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Free clinic not a cure-all

Some patients needed treatment beyond the scope of the event. What they'll do next is uncertain.

May 05, 2010|By Molly Hennessy-Fiske, Los Angeles Times

As a doctor checked his back in a makeshift exam room at the Los Angeles Memorial Sports Arena, Demond Lewis, 34, braced himself for bad news.

Six years ago, the cabinet installer and handyman was pulling old pipes from a field when he heard his back pop. He did not have health insurance, so he did not see a doctor.

He has been in pain ever since. Makes it tough to work, he said, tough to even play with his 5-year-old son.

Now Dr. Mark Vaisman, a volunteer at the massive mobile free clinic that ended Monday, was telling him he needed to see another doctor for follow-up treatment.

"X-rays to start, maybe an MRI," Vaisman said as he filled out Lewis' medical paperwork.

Lewis was among the more than 6,600 uninsured or underinsured patients who saw doctors, dentists and other medical professionals during the weeklong free clinic run by the Tennessee-based nonprofit Remote Area Medical. Their stories illustrate both the short- and the long-term challenges facing the medical community as tens of millions of uninsured Americans — as many as one in four Californians — are folded into the nation's healthcare system in coming years.

Advocates say it remains important to match patients such as Lewis with regular care now. Otherwise, chronic conditions will worsen, and costs will continue to rise as the uninsured await sweeping changes to national healthcare passed by Congress in March and signed into law by President Obama.

"You wonder about follow-up," Vaisman said as Lewis pushed his way through the tarpaulin curtain and into the arena. "What will happen after here?"

Cindy Wilson, an unemployed home health aide, lost dental coverage last summer when state lawmakers cut Denti-Cal for 3 million low-income adults. Like many at the clinic, Wilson, 48, of Twentynine Palms, came seeking dental work, only to learn during triage that she had chronic conditions — pre-diabetes and high blood pressure — that a one-time checkup could not fix.

Under national health reform, Wilson might qualify for expanded Medicaid, or Medi-Cal, coverage if she does not find a job. But her plans to start cleaning a local bank for $300 a week would put her above the new threshold for receiving Medicaid: 133% of the federal poverty level or $10,830 for an individual. In that case, she would be required to purchase health insurance starting in 2014, with help from government subsidies, or pay escalating penalties.

Wilson said she would probably pay a penalty the first year but would be hard-pressed beyond that to afford either insurance or more fines.

Gilbert Ortega, 53, of Culver City waited in line for hours to be among the first treated at the arena last week. The unemployed shop worker had five teeth pulled and got new prescription glasses and reading glasses. But he said he still needed partial dentures and a root canal and was willing to pay. Volunteers gave him a list of local clinics to contact, and he said he planned to stop by the Venice Family Clinic.

But the Venice clinic, which does not charge, relies on a single dentist to serve its 24,000 patients, according to Medical Director Dr. Karen Lamp. Often, patients seeking the services that Ortega needs are referred elsewhere.

Even without an influx of patients from the mobile clinic — which also served more than 6,300 at the Inglewood Forum in August — clinics countywide have been overwhelmed during the last year by new patients who have lost their jobs and health insurance, Lamp said.

"I am concerned where these patients can really fit in to get ongoing care," she said. "We have very limited capacity for new patients."

U.S. Sen. Bernie Sanders (I-Vt.), a proponent of national health reform, said he followed coverage of the free clinic and discussed it with fellow members of Congress. He hopes it can connect uninsured and underinsured patients with regular preventive care.

"What we want to do is get people a permanent medical home and keep people out of emergency rooms, which is the most expensive form of care," Sanders said.

For now Penny Zellman and her family are in danger of falling through the cracks.

The Zellmans drove up to the Sports Arena from Garden Grove to get dental and medical care. Penny Zellman, 37, was recently laid off from her job as a pharmacy technician, just shy of qualifying for comprehensive health insurance.

Her uninsured husband, Jason, 37, a consultant for a vacation club, had a cracked tooth and needed two root canals. Daughter Alexis, 4, has a lazy eye and Julia, 8, needed a stubborn baby tooth pulled.

Dentists at the arena did not have time to do root canals. They pulled one of Jason's molars and Julia's baby tooth. An optometrist gave Alexis a new pair of glasses but said she really needed to see a vision specialist.

"We'd love to see a specialist," Jason Zellman told her. "That's why we're here."

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