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Feeling the Pain of Health-Care Cuts

Clinics: Reductions of service at local centers and their pending closures pose a hardship for residents.


News that the North Hollywood Health Center would no longer take walk-ins had run on Spanish-language television and elsewhere, but Peter Jacquin hadn't heard.

On Tuesday morning, the 31-year-old Van Nuys resident showed up at the Los Angeles County clinic with son Christopher, 13, in tow. Before the boy could start classes at nearby James Madison Middle School, he needed to be immunized against hepatitis B.

The woman behind the counter told the Jacquins that the clinic is no longer doing immunizations or TB tests and that only patients with appointments are now being seen at the North Hollywood clinic and a smaller facility in Tujunga.

"She said the only place to go is Pacoima, and they're packed. It means I'm going to miss another day at work," said Jacquin, a sales associate at Home Depot in Woodland Hills.

The San Fernando Valley facilities are the first of 11 community clinics and four school-based health centers operated by the county that will close by Oct. 1 because of budget constraints. Approved in August by the Los Angeles County Board of Supervisors, the closures will force about 18,000 people to seek care elsewhere, according to John Wallace, a spokesman for the county Department of Health Services.

"I've been taking the kids here for years," said Jacquin, who hoped Christopher could get the necessary immunization today at Mid-Valley Comprehensive Health Center in Van Nuys, which is expected to remain open.

Without walk-ins, the North Hollywood clinic was uncharacteristically quiet Tuesday morning.

"It's like we're on vacation," one of the health workers said to her colleagues. "Last week, it was really, really busy," said another. "But word gets out on the street and now it's dead."

Patients make about 36,000 visits a year to the North Hollywood clinic, a neighborhood fixture for 50 years, said nurse manager Karen Menacker. Typically, the nurse practitioner who handles drop-ins sees about 20 patients a day and another 40 people come in for immunizations or TB tests. About 80% of the patients are Latino, she said.

"We feel bad for these patients," said Menacker, who runs both the North Hollywood and Tujunga facilities. "The majority of our patients are the working poor. They're working, but they don't have health insurance."

More than a dozen people who visited the clinic Tuesday morning without appointments were referred elsewhere.

Roxanne Rodriguez, 22, of North Hollywood was concerned about a swelling in her arm. She was told to have it checked out at Olive View/UCLA Medical Center in Sylmar.

The lack of bustle at the clinic came as a pleasant surprise to Aura Sobernis, 23, who had brought in her 6-month-old daughter, Emily, who had a rash. Sobernis had made an appointment the week before and was seen promptly by one of the medical staff who prescribed an ointment for the baby. "Usually we have to wait," Sobernis said.

Menacker said that the clinic would continue to provide adult primary care, pediatric care and women's services, by appointment, for the rest of the month.

"And we'll still triage patients in case we have a patient who's having chest pains or something," she said. "We do have physicians who will check the patient and say, 'Call 911,' or refer them elsewhere."

The North Hollywood clinic has 22 nurses on staff, eight to 10 health-care providers--either physicians or nurse practitioners--and an office staff of 21, Menacker said. "We are not emergent care," she said. "We don't do stitches or broken bones or anything like that." Such cases are usually referred to Olive View, she said.

But there is concern about the large number of people with chronic illnesses--about half the clinic's adult patients--especially those with diabetes and high blood pressure, Menacker said.

"A lot of our patients have no other health care," she said. "If they run out of their medication, that's when they get into trouble. That's when you see them in the emergency rooms."

She predicted that displaced patients will overtax remaining public health facilities. "I think in the long run it's going to be more expensive," she said.

The staff has been told that they will be offered jobs elsewhere in county health services, Menacker said.

But Maria Castro, who runs the business side of the North Hollywood clinic, said she is afraid many staff members will not be able to take jobs elsewhere because they live nearby. "We have employees with children, so they have child-care issues," Castro said.

Menacker said the clinic's closure will be a real blow to the neighborhood. Currently, patients without other health insurance pay $40 a visit, which includes any lab work, X-rays and medication.

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