Free Medical Clinics May Soon Feel Budget Pinch From Political Battle

Isabel Ayala, six months pregnant and uncomfortable after waiting three hours for her prenatal care appointment, could still manage a smile. The 21-year-old Anaheim woman is accustomed to long waits at the Community Clinic of Orange County, the facility where she gets free medical care once a month.

Ayala is one of thousands of Orange County residents who receive free care because they are indigent, have no medical health benefits or receive federally funded Medicare assistance.

At the Community Clinic, 2000 W. Walnut Street, Santa Ana, long waits are necessary. No one is turned away at the clinic, which is run by the UCI Medical Center, but non-emergency treatment is slow. Many of the 120 patients seen each day arrive early in the morning and do not see a doctor or nurse until noon, sometimes a little later.

Ayala was getting hungry. It was past 11 a.m. and she still had little idea of when she would be seen.

‘Always Like This’

“It’s always like this. But I really don’t mind. There’s nowhere else I can go,” she said.

Three-year-old Lucinda Roman tugged at her mother, Petra. Lucinda was in the clinic to have some sores on her legs examined. “Mama, I’m tired and I want some soup,” she pleaded with her mother.

Roman, who said she has been coming to the clinic for six years, could only shrug. Her face was full of exhaustion.

“It’s not so bad. I’ve only been waiting for an hour today. Sometimes I have waited up to four hours,” she said.

County health officials, however, indicate that if Gov. George Deukmejian and Democratic legislative leaders do not resolve a bitter budget fight, cuts will have to be made that could mean even longer waits for clinic patients.

Clinics that treat low-income residents could feel the budget pinch as early as next month.

The funding dispute involves $283 million in statewide education and human services programs, including more than $3.3 million in medical funds for Orange County. Last year, the state allocated to counties a new category of funds to help cover the costs of caring for increasing numbers of indigent patients. Earlier this year, the governor vetoed this category.

Agree on Funds

The political battle in Sacramento does not revolve around a lack of funds. Both Deukmejian, a Republican, and Democratic legislative leaders say that funds are available and that the cuts are unnecessary.

What the two sides have not been able to agree upon is where the money to pay for the programs should come from. Democrats want to tap a $1-billion budget surplus. But Deukmejian, who has made fiscal responsibility a major plank of his reelection campaign, has insisted that the surplus be maintained for unforeseen emergencies.

Deukmejian wants those programs financed with surplus money from the state public employees retirement fund. In previous years, health care for the indigent has been financed through the state’s general fund.

State lawmakers remained in the capital this past week for an unusual extended legislative session to resolve the matter. AB 3216 was passed and sent to the governor. However, a Deukmejian aide said the governor will not consider the bill for at least another week.

Health officials, however, say the cuts could take effect beginning Oct. 1 if the state funding is not provided.

Thomas Uram, director of the Orange County Health Care Agency, which administers the indigent health care programs, is not optimistic.

“I’m afraid the governor is going to veto the bill again,” Uram said.

In Los Angeles County, which stands to lose $20 million, officials say that health services for the poor will be curtailed. But Uram said that would not be the case in Orange County, although some alcohol abuse and mental health programs might be diminished.

He said the alternative would be to provide less money for the 33 local hospitals and 1,400 physicians under contract with the county to provide indigent health care. Currently, hospitals and doctors under contract receive a percentage of what the normal medical fees would be.

Those who contract with the county to provide health care for the poor handle about 30,000 patient-visits a year. The Community Clinic of Orange County, the largest single facility that provides indigent health care, handles at least 6,000 patient visits each year. In all, the County Health Agency estimates that 4,700 indigents are eligible for medical services each month.

Fears Loss of Doctors

And although Uram insisted that most services will not be slashed, he said he was worried that some doctors will choose to end their contractual obligations with the county.

“We’re afraid that lowering the funds would cause some to drop out of the contract,” he said. “If they don’t like what is happening, they could drop out.”

Dr. Scott Ekdahl, the medical director of the Community Clinic, said that if the political dispute in Sacramento is not settled satisfactorily, care for the poor will indeed suffer.

“My feeling is that there is already a tremendous need for the poor,” Ekdahl said as a group of mostly Hispanic patients waited in the clinic’s crowded reception room.

“Poor people are out of work and they need the medical attention. They can’t put up with this. We’re still unable to do what we’re suppose to do as it is. We’re already ‘maxed out’ and, unfortunately, it takes long, long hours to take care of these people.”

Although no one is turned away at the clinic and the waiting seems endless on occasions, Ekdahl said the facility will not close until every patient has been treated.

He also said that more personnel, especially in administrative posts, are needed in the county to deal with the poor, many of whom speak little or no English. At the Community Clinic, 48% of the patients are Hispanic and 30% are Asian.

“It’s very intimidating when a Cambodian family of eight or nine comes in because we cannot effectively communicate with them. Consequently, sometimes they choose to go without treatment or do it themselves,” Ekdahl said.

The clinic director added that it is unfair for the state to force the doctors and nurses who work at health clinics for the indigent to perform their tasks for even less money than they currently receive.

“It takes special people to provide that kind of care for the poor,” Ekdahl said. “To expect them to do it with even less funding . . . well, I just don’t see how we could do that.”