YOU ARE HERE: LAT HomeCollections

'The Last Stop' for Health Care : Clinics in 'Medically Underserved' Areas Are Safety Net for Poor


Dr. Don Garcia walks quickly through the small Bell medical clinic where patients sit anxiously in a reception area, awaiting a chance to see him.

He moves from room to room, patting children who roam the corridors as he races to stay on schedule. Garcia has about 12 minutes to attend to each patient--many of whom have not seen a doctor in years.

"We are the last stop, the safety net for health care," Garcia says. "We have no one else we can refer people to from here."

Garcia, one of two doctors at the Community Health Foundation of East Los Angeles at 4129 E. Gage Ave., works in a community where physicians are few and medical care is scarce.

The ratio of full-time primary care doctors to residents in cities such as Bell is one for every 9,750 residents, according to a 1991 study conducted by the Community Health Foundation that used information provided by Los Angeles County and United Way. In neighboring Bell Gardens, the absence of doctors is more acute, with about one for every 27,000 residents. The shortages in Cudahy and Maywood are just as severe, the study found, though in Santa Monica there is about one doctor for every 500 residents.

In light of these figures, the four Southeastern cities were designated medically underserved by the federal government last August, according to Kondor Chung, an analyst with the state's Primary Care Resources and Community Development Division in Sacramento.

The designation, which was made after the Community Health Foundation applied to the Bureau of Primary Health Care, allows the foundation and other primary care providers to apply for additional federal funds to work in these cities.

The foundation currently receives state and federal funds. Under the designation, it will be able to continue to treat the growing number of uninsured patients.

The absence of doctors is reflected in the health problems Garcia treats.

"If it wasn't for the fact that they were pregnant, a lot of women would not come in to see a doctor," Garcia said, adding that many say they have not had gynecological exams in years.

Others, like Cecilia, a 26-year-old former farm worker who saw a doctor after suffering chest and back pains, could not afford follow-up care. Garcia listened as she described the pain that has intensified since it began in 1987, while she worked at an apple farm outside Seattle.

"Since we have to pay up front, I can't afford (medical care)," said Cecilia, who did not want her last name used. "I came here because my aunt told me it wasn't as expensive."

Fees for the foundation's patients are based on their ability to pay.

Cecilia added that she is reluctant to go to a county health facility because she has no insurance and would have to wait a long time with her two children. She now awaits the results of tests Garcia ordered.

"People have to overcome barriers of poverty, transportation, and barriers caused by the environment where they live," said Rodolfo Diaz, executive director of the Community Health Foundation. "When compounded, these things make people more vulnerable to contracting disease, and the problem increases when the illness becomes acute beyond the point where it is easily treated."

A recent national study found nearly 23%--or 2.1 million people--in the county medically underserved and unable to afford access to basic health care. Statewide, the number approaches 6.7 million, according to a study conducted by the National Assn. of Community Health Centers in Washington.

The lack of doctors coupled with the inability of many residents to pay for care in Bell, Bell Gardens, Cudahy and Maywood means that county health care centers and community clinics are the only choice for many. The area is serviced by county centers in Huntington Park and Bell Gardens, which are part of the seven-city San Antonio Health District. Both centers have seen an increase in patient visits, according to Willie T. May, chief executive officer for the county's Metro South County Health Centers, which includes San Antonio.

And although a number of clinics can be found in malls and on street corners, county and community groups say many of the clinics lack full-time doctors and will only treat patients who are insured or pay cash.

Doctors and health care experts point to the lack of minority doctors, the high cost of medical school that prompts many doctors to specialize, and the growing numbers of uninsured as some of the reasons for the shortage of doctors in low-income areas.

David E. Hayes-Bautista, a professor in the Division of Preventive and Occupational Medicine at UCLA's School of Medicine, said more must be done to distribute the burden of paying for health care. "We've lost vision of who we are as a society and we've become Balkanized. What you hear a lot is 'Why should we do something or pay for a health care plan that will only benefit them?' We didn't think that way in the 1950s. Then, it was everyone who benefited, not this them-versus-us mentality."

Others contend that continued doctor shortages and funding problems will result in a rise in communicable diseases and drive up the cost of health care.

"Some conservative constituent in Beverly Hills may say, 'I don't want to pay for health care for someone in the San Antonio Health District,' " May said. "But what that same constituent who lives in Beverly Hills may not realize is that the people they hire to work in their home may live in that crowded area where there is no testing for things like tuberculosis. And if there is no testing, then that worker may infect their boss who lives in the mansion in Beverly Hills."

Los Angeles Times Articles