COLUMN ONE : A Medical Lifeline for Teens : High school clinics offer vital care to students with nowhere else to turn. Rise in trauma and abuse cases worries officials struggling to fund already overburdened programs.

It could have been the frenzied emergency room of a county hospital.

A teen-aged rape victim lay on the floor in the fetal position, crying inconsolably and sucking her thumb.

A petite girl with long brown hair asked for a pregnancy test but ended up disclosing that she recently had been molested and beaten.

A 17-year-old with purple eyebrows and barrettes to match was having an asthma attack triggered by stress. Another teen-ager wanted the Norplant contraceptive removed from her arm. A boy needed his daily dosage of tuberculosis medicine. And a 17-year-old mother waited for a postpartum exam.

This, however, wasn’t a hospital. It was the clinic at San Fernando High School, one of three such centers operated by the Los Angeles Unified School District to offer free care to students in areas beset by unusually high rates of health problems.

In eight years, the centers have become a lifeline--providing triage to teens every school day.

The response has been enormous--the clinics dealt with nearly 10,400 patient visits in the 1993-94 school year, the highest number since they opened at San Fernando, Jordan and Los Angeles high schools.

In a report released this week, the district says 57% of visits involved medical services; 27% mental health; 7% health education, and 9% other services.

The high numbers of students receiving medical and emotional care reflect changing times and social attitudes. Denounced when they opened as “sex clinics” that would promote promiscuity, the centers operate without much controversy or parent criticism.

In fact, 6,266 students--77% of the three schools’ enrollment--have received parental permission to use the clinics.

The centers offer free services to students, most of whom have neither family doctors nor health insurance. Students need only a signed parental consent form; the clinics bill Medi-Cal to help cover the uninsured.

The program’s success has created a dilemma for clinic operators. They are struggling to raise enough money--each center costs about $250,000 a year--to continue serving the young people seeking them out in ever greater numbers.

Indeed, experts, policy-makers and even the White House agree that schools are the best places to reach the young in need of health care.

“Schools are the only place that children have to go, by law,” said Dr. Philip Porter, director of the Healthy Child program at Harvard University. “If you want to meet the needs of this population, then you have to go where they go.

“You really have to scratch your head to figure out where they would go if they couldn’t go to a school clinic.”

Teen-agers are reluctant to seek health care, so the services must be easily accessible, studies show. A Congressional Office of Technology Assessment report found that teen-agers have the fewest--and the shortest--doctor visits and rarely make or keep appointments.

Further, the report found, one in five teen-agers has at least one serious medical problem; one in four is considered to be at risk for drug or alcohol addiction, pregnancy or a sexually transmitted disease.

Los Angeles Unified statistics bear this out, showing that 22% of visits to the clinics in the last school year involved reproductive health services, including contraceptives and pregnancy tests.

The centers are not like “the typical nurses’ offices with Band-Aids and hot water bottles,” said Dr. Martin Anderson, director of adolescent medicine at UCLA, who works part time at the San Fernando clinic.

“It’s significant, acute and chronic illnesses. These are kids who have real, significant needs for health care.”

Most students will not seek help until their problems warrant hospitalization, clinic staff members say. Some students have never before seen a doctor.

One recent morning, a mother brought her daughter to the clinic at Jordan High in Watts, telling the staff that the girl had been sick at home for a week and that she didn’t know where to take her. “She had no health insurance, she couldn’t afford a doctor and she just didn’t know where to turn,” said Ava Battle, the physician at Jordan. The girl had severe tonsillitis.

At San Fernando, the center’s waiting room often is jammed and the two tiny examining rooms are filled--keeping busy the daily staff of at least one doctor, one psychologist, a nurse practitioner and a clerk. To accommodate the many students seeking mental health care, the school secured a special bungalow for psychologists.

It is not unusual for doctors and nurses to find more than one problem. Students complete medical and emotional histories that often point to new problems.

A teen-ager who came in for a pregnancy test ended up being seen by a psychologist because she answered “yes” to half a dozen questions about sexual and physical abuse.

“This one just put me over,” said Susan Mitchell, the nurse practitioner at San Fernando, her eyes brimming with tears. “There’s just so much violence in these kids’ lives.”

The clinics have developed specialties based on need. This school year, San Fernando is swamped with pregnant teen-agers and students who have suffered emotional, physical or sexual abuse. In the first month of school, staff members say, they filed abuse reports with the county nearly every day.

“What I’m seeing is a real increase in severe cases--trauma and abuse,” said Chris Kilbourne, a clinic psychologist.

The teen-ager who was sobbing in the clinic office was referred to psychologists after she began crying and yelling in the restroom. “She had been sexually abused by her father for a long time and been raped by a violent man over three months,” Kilbourne said. “She thinks she sees him (the rapist) coming for her. She screams, ‘Get away, get away.’ ”

One recent day, the therapists’ bungalow was full. Every counseling office was occupied. Half a dozen students met in a comfortable room with armchairs and a sofa. Rock music played on a tape recorder and students’ paintings and poetry covered the walls.

Students readily admit they wouldn’t know where to seek assistance--or even if they would try to find it--if medical and emotional help weren’t available on campus.

“She’d probably be dead and I’d probably be out using drugs,” said a junior, pointing to a classmate who had recently attempted suicide. “But I’ve been sober for a year and a half--ever since I started coming here.”

The staff runs group counseling largely because therapists cannot see all the students individually. The school has three groups for sexual abuse, two in English and one in Spanish; a post-traumatic stress group for victims of violence, and groups for students with suicidal tendencies; gays and lesbians; recent immigrants who feel isolated, and teen fathers.

Group therapy is “really an effective method of treatment . . . but the real impetus is that we have too many people to see,” said clinic psychologist Jose Cardenas, a San Fernando High graduate. “We are dealing with major issues here. We’re heavy-duty.”

Senior Gualberto Ochoa says the clinic is saving his life. He tested positive for tuberculosis in a routine physical at the clinic, but a subsequent chest X-ray was normal. The staff immediately put him on a six-month preventive treatment program of medicine.

Ochoa attends group therapy and meets individually with a psychologist. “If it (the clinic) wasn’t here, I don’t know what I’d be doing,” he said. “I know I wouldn’t be taking good care of myself.”

At Jordan, the staff noticed a dramatic increase in students seeking counseling at the beginning of each week--after some had seen or were victims of gang violence. So the staff created a 10-day violence prevention curriculum for homeroom teachers to discuss ethnic tensions, gang violence, self-esteem and other issues.

“These kids have had brothers, sisters, cousins and good friends shot,” said Bobby Sheffield, director of the Jordan clinic. “They’re dealing with the stress from seeing drive-by shootings on the weekend or stabbings or other violence.”

The school also found that students sought clinic services through word of mouth. So Sheffield set up an advocates’ program in which students are paid to promote the clinic to classmates and to work in the office.

“A lot of kids are sexually active and they don’t feel comfortable talking about it or asking for what they need,” said LaTasha Thomas, a 17-year-old senior who works at the clinic. “We just let them talk and then we show them the proper options. Sometimes they just want to come in and talk to us, ask us questions they can’t ask their parents or their boyfriends.”

The Los Angeles High clinic, which also has a core group of teen-age advocates, is a training ground for Childrens Hospital/Los Angeles: Its nurse practitioners spend several hours a week at the clinic.

But the school’s services were dramatically reduced last year when budget constraints left the clinic without even a part-time nurse practitioner for several months. Clinic Director Diana Juarez said the school also cut back the physician’s time from 20 hours a week to eight.

“We can only do so much with only so much money,” Juarez said. “I’m writing grants for everything--even the phone bill.”

A can on the receptionist’s desk at the Los Angeles High center reminds students of the financial problems: “Keep your clinic open. Please donate.” But staff members say they collected only about $5--all in change--last year.

Clinic staffs say they need more money, space and staffing. They say Medi-Cal reimbursements are slow to arrive and do not fully cover medical services.

A six-year, $1.7-million grant from the Robert Wood Johnson Foundation expired 18 months ago and a fund-raising group established by the Board of Education is scrambling to fund the health centers.

In a bid to aid the centers and attract funding, the Student Health Services Support Fund, as the nonprofit fund-raising arm is called, is seeking either to revamp the clinics or to expand them.

“Potential funders like new projects,” said Marcia Charney, the fund director and former aide to ex-school board member Roberta Weintraub, a clinic champion. “Sustaining three clinics is just not moving forward. I think we have to have a new project or do something different with what we have--we must.”

The clinics, the first of their kind in the district, are run by outside agencies located near the schools: Jordan by the Watts Health Foundation, Los Angeles High by Childrens Hospital and San Fernando High by the Northeast Valley Health Corp. The agencies provide staffing and other services.

Overall, budget cuts have forced the district to reduce the number of nurses throughout its schools. Beginning in 1980, when 261 nurses were cut, the district has slowly frozen or reduced positions.

Currently, most schools in the system have a part-time nurse. The district employs 486 nurses for 650 schools.

But in recent years, district schools have taken it upon themselves to hire nurses for longer periods or to set up their own clinics. None offer the same magnitude of services as the high school centers.

Vaughn Elementary in Pacoima, for example, opened a “family center” with a part-time nurse practitioner. The school continues to make outside referrals for serious health problems.

More than 600 school health clinics exist throughout the country. National education studies continue to stress the need for more on-campus health services, particularly for younger students.

Few other school districts in Southern California have campus health centers as comprehensive as the three in Los Angeles Unified. The Culver City Unified School District has one campus community health clinic that also dispenses contraceptives and provides medical services to students with parents’ permission.

In Orange County, several elementary schools have clinics for students and their families. And the Santa Ana Unified School District operates a mobile health clinic that serves five elementary campuses in low-income areas.

The Los Angeles school district’s fund-raising group is considering a fourth clinic--possibly on an East Los Angeles campus--both to encourage potential donors and to reach younger adolescents who officials believe could also benefit from on-campus health care.

Support for school-site clinics has come from disparate sources, including the Clinton Administration, whose health care reform proposal called for funding school clinics in predominantly poor communities, and from the George Bush Administration.

The clinic staffs say they are increasingly concerned about the effects of Prop. 187 on students’ health care. The school district is mounting a legal fight against the measure, which would ban undocumented residents from public education and other social services. Clinic staff say they could lose students who need services if they are expelled from school.

Meanwhile, at San Fernando, the steady stream of students continues every day. One recent morning, a weary Susan Mitchell, the nurse practitioner who has worked at the clinic since it opened, said simply: “Send help.

“If there was just some hope of some more money and staff,” she added, without finishing her thought. “It’s Grand Central Station here and these kids really need help.”