies lacks administrative skills and has alienated colleagues at UCLA. Shine also said the personnel change is an effort to strengthen the program, which is on probation with an accreditation panel.
Dr. James Puffer, chairman of the family medicine division at the medical school's Westwood facility, would replace Matthies, splitting his time between the two programs. Under that plan, Matthies would become acting associate to Puffer.
But faculty doctors at the clinic charge that the proposed replacement is in retaliation for Matthies' successful fight last year to save the residency program after it was ordered terminated as a cost-cutting move by the medical director of the Los Angeles County Harbor-UCLA Medical Center.
Matthies, 59, declined to comment on the matter, but associates say he is deeply disturbed by the proposed change.
Harbor-UCLA, on Carson Street just west of the Harbor Freeway, is a county-run facility that UCLA uses as a teaching hospital. For the most part, the county pays the salaries of the UCLA teachers and resident doctors at the hospital and clinic.
The faculty doctors at the family health clinic said they fear that a change in leadership could be the first step toward elimination of the program and the clinic's closure.
Patients at the clinic, about 90% of whom are on Medi-Cal or Medicare or pay reduced fees based on income, said that if the clinic closes they will have to return to what they called impersonal care and the long lines at the huge county hospital across the street.
Earlier this month, the county Board of Supervisors ordered a study of the effects that the proposed change would have on the clinic. The action delayed the change for at least 60 days, when a report is expected.
The dispute is the latest in a series of struggles to keep the 16-year-old family-medicine residency program alive at Harbor-UCLA. The university has similar programs in Westwood, Santa Monica, Northridge and Ventura.
Family medicine, a three-year program that trains doctors in general medicine, pediatrics, obstetrics, cardiology, psychiatry and other specialties, has been controversial in the medical profession because one of its aims is to lessen the need for treatment by specialists.
Doctors of family medicine, who say they can treat more than 90% of a family's medical problems, also consider a patient's home and work environment when determining diagnosis and treatment.
Family medicine physicians say they often are snubbed in academic environments because they are not specialists and are not involved in research.
From 1970 to 1982, the Harbor-UCLA clinic was moved from one location to another on the hospital grounds, including bungalows and a former dental office. The faculty doctors finally formed a nonprofit organization to establish a permanent facility in a small shopping center across the street from the medical center.
The facility, which is operated by a board of directors, pays its support staff and buys its own equipment with patient fees and state aid.
Budget Cut Ordered
Doctors' salaries were paid entirely by the county until 1981, when the supervisors ordered a 10% budget cut, and county and university officials decided to eliminate the family medicine program at Harbor-UCLA. But UCLA had a change of heart and agreed to pay the salaries of the program's three faculty doctors, and the county agreed to pay its residents.
Two years later, the clinic was in danger again when UCLA said it could no longer afford to pay the faculty salaries, and the medical center said the residency program would have to become self-supporting to continue.
The doctors at the clinic organized patients and other doctors to protest the closure, and received a $125,000 grant from the state and about $20,000 in private donations and equipment to support the program.
UCLA agreed to make up the balance of salary costs, but hospital officials said not enough long-term financing had been arranged and the clinic would have to close. Most of the family medicine residents were told they would have to choose among more specialized departments.
But six months later, after the county supervisors ordered an investigation into the matter, the county Department of Health Services overturned the decision, saying the clinic had enough financing to continue.