Medical Oasis in the High Desert : Health: For many poor children, Dr. Ramasamy Mahadevan’s clinic is the last and only resort.

In the middle of another 13-hour day of coddling newborns, examining 50 older children and explaining heart defects, ear infections and other ailments both serious and minor to anxious parents, Dr. Ramasamy Mahadevan still manages a small smile.

For 16 years, he has worked at the county clinic at High Desert Hospital as the only pediatrician from Santa Clarita to Bakersfield who cares full-time for indigent children. Their parents lack money or medical insurance, and they often drive miles from remote high desert outposts to seek help for their children.

“People come here,” says Thomas Bretz, a registered nurse at the clinic, “because it’s the last stop on the road.”

That is true both literally and figuratively.

The modest clinic is in a trailer parked in a section of town boxed in by correctional institutions--a state prison, the now-closed Mira Loma Jail and a juvenile probation center.

It is little more than a blip on the dry, stubborn flatness of the Antelope Valley. But for poor families, the area offers few options. With the area having an under-17 population of about 70,000 and a poverty rate of about 8.5%, Mahadevan’s services do not go unwanted.

Each month, between 900 and 1,000 people line up to fill prescriptions, get checkups and the like. About 400 of those seeking walk-in exams are rescheduled, in keeping with Mahadevan’s ideal: “If you need help, we don’t turn you away.”

On a sunny Thursday in April, 51 children are penciled in for appointments and 20 or so other kids are in the waiting room. Of those without appointments, only six or seven of the sickest children will be seen. The rest will be asked to come back on dates spread out over the next three weeks.

A typical day, says the 53-year-old doctor.

But the clinic’s days could be numbered. Los Angeles County’s public health care system--the nation’s second-largest with 1,342 clinics, 39 health centers and nearly 29,000 employees--is in line for substantial restructuring and widespread layoffs over the next several months.

The nation’s health care is increasingly dominated by corporate hospitals and health-maintenance organizations, and there is a shortage of pediatricians willing to work in public facilities. So Mahadevan is something of an oddity: a doctor who treats every patient who walks through the clinic’s squeaky door.

Few can pay for his inoculations, checkups and no-nonsense advice. Many, he believes--but never asks--are illegal residents who do not qualify for Medi-Cal, the state’s medical insurance for the poor. Others are children who are part of Head Start programs or the county’s foster-care system. Not one fits into an easy stereotype. All lack access to private health care.

“A lot of people lost aerospace jobs,” he said. “But they have a home or a car . . . too many assets to qualify for Medi-Cal. So they end up with me.”

How long the clinic can continue taking all comers is unclear, however, because of the passage of Proposition 187, which would bar undocumented residents from receiving free medical care, among other public services. Mahadevan believes that turning people away from clinics like his will only increase demand for more expensive emergency-room services.

“We would rather take care of them on a routine basis than treat them on a catastrophic one,” he said. “We haven’t gotten to the point where we say, ‘Bad luck--you die.’ ”

Still, there is plenty of reason for gloom at the clinic.

The county Department of Health Services is $96 million in the hole this fiscal year, with projections rising higher: $606 million in 1995-96 and $628 million in 1996-97. Overall, the county deficit has been projected to be as high as $1.2 billion.

Rumors about the impending closure of one of six county-run hospitals as well as clinics and health centers have been circulating for weeks around the Hall of Administration, and the Health Department has devised an action plan based on its projected deficit.

“Once we start talking about a deficit of $200 to $300 million, we have to look at closing one of the mid-sized hospitals,” said Assistant Health Director Walter Gray. “Our priorities are to try to preserve the trauma centers and emergency services. . . . But we really don’t know what the numbers are at this point.”

In a report presented to a state Senate committee this month, county Health Services Director Robert Gates wrote that to save $606 million in costs the Health Department might have to lay off more than 10,000 employees.

Gates also warned that by barring non-citizens, even legal immigrants, from receiving public health care, the Republicans’ proposed welfare-reform bill in Congress could “aggravate the already tenuous health status of low-income families . . . and reduce medical benefits to legal residents who represent 35% of the department’s patients.”

Last fiscal year, the county’s health care system handled 5.1 million outpatient visits, and the six hospitals admitted 152,000 patients.

One possible solution being discussed is to send Medi-Cal patients to private hospitals--and to the estimated 1,200 to 1,500 beds there that remain empty on a daily basis. But some county health officials contend that private hospitals already accepting Medi-Cal patients are robbing the county of revenue for its health-care system.

Health officials say that even if the county is able to avoid shutting down clinics or a hospital, patients’ waiting time will be longer because of cutbacks in staffing. That makes Mahadevan’s clinic--with its annual operating budget of about $1.8 million--all the more valuable to his patients, who are well aware that their current level of care may not last.

The county has been trying to hire a second pediatrician at the clinic for three years, but there have been no takers.

“I don’t know what I’d do if this clinic wasn’t here,” said Patricia Anaya, 25, who had just moved to Lancaster. “My kid would be sick, and I couldn’t stand that. I don’t have anywhere else to go.”

Built in 1961 so Los Angeles County jail inmates with tuberculosis could benefit from the desert air, High Desert Hospital has outgrown its original facility, and most of its departments, including pediatrics, now operate inside trailers.

Construction is scheduled to begin this year on a new hospital, which, however, will lack an emergency room and an obstetrics department, in part because of complaints from the privately owned Antelope Valley Hospital Medical Center about seven miles away.

It’s morning again, which means Dr. Mahadevan is in the nursery at Antelope Valley Hospital Medical Center, checking on the newest arrivals--some crying, but most sleeping.

As he moves around the room, peering at the lobster-red babies, examining charts, talking to nurses, he doesn’t dawdle. Back at the clinic, patients are already waiting. It is 7:30 a.m.

The infants were born at Antelope Valley because of a joint obstetrics program that Mahadevan helped organize between it and High Desert, which lacks a maternity ward. So he comes to the nursery first thing in the morning, seven days a week.

The 6-year-old program allows poor mothers to get their prenatal care at High Desert and deliver their babies at Antelope Valley Hospital. But they go back to High Desert--and to Mahadevan--as their children grow.

By all accounts, the cooperative agreement has had a dramatic effect on the health of newborns. Through the program, 80 to 100 babies are delivered at Antelope Valley Hospital a month, about one-fourth of its total. Clearly proud of the program, Mahadevan--a usually modest man--comes close to boasting.

“Five or six years ago, indigent moms couldn’t get any prenatal care,” he said as he left Antelope Valley for High Desert. “What happened is they came here without having prenatal care, and some of them delivered (at Antelope Valley) in the parking lot. They were giving birth to lots of high-risk babies with lots of problems.

“Formerly,” he continued, “there were a lot of one-pound and 1 1/2-pound babies. Now there are none. . . . The biggest thing for this community is this program.”

Mahadevan came to the Antelope Valley in 1979, specifically to run the pediatric clinic, after a residency in New York. It is a long way from his native Sri Lanka, but Mahadevan has grown accustomed to the desert, with its searing heat and isolation.

He even got used to the relatively low pay. While county physicians of his experience level make about $103,000 a year, the average private-practice pediatrician starts out at $80,000 and can eventually earn more than $225,000 annually.

In the beginning, he recalled, there were just three pediatricians in the entire Antelope Valley. Although there are about two dozen now, only a handful are willing to see Medi-Cal patients, and he is the only one who treats those without any ability to pay.

The problem is one of statewide proportions, as Mahadevan sees it. Although Medi-Cal reimburses hospitals a reasonable amount for obstetrics, its repayment for pediatric services tends to be relatively low, making it not profitable enough for physicians and hospitals in the private sector to treat children from poor families.

The High Desert Hospital clinic fills up early. By the time Mahadevan gets there, at about 9 a.m., its staff of nine is already hard at work, and the small waiting room is filled with the cries of a dozen children with colds, infections and painful, mysterious rashes.

There are so many people, in fact, that a nurse spends a good part of the morning screening patients to make sure they really need the doctor immediately.

A few months ago, the county Health Department said the clinic had a 114-week waiting period--in other words, a child would be more than 2 years old before its first visit to a doctor.

Before the department realized that figure was an error, the assertion caught the attention of angry supervisors and in turn prompted the Antelope Valley Press to run a front-page story. The clinic’s staff laughs about it now. They say the average waiting time is two weeks--three weeks maximum. If it’s something serious, patients can be seen the same day.

As if on cue, Kimberly Haro, 28, walks into the clinic carrying her 2 1/2-year-old son, Victor. Alternating between placidity and a high-pitched wail, the child is covered with blisters. Even though the family is here from Colorado on vacation and technically is not supposed to use county hospital services, the child is seen.

Victor’s mouth is covered with fiery sores inside and out, and, his mother tells the doctor, he hasn’t eaten for a week.

A few days earlier, she had taken him to another hospital’s emergency room, where he was prescribed an antibiotic. Soon afterward, he broke out in an uncomfortable rash.

“I wish I could be sick for him,” the worried mother says as her son was being examined.

The doctor patiently gives her his evaluation: The fever blisters on Victor’s lips and gums are part of a viral infection commonly called trench mouth. It is very painful and causes difficulties in eating. It will clear up in a week to 10 days. Not much you can do about it.

The rash was caused by the unnecessary antibiotic. “It’s a virus,” Mahadevan said. “It doesn’t need an antibiotic.”

Next he sees children with asthma, ear infections, epilepsy, common colds and mental and physical retardation. And it is not yet noon.

In the clinic hallway, controlled chaos reigns. Still more children crowd around, waiting to take an eye test. Twins laugh and play--until they are told that they will have to get a vaccination. Then they begin to cry. Other children hear the wailing and promptly join in. Later, a 12-year-old faints after getting a shot. “He didn’t eat breakfast,” a nurse explains.

Despite all the activity, the clinic still manages to serve all its clients. Patients with appointments are seen on time. The clinic’s three nurses, two attendants and three clerks keep everyone moving. A nurse practitioner splits the patient load with the doctor.

A little before 1 p.m., Mahadevan rushes to his home nearby for a 45-minute lunch with his wife, a retired pharmacist. He rushes back, not missing a beat. Awaiting him are more of the same: children in the throes of violent coughing, sneezing, crying.

The afternoon also brings Elbia Benitez, 21, of Palmdale. She sits in the waiting room, nursing her 11-month-old son, Joe Alejandro Herrera. He has a hole in his heart--in medical terms a ventricle septile defect.

Benitez has been coming to see Mahadevan since the birth of her daughter, now 3.

On this day, the doctor happily tells her that he has obtained an appointment for her with a private pediatric surgeon, which means that Joe, who is two pounds below his normal weight, can have a life-saving operation.

The arrangement is a coup for Mahadevan because Joe’s family has little money and no medical insurance, including Medi-Cal. His parents are also undocumented residents who may soon be barred from using the county clinic.

Asked if the baby would have been at risk of dying if Proposition 187 were in effect, Mahadevan responds quietly and forcefully: “Of course.”

Later, he is interrupted by a phone call. A private physician wants to know if Mahadevan will see a patient with crossed eyes. The child ‘s family has no medical insurance. “Of course,” Mahadevan says once he is off the phone. “We don’t turn anyone away.”

Pausing, he smiles again. “We see everything. We don’t choose.”