Children’s Hospital & Medical Center of San Diego agreed Tuesday to run the medical portion of the school-based health clinic being planned at Hoover High School in East San Diego.
The agreement is a major step forward for clinic planners, who will now be able to cite the backing of Children’s Hospital in soliciting private foundation money for setting up and operating the clinic. The hospital has a strong reputation for quality pediatric care and the expertise for handling serious medical cases, throughout San Diego and Imperial counties.
Hoover planners expressed pleasure with the decision by hospital trustees. The collaboration has been under discussion for almost six months between the school and the hospital.
Under existing plans, the hospital will operate a primary care clinic based at Hoover under contract with the school district, similar to the way Childrens Hospital of Los Angeles runs a 3-year-old clinic at Los Angeles High School.
“Trustees decided that this is a worthwhile program, that we want to expand somewhat into adolescent care, since we are known primarily as a baby-care hospital, and we know that studies show these high school kids are not getting their health care needs met,” said Steve O’Kane, vice president of ambulatory and clinical care at Children’s Hospital.
O’Kane said that trustees discussed Tuesday the controversy that surrounds school-based health clinics nationwide, in large part a result of Catholic diocesan opposition to the fact that many clinics include reproductive and family-planning services, such as providing contraceptives and abortion counseling.
“Basically, we agreed that the risk should not be one to stop us moving forward,” O’Kane said.
As the clinics get started, however, no reproductive or family-planning services will be offered, a Hoover planning committee has already decided.
O’Kane believes that Children’s Hospital, together with Hoover, will prove “an intriguing combination” to a lot of foundations. O’Kane said that the joint federal-state maternal health child grants could be sought by clinic planners.
The concept of a pilot clinic at Hoover High was approved by San Diego school trustees in May, 1989, over fierce opposition largely from religious groups, with the proviso that no school district funds be used to set up or operate the facility.
The Hoover plan parallels other projects in the San Diego district, particularly one called New Beginnings, in trying to have more social services located on a campus. But the Hoover project goes beyond offering coordination of services to breaking ground by providing actual medical care.
Since May, 1989, various committees of Hoover parents, teachers and East San Diego-area residents have been thrashing out details and looking both for medical and counseling providers as well as funding. Committee members have the final decision over what services the clinic should offer and to what extent parent approval will be required before students are eligible to use the clinic.
Jerry Moss, a Hoover parent who heads a clinic advisory committee, said Tuesday that it is believed that there are enough free or low-cost services in the city now to handle reproductive counseling. “We want to handle the basic health-related services that students do not have access to,” he said.
Studies done by medical planners for Hoover administrators two years ago showed that a majority of students do not have basic medical care available, and many families have neither government nor private insurance to help pay for basic medical care.
“Those services are medical, dental, nutritional and counseling care,” Moss said, adding that Hoover parents wanted to avoid the question of contraceptives complicating the start-up of the clinic and causing further controversy.
All plans must come before city schools trustees later this spring for final approval before the clinic can move ahead with any construction and operation for next year. Hoover principal Doris Alvarez estimates that at least $250,000 is needed to remodel the former campus auto shop into a clinic area.
O’Kane said that, if San Diego follows the Los Angeles model, a nurse-practitioner will be stationed full-time at the clinic, with pediatric physicians on call for more serious cases. Specialists ranging from dermatologists to ophthalmologists rotate through the Los Angeles clinic weekly to see students referred to them.
Children’s would attempt to maximize collections from government and other medical insurance programs that the predominantly working-class families of students may qualify for, but the clinic would need foundation funds to cover part of operating costs, O’Kane said.
The Los Angeles clinic, with a $250,000 annual budget, covers only 5% of its costs through medical insurance reimbursements, O’Kane said. Hoover students might be able to provide up to 40% of costs through insurance programs. “But we plan to provide our services at cost and just want to break even; we realize there is no money to be made in this,” O’Kane said.
Hoover, administrators plan to offer comprehensive counseling services and dental care as well as medical treatment.
Clinic planner Nancy Siemers said Tuesday that informal agreements have been arranged with five social service agencies to provide comprehensive counseling on the campus. She said also that the Fieldstone Co., a residential builder, has offered to remodel part of the auto shop for the counseling services, using donated building materials. That could be done by spring, she said.
“We’d like to go ahead as soon as possible with the mental health component, including police diversion work, general counseling, alcohol and drug counseling, as well as job counseling,” she said. Siemers also downplayed the importance of offering family planning counseling, saying that much of that is done already in existing sex and family education classes at the high school level.