Curing Kids : Collaboration between the county and private-sector physicians offers hope to sick children from poor families.

Dr. Naomi Neufeld hurried down the hallway of the Pediatric Diagnostic Center in Ventura, apologizing as she went for her late arrival. A seven-car accident, she explained, had turned the freeway into a parking lot and her monthly drive from Los Angeles had taken longer than expected.

But to Carmen Esperanza and her family, who had been sitting patiently in a small room of the clinic for nearly an hour, Neufeld’s delay was barely noticeable. The family already had traveled too far--and waited too long--to be bothered by something as trivial as a traffic jam.

“I have never seen a case like this where a child didn’t receive treatment for this long,” Neufeld said to the interns gathered outside the family’s room. She then outlined what she knew about the child that they were about to see.

Esperanza and her two sons, Paulin and Martin, arrived from Mexico a few months ago. Although the thyroid glands of children in the United States are routinely screened at birth, Paulin, like many children from Third World countries, never received medical treatment for his hormone deficiency.

The result, Neufeld said, is a phenomenon rarely encountered by American physicians: A 16-year-old perpetual child, 42 inches tall and unable to speak, who has the mind, body and emotional maturity of a 4-year-old.

“From a textbook point of view it’s fascinating, but we also need to consider the social dynamics here,” Neufeld, a pediatric endocrinologist at Cedars-Sinai Medical Center in Los Angeles, said to the interns before entering the family’s room. “He’s been the baby of the family for all these years, so it’s not enough to just make him bigger. We also have to talk to them about helping him to think like an older child.”

Despite its rarity, the case is in many respects typical for the clinic, described by some health-care professionals as a pioneer collaboration between the county and private sector physicians.

Since its inception two years ago, the clinic is rapidly gaining a reputation as a center of hope for some of Ventura County’s sickest children from poor and indigent families.

It is here that children with severe, unusual and often baffling disorders are referred for evaluation and treatment, and where their care is overseen by some of the top pediatric specialists in Southern California.

Like Neufeld, many of the clinic’s physicians travel once or twice a month from medical centers as distant as Childrens Hospital of Los Angeles, UCLA Medical Center and Cedars-Sinai Medical Center.

In most cases the doctors receive only a fraction of their normal fees. No family, regardless of its ability to pay, is turned away.

“From the county’s perspective, it’s absolutely an asset,” said Phillipp Wessels, director of the Ventura County Health Care Agency, which oversees the Ventura County Medical Center. “It makes available those highly specialized services, which patients used to have to go to Los Angeles to receive.”

But the existence of the clinic is financially advantageous too. Under contract with the county, the clinic provides care for poor and uninsured patients at a reduced rate.

The county then bills agencies such as Medi-Cal and California Children’s Services for the care that was rendered, according to the clinic’s director, giving the Pediatric Diagnostic Center its agreed-upon percentage of fees and keeping the remainder.

“It’s a very good arrangement,” Wessels said. “We’ve been able to essentially serve two to three times the number of patients with the same amount of money we used to spend.”

The Pediatric Diagnostic Center also serves as an adjunct to the medical center across the street, providing mainstream pediatric care on a sliding-scale basis. Children who need more intensive follow-up are referred by one of the clinic’s residents or interns, or by the child’s private physician. Unless they are deemed emergencies, visits are on an appointment-only basis.

Credit for the creation of the clinic, physicians and health-care officials say, belongs to Dr. Chris Landon, a pediatric specialist in childhood chest diseases. Landon had been content in his private practice for 10 years. Then, he said, he took a closer look at the illnesses of his patients and re-evaluated his efforts.

What he found was that his expertise--along with that of many other highly trained pediatric specialists in private practice--was going largely unused.

“Residents at hospitals today learn about liver transplants, even though most of them will never see a case like that in private practice. They never see a lot of things,” said Landon, a soft-spoken man with the energy of a long-distance runner. “What happens to a lot of pediatricians is that they turn into runny-nose doctors.”

He also discovered that the county needed more pediatric specialists. With about 150,000 children in the county--a large percentage of them from uninsured or working-poor Latino families--Landon said the medical needs of many sick children were not being met.

“There’s a certain wariness by a lot of these families to get medical care anyway, and having to make an appointment months in advance to see doctors who are completely overworked, and then to wait all day in one of those clinics that smells bad, doesn’t help things,” he said. “I figured there had to be a better way.”

Landon picked up the phone and contacted every pediatric specialist he could think of, with the aim of enticing them to come to Ventura. He praised their talents and said what a waste their knowledge was in private practice. He talked to them about the good that they would be doing for children who wouldn’t otherwise receive care. Determined to succeed, he used “anything that came to mind,” Landon said.

“He promised me Mrs. Fields cookies,” said William Goldie, a pediatric neurologist with the Magan Medical Clinic in Covina. “That’s what did it for me.”

On a more serious note, Goldie echoed the sentiments of many of the clinic’s specialists, saying he gets tremendous personal satisfaction from giving his time to the clinic. “There are two kinds of satisfaction for a physician: seeing a lot of patients for a lot of money, and seeing a lot of patients who need to be seen. I have the best of both worlds.”

For doctors such as Goldie, Landon’s timing was just right, coming as it did when the specialists were rethinking their approach. “Generally, the attitude in academic medicine has been that the patients should come to us, that they should wait in line and trudge through snow to see us. But too many patients don’t come,” Goldie said. “Perhaps it is no longer an acceptable way to provide care.”

With a list of nearly 20 willing physicians in hand, Landon approached the county Health Care Agency. The agency then entered into a contract with Landon to work in cooperation with the county Medical Center, which operates a three-year family medicine residency program for interns. Landon now wears the three hats of clinic director/administrator, pediatric pulmonolgist and director of the county hospital’s pediatrics department.

The Pediatric Diagnostic Center provides interns and residents with cases that they need to understand pediatrics at its most complex, but in an atmosphere unlike the stuffy or somber one found at most teaching hospitals.

On a recent afternoon, Dr. Clark Craig, a first-year resident, was poring over medical books in Landon’s office.

He had been baffled by the case of a young Mexican boy, who had a form of dysentery that no laboratory tests had yet been able to identify.

Dr. Marvin Ament, a pediatric gastroenterologist at the UCLA School of Medicine who was at the clinic for the day, remembered a similar case he’d seen 10 years before. He suggested that Craig run another test and look in a different textbook.

“Yes!” Craig yelled, his fist shooting into the air as if he’d kicked a field goal. “We found it!” The boy, he discovered, had a case of shigella dysenteriae, a disease practically eradicated in the United States 40 years ago.

“At UCLA, they are used to seeing a lot of things and thinking they know it all,” Ament said. “But in Ventura, there is a much higher appreciation of the teaching we do. Everyone out there is very enthusiastic.”

The types of diseases aren’t the only differences seen by interns and physicians.

Citing a recent Rand Corp. report, Landon said sick children from poor and indigent families as a rule enter the health-care system much later in the course of their illnesses, and many have had no prior medical attention at all.

“What we’ve found here at the clinic is that if the mother works or doesn’t have a car, we have a 50% no-show rate,” Landon said. “So when these kids do get to us, a lot of times their diseases have progressed and they’re just a lot sicker.”

One mother living in Camarillo, whose daughter has juvenile onset diabetes, missed a series of appointments because of what she said were transportation problems.

The woman had no car, and later explained that she didn’t have enough time to travel to and from the clinic with her daughter on the bus.

Landon solved the problem with a phone call. In a few moments, a taxi was on its way to bring the mother and daughter back to the clinic.

“The little girl has severe diabetes,” Landon said. “Without care, she’s bound to have all sorts of problems. There’s the cost of a kidney replacement, the loss of an eye. . . .” His voiced trailed off. “When you look at the alternatives, it’s worth the cab fare.”

For parents such as Lisa Broderson, a mother of three who brought her 2 1/2-year-old son, Brandon, to the clinic several months ago, that attitude made a critical difference.

Broderson said she initially took her son to a pediatrician in private practice after she became concerned that the clothes he wore at age 1 still fit him more than a year later.

The pediatrician, she said, told her that her son was destined to be short because his father is also short.

Neufeld, who had examined the boy once before, thought otherwise.

She ran some tests and determined that the child’s slow growth was caused by an inability to absorb bicarbonate--a condition easily corrected by taking supplements.

“Isn’t that cool?” said Broderson, a nursing student at Oxnard College. “This is incredibly simple. But if I had listened to that other doctor, Brandon would be a dwarf.”