Steady Pulse of Health Clinic in L. B. Jolted as Insurance Pinch Cuts Hours

Doctors and nurses at the Westside Neighborhood Clinic stir their morning coffee with disposable medical tools.

“Nothing is wasted here,” said Germaine Schwider, administrator of the clinic.

Donated by a retired doctor, the instruments were not used on patients because they duplicate tools that come included in laboratory kits. So thrifty administrators put the extras to use near the coffee machine.

Indeed, for 11 years the clinic--the only one of its kind in Long Beach--has offered low-cost medical services to a largely Spanish-speaking clientele with the sparse efficiency borne of economic necessity. Also, the clinic--in what used to be a Sunday school next to Garfield Baptist Church on 23rd Street--has served as a teaching facility for medical students from throughout the area.

For most of that time the clinic’s budget, which in 1986 will be about $228,000, has remained roughly balanced. Supplemented by individual and corporate contributions, teaching contracts with area institutions and low overhead made possible by the church-donated space, the clinic supports itself largely through its sliding scale of fees, which average $15 per visit.

No Nighttime Hours

This year the situation could drastically change. Dramatic increases in the cost of medical liability insurance have forced the clinic to eliminate its nighttime hours. The loss of income from that business, coupled with the higher premiums, is expected to create a deficit of $20,000.

The curtailed hours also mean that many working clients who have no medical insurance must choose between taking unpaid time off from work to go to the clinic during the day or forgoing medical treatment altogether.

“Their only (other) option is to go to the emergency room,” Schwider said. And to do that, she added, would be extremely expensive.

The cutback in service and resulting deficit have their roots in a changing health-care and insurance environment in which small community clinics that charge low fees are paying liability rates comparable to those paid by larger clinics that charge customary fees and have substantial revenues.

Founded in 1975 by a group of area residents armed with a $25,000 donation from a local Presbyterian service organization, the Westside Neighborhood Clinic treated 1,100 patients in 1978--the first year in which records were kept--for everything from minor aches and pains to ailments involving children. By last year, the annual patient load had grown to 6,000--85% of them Spanish-speaking--and this year, according to Schwider, the clinic expects to see 7,000 patients.

More Seriously Ill Patients

Also, Schwider said, as the client load has increased, cuts in state and federal medical benefits have changed the health care environment, prompting more seriously ill patients who otherwise might have seen private physicians to seek help at the clinic. Thus, she said, this year, for the first time, the facility treated several cancer patients.

“We’re meeting a real need,” said Dr. Lawrence P. Cutner, the clinic’s only staff physician, who works half-time there for $40,000 a year. “Most of these people don’t have any benefits or medical insurance. It’s a great mission.”

One thing that makes the clinic unusual, he said, is its emphasis on “humanistic medicine.” In treating patients, Cutner said, he and the residents, interns and nurse practitioners who assist him emphasize preventive measures and life style changes aimed at promoting overall health and well-being.

“You can have all the exotic medicines in the world,” Cutner said, “but if people are dissipating their lives away . . . the medicines won’t help.”

For the past 1 1/2 years, he said, the clinic has even conducted a teaching project in which medical students and nurses are videotaped and later critiqued on their communication skills during patient examinations. Communication is especially important, he said, during encounters with non-English-speaking patients, when eye contact and nonverbal cues are essential.

“It’s sort of a country doctor approach” is how Schwider describes the clinic’s way of doing business.

2 Insurers Out of Business

Recent changes in health care and the national insurance climate, however, have put that approach in jeopardy. In the past several years, Schwider said, two companies that were issuing medical malpractice insurance to the clinic have gone out of business.

“Because we’re a community clinic, we’re (now) considered high-risk even though we haven’t had a claim filed against us in 11 years,” she said. As a result, when the facility lost its most recent insurance carrier earlier this year, it found it nearly impossible to find a new one. And when a new carrier was finally found, the only policy available was one costing $8,000 to $10,000 a year for a 20-hour week-- more than twice the $4,000 the clinic paid last year to cover 40 hours.

“Community clinics have a lot of unique problems because of volunteers and high turnover,” said Nancy Baker-Velasquez, an agent with Insurance Center Associates of San Gabriel, which represented the Westside Neighborhood Clinic in its search for coverage. Because they now serve more people and perform more complicated medical procedures than in the past, she said, small neighborhood clinics like the one in Long Beach are more open to lawsuits. As a result, she said, insurance companies consider them high-risk and are generally unwilling to provide the less expensive coverage that was available before.

“It’s frustrating,” said Baker-Velasquez, who has specialized in community clinic insurance since 1974. “You want to provide what your clients need, yet you know that the insurance cost is going to eat up a good percentage of their budgets. They are really in a bind.”

Fees Bring 60% of Income

About 60% of the clinic’s income comes from the fees charged its clients, according to Schwider. The rest comes from Medi-Cal payments, contributions from individuals and corporations such as the Polaroid Foundation, Monsanto and Arco, and teaching contracts with the College of Osteopathic Medicine of the Pacific; Memorial Medical Center; California State University, Long Beach; and Pacific Hospital of Long Beach.

Because it could not afford the higher-priced, 40-hour policy, Schwider said, the clinic opted for the 20-hour policy, which required the elimination of the facility’s only evening hours--Tuesday nights. With the loss of income from the 25 to 30 nighttime clients and the increased cost of the part-time insurance, Schwider said, this year’s deficit could be the highest in the facility’s history.

Clinic officials hope to reduce it by appealing to the community for increased donations.