Van Drives Home Woes in Indigent Health Care

It was raining and the freeways were a mess. I was on my way to a parking lot in La Habra where a mobile pediatric clinic stops once a week.

I was writing another story on indigent care--this one on the troubles that St. Jude Hospital and Rehabilitation Center in Fullerton was having in starting a “mom-mobile,” a new van similar to its 2-year-old pediatric van, that would provide free prenatal care. I wanted to look at the pediatric van, talk to some patients, see how the program worked.

As drizzling rain turned to a downpour, I doubted that any of the van’s clients would show up. But as I pulled into the parking lot, there they were: a dozen parents, their children wrapped tightly in blankets, huddled under a cluster of pine trees. They were waiting their turn to board the van and see a doctor, and trying--not very successfully--to stay out of the rain.

Some of these babies and toddlers, I would learn, were here for routine childhood immunizations--against measles, rubella, mumps. Others waiting in the rain were suffering from colds, ear infections, fever.

Except for the rain, it was just another day at the clinic. Though many of the parents there that day had jobs, most did not have private health insurance, Joan Furman, director of St. Jude’s Care for the Poor program, said later. The van might be their only contact with a doctor outside of an emergency room.

I thought of those parents and children at the van last week.

It was raining again and this time I was driving my 2-year-old daughter, sick with a bad chest cold, to the pediatrician. Only my situation was light-years away from the scene in the La Habra parking lot.

Unlike the parents at the van, my husband and I have health insurance. And a family physician. And when my daughter and I went to see him--first traveling in my heated car, then waiting in his office, with its toys, comfortable chairs and a medical education video playing on the lounge TV--the contrast between my access to health care and that available to the families shivering under the trees seemed stark.

As a medical reporter, much of what I have been writing lately concerns indigent health care. I and other reporters routinely talk to county officials, hospital executives and other health care experts about the 400,000 Orange County residents who don’t have private health insurance. We write about crowding in Medi-Cal maternity wards, trauma centers threatened with closure and last week, two hospitals quitting Medi-Cal because, their executives said, a flood of indigent patients was crowding out patients who could pay.

As I write about the politics of indigent care, sometimes I wonder if readers understand what this is all about--the flesh-and-blood people who have no money and need medical care.

Thinking about the parents and children in the parking lot, I asked Furman and several health care experts last week if they thought the general public understood who Orange County’s medically indigent were. To a person, they answered, “No.”

And asked if newspapers were helping to explain, they said: “Not enough.” Reporters cover crises, said Chauncey Alexander, chairman of United Way’s Health Care Task Force, but are not doing enough ongoing educational or investigative reporting.

Added Furman: “I would like to see a little more of the actual on-the-spot observance (of health access problems) . . . and a focus that would raise the consciousness of the general population and eliminate some of the stereotypes in our county--that (indigents) are lazy, that they don’t want to work, that all they want to do is have babies and they shouldn’t be here in the first place.”

Most of the St. Jude van’s largely Latino clients are legal residents, Furman said, usually working one or two jobs that don’t provide health insurance.

She also noted that indigent health issues were not just a Latino problem. In recession times many Anglo, middle-class county residents “are just a paycheck away” from losing their jobs. “And once they’re out of work, let them try and find a doctor!” she said.

But the average middle-class county resident doesn’t understand the problems a poor person--even someone with a Medi-Cal card--has in finding a doctor, Furman said.

“It’s almost like, if we could have a registry of (white Anglo-Saxon Protestants) that have experienced all the difficulties” of Orange County’s health care system, “and if we could call them to testify” to reporters or county officials, perhaps there would be greater understanding.

Added David Langness, a vice president of the Hospital Council of Southern California: “Whenever I say the word ‘indigent,’ people think of . . . a homeless person, a drug abuser, someone who’s mentally ill--or they think of someone from Mexico”--when in fact many of these people are employed but have no insurance--or recently lost their jobs.

County officials say that of the 24,000 patients who are covered under its Indigent Medical Services program, 54% are male, 73% are Anglo, most are 21 to 34 years of age, all are U.S. citizens and 54% are working either full or part time--and so earn too much money to qualify for state aid under Medi-Cal. Meanwhile, of Orange County’s 63,700 Medi-Cal recipients, 61% are Latino, 21% are Anglo, 10% are Vietnamese, 1% are black and 7% are other races. Many of these recipients work but at low-paying jobs that do not provide health insurance.

But Russ Inglish, another Hospital Council vice president, suggested that, even when reporters accurately describe Orange County’s medically indigent population, “in today’s fast-paced environment,” people may not read the article carefully enough to understand that some of these people are employed. Also, Inglish said, sometimes the description of a typical IMS patient may be edited out of an article “because it doesn’t provide the pizazz.”

And county medical services director Herbert Rosenzweig said he thought reporting on indigent care was overly negative. He also concurred that there was public “confusion” over the differences between IMS and Medi-Cal patients. “I don’t think some of the reporters themselves are aware of the differences,” he said.

Maybe. But somehow the scene of parents and children waiting quietly in the rain to see a doctor brought the image of Orange County’s indigent health care problems home to me.