County Plans Health Clinic in Fillmore : Medicine: Officials at facilities nearby are critical, saying area’s low-income residents are already well-served.

Ventura County health officials hope to open a health clinic for the poor in Fillmore by summer--a move that two existing clinics say would undermine their businesses and reveal the county’s intent to compete for patients, not just provide a safety net for the needy.

The new county clinic would also hurt struggling Santa Paula Memorial Hospital, Executive Director Rulon J. Barlow said, by routing Medi-Cal patients from Fillmore past nearby Santa Paula to the county hospital in Ventura.

“We’re concerned,” Barlow said. “They’ll say they’re only providing for people who can’t get care. And, in some places, that’s a true statement. In Fillmore, I don’t think it’s a true statement.”

County officials confirmed Wednesday that they are shopping for a vacant lot in Fillmore to relocate a 5,000-square-foot portable building as the county’s sixth clinic.

“We’ve been looking at Fillmore for some time because we recognize the need is there,” said Pierre Durand, administrator of the county hospital and its expanding network of clinics. “We hope to be there within the next six months.”

Durand said many patients from the Fillmore and Piru areas show up at a county clinic in Santa Paula and at the county hospital in Ventura, indicating a strong need for care that is not being met by existing clinics and doctors.

Nor do any of the existing clinics offer access to the broad spectrum of specialists and treatments that the county system provides, he said.

The final decision on opening a Fillmore clinic will be made by the County Board of Supervisors, which has not considered the issue, he said. In the past year, the board has approved opening clinics in Thousand Oaks and Simi Valley, adding to a network that includes facilities in Oxnard, Ventura and Santa Paula.

But directors of the two private clinics in Fillmore said their community’s low-income residents are already well-served and that the county is responding not to the needs of the poor but to a desire to lure Medi-Cal patients--especially the lucrative obstetrics practice--to the county hospital.

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The county is also positioning itself to compete with private hospitals and doctors for patients, the administrators said. Their comments echoed recent charges by officials at the private Community Memorial Hospital in Ventura.

“It’s a waste of taxpayers’ money for them to set up in Fillmore,” said Roberto S. Juarez, executive director of Clinicas del Camino Real, which runs four not-for-profit clinics in Ventura County. “I don’t see duplicating services and spending taxpayers’ money to set up an empire.”

Juarez said his Fillmore clinic, which is temporarily housed in trailers because of earthquake damage, usually sees 1,500 patients a month, most of whom are poor and insured by Medi-Cal. Fillmore has about 12,000 residents and Piru 1,150.

James Howatt, who operates the four-physician Fillmore Medical Clinic, said Fillmore’s doctors and clinics provide good health care for the poor.

“This stinks. It’s not needed,” he said. “It would make the county hospital healthier, but it would destroy care at Santa Paula Hospital.”

Howatt said Durand approached him 18 months ago about buying his clinic building and sending all 500 of his hospital patients a year to the county hospital, rather than to the Santa Paula hospital.

“It was basically an all-or-nothing sort of thing,” Howatt said. “You can fight us or join us. . . . It appears the county is planning to make good on their threat to me.”

Howatt said 75% of his patients are privately insured, not Medi-Cal patients. So county officials were clearly interested in funneling privately insured patients into its hospital, he said.

“They wanted all of my commercial contracts,” he said. “They wanted access to all of my fee-for-service and HMO contracts. They wanted to take over my office . . . which is a different story than what they’ve been feeding the papers.”

Durand acknowledged some “very preliminary discussions” with Howatt in 1992, but said that they did not get specific. It was never his intention to capture privately insured patients for the county hospital, he said.

“I do not go after the private sector,” he said. “Our mission is to provide access to the poor, to the unemployed, to the underemployed (without private insurance).”

Indeed, fewer than 10% of the county’s patients are privately insured, he said.

Howatt said he rejected the county’s offer partly because of the damage it would have done to Santa Paula Hospital, which gets between one-third and one-half of all its baby deliveries each year from Howatt’s practice.

Howatt also said he told Durand that he could not serve Fillmore adequately if he delivered babies 25 miles away in Ventura.

“They said we’ll have our residents deliver them and you can bill for the service, and that’s the truth,” Howatt said. “I don’t know what that is, but it doesn’t seem quite right. . . . It came out of Pierre Durand’s mouth.”

Durand denied making any such statement and dubbed Howatt’s comments outrageous. He said it would have been illegal for Howatt to claim deliveries he never made.

“That is not an acceptable practice any place, and he knows that very well,” Durand said.

In general, Durand declined to comment on his negotiations with Howatt and on the critical comments by Juarez.

“I’m not going to get into one physician says this and someone else says that,” he said. “Our record speaks for itself. Our record is one of providing services for the poor population.”

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A county clinic is needed in Fillmore, he said, because other clinics and doctors accept only some poor patients. An increasing number of indigents and the working poor have trouble getting care because the state provides little or no reimbursement, he said.

And a Medi-Cal patient who needs surgery is often referred to the county hospital because of low state reimbursement, he said.

Samuel Edwards, medical director at the county hospital, said clinics such as Howatt’s are restrictive on which Medi-Cal patients they will see.

“He’s skimming the best he can,” Edwards said. “He’s taking the ones that make money, and not taking the ones that don’t make money. We take them all.”