Q & A : She Cares for Clinic That Cares for Needy

Fern Seizer, executive director of the Venice Family Clinic.

Claim to fame: Steers the Westside’s largest free health clinic through tight financial times, increased patient demand and changing community needs. “Makes the whole place run,” clinic doctors say.

Background: A New Yorker whose father produced “Dr. Kildare” and created “Marcus Welby, M.D.,” Seizer went to UCLA, married a television sports producer and reared two children. She worked for 12 years with the National Council of Jewish Women, then nearly three with the Fair Housing Council of the San Fernando Valley. She found her current job nine years ago in a newspaper classified ad.

Interviewer: Staff writer Lois Timnick

Q: What is the Venice Family Clinic?

A: A private, nonprofit, community-based free clinic whose mission is to provide affordable, accessible and appropriate health care for people with no other access to it. Everything we do is to toward that.

A: What do you offer?

Q: Complete medical care, short of hospitalization, for all ages. Immunizations and other preventive care. Health education in simple Spanish and English on everything from how to take your child’s temperature to what to do for ear infections. General medical visits.

We have special clinics that address the needs of specific groups like seniors, women, the homeless, and we care for many patients with chronic diseases like diabetes, hypertension or asthma that are really very potentially dangerous but can be treated and controlled.

Whenever a patient sees a doctor, whatever else is needed--lab tests, X-rays, hospitalization, eyeglasses, consultations with specialists, medications, even shelter or bus transportation tokens, whatever it is--all that is coordinated here, in one place.

We have 20 examining rooms, a lab, a dispensary and connections with physicians, hospitals and labs who provide free services for our patients. And for the past 18 months, we have also offered individual and group counseling. We found that our doctors were spending a lot of time with patients complaining of headaches and stomach problems that had no physical explanation. We referred people to mental health services but they didn’t go. So we decided to bring it right here.

We are open six days and four nights a week to see patients, with various kinds of clinics held different hours of the day for the convenience both of patients and volunteers.

In addition, we are the only free clinic in the country participating in a national five-year pilot program called Enrich, which seeks to help poverty-level families with new infants become economically self-sufficient. It costs $1 million a year and involves 120 families. We provide their health care and arrange for child care, job training, job placement, parent education, home visitors, counseling, whatever they need.

Q: What don’t you do?

A: We don’t do hospitalization, we don’t do substance abuse programs and we’re not a family planning clinic. We don’t want to duplicate anything that already exists, we prefer to network and we work closely with at least 70 other organizations on behalf of our (medical) patients, their clients.

Q: What happens when somebody needs hospitalization?

A: To put it bluntly, these are people who are the county’s responsibility. The best we can do is to pave the way.

Q: How did the clinic start?

A: It began 21 years ago when people in the Venice community needed a doctor and there was no doctor. Poor people had no way to get any medical care. Even today there is only one doctor for about 18,000 people in Venice, while the state average is something like 1 for 420, so you can see what a medically under-served community this is. We started in borrowed space in a dental clinic at night, with all volunteer doctors, expanded into daytime, got a small grant, were able finally to rent our own space. We moved here (Rose Avenue) in 1984 and built an addition less than two years ago.

We are already filled to capacity. We are seeing 135 patients a day, six days a week, and turning away another 70.

Q: Who are those patients?

A: We see 10,500 children and adults each year, about four times each, making 41,000 patient visits. We have another 2,500 people participating in groups, such as medical compliance sessions for diabetics.

Ninety-two percent of our patients are uninsured completely, and 92% are also below the federal poverty level--which is $6,600 for one person and $13,500 for a family of four. Our cutoff is two times the poverty level, which is still an extremely low income. That’s because we are here to take care of the really neediest, not those who have another way to get medical care.

Seventy-nine percent are minority group members: 64% Latino, 13% black, 2% Asian. Those numbers are reflective of lots of things, primarily of access problems. Lots of people are very poor, minorities have it worse. People with language barriers have it bad and Latinos have the least insurance coverage of any ethnic group.

We had no boundaries when we began, and we don’t drop poor patients regardless of where they live. But we no longer take new patients unless they live in Venice or Santa Monica, because of the numbers we are turning away.

Q: Do patients have to be legal U.S. residents?

A: No. Anybody who needs us is welcome. I don’t even know what percentage is illegal. It really doesn’t matter--we want a healthy community. There is already enough fear and hesitation on the part of people who are not legal.

Q: How do you determine who can pay and how much?

A: We do financial screening to make sure that the patient really needs us. We ask for family size and proof of income and residence, and we ask for contributions from people who can. They get everything free when they are patients here. So it’s a big nut for us to crack, and we have a lot of money to raise. The average patient contribution is less than $3.

Q: What alternatives do poor people on the Westside have?

A: Not many. We’re really unusual in having the ability to really be the family doctor for a community with no other way to get that. The best most can hope for is in a moment of crisis to get that particular problem resolved.

There is the L.A. Free Clinic, but it’s some distance away and provides different services.

I think that free clinics are a model for how health care can be delivered at a community level. We have what governments can’t really provide--volunteers, donors, private interests that care about us, foundations, businesses, hospitals. The Los Angeles County Medical Association recruits volunteer doctors for us. It’s what’s American--that’s a little corny, but the volunteer spirit is so in us.

Q: Are you seeing sicker people these days?

A: Yes. We see some very, very sick people here, some having heart attacks. People can’t get medical care unless they show up in an emergency room sick enough that they will wait the long wait to get in. This is the wrong way to go completely. You are forcing people to be sick before they seek help--to be on a triage system where only the sickest and most acute will get care. It’s really a crazy way to deliver health care with all that’s available.

Say a child is having an asthma attack, he might get treatment in the emergency room but it doesn’t address ways to avoid those attacks, to get him on a good regimen, to bring the condition under control, to give him the necessary supplies.

And course it’s crowding the emergency rooms so badly that they’re not doing what they’re really there for, which is emergency care, not medical care.

Q: How have your goals changed during the past 21 years?

A: They haven’t. We can’t do everything, we can’t be everything, but we are still focused on providing affordable, accessible and appropriate health care. Appropriate means very good quality, culturally sensitive to the people you are serving. Accessible means not only that you can get there, but we are open lots of hours, that we have staff that speaks your language, that there are no barriers financially. We try to eliminate the barriers, the fear barriers.

Q: What has been the impact of the vast numbers of homeless in the Venice area?

A: The homeless have been our patients from the beginning, and today 29% of our population is homeless.

Although we have an appointments system, the homeless are welcome to walk in at 1 p.m. any day--because it’s too difficult to keep appointments when you are homeless. They can shower, get some clean clothes and hygiene kits and see the doctor. We are always focused on the dignity of the patient. This place is nice-looking, there’s no dirt or graffiti. Our patients respect us and we respect them.

Q: What has been the impact of AIDS?

A: We have an AIDS education and prevention program aimed at the homeless population and the young mothers, primarily Latina, who bring their kids in for pediatrics, because both are very much at risk. But we are not equipped to take care of people with AIDS. We do, clearly, if you come in with symptoms and have some of the risk factors, test for it when it’s medically indicated, and we do treat people here with HIV infection. But there are AIDS programs elsewhere, and ours is more a family population, not primarily gay men or intravenous drug abusers.

Q: Where does your money come from?

A: Our yearly budget is $3.2 million for the clinic’s basic program, plus another $1 million for the Enrich program. We get another $1.5 million of “in kind” contributions--volunteer hours, services and goods that we don’t have to pay for. That makes it possible for us to be cost-efficient doing medical care.

Seventy-five percent of what we actually need to pay is raised privately--from individuals, fund-raising events, contributions from businesses or foundations. The other 25% is contracts and grants from cities, county, state, government entities. Our biggest chunk comes from our annual Venice Art Walk, which sometimes pulls in as much as $600,000.

Area hospitals like Saint John’s, Daniel Freeman and UCLA donate all the X-rays that we need and the complicated lab work. Santa Monica Hospital does some emergency room care and suturing. Thrifty Drugs supplies us with wholesale drugs. So they are all doing their part.

Q: Has that government percentage changed over the years?

A: No, it has stayed about the same. But of course we have increased 31% in patient visits over the last year, and we have had to dip into reserves. Patient visits are not like customers to us--a private business where if you get more customers you get more revenue, right? We get more customers, it costs a lot more.

Q: Has the recession affected your patient population and sources of funding?

A: Absolutely. All of these cutbacks and layoffs and mergers that we read about have a direct impact on people needing medical care. And when businesses are in a tight squeeze, they often cut back their health-care packages and no longer cover certain family members or services. Most of our patients work, but many still don’t have health benefits.

And at the same time that the need, the demand, for free health care is growing, the ability of our financial supporters to support us is being impacted by the recession too.

Q: Who staffs the clinic?

A: Volunteers--1,700 volunteers. Up until six years ago we didn’t even have a staff doctor. Now we have seven staff doctors and a nurse practitioner. But we have 300 volunteer doctors--not only in pediatrics or internal medicine but also in special fields like oncology, cardiology, ophthalmology--and 200 medical residents. We hold clinics here and send patients to specialists out in the community. Our entire staff who work with patients are bilingual, because Spanish is the primary language for 58% of our patients.

We train medical residents from nine different programs, and are formally affiliated with University of California, as a department in the school of medicine. It’s mutually beneficial and, I think, a model for the country. The residents get an experience in community medicine at a real level, where they are working with people they may not come into contact with other ways and they all love it. Many come back as volunteers once they are full doctors out in practice someplace.

Through UCLA we are covered for malpractice and liability insurance. Our employes are all considered university employees, and we use their personnel policies and benefits package.

Q: How do you and your staff cope with burnout?

A: I don’t burn out. I see that we’re able to accomplish a lot. I see a lot of challenges, but probably because it’s in a health setting and I see people get well, it’s very inspiring. And our paid and volunteer staff work terrifically well together.

We really have very little burnout and really if it happens at all it might be in the area where you work with homeless people all the time and it is frustrating. It’s definitely frustrating on their part too, of course. So sometimes we may shift around within the organization.

But the jobs we do are very diverse, everybody has input, and we’re small enough we can make changes without a lot of bureaucracy.

Q: Is there an upside to the recession, in that now even middle-class people are agitating for a national health insurance plan?

A: Yes, every survey of what people feel are the most important issues shows that health care is it. People really believe that everybody is entitled to health care, although to what degree hasn’t been settled. Now is the time to bite the bullet. It is everybody’s biggest fear, that they’re going to end up with no health care and no health insurance. The fear of losing your job is as much the fear of losing health insurance, and the fearing of growing old is the fear of that.

We try to address it piecemeal--and it can’t be done. I think really, with a will, the country could put together a good system. Canada has a model. Oregon is making a stab at it. Sure there are things wrong, there are things that aren’t our way of doing it, but it’s there for us to work with.

When the clinic was started we actually thought we were just temporary, that we wouldn’t be here long. We didn’t build buildings. We said, “OK, we’re going to do this until the country comes up with a system where everybody has health care,” but that is moving and moving and moving (beyond our grasp) and it isn’t happening. Yet.