Storefront Clinics’ Care Faces Scrutiny

Thousands of low-income immigrants are flocking to storefront medical clinics that have sprung up on street corners and in mini-malls throughout Southern California--walk-in, cash-only facilities where the service is quick but the quality of care, authorities say, can be dangerous.

Most are legitimate operations that give the poor and working class access to medical attention they might not otherwise have.

But authorities say an increasing number are unlicensed facilities where unqualified and overworked employees practice medicine illegally.

They do a brisk business. One four-clinic chain, whose operators face trial for the unlicensed practice of medicine and related charges, was attending 1,000 patients a week when police raided it last year.

Through court records, medical investigators’ reports and interviews with former employees and patients, a number of examples emerge of alleged illicit medicine at clinics frequented by immigrants:

* A man previously convicted of illegally practicing medicine is accused of using his wife’s license to treat scores of patients in Spanish-speaking neighborhoods.

* A doctor schooled in Mexico but not authorized to practice in this country repeatedly failed a test that measures medical knowledge, yet was hired by clinics twice.

* A doctor whose license was revoked in 1987 answered a newspaper ad and started attending patients in a clinic in the Westlake area, authorities said. His true status was revealed only by a chance encounter with a physician familiar with his history.

The Los Angeles city attorney’s office says the number of bogus-clinic cases it has prosecuted has doubled since 1986, to about 12 last year. But many go undetected, and those that are shut down by police often reopen days later.

“These clinics spring up not only in poverty neighborhoods but more in neighborhoods where there is an ethnic community, where people prefer to go to (doctors) of their own ethnic group,” said Joan Jerzak, supervising special investigator for the Medical Board of California, which is empowered to investigate complaints about doctors.

“People might not even know whether the doctor has a license,” she said. “The doctor says he’s a doctor, and they believe him. It’s a man or a woman with a white coat and a stethoscope, who says ‘ doctor ,’ and that’s it.”

A legal loophole in the state Health and Safety Code allows some clinics to fall into a gray area that is not closely monitored by any regulatory agency.

Normally, a clinic must be licensed by the state or, in the case of Los Angeles, by the county, whose agencies are in charge of regulating the facility. But a doctor can bypass the county by incorporating, obtaining a fictitious business permit from the Medical Board and using the term “clinic” to label his or her private practice. In those cases, the clinic is not subject to the same regulatory scrutiny that county-licensed clinics receive.

And, in many cases, the doctor illegally fails to obtain the fictitious-business permit, meaning no agency at all is responsible for inspecting the facility.

Even if there were more scrutiny, officials say, bogus clinics are likely to flourish for other reasons. Their storefronts fade into their densely populated community, attracting little official attention. Their mostly immigrant patients--many of them in this country illegally--fear authorities and will not report poor medical care.

The clinics can tap quickly into a ready and huge clientele--a pool of patients whose health-care options are already limited by poverty, illegal status, culture and mistrust. They are reluctant to go to government-run hospitals but eager to find practitioners who speak their language.

The case of Leopoldo Torres, 40, is typical. Unable to take time off work to spend in the waiting rooms of county hospitals, he went to an East Los Angeles clinic that he had heard of through family word of mouth. They spoke Spanish there. He felt comfortable. He trusted.

Now, Torres blames his partial blindness on the care he received at the unlicensed clinic. The personnel treated his symptoms, giving him vitamin shots and drugs, but ignored his diabetes, he says. Treatments sometimes cost $150--nearly half his weekly earnings as a food-truck vendor.

He never suspected the clinic’s “doctors” were unlicensed--until police shut the facility last year.

“How can you know?” Torres, a native of Mexico, asked in Spanish. “Supposedly, they were doctors. If I had known, I would not have gone. Going to a witch doctor would have been better.”

When health inspectors climbed a wide flight of stairs and walked into the second-floor offices of the Santa Ines Clinic, in the Westlake District near MacArthur Park, they found unlicensed workers examining urine specimens under a microscope and administering intravenous infusions, according to court documents.

In one examination room lay an elderly Mexican woman with an IV tube attached to her arm; in another room sat a younger woman suffering from facial pains.

In a third room sat a 14-year-old boy. The investigators asked the youth why he had come to the clinic, and he said he had “an infection.”

“He showed me a 2-centimeter broken skin area on his right wrist and stated that he also had a sore in the groin area,” one of the inspectors, a registered nurse employed by the county Department of Health Services, reported in court papers.

“I asked him what caused this, and he said that the doctor had told him it was caused because he ‘ate’ too much bread or something like that.”

Inspectors were so alarmed by one patient’s condition that they called paramedics to take her to a hospital, said David Childress, a county health facilities surveyor who led the inspection.

“It was a questionable operation,” Childress said in an interview. “Whenever you have untrained people giving injections, starting IVs, giving treatment . . . there’s always a potential for danger or injury.”

On that day last summer, police arrested Salvador Cano and his wife, Dr. Enriqueta Silva, identified in court papers as sole shareholders in the Santa Ines Medical Enterprises Inc., which managed Santa Ines and three other clinics. Silva is a licensed physician. Authorities allege that Cano used Silva’s license, prescription pad and even the masculine form of her name--Dr. Enrique Silva--to write prescriptions and treat patients.

Cano, who was convicted in 1986 for the unlicensed practice of medicine at the same location, faces trial later this year on three misdemeanor counts of practicing medicine without a license and 68 other counts, including Labor Code violations. Silva is charged with aiding Cano by lending him her medical license. Both deny the charges.

Silva also has been accused by the Medical Board of signing a death certificate for a patient she never saw and of failing to notify the coroner’s office of the patient’s death, according to a complaint obtained by The Times. She faces a hearing and could lose her license.

The patient, Maria Pena, a diabetic mother of four, died Jan. 22, 1989, after receiving treatment at a clinic in the Santa Ines chain, the complaint states. Pena’s family has filed a wrongful-death suit naming Silva, Cano and the corporation.

Silva is contesting the Medical Board accusation. Her attorney, Joshua Kaplan, declined to comment further except to deny the charges against her.

In court papers seeking a separate trial for Silva, Kaplan stated that if her license had been improperly used, it was “without the consent of Dr. Silva.” Kaplan added that Silva had no hiring or employee-relations responsibilities in the clinics and suggested he would argue that Cano exerted a Svengali-like influence over Silva.

Cano’s lawyer, Ed Tolmas, labeled the Svengali characterization as “crazy.” Tolmas said Cano has a medical degree from a university in Mexico but that his role at Santa Ines was limited to bill-paying and other administration tasks--not the practice of medicine.

Five other people involved in operating the clinics were also charged with Cano and Silva. They were James E. Mack, a disbarred attorney identified in court papers as secretary of the corporation; Frank Hegyi, a licensed chiropractor who is also accused of threatening to turn in an employee to immigration authorities if he spoke to investigators; Bruce Miller, an accountant for the chain of clinics; and Kelly S. Klatt, a Los Angeles police officer on disability leave, and his wife, Samantha, identified as former clinic administrators.

All claim innocence. Kelly Klatt, tried separately, was convicted last fall of unfair labor practices and misrepresentation to the public by claiming the clinic was a legitimate medical clinic.

Most of the charges in the Santa Ines case involve labor practices and tax evasion. A separate investigation by the Division of Labor Standards Enforcement of the state’s Department of Industrial Relations turned up a number of alleged violations: employees were required to work up to 11 hours a day, six or seven days a week, without receiving overtime pay.

Authorities said the clinic administrators, who often paid employees in cash, failed to withhold taxes and underreported the size of its payroll. Employees were owed back wages exceeding $100,000 but, because they were undocumented immigrants, could be counted on by clinic administrators to keep quiet, police said.

Cano was “running a sweatshop,” said state Deputy Atty. Gen. Gary Wittenberg. In addition to the criminal charges filed by the city, the state is suing Santa Ines Medical Enterprises, Cano and some of his co-defendants in Superior Court in an effort to exact civil penalties and recoup back wages allegedly owed the clinics’ workers.

“We did not know he (Cano) was not a doctor,” a former employee told The Times. “Everybody always called him ‘Doctor.’ He always used the name Dr. Silva, Dr. Enrique Silva.”

The former employee, who asked that her name not be published, worked for nine years in a hospital in her native Ecuador but has no U.S. license. She served as a medical assistant in the clinic. In an interview, she described long hours, days without lunch breaks, and duties for all the employees that ranged from mopping floors to clerical work to giving shots and pregnancy tests.

“We all did a little of everything,” she said. “I had experience but many (co-workers) did not. One had worked as a secretary in Mexico; here, she worked as a nurse with Dr. Silva. Another had never worked anywhere. She didn’t know what a syringe was. The doctor showed her, more or less, and she was giving injections, regardless of what might have happened.”

Former employees have told investigators that while an average visit would cost $20, many patients ended up having to pay $100 by the time tests and treatments had been prescribed.

Tolmas, Cano’s lawyer, contended that Cano and Santa Ines were a “clean operation” that had been unfairly singled out.

“If you drive up and down 7th Street from two blocks east of Alvarado . . . you can turn your head left and right, and every place says ‘Clinica, clinica,’ and (I’m told) there are no doctors in those places,” Tolmas said. “Why Cano and that facility are being singled out personally bothers me.”

Tolmas added that since the first injunction last summer, Cano and his staff have followed all of the court’s instructions, such as taking down the “Santa Ines Medical Clinic” sign. Further, he argued, the clinic had provided an important service for the community by offering medical care to the indigent.

Under a Superior Court judge’s orders, Silva is allowed to continue in private practice; her offices are at the former site of the Santa Ines Clinic. And Cano has been allowed to continue to work in clinic administration while he awaits trial.

Wired to a listening device, an undercover medical board investigator using the name Ernesto Zapata entered the All Stars Medical Clinic in East Hollywood last fall, complaining of stomach pains and a burning sensation in his gut.

The “doctor” who examined him, according to charges filed last month in Municipal Court, was Andres Lugo, a man who said he was trained as a physician in Mexico but who did not have a license to practice medicine in the United States. According to the complaint, Lugo, 35, later told investigators he had failed to pass--three times--a medical test routinely given to graduates of foreign medical schools that would have allowed him to study for a license in this country.

Lugo poked around Zapata’s stomach and asked questions about other symptoms, about what he had eaten, how much beer and tequila he had consumed and whether he had any history of heart or kidney trouble, according to a transcript of the secretly recorded conversation filed in court. An assistant took Zapata’s blood pressure.

Lugo diagnosed Zapata as having gastritis and prescribed Mylanta and a drug used in treating ulcers, according to the transcript. Investigators said Lugo later acknowledged using a prescription pad pre-signed by the licensed doctor who runs the clinic.

Once Zapata dressed and left, investigators moved into the All Stars Clinic, arrested and handcuffed Lugo and took him to jail. He was released on his own recognizance and is scheduled to be arraigned this month on three misdemeanor counts of unlicensed practice of medicine and falsely advertising himself as a doctor.

Lugo told investigators he was hired by Dr. Jairo Gomez, a psychiatrist, to help run the clinic, according to court documents. Prosecutors say Lugo was also hired last year to fill in for a sick doctor at a clinic in Whittier. He had checks printed with the title “Dr.” before his name, court records show.

Lugo could not be reached for comment. Gomez, who has not been charged, told The Times he hired Lugo to work as a “medical assistant” to perform specific tasks but not to practice medicine. While declining to discuss details of the case, Gomez said Lugo was not authorized to use his prescription pad.

Staffing a clinic for low-income patients can be difficult, Gomez said, because there is a shortage of bilingual, well-trained, highly qualified personnel willing to work “in a ghetto.”

“Someone (can be) quite qualified but credential-wise cannot practice,” he said. “It is kind of a paradox; they are accepted by society to work but are deprived of making a living.”

In a sense, it was the Clinica Medica General that became the alleged victim. The Westlake facility put an ad in a newspaper seeking a doctor for occasional, part-time work. Within days, Victor A. Matalka responded, presented a photocopy of his medical license to a clinic administrator and allegedly began treating patients.

But what he failed to mention, according to criminal charges filed last month, was that his license had been revoked three years earlier. Matalka, a 56-year-old Yale graduate, lost his license amid charges he prescribed drugs without examinations, records show.

Three days after Matalka started practicing at the Clinica Medica General, a doctor who had served on the Medical Board panel that revoked Matalka’s license visited the clinic as a consultant, the complaint says. He immediately reported Matalka to the board, and an investigation ensued.

Matalka faces arraignment this month on five misdemeanor counts of illegal practice of medicine and false advertising. A woman answering a telephone number registered to Matalka said there would be no comment on the case.

The clinic, which authorities said was not at fault because it correctly required Matalka to show his license, was not charged.

“But for that (the other doctor’s visit), he would still be working there,” said Deputy City Atty. Ellen Pais, who is prosecuting the case.

The boom in unlicensed medicine in immigrant communities underscores the issue of access to medical care. As authorities crack down on illegal clinics, they--paradoxically--reduce the amount of medical care available to thousands of low-income immigrants.

Some immigrant-rights advocates argue that the care provided by practitioners trained in other countries, whether or not they have U.S. licenses, is better than no care at all. Many otherwise qualified doctors are barred from working here legally because their immigration status is irregular, these advocates say.

But regulators disagree. Said Wittenberg of the attorney general’s office: “When you practice medicine without a license, whether you do it right or wrong, it’s illegal, and that represents a danger.”