Dr. Naomi Neufeld hurried down the hallway of the Pediatric Diagnostic Center in Ventura, apologizing as she went for her late arrival. A seven-car accident, she explained, had turned the freeway into a parking lot and her monthly drive from Los Angeles had taken longer than expected.
But to Carmen Esperanza and her family, who had been sitting patiently in a small room of the clinic for nearly an hour, Neufeld's delay was barely noticeable. The family already had traveled too far--and waited too long--to be bothered by something as trivial as a traffic jam.
"I have never seen a case like this where a child didn't receive treatment for this long," Neufeld said to the interns gathered outside the family's room. She then outlined what she knew about the child that they were about to see.
Esperanza and her two sons, Paulin and Martin, arrived from Mexico a few months ago. Although the thyroid glands of children in the United States are routinely screened at birth, Paulin, like many children from Third World countries, never received medical treatment for his hormone deficiency.
The result, Neufeld said, is a phenomenon rarely encountered by American physicians: A 16-year-old perpetual child, 42 inches tall and unable to speak, who has the mind, body and emotional maturity of a 4-year-old.
"From a textbook point of view it's fascinating, but we also need to consider the social dynamics here," Neufeld, a pediatric endocrinologist at Cedars-Sinai Medical Center in Los Angeles, said to the interns before entering the family's room. "He's been the baby of the family for all these years, so it's not enough to just make him bigger. We also have to talk to them about helping him to think like an older child."
Despite its rarity, the case is in many respects typical for the clinic, described by some health-care professionals as a pioneer collaboration between the county and private sector physicians.
Since its inception two years ago, the clinic is rapidly gaining a reputation as a center of hope for some of Ventura County's sickest children from poor and indigent families.
It is here that children with severe, unusual and often baffling disorders are referred for evaluation and treatment, and where their care is overseen by some of the top pediatric specialists in Southern California.
Like Neufeld, many of the clinic's physicians travel once or twice a month from medical centers as distant as Childrens Hospital of Los Angeles, UCLA Medical Center and Cedars-Sinai Medical Center.
In most cases the doctors receive only a fraction of their normal fees. No family, regardless of its ability to pay, is turned away.
"From the county's perspective, it's absolutely an asset," said Phillipp Wessels, director of the Ventura County Health Care Agency, which oversees the Ventura County Medical Center. "It makes available those highly specialized services, which patients used to have to go to Los Angeles to receive."
But the existence of the clinic is financially advantageous too. Under contract with the county, the clinic provides care for poor and uninsured patients at a reduced rate.
The county then bills agencies such as Medi-Cal and California Children's Services for the care that was rendered, according to the clinic's director, giving the Pediatric Diagnostic Center its agreed-upon percentage of fees and keeping the remainder.
"It's a very good arrangement," Wessels said. "We've been able to essentially serve two to three times the number of patients with the same amount of money we used to spend."
The Pediatric Diagnostic Center also serves as an adjunct to the medical center across the street, providing mainstream pediatric care on a sliding-scale basis. Children who need more intensive follow-up are referred by one of the clinic's residents or interns, or by the child's private physician. Unless they are deemed emergencies, visits are on an appointment-only basis.
Credit for the creation of the clinic, physicians and health-care officials say, belongs to Dr. Chris Landon, a pediatric specialist in childhood chest diseases. Landon had been content in his private practice for 10 years. Then, he said, he took a closer look at the illnesses of his patients and re-evaluated his efforts.
What he found was that his expertise--along with that of many other highly trained pediatric specialists in private practice--was going largely unused.
"Residents at hospitals today learn about liver transplants, even though most of them will never see a case like that in private practice. They never see a lot of things," said Landon, a soft-spoken man with the energy of a long-distance runner. "What happens to a lot of pediatricians is that they turn into runny-nose doctors."
He also discovered that the county needed more pediatric specialists. With about 150,000 children in the county--a large percentage of them from uninsured or working-poor Latino families--Landon said the medical needs of many sick children were not being met.