Earl Richardson's medications were running out, his feet were swelling and he felt a hard bulge in his stomach.
His wife told him he couldn't wait any longer. He must see a doctor. It had been almost a year since the 56-year-old lost his tech support job after it was outsourced to India. He had gone without seeing his internist, dermatologist, dentist and optometrist for months because he could not afford costly COBRA health continuation benefits. With diabetes, high cholesterol and high blood pressure, Richardson knew the danger he faced but said times were tough.
"Do I try to pay the car note, keep a roof over my head, buy food, or pay for high-priced prescriptions without benefits?" said Richardson, who lives in Culver City.
But with his health rapidly deteriorating, he made an appointment at the Venice Family Clinic, a last resort for help. On Wednesday, a doctor examined him and told him the bulge felt like a hernia and that he would probably need surgery. Then she refilled his prescriptions and told him to return for blood work.
"There are a lot of people having to look for care here who haven't done so before," said Liz Forer, chief executive of the Venice clinic, the largest in the nation. "They are calling and saying, 'I never thought I'd be calling you.' "
Free and community clinics have long been considered the safety net of the healthcare system, providing primary and preventive care to the poor and uninsured.
But in California and elsewhere, that safety net is in danger as clinics -- already reeling from a decline in donations -- are struggling to meet overwhelming demand from new patients who have lost jobs and health insurance.
"We have had to think outside the box to keep our doors open," said Nicole Lamoureux, executive director of the National Assn. of Free Clinics. She said clinics are seeking out new funding sources, recruiting more volunteers and triaging patients.
The Venice clinic has seen a 30% increase in new-patient requests since January and has limited first-time registrations to Westside residents. The Saban Free Clinic in Los Angeles is receiving 500 new-patient calls a month -- nearly triple the number from last year. The Northeast Valley Health Corp. registered 255 new patients last month alone and is trying to recruit new doctors to handle the growth.
Although clinic administrators said their patient loads typically rise as the economy declines, the impact is worse this time because of the magnitude of the recession. Also, centers were already burdened with growing numbers of uninsured patients before the economic crash.
The increased demand comes at a challenging time for fundraising. Private donors aren't able to give as freely, foundations have seen their own revenues drop, and money from local and state governments has been slashed.
"California clinics, given the state of our economy, have been particularly impacted," said Chris Patterson, spokesman for the California Primary Care Assn., which represents 800 community clinics and health centers.
Clinics' budgets vary widely, but depend on public funds, private donations and government-reimbursement programs such as Medi-Cal. The Saban clinic, for example, has a budget of $13 million -- about one-third from donations and two-thirds from government grants and health programs.
With 12 staff doctors and several hundred volunteers, the clinic saw nearly 22,000 patients at four sites last year. But this year, investments from the clinic's endowment have dropped 20%, said co-chief executive Abbe Land. So the clinic, which started 40 years ago as the Los Angeles Free Clinic, is cutting costs and turning to longtime donors for help.
Without a significant influx of money, however, Land said the clinic won't be able to meet the demand. Wait times for medical appointments have increased from 30 to 45 days, and from one week to as long as four for mental health appointments.
Even before the recession, many California clinics were in a precarious financial position, according to a recent study by the California HealthCare Foundation. More than two-thirds of community clinics were breaking even or running a deficit in 2006, the authors reported. The deficits are expected to only worsen because the majority of clinics' revenue comes from Medicare and Medi-Cal -- benefits the newly unemployed and uninsured often don't qualify for, said Melissa Schoen, senior program officer at the foundation.
"If you are going to increase the number of uninsured, it is certainly going to increase pressure on the financial viability of the clinics," Schoen said. This could "certainly tip clinics over the edge."