Difficult to Get Appointments : Demand for Prenatal Care Bogs Down Public Clinics

At the first sign of pregnancy, Sonia Iranpoor was delighted. Immediately, she felt an overwhelming desire to protect and nurture this precious new life. She knew that she should see a doctor soon.

But trying to get an appointment at a public health clinic in Los Angeles County can be a cruel experience, she discovered. She never did get one.

“I was so upset,” she recalled in a recent interview. “I know how important it is to take care of the baby before it is born. I may be poor, but I will pay for this care, anything for my baby.”

Iranpoor first tried calling for an appointment on the day before Christmas last December, when she was two months’ pregnant.

Called ‘Every Five Minutes’

She said she tried “calling and calling and calling, every five minutes” to schedule an appointment at the Hollywood-Wilshire Health Center.

The clinic, at 5205 Melrose Ave., sets aside one day a month to take calls for prenatal appointments.

When she finally got through, just before the office closed on Christmas Eve, she was told that all appointments were booked and was advised to call back on Jan. 26.

On that date, Iranpoor said she started calling before the clinic opened at 8 a.m. and continued “calling, calling, calling.” But the line was always busy. In frustration, she went to the clinic.

Five other pregnant women were there trying to get appointments too, she recalled. One told Iranpoor that she had been trying to get prenatal care for months and was now bleeding during her seventh month of pregnancy.

Request Refused

Iranpoor went to the patient intake window to ask for an appointment, but her request was refused. She was told that she had to make an appointment over the phone.

So she clutched her purse and headed down the hall for the clinic pay phone. The line continued to be busy. She left, angry and tearful.

With the help of friends, Iranpoor finally found prenatal care at a Planned Parenthood clinic and recently delivered a healthy 8-pound, 9-ounce boy.

Dr. Dorris Harris, north area chief for the county health department, described the prenatal care situation at the Hollywood-Wilshire Health Center as “cruddy” and said there has been no improvement since December, when Sonia Iranpoor tried to schedule an appointment.

Harris said additional funds recently approved by the Board of Supervisors to help ease the prenatal care crunch countywide will definitely help, but she fears that they may prove to be “just a finger in the dike.”

Prenatal visits at county clinics jumped 48% between 1983 and 1987--from 157,000 visits a year to 232,000.

With the growing demand for prenatal care, the county has fallen far behind in meeting its goal of making women wait no more than two weeks for prenatal appointments at the clinics.

At the urging of Supervisor Ed Edelman, the board recently allocated an extra $1 million to the clinics for 47 additional medical personnel. With the extra funds, the clinics are expected to reduce appointment backlogs and provide prenatal care to 15,750 new patients.

Not a Panacea

More money will help, but it will not necessarily solve the problem.

“I don’t see this as a panacea. I don’t see $1 million or even $5 million as the solution,” said Larry Roberts, deputy director for health center operations for the county. “As a rule, the more capacity we create, the more patients we get.”

A survey by the Southern California Child Health Network last summer found a 16-week wait for women using the Hollywood-Wilshire Health Center; 12 weeks at the Hubert Humphrey Comprehensive Health Center, and 10 weeks at clinics in North Hollywood, Lawndale and Canoga Park. Only three of the 13 clinics surveyed had waits of less than six weeks.

Sometimes, getting the first appointment required two trips: one to fill out forms for an appointment and another for a physical examination. Some clinics take calls for appointments only during the last week of each month.

Typically, openings were filled on the first day, and women unable to make appointments had to wait an entire month before they could try again. In many cases, the telephone lines were busy for hours at a stretch, the survey found.

Acknowledge Backlogs

County health officials readily acknowledge big backlogs for prenatal care at many county clinics. A survey of 21 clinics by the county in March, 1987, found that 18 had waits of four weeks or longer, 10 had delays of six weeks or longer and five had waits of eight weeks or longer.

A June report by the Legal Aid Foundation pointed out that even those women who did get access to the clinics often spent hours waiting for care. At 14 prenatal clinics, women waited an average of two hours for their appointments, and “it is is not unusual to have pregnant women spend three or more hours,” the report said.

The ambiance of the public clinics is a far cry from the serenity of a private obstetrician’s waiting room--no air conditioning, soothing background music or colorful aquariums.

Especially during the summer, when fans are often broken and all the chairs are taken, pregnant women have fainted while standing in line, doctors said.

In some parts of the county, women who do manage to see a doctor are spending little time in consultation. At the crowded North Hollywood clinic at 5300 Tujunga Ave., Carmen Cordero said the clinic’s obstetrical team typically examines 30 to 40 women during a four-hour session. That should be cut to 20 patients, and the number of prenatal sessions doubled when new funds arrive.

Some Clinics Better

Some clinics have succeeded better than others in meeting the rising demand for prenatal care.

The Central Health Center on North Figueroa Street in downtown Los Angeles provided 13,527 prenatal care visits in 1987--three times its 1984 caseload.

“It was a matter of utilizing what resources we had and making . . . patient care a priority,” said Dr. Dorothy McVann, area chief of health for the eastern quadrant of the county. “I personally feel it’s a management issue. . . . You’ve got to get everybody out working on the line.”

With no additional funds, she said, she has more than doubled prenatal care services by shifting around clinic personnel and eliminating “down time” among clerical workers.

In South-Central Los Angeles, the need for prenatal care is especially acute, but the public clinics that provide it have not seen much of an increase in their patient visits during the last three years.

Patient Load Drops

County statistics show that the patient load at five clinics serving this area have increased only slightly during the last three years. Visits are actually down 13% from last year.

Dr. Margarita Velarde, Compton district health officer, said visits to two clinics in her jurisdiction--Dollarhide and Paramount--have mysteriously dropped from 7,100 to 6,899 in the last year.

Several county health officials suggested that a long history of management difficulties are partly to blame for the relatively low patient load.

The post of area chief for this part of the county has turned over three times since 1984. A shortage of doctors has plagued the obstetrical program. And clerical personnel until recently were not booking enough patients to offset patient no-shows, they said.

But Velarde said clinics have recently begun seeing more patients. This is because additional funds have been allocated for prenatal care by the county supervisors and a new performance standard was set requiring clinics to schedule at least 10 new patients for every four-hour session.

In the past, Velarde said, only eight patients were scheduled. “Sometimes only six, or seven or sometimes only four” would keep their appointments, she said.