Before Arroyo Vista Family Health Center opened temporary quarters in Highland Park four years ago, the closest affordable health care for many low-income residents of Northeast Los Angeles was several bus rides away at County-USC Medical Center.
"As kids, that's where Mom took us," said J. Lorraine Estradas, a native of the Northeast Los Angeles community of El Sereno. "I remember we would take three buses, and I remember waiting there for hours."
Now Estradas, associate director of Arroyo Vista, is awaiting the opening of a $2.1-million permanent home for the health center in Highland Park. The wait shouldn't last much longer.
A ground-breaking ceremony is scheduled for 1 p.m. Friday at Avenue 60 and North Figueroa Street. Construction is expected to start by January and take about a year.
The new facility will be a few blocks north of the cramped offices the center leases at 5224 N. Figueroa St.
A larger and better-equipped medical center has been planned since 1980, but construction was delayed by controversy over the clinic's original sponsor. It took five years to tie together a funding package that includes money from the city, county and federal governments as well as grants from private foundations.
Arroyo Vista, a privately operated clinic, was established with federal funds in 1981 to help meet the needs of a medically understaffed area in heavily Latino Northeast Los Angeles that encompasses Highland Park, Lincoln Heights, El Sereno, Mount Washington and Montecito Heights. Arroyo Vista is one of five federally funded community health centers in the city of Los Angeles where fees are based on a patient's ability to pay.
Besides medical care, the clinic provides referral services and a community outreach program, with health education, family planning classes and other social services.
Center officials said they have served about 20,000 people in each of the past two years--four times the number that came the first year. The new clinic is expected to accommodate 40,000 patients a year.
The new, 16,000-square-foot, two-story building will quadruple the size of the existing clinic. With the additional space will come more services, such as cardiology, orthopedics and neurology, Estradas said. A physical therapy department and pharmacy will be new features of the center, which now has room for only a small stock of medication kept in a refrigerator.
The center services are now scattered among three locations: a long, narrow suite of 10 offices for examinations and X-rays, an adjacent trailer for dental and optometric services and registration, and another suite of administrative offices across the street. One small room now serves as the X-ray reading room, laboratory, supervising nurse's office and a patient counseling area.
The new facility will enable Arroyo Vista to double its medical staff of 13, which includes one full-time physician, a medical director who performs clinical and administrative duties and six part-time doctors. But Dr. Curlee Ross, medical director, said he is not having an easy time recruiting doctors.
"We don't have the same financial incentives places like Kaiser or Cigna have," Ross said, referring to private health-care organizations. "And there is difficulty finding physicians proficient enough in Spanish to communicate with patients to the extent we think they should."
The entire medical and administrative staff is bilingual because of the large number of Spanish-speaking patients the center treats.
Arroyo Vista's difficulty in recruiting physicians to Northeast Los Angeles is symptomatic of the chronic problem facing the East Los Angeles area in attracting primary-care physicians to serve a population that is largely low-income and Spanish-speaking, said John Bruce, public health adviser for the federal Department of Health and Human Services. Bruce oversees operation of 10 community health centers in California.
"No question about it, it has the highest unmet need of any area of comparable size in the entire region," Bruce said, contrasting East Los Angeles with the rest of the department's Western Region, which includes California, Nevada, Arizona, Hawaii, American Samoa and Guam.
According to federal statistics, there is one doctor for every 9,131 people in Northeast Los Angeles, which has a population of 131,489--a figure that does not include residents who are in this country illegally, Bruce said.
"That's a pretty high ratio," Bruce said, adding that the government considers a ratio of one physician for every 2,000 acceptable. "There ought to be three times the number of doctors in that area."
The shortage of health-care facilities led the federal government to designate Northeast Los Angeles a "health manpower shortage area" and "medically underserved area" six years ago, Bruce said. The area thus qualifies for federal funds for operating a clinic whose fees are based on ability to pay.
The first year of operation, the federal government granted the clinic $366,729. That figure has steadily increased to $607,722 this year, Bruce said.
The area also qualifies for the free services of two physicians who, under assignment to the National Health Service Corps, work at Arroyo Vista in return for medical school scholarships they received from the federal government.
Bruce said most young, unestablished doctors stay away from low-income areas because, "unless they work for a community health center" which pays their salaries, "they wouldn't be able to make a living there."
Few Have Insurance
Medical director Ross said 60% of the center's patients have no insurance, either private or the publicly provided Medi-Cal. Of those who pay for their own care, about 75% can afford just 20% of the actual cost, Ross said.
"That makes it hard to make ends meet," Ross said.
Ross and other clinic administrators hope the new facility will help draw patients who either have insurance or who can pay the entire cost of their care.
Budget troubles were not the only difficulties plaguing the center.
The delay in building the new center was caused by controversy surrounding the original sponsor, The East Los Angeles Community Union, or TELACU, said Gloria Garcia, Arroyo Vista's executive director. The anti-poverty group ran into trouble in 1982 when the federal government conducted an audit that revealed improper use of millions of dollars in grants.
The audit led federal and local agencies to cancel contracts with TELACU and resulted in the group's chairman, Joe L. Gonzales, and his wife, Blanca, pleading guilty to felony charges. TELACU is still operating but only with private funds.
Arroyo Vista, known at the time as TELACU Family Health Center, severed ties with the group in November, 1982. However, about two years passed before health center officials could persuade the city and county to release funds that had been appropriated for the center, Garcia said.
"That was awful," she said of the effect of the TELACU controversy on negotiations for funds, which were nearly complete when "the whole TELACU issue blew up."
The city provided seed money for the permanent building in 1980, appropriating $1,036,906 in federal community development block-grant funds and city funds. The county added $320,000 in block-grant funds.
Atlantic Richfield Foundation made the first private donation, granting the center $100,000 in 1984, Garcia said. Soon afterward, four other foundations gave a total of $380,000.
The Health and Human Services Department provided $300,000, which could be used only for equipment.
Because the city is the largest donor, it will own the building. Arroyo Vista will lease the facility from the city until it can raise money to buy it.
The site was chosen because of its central location and proximity to bus service along Figueroa Street.
Initial opposition from the business community was overcome when center directors agreed to build the health center on the edge of the business district instead of in the middle. And Wanda Hatler, president of the Highland Park Chamber of Commerce, said merchants feel better about the center now that it is no longer affiliated with TELACU.
"People just didn't trust TELACU, and they found out they had a reason not to trust them," Hatler said.
Some merchants say they are looking forward to the opening of the health center in the hope that its increase in staff and clients will boost sagging commerce along North Figueroa Street.
Robert Siraganian, owner of Submarine Express sandwich shop across from the new site, said he is eager to see construction begin.
"If this was going to fall through," Siraganian said of the center project, "I was going to put the place up for sale and move on."