Rough Road for Traveling Clinic : Without UCI Center’s Doctors, Van Loses Its Appeal to Poor

For 8 years, a small white medical van has traveled the back streets of Orange County, treating people who would otherwise not seek care because they lack money, health insurance or adequate transportation.

Last year, the Community Development Council’s mobile free clinic saw more than 3,600 patients. In some neighborhoods, people lined up an hour and a half before the clinic was scheduled to open. One or two doctors, assisted by a technician, gave prenatal advice, administered injections and wrote prescriptions for illnesses ranging from infections to malnutrition.

But since January, the number of patients has drastically declined because--officials say--word is out that doctors no longer ride along. The UCI Medical Center in Orange has stopped staffing the mobile clinic, and no other hospital has been willing to fill the void.

UCI officials say when they agreed to provide doctors 3 years ago, they hoped to use the clinic to train physicians in residence at the teaching hospital. But they found that the tiny van--a 36-foot-long converted recreational vehicle--was too cramped to be an effective learning environment.

However, they also acknowledge their general fear that continued affiliation with the clinic would have brought the medical center more patients who could not afford to pay.

“We are really kind of desperate at the moment,” said Clarence W. (Buddy) Ray, executive director of the CDC, the county’s designated anti-poverty agency based in Costa Mesa. “We are getting calls every day, asking when will the clinic be out with a doctor aboard.

“If we could go out and simply hire a doctor we would,” Ray continued. The agency is willing to pay $40,000 a year for a physician to staff the clinic 20 hours a week. “But we need an affiliation with a licensed clinic or hospital or our general liability insurance will not cover us.”

Without doctors, the mobile clinic shut down for the first 3 months of this year. It returned to the road in April but found considerably fewer patients. Now, it is staffed only by a medical services clerk--who doubles as the driver--and a certified medical assistant, who can screen patients for pregnancy, high blood pressure, anemia, diabetes and tuberculosis but lacks the credentials to treat illness.

It remains the only mobile clinic of its kind in Orange County. And unlike many stationary clinics that require patients to disclose their immigration status and pay a $20 fee, CDC officials ask no questions and request only a $5 donation from those who can pay.

Still, Mary Ann Salamida, director of Santa Ana’s Neighborhood Service Center on South Standard Avenue, said she no longer invites the van to stop by because it unfairly raises the expectations of residents, many of whom are Cambodian immigrants or undocumented families from Mexico who need more than basic screening tests.

“They don’t feel comfortable speaking out for their needs. . . . You have to be pretty strong to speak out in another language and demand to be heard,” Salamida said.

Salamida worries that many sick people in the neighborhood are now putting off going to the doctor.

“They let things go too long,” she said, “and then they really get in trouble and have to go to the emergency room.”

In recent years, local medi

cal officials have struggled to cope with a crisis in indigent care. According to the Southern California Hospital Council, Orange County hospitals this year alone will lose $230 million on patients who have no way to pay for treatment or are inadequately covered by state Medi-Cal insurance.

So far this year, three hospitals--United Western Medical Center-Santa Ana, United Western Medical Center-Anaheim and Chapman General Hospital in Orange--have quit taking Medi-Cal patients, and a fourth, Fountain Valley Regional Hospital and Medical Center, has warned state officials that it may do the same.

UCI Medical Center has been the county’s largest provider of indigent care. But it, too, has threatened to stop treating the poor--other than for emergencies--if it cannot obtain more generous state insurance reimbursements.

Dr. Walter Henry, UCI’s vice chancellor of health sciences and dean of the College of Medicine, is scheduled to hold a press conference today to outline how the problem is affecting the county, the state and the medical center.

UCI’s contract with the mobile clinic actually expired last July. But officials agreed to keep providing doctors until the end of the year as CDC director Ray tried to renegotiate.

“We thought we had a contract with acceptable language and that it was going to be approved,” Ray said, but last month, the effort fell through.

‘Minuscule Part’

The final decision was made by Dr. Tom Nelson, the medical center’s associate dean for hospital affairs. In a recent interview, Nelson described the clinic’s dilemma as “a rather minuscule part” of the county’s indigent health-care crisis.

Apart from problems in using the clinic as a teaching tool, Nelson said he was also concerned that continuing the community outreach program might encourage more poor patients to come to the medical center.

“If we didn’t find hospitals in the areas where the patients live who were willing to take them,” Nelson said, “we would have a responsibility to continue the patients’ care. We couldn’t drop them.”

If mobile-clinic patients needed hospitalization, Nelson continued, the UCI doctors would have had a legal obligation to admit them to the medical center if no alternative hospital was available. He acknowledged, however, that the clinic has not generated many admissions at the medical center in the past.

For now, Ray said, the mobile clinic will continue its limited operation while he searches for another hospital or stationary clinic willing to staff it with doctors. But he has also asked the state Department of Health Services to grant CDC a license to hire doctors on its own. He said the state agency has agreed to review a license application, although in the past it has opposed licensing any mobile clinic.

The Monthly Mobile Unit Decline UCI Medical Center is no longer supplying staff doctors to the mobile clinic that treated more than 3,600 people last year.