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Homeless patients present unique problems for Venice free clinic

The Venice Family Clinic sets up in parks, shelters and other places to bring medical services to a population that is more likely to develop health problems but less likely to seek treatment.

January 05, 2011|By Duke Helfand, Los Angeles Times
  • Dr. Greg Yesensky of the Venice Family Clinic examines Jennifer Pisa, 35, at the National Guard armory in Culver City, which serves as a homeless shelter during the winter.
Dr. Greg Yesensky of the Venice Family Clinic examines Jennifer Pisa, 35,… (Jay L. Clendenin, Los Angeles…)

Cheryl Terry coughed sharply as she stepped into the homeless shelter's crude medical clinic: a cinder block room with folding tables and plastic tubs of medicine.

Her doctor was pressed for time. He had just two hours to see more than a dozen patients at the crowded Culver City facility on this rainy December night.

"Cheryl, I'm Greg. What's going on?" Dr. Greg Yesensky asked.

"My chest — coughing — it's bright, yucky yellow," she said.

A quick exam revealed bronchitis. Yesensky gave Terry an inhaler, cough medicine and antibiotic tablets, all free of charge.

"It keeps me out of the ER tonight," a thankful Terry said of the 10-minute appointment. "Saves my life."

Most of Yesensky's homeless patients said they would skip medical care if not for his weekly visits during the cold winter months. Many would end up in emergency rooms. Yesensky and fellow doctors from the nonprofit Venice Family Clinic are trying to break that cycle by bringing medical services to the homeless in parks, shelters and other places where they congregate on the Westside.

Delivering preventive care, the doctors believe, not only keeps their patients healthier, it also makes financial sense. People who live on the streets are up to five times more likely to be hospitalized than those with roofs over their heads. Those hospitalizations produce big medical bills that wind up being subsidized by taxpayers and consumers with private insurance.

"It's much less expensive to take medical care to them than to let them get so bad that they end up in the ER," says Dr. Theresa Brehove, director of homeless services for the Venice clinic.

Los Angeles County has 48,000 homeless people, local government agencies report. The numbers have been declining steadily for several years thanks to a variety of public and private programs that provide affordable housing and social services, officials say.

Those who remain on the streets often endure chronic — and sometimes life-threatening — medical conditions such as diabetes, tuberculosis and emphysema.

Treating these people is no easy task. Many neglect their medical problems because they lack transportation, distrust doctors or suffer from mental illness or drug addiction. Others move around frequently and devote the bulk of their time to meeting the more basic needs of food and shelter.

With little or no access to preventive care they often wind up suffering from several ailments simultaneously.

"Homeless people generally have multiple health problems that are complex and interrelated," said John Lozier, executive director of the National Health Care for the Homeless Council. "The cases are very complicated as a rule."

Venice Family Clinic, founded in 1970 and believed to be the largest free clinic in the nation, has sought to tackle these cases one at a time.

Its doctors treat 3,700 homeless people a year, about 15% of the more than 24,400 patients who receive medical, dental and mental health services at the clinic's nine locations. The clinic relies on public and private funding for its $22-million budget, as well as supplies and services donated by hospitals and pharmaceutical companies. It also depends on volunteer doctors, dentists, pharmacists and others to supplement its 18 physicians and four nurse practitioners.

Despite the clinic's reach and longevity it strains to keep up with the serious medical and mental health needs of the area's large homeless population.

Yesensky sees the dimensions of the problem every Wednesday night at the cold-weather shelter inside the National Guard armory in Culver City. It's far from the ideal location to practice medicine, a veritable germ incubator where patients wheeze and cough, suffering from a condition one woman called "shelter hack."

During a recent visit, one patient ticked off her ailments as if reading from a menu — nosebleeds, itchy skin, a broken tooth, a cold sore — before asking Yesensky whether he could refill her anti-anxiety medication. Others sought treatment for fevers, chills, rashes and foot fungus. One man was bleeding from hemorrhoids. A woman, looking exhausted and frail, was fighting arthritis brought on by the autoimmune disease lupus.

A clinic coordinator jotted down patients' names and personal information. A medical assistant weighed each and took vital signs. Then Yesensky conducted his exams and dispensed medicine. The most common: ibuprofen, decongestants, cough medicine, antibiotics and vitamins.

The last patient of the night, 55-year-old Donald Billups, sat down and told Yesensky that he was feeling lethargic and coughing. Yesensky peppered him with questions: Was he eating? Had he been around anyone who was sick?

After examining Billups, Yesensky urged him to visit the Venice clinic's headquarters the next day. "Do you want to come for a blood test?" Yesensky asked.


"Do you want to come for a TB test?"

Billups again shook his head no.

Billups accepted bottles of vitamins and cough syrup. As he turned for the door, he uttered words that belied his worn-out appearance: "I think I'll be one of those people who lives to 100 and never has a sick day in his life."

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