Patient Ana Hernandez has been waiting for more than two hours to see a doctor;… (Mark Boster / Los Angeles…)
Most weekdays the line outside Clinica Monseñor Oscar A. Romero in Pico-Union starts forming long before the clinic opens at 8 a.m.
Those waiting are women with children, the elderly, undocumented and unemployed, all hoping to get appointments for everything from prenatal care to counseling.
Since its founding in 1983 as a resource for Central American war refugees, this storied clinic has become a key stopping point for thousands of immigrants who arrive every year in this neighborhood and those nearby. Over the years, it has grown beyond basic care to offer innovative programs meant to help patients integrate into their new community.
"It's the place that immigrants go when they first come here from El Salvador and Mexico and many other countries," said Oscar Cintigo, a member of a clinic patients group, "where they know they won't be asked too many questions. It's an entire community."
But for the last several months the clinic — which also has an office in Boyle Heights and a children's clinic down the street from the main one —- has become embroiled in controversy and financial uncertainty. This spring, the clinic's executive director announced that it was facing a $1-million deficit and that the only remedy was laying off more than a dozen workers.
After the reduction in staff, management sought to take out a $500,000 line of credit leveraged on its building to meet monthly obligations. Workers complain about insufficient medical supplies, including needles and basics like toilet paper.
"There's a kind of chaos inside the clinic right now," said Connie Corvera, a 10-year employee.
The financial turmoil came as a surprise to Corvera and many other workers who, just a few months earlier, negotiated a 4% raise without any indication that finances might be in trouble. Now they worry about the clinic's ability to stay open.
There is tension between the leadership, which includes an executive director who was hired a little over a year ago, and its employees. Albert Pacheco, the executive director, has accused workers of insubordination, and clinic supporters hold regular protests, calling on him and Carlos Vaquerano, the president of the clinic's board, to step down.
There's disagreement about the source of the problem, but everyone involved agrees that the creative, educational programs that the clinic is known for are threatened.
Clinica Romero was founded three years after the death of Archbishop Oscar A. Romero, the outspoken advocate for the poor who was killed while celebrating Mass in San Salvador. For the many Central Americans in Los Angeles, it was a period of turmoil but also one of activism and engagement driven by a desire to provide assistance to thousands of migrants.
Other organizations, including El Rescate Legal Services and the social justice advocacy group Central American Resource Center, also were started during that time.
"There were many refugees fleeing the war," said Isabel Cardenas, who helped found the clinic. "And we saw that there was going to be an even greater influx of people without insurance, or access to welfare, or any kind of money."
When the clinic opened in a converted bungalow in Pico-Union, it relied on donated medical supplies and volunteer doctors.As the clinic expanded, it came to be known for its unique approaches to outreach, including a one-of-a-kind program that sought to reach out to increasing numbers of indigenous Maya migrants.
The clinic now serves tens of thousands of patients every year.
For Pacheco, the clinic's new executive director, and Vaquerano, the president of the board, the increase in patients, particularly uninsured patients, and the bad economy are the reasons for the clinic's troubles.
Pacheco said he realized that the clinic was in financial trouble only at the beginning of this year, after the negotiations with the employees union were complete. He also said the clinic was denied several grants it had expected.
According to the most recently available tax records, the clinic's yearly revenues of about $10 million have remained relatively steady and even increased a bit through the worst of the recession. But Pacheco says the clinic has so far spent nearly all of its $10.37-million budget this fiscal year, and he projects a $1-million deficit.
Union representatives said the clinic was overspending by about $200,000 a month over the last few months. In addition, they said, the clinic has missed or been late with grant applications. They also accuse the clinic's leadership of veering from its stated mission of serving local patients by sending several thousand dollars to a clinic in El Salvador.
"I don't think you can blame the economy for basic lack of execution," said Joshua Rutkoff, health services director for SEIU Local 721, which represents the clinic's workers.
Pacheco acknowledged overspending but said it was the result of an increase in patients. Vaquerano said the money sent to El Salvador was part of continuing "the philosophy of Monseñor Romero."
In the future, said Pachecho, Clinica Romero will have to focus less on educational services and more on increasing the number of Medicare and Medi-Cal patients whose services are reimbursed, and dropping some of the other programs.
For workers like Corvera, the former community organizer, and Idalia Xuncax, who for nearly a decade provided translation, advice and guidance to Maya women unfamiliar with the U.S. healthcare system, the cuts have led to a sense of loss and anger.
They see the services they provided not as luxuries but as key to successfully providing healthcare to a migrant community.
"The whole world admired Clinica Romero as the place where you could get these types of services," Xuncax said. "But now that is lost."