Free Clinic Feeling Pain of the Recession : Health care: The patient load is up and government funding is down at the facility where general medical treatment, testing and advice is dispensed.
The telephone lines light up with calls promptly at 10 a.m. every Thursday--appointment-setting day at the South Bay Free Clinic.
Each caller tells a similar story. Please, one says, I’ve been laid off and I don’t have any insurance, but I have this rash. . . . Please, implores another, I need birth control pills but money is so tight . . .
Within 15 minutes, a week’s worth of new-patient appointments are filled. There are no more to be given out, no matter what the plea. Many people do not take the news well.
“I’m sorry, really I am,” receptionist Irma Arellano patiently tells a caller as the clinic’s three other telephone lines light up. “Look, I can’t stay on the phone with you. Other people are waiting. . . . No, I’m sorry. I’m sorry.”
As the recession pinches the South Bay, demand for services is swelling at the Free Clinic, where general medical care, testing and advice is dispensed free of charge. But as the clinic’s patient load grows, its financial future looks increasingly bleak.
Clouding the clinic’s forecast are the state budget talks in Sacramento, where lawmakers are wrestling with a $10.7-billion deficit. Among the areas being considered for cuts are several state programs that collectively provide about $630,000 for the Free Clinic--42% of its $1.5-million operating budget.
“We’re holding our breath to see what kind of cuts we’re going to have to take,” said Free Clinic executive director Suzanne Rivera. “We hear rumors saying things like our entire dental program will have to be cut. Then we hear rumors that they’re not going to touch a penny of it.”
She added: “Who knows what they’re going to do?”
Ninety percent of the clinic’s prenatal program is funded through Medi-Cal reimbursements, which could be sharply reduced. Half of its general medical services and half its pediatric program are covered by state funds.
For nearly 25 years the South Bay Free Clinic has provided health care to the area’s needy--counseling teen-agers about birth control, shepherding pregnant women through comprehensive prenatal care, checking up on their newborns and dispensing medications for the routine ailments that plague parents and children.
At the clinic’s Redondo Beach center, thousands of financially struggling South Bay residents have found the individual and group mental therapy many so desperately need.
The clinic’s storefront centers in Manhattan Beach and Gardena offer a dizzying array of medical care--gynecology, AIDS and cancer screening, teeth cleaning and dental fillings, podiatry, dermatology.
Staffed by more than 250 volunteer doctors, therapists, nurses, clerical workers and fund-raisers, plus a salaried dentist, full-time nurse practitioners and social workers, the Free Clinic operates the kind of shoestring programs that rejoice at a $100 donation, or free medical equipment, or a case of free condoms.
Patients are not charged for services, but they are welcome to donate what they can afford. Their donations, often no more than the change in their pockets, make up 10% of the clinic’s budget.
Last year the Free Clinic recorded more than 30,000 patient visits, up nearly 10% from the previous year. The clinic could have seen more patients, organizers said, if it had more staff and more funding.
“We can’t meet the demand now,” said Dr. Ian Kramer, 43, the clinic’s volunteer medical director who devotes one day a week to seeing patients and supervising the medical staff. Given more resources, he said, the clinic could quickly double its patient load.
In Gardena, the clinic manager pitched in one frenzied afternoon to complete a backlog of lab work. A nurse practitioner moved quickly and efficiently from room to room and patient to patient, peering into eyes, listening to heartbeats and checking blood pressures as a steady stream of women entered the clinic’s two waiting rooms to join more than 25 women already waiting there.
With that kind of a crunch, a key question for the clinic is how to avoid cutting services.
A decade ago, 76% of the budget came from government sources, including grants from individual South Bay cities. Today, government sources cover 69% of the clinic’s funding needs, but that number is expected to drop rapidly, Rivera said. The most immediate concern is state funding, under discussion now in Sacramento.
The rest of the clinic’s budget comes from private grants and donations, which covered 13% of the budget 10 years ago and now account for 21% of it. Donors range from community groups, such as the Manhattan Beach Lions Club and the South Bay Unitarian Fellowship, to businesses as large as Chevron and as small as Good Stuff on the Strand restaurant.
Rivera said she hopes stepped-up fund-raising efforts eventually can increase the private funding figure, when combined with patient donations, to 50%.
“People know we’re here and that we provide a valuable service to the community,” she said. “Now we need to make sure the community knows how much we need its support.”
The South Bay’s poor have fewer and fewer places to go.
Federal and state cuts have forced the county to close several mental health clinics, while emergency services have been sharply reduced at county hospitals.
At Harbor-UCLA Medical Center, the primary county facility in the South Bay, services are stretched to the breaking point, both officials and patients say.
“In the past, if a patient wasn’t in critical need he or she used to be seen in two to four hours at Harbor-UCLA,” Kramer said. “Now if they aren’t dying . . . they wait 12 to 18 hours to be seen.”
With nowhere else to go, the poor find their way to the South Bay Free Clinic. Most are from low-income, blue-collar neighborhoods in Gardena, Lawndale, Inglewood, north Redondo Beach and the Harbor-Gateway. Many have lost their jobs and their health insurance.
“The South Bay Free Clinic is a godsend,” said the Rev. Richard Haddon, pastor of the First United Methodist Church in the impoverished Harbor-Gateway area east of Gardena. The church feeds and clothes hundreds of destitute families through its charitable efforts.
The doctors and nurses at the Free Clinic’s Gardena office, near the Methodist church, see up to 80 patients a day. Most are pregnant women like Ana Agredano, who sought help for prenatal checkups.
“My husband was laid off three months ago and we lost his insurance,” said Agredano, 26, of Gardena. Eight months pregnant with her second child, she will soon have to quit her $9-an-hour job. Without her husband’s insurance, she could not afford prenatal care anywhere else.
“We’re so thankful” for the clinic, she said.
So is Nelida Ruiz, 18, who watched a breast-feeding video as she waited to talk to the doctor scheduled to deliver her baby the following week.
Newly married late last year and struggling to make ends meet, neither Ruiz nor her young husband have medical insurance.
“They talk to you here and treat you like a friend,” she said, softly laying a hand on her swelling abdomen. “I was so surprised that this was a Free Clinic, that they don’t make me pay any money and I can get such good care here. . . . Until I found this, I didn’t know what I was going to do.”
Most likely, she would not have received any prenatal care at all--a tragedy that costs taxpayers millions of dollars over the long term, said Dr. Herbert L. Hemsley, an obstetrician from Carson who volunteers one day a week at the Gardena clinic. He delivers 10 to 12 Free Clinic babies a month at nearby hospitals.
“A premature, underweight baby can easily cost $30,000 to $60,000 in medical care during the first weeks of life, but if a woman comes in, gets her checkups and is healthy when she delivers, everyone wins,” Hemsley said.
Prenatal care is only one of the services the clinics offer.
Trini Woods, 23, of Hawthorne needed a tuberculosis test before he could take a new job.
“It would have cost me $50 for the office visit and $25 for the test if I went to a regular doctor, but I didn’t have the money, then I heard about this place,” he said as he waited in the Free Clinic’s Manhattan Beach office.
For 63-year-old widow Cornilia Rozendaal of Manhattan Beach, the clinic means dental care she could not otherwise afford. Fresh from the dental chair where she had had three fillings, Rozendaal praised the care she has received.
“Health insurance has been just out of the question with only Social Security to live on,” she said, noting that she is too young to qualify for Medicare. “Once I’m 65, I’ll be in better shape on that, but now I’m in those in-between years.”
For a 23-year-old college student, the clinic is a place to get birth control pills, rather than risk another pregnancy and abortion.
Rivera explained that birth control and family planning are a major part of the clinic’s work.
“Our emphasis is on preventive medicine,” she said.
If women want children, they can get medical advice and enroll in parenting classes. If they don’t want to get pregnant, the clinic offers advice and contraception. The clinic does not abort pregnancies, Rivera said.
As the politicians debate how best to cut billions from the state budget, the Free Clinic was notified it was getting a special pregnancy prevention grant of $176,000 to finance a two-year outreach program in schools and welfare offices.
“Studies show that 70% of the high school students are sexually active by the time they reach the 12th grade,” Rivera said. Two counselors are being hired to reach out to these youngsters and educate them in birth control techniques.
Such programs have been pioneered by the Free Clinic since its founding in 1969. In the beginning it was a small mental health clinic modeled after the Haight-Ashbury free clinics in San Francisco. The effort then was to help youthful drug users.
The approach now is family-oriented, preventive medicine.
“When a woman with a sick child comes in, we often see that she’s ailing too. She may have two other children and chances are they have runny noses and need care, maybe one has bad teeth,” Kramer said.
The clinic’s goal is to help the whole family, he explained. But how well clinic staff can keep meeting that goal rests in the hands of state legislators.
Crunch Time The South Bay Free Clinic gets most of its funding-$15 million last year-from government sources. Shaded area shows the portion that state budget officials are examining for possible cuts. 1991-92 Funding Client Donations: 10% State: 42% Federal: 10% Local and county: 17% Foundation, Corporate, Community Contributions: 21%
