Health Problems Loom Larger as Jobs Are Lost : Medicine: O.C.’s ex-middle class workers, now uninsured, find it difficult to receive needed care.

A 37-year-old guitarist who recently beat cancer but hasn’t been able to find work worries because he should have had an X-ray months ago to see if the cancer has returned.

A former controller for an Orange County construction company, who made $45,000 a year plus bonuses, resorted to crossing the border to Tijuana for penicillin when she lost her job and, with it, her medical insurance.

And a 24-year-old, unemployed roofer who couldn’t find a doctor to set his broken right hand has been warned that the deformed hand may remain too painful to ever wield a hammer.

Those are indicative of the frustrations faced by people in Orange County who need to see a doctor but who have lost their jobs or medical insurance and depleted their savings as the economic recession drags into its third year.

Many middle-class workers who never gave a second thought to paying for medical care are getting a taste of the medical plight of the poor. They are also placing additional pressure on the already overtaxed system that the poor rely on.

Those who become eligible for Medi-Cal or Indigent Medical Services, the two government-subsidized, medical insurance programs for the indigent, discover it is nearly impossible to find doctors who will see them. Only about 100 of the 2,850 members of the Orange County Medical Assn. are on the association’s list to take those patients. The reasons: red tape and the fact that the programs pay doctors only 24% to 40% of their usual fees.

With no alternative, newly unemployed people accustomed to their private doctors are instead filling hospital emergency rooms and community clinics, where they are joining a flood of immigrants and the uninsured working poor. Some of the clinics are so overloaded that they must turn patients away.

“Across the board, clinics are seeing more people recently employed and recently from the middle class,” said Faith Hagerty, executive director of the Coalition of Orange County Community Clinics.

The 18 Coalition clinics, supported by private grants and government reimbursements, have been deluged. In the last half of 1991 they saw 88,500 patients, up 32% from the same period the previous year.

Dr. Pedro Carillo, medical director at the South County clinic, said: “We see 50 patients a day now and saw 25 two years ago. We could see 100 a day and that still would not be enough.”

In many ways, Larry Fierro is typical of the 26,000 patients who receive treatment each year at the UCI-North Orange County Community Clinic in Anaheim, also one of the busiest in the county.

Fierro, 33, is unemployed, uninsured and had been delaying treatment for a cyst growing over his right eye because he simply did not have the money. The former diesel mechanic recently arrived at the clinic when after a year the cyst bulged to the size of a golf ball and he began suffering headaches.

At the clinic, Fierro was treated under the Indigent Medical Services program. To his relief, the growth was benign and would be removed.

But even at the clinics, treatment is not easy to get. Waiting times for appointments at the Anaheim clinic can run two months, and only a handful of walk-in patients are treated each day. Most mornings, the line for patients without appointments begins forming as early as 5:30 a.m., and more than half of the 20 or 25 in line are turned away when the doors open at 7:30 a.m.

“The problem is we don’t have the capacity to care for all the people who have health care needs. We also don’t have the scope,” Hagerty said. The clinics, she said, can treat the flu or bronchitis but few have specialists such as cardiologists or orthopedic surgeons.

“If we don’t have the specialty care for a patient and can’t locate a private physician who will provide it, we have to tell the patient to go to the emergency room,” Hagerty said. “It is the only place in this country where people have a right to health care.”

Unlike many other counties, Orange County has no county-operated hospital to provide routine health care to adult indigents other than pregnant women.

Those who don’t know the patchwork system of clinics and who can’t pay for a private doctor are letting small maladies worsen, trying to make do with home remedies and postponing diagnostic tests and treatments such as teeth cleanings, eye exams, physicals, pap smears and mammograms.

And when their problems become acute, they also end up in emergency rooms.

“There are a whole bunch of deferred and unmet needs,” said John R. Cochran, chief executive officer at Martin Luther Hospital in Anaheim. “A baby might get an ear infection that could be cleared up early with antibiotic,” he said, “but instead the parents will wait and bring the baby in at 3 in the morning hollering with a ruptured eardrum.”

Cochran said that today about 25% of the patients in the hospital’s emergency room are uninsured, compared to about 6% five years ago. Another 25%, he said, are on Medi-Cal.

Just keeping hospital emergency rooms open has become a struggle, administrators say, because of the difficulty of compiling on-call lists of specialists such as neurosurgeons and orthopedic surgeons who will come when they are needed. Such specialists are increasingly reluctant to treat emergency room patients who frequently will not pay them.

When Anaheim Memorial Hospital recently required all its staff orthopedic surgeons to take a turn in the emergency room, physicians in various specialties resigned from the staff in protest, said Stephen Groth, director of emergency services.

Groth said his own salary has shrunk by 20% in the last nine months, mostly because of the tremendous influx of non-paying patients.

A survey last fall by the Hospital Council of Southern California found that 40% of Orange County hospital emergency rooms, especially those with a large concentration of poor patients, were having trouble keeping physicians on call.

Santa Ana Hospital Medical Center and College Hospital in Costa Mesa have closed their emergency rooms because of the problem.

Orange County’s emergency room crunch reflects a far-ranging problem, said David Langness, spokesman for the Hospital Council of Southern California.

“What we are approaching now is Southern California without enough emergency rooms to serve its population,” he said.

The luckiest of the unemployed are those with long-term relationships with family doctors, who often will waive fees to try to treat patients for whom they feel responsible.

“I see a lot of primary care doctors seeing people who have been their patients and continuing to see them even if they are not getting paid,” said Dr. Laurence Wellikson, an internist. Wellikson said about 5% of his patients cannot pay.

“We used to have no bad debt. Everyone just came in and paid their bill and that was that,” he said. “You know things are getting hard when you get a very prideful person beginning to say, ‘Can I mail you a check?’ ”

Dr. Jane Curtis, an internist in Santa Ana, recalled: “The big change started last summer when people stopped coming in for routine things like physicals and mammograms and paps smears. They don’t call and say, ‘I don’t have the money.’ They just don’t come in.”

She said that if a patient with a serious problem doesn’t come for a follow-up exam, she will call and offer her services free of charge or accept installment payments. “If someone can pay $5 a month and stretch it out a couple of years, that’s fine,” she said.

Sometimes patients try to call for free advice rather than come into the office, where they feel obligated to pay, Curtis said. But that shortcut can be dangerous.

One patient, a diabetic who had dropped her insurance when the business she owned went sour, “tried to get me to prescribe something for an infection on the phone. I said come in. The infection was so serious that she wound up being sent by ambulance to have surgery at Western Medical Center.”

Uninsured patients or Medi-Cal recipients who are initially treated in hospital emergency rooms frequently struggle to obtain follow-up care.

That was the predicament that faced Albert D. Archibeque who, after breaking his hand in an accident at his Huntington Beach home last May, rushed to a local hospital emergency room. There his hand was placed in a splint and he was referred to an orthopedic specialist to see about setting it. When that doctor learned that Archibeque had no way to pay, he refused to treat him.

Archibeque said that even after he enrolled in the county medical insurance for the indigent, he was unable to find a willing doctor, although he called a couple dozen on referral lists. By the time he found Dr. Robert Cassidy, three weeks had lapsed and the bones had mended out of place.

“He told me it was too late,” Archibeque said.

Cassidy, who said, “I yell and scream until I am blue in the face” to hospitals about the need to assure follow-up care for emergency room patients, contends that treating the poor is a physician’s professional obligation. “It should be a requirement of obtaining your medical license,” he said.

But there isn’t much hospitals can do about the problem, said S. Russell Inglish, a spokesman for the Orange County Region of the Hospital Council of Southern California.

“Hospitals can’t control what physicians do in their private offices,” he noted.

Some people report that their private physicians dropped them when they lost their jobs and could no longer pay.

Diane Roxbury, a 31-year-old resident of Aliso Viejo, said she was laid off from a $45,000-a-year job as a controller for a construction company about three months after having surgery to remove an ovarian cyst. She said she couldn’t afford to pay 20% of the surgical bills that she still owed under her former employee group insurance policy.

After learning that her doctor would not continue treating her, Roxbury said, she became concerned when her incision grew swollen. She drove to Tijuana to buy penicillin to treat herself. She also suffered chronic migraine headaches because she couldn’t find a doctor to prescribe medication to control them. When the headaches became unbearable, she said, she would visit a walk-in clinic and use a credit card to pay for painkillers until her cards “got maxed out.”

After six months, Roxbury discovered the South County Community Clinic in San Juan Capistrano, which charged her only $10 a visit. But by then, she said, she had developed ulcers from the stress of being unemployed and worrying about her health.

While larger employers must offer laid-off employees extended medical insurance up to 18 months, few people can afford to pay the cost of such policies, which range from $150 to $250 a month for a single person and $350 to $600 a month for a family.

The newly unemployed who seek medical assistance frequently wind up at the Orange County Social Services Agency offices. Among the crowd at the South Laguna office one afternoon was Kevin, 37, a recent immigrant from Washington, D.C., who had conquered cancer with surgery and radiation therapy.

Kevin, who asked that his last name not be used, said he couldn’t get a job playing guitar for at least several months and hadn’t been able to land a job as a clerk or waiter to tide him over. So he was sleeping on friends’ couches and eating one meal a day to ration the $26 left in his wallet. But he said he needed to see a doctor soon to make certain the cancer has not recurred.

“I was supposed to have a chest X-ray two months ago,” Kevin said. He would not learn that day whether he could get help, because he had missed the county agency’s interviewing period. “I was told to come back tomorrow and to expect to wait for four hours,” he said. “I’ve never been through anything like this before. This is real new and real sobering.”