Clinics See Fewer Patients After Prop. 187 : Health: Officials at O.C. facilities say fear continues to keep patients away. Many aren’t aware that enforcement is on hold.

Physicians at the East Los Angeles clinic became concerned when Lilian Morales uncharacteristically missed an examination for precancerous lesions on her uterus. Reaching her by telephone at home, health workers soon ascertained what had happened: Morales, an illegal immigrant from Mexico, feared she would be reported to immigration authorities. So she stayed away.

“We had to convince her to come in,” said Dr. Rene Sanchez, a staff physician at the Community Health Foundation of East Los Angeles, a nonprofit facility that serves a largely immigrant clientele.

The scenario, although not universal, has become familiar in some largely immigrant communities, many health providers say.

Since the passage of Proposition 187, according to administrators at many clinics, many fearful immigrants such as Morales have skipped appointments for routine examinations, both for themselves and their children--the latter often U.S. citizens.

In Orange County, visits to some clinics serving immigrants took a dramatic dive after passage of the proposition and in some communities, health officials said, fear continues to keep patients away.

Overall, however, officials said patients now are showing up in steady numbers--thanks largely to the educational efforts of the Latino media.

“What I’m hearing from the community is that the word is getting out” that Proposition 187 is not being enforced, said Russ Inglish, executive director of Orange County’s Coalition of Community Clinics.

“I don’t know if (patient visits) have reached previous levels,” Inglish said.

Margot Hughes-Lopez, executive director of the South Orange County Community Clinic in San Juan Capistrano, where about 60% of the patients are Latino, said the initial decline in patients has leveled off.

“There’s been no further decrease,” she said. “I think the Spanish (media), which I watch every night, does a good job of enforcing the positive message.”

Still, Hughes-Lopez said, many patients ask warily upon coming in whether they need documentation of their legal status to obtain treatment.

“We’ve had many, many inquiries,” she said. “They literally walk up to the person in the window and say, ‘Am I going to be asked for papers?’ ”

When patients have been seen before at the clinic, they generally are more trusting and will risk an inquiry, she said. But the clinic official said she is concerned about people who are not plugged into the medical system and feel they have no one to ask.

In some quarters, physicians and health officials said the fear of being reported under Proposition 187 still is keeping undocumented patients from seeking basic care.

“Our clinic is having a high incidence of no-shows” said Jean Forbath, who sits on the board of Share Our Selves, a Costa Mesa clinic. “I think that people are afraid to come.”

Forbath said the clinic’s staff, which typically sees 30 patients daily, recently had 14 no-shows in one day. The usual number is four or five, she said.

“The illegal Hispanic community is afraid,” said Dr. Fernando Montelongo, a general practitioner in Orange and president of the California Hispanic Group, a group of board-certified doctors. “The rumors are out there that they are going to be deported.”

OrNda HealthCorp, an organization that owns about a dozen Southern California hospitals, sent out a news release Monday saying many Latino patients are shying away from medical attention for themselves and their children.

“We’ve had calls including those from women whose babies are suffering extremely high temperatures or have been injured, and they are afraid to visit the hospital because they believe they will be reported,” Roseann Gonzalez, the company’s Latino community liaison for Orange County, is quoted as saying. “We are trying to communicate that they have nothing to fear. It is not our position to police our patients.”

OrNda hospitals include Chapman General in Orange, Coastal Communities in Santa Ana, Mission Hospital in Mission Viejo, Doctors Hospital of Santa Ana, Santa Ana Hospital Medical Center and Fountain Valley Regional Hospital and Medical Center.

Failure to identify and treat diseases at an early stage “could be a public health hazard,” said Dr. Juan Ruiz of the Clinica Oscar Romero near downtown Los Angeles. “Disease could be really advanced if people wait until the last minute to come to us. That could put the entire community at risk.”

In the insular neighborhoods where many recent immigrants live, word has often not filtered down that court challenges have blocked implementation of Proposition 187--which, among other things, would deny non-emergency public health care to illegal immigrants and require that providers turn in those suspected of being undocumented.

“People don’t know exactly what’s going on and they’re being scared away,” said Ruiz, chairman of the board of Clinica Oscar Romero, which serves a large Central American population in the Pico-Union neighborhood. “As a physician, it really concerns me.”

Hospital outpatient clinics and nonprofit community facilities--often favored by an undocumented population that is leery of contacts with government--have reported a steady 10% to 20% decline in patient visits during the last two weeks, according to the Hospital Council of Southern California.

“Very few people understand what a temporary restraining order is, and what they’ve heard is that the overwhelming majority of Californians voted to turn (undocumented) people in,” said David Langness, vice president of the council, which represents 250 health-care facilities across Southern California. “That frightens many folks and keeps them away from health care.”

To be sure, some Los Angeles clinics, such as the South-Central Family Health Center, have continued operating at capacity since Proposition 187 was approved. “We’re not turning anyone away these days, but we are keeping ourselves busy,” said Sue Scott, director of the South-Central center.

At Los Angeles County health facilities--probably the nation’s largest care providers for illegal immigrants--there is no definitive indication that residents are avoiding health care facilities in large numbers. Anecdotal reports that prenatal visits or immunization rates dropped at some county facilities after Proposition 187’s passage do not necessarily signal a trend, officials caution.

“There has been nothing that has popped up and smacked us against the face,” said Toby Staheli, a spokeswoman for the Los Angeles County Department of Health Services, which operates six hospitals, six comprehensive health centers and 39 public health centers. “It’s just too early to tell.”

Yet at some inner-city private clinics, workers have been busily attempting to contact missing patients and otherwise let residents know that nothing has changed for illegal immigrants, pending resolution of a court case in Los Angeles concerning the legality of Proposition 187.

“My sense is that there has been an impact, but it varies from clinic to clinic,” said Yolanda Vera, a staff attorney in the Los Angeles office of the National Health Law Program, a legal services support center that works on health issues. “There’s a lot of confusion out there, and there are people who are fearful of coming in, whether for clinic appointments or for treatments of something that may become an emergency down the line.”

The possibility that Proposition 187 may be having an effect was publicly spotlighted in the last week when 12-year-old Julio Cano of Anaheim died. His parents said they had avoided taking him to a hospital because they feared being asked about their immigration status. Both parents are illegal immigrants from Mexico, as was the boy.

Coroner’s officials said Julio had acute leukemia, a childhood cancer that can lead to aggressive infections and cause death in a matter of months or even weeks. But whether Julio’s life might have been saved by an earlier diagnosis of acute leukemia remains uncertain, medical experts said.

The vast majority of hospitals and clinics in California receive some public funding, meaning virtually all state health facilities would be required under the dictates of Proposition 187 to deny services to anyone who could not demonstrate lawful immigration status.

Experts say the requirement could jeopardize the existence of some private clinics, particularly those serving poor immigrant communities. This may be one reason, according to Proposition 187 advocates, that clinic operators have been so vociferous in pointing out the early impacts of the measure.

“Follow the money,” said Barbara Coe, a founding member of the Proposition 187 movement. “Of course, they don’t want to lose patients--that’s why we’ve been attacked so viciously--it’s a threat to their coffers.”

Proposition 187’s opponents--who included most professional medical associations--have long warned that implementation of the wide-ranging measure could result in a sharp decline in preventive care and a consequent rise in emergency room cases and preventable deaths.

Many physicians also cited the potential for epidemics, as immigrants would likely avoid immunizations, screening and treatment for tuberculosis (still widespread in many immigrants’ homelands) and treatment for sexually transmitted ailments and other infectious diseases.

“Our biggest concern is that we’re going to see a drop-off in things that aren’t emergencies,” said Dr. Shirley Fannin, director of public health disease control programs for Los Angeles County. “Immunizations are preventive, and most people will put them off with the slightest excuse.”

In comments after approval of Proposition 187, however, Gov. Pete Wilson pointedly sought to quell the fears of a health disaster and made clear his intention to continue providing everyone--regardless of immigration status--with government-funded services considered essential to public health, presumably immunizations and contagious disease screening and treatment.

Although such a policy would seem to violate the intentions of Proposition 187’s framers, Wilson has indicated that his obligation to protect Californians’ health is paramount.

As part of his executive order after passage of Proposition 187, Wilson directed officials of the Department of Health Services to issue emergency regulations “which provide for the continued availability at all levels of government, independent of citizenship or immigration status, of such public health services as they deem necessary to protect the general public from threats to the public health.”

Now, all is on hold pending the resolution of the court challenges. But the sense of worry is evident at many clinics.

Prenatal examinations at the Community Health Foundation of East Los Angeles have dropped about 60% since just before the election, administrators say. Immunizations against infectious childhood diseases such as measles, polio and diphtheria have nose-dived more sharply. Clinic physicians administered 72 immunizations during the first 15 days of November, compared to a normal rate of 400 child immunizations for that period.

“It’s directly tied to the fear of Proposition 187,” said Rodolfo Diaz, executive director at the federal- and state-funded facility, which logs about 150,000 patient visits annually. “The undocumented parents, the parents of mixed undocumented and resident families, are not bringing their kids in. People are fearful. They think we’re going to start reporting them.”

At the Clinica Oscar Romero in Pico-Union, patient visits declined more than 50% during the first five days after the election, Ruiz said. Activity has since rebounded to about 70% of the pre-election clientele, he added, thanks to an aggressive advertising and outreach campaign notifying residents that no one would be denied services or turned in.

Some clinics in Ventura County have also reported a dip in client visits, with the Clinica Vista seeing half its normal patient load, according to Dr. Chris Landon, who runs the prenatal facility Clinica Vista in the city of Ventura. Landon attributes the decline at least partially to concerns over Proposition 187.

In Simi Valley on a recent weeknight, the normally bustling Free Clinic was empty. “I don’t know why no one is here, but I fear it is because of Prop. 187,” said FredBauermeister, director of the clinic, which provides medical care to about 4,700 clients. Alarmed at the decline of patients at some inner-city health facilities, a new coalition of organizations that opposed Proposition 187 plans to tape public service announcements in Spanish and English next week to advise illegal immigrants to continue seeking health care.

The message “will be especially targeted to pregnant mothers--we’ll tell them to continue to seek prenatal care,” said Langness, whose organization is co-sponsoring the announcements along with the Hollywood Women’s Policy Center, Asian-Pacific Planning Council, Community Clinics Assn. and the Los Angeles Unified Board of Education.

The drop-off in immigrant patients is more notable in urban clinics than at rural sites, said Arnoldo Torres, a Sacramento-based policy consultant who represents 15 nonprofit clinics statewide. In rural facilities, Torres said, workers cited no significant decline in patient visits since the passage of Proposition 187.

“You don’t have as much media attention in the rural communities,” he said.

In Los Angeles, no definitive statistics are available on November patient levels. However, some initial data and anecdotal evidence indicates a drop-off in some segments of the massive government-operated system.

In comparing election week of 1994 with the same week during 1993, administrators found that prenatal visits systemwide were down 4.2%. However, officials cautioned that such a decline did not necessarily indicate a trend.

At the El Monte Comprehensive Health Center, which provides everything from dental services to prenatal checkups, a sharp reduction has occurred in immunizations administered since October, according to Edis Callejas, who manages the immunization clinic.

More on Immigration: Reprints of the Times immigration series, which examined significant immigration issues, are available from Times on Demand. $5. Mail only. Order No. 8504. For a reprint of a recent Times article explaining Prop. 187, order No. 5509. $2.50. Fax or mail. An expanded package of articles on immigration and the impact of Proposition 187 is available on the TimesLink on-line service.

Details on Times electronic services and ordering instructions, A5.

* FUNERAL PLANS: Remains of boy who had leukemia will be sent to Mexico. B1