HEARTS OF THE CITY: Exploring attitudes and issues behind the news. : Crisis in the Care Zone : San Gabriel Valley facility has struggled to survive and grow. Now, with the county system in trouble, it braces for another challenge.

ne only has to glance around Alicia Thomas’ office to get a sense of her 15 years at the East Valley Community Health Center.

The paint is chipped, the ceiling tiles have formed wave-like ripples--symbols of life in community clinics, where there are always too many patients and not enough dollars.

“There’s always a crisis. There is always someone who doesn’t like some of what you do,” she says.

There is more humor than bitterness in her voice. That is just the way it is at this medical outpost for the poor of the east San Gabriel Valley.

Founded in 1970, the East Valley center is one of about 50 private nonprofit clinics offering primary medical care to Los Angeles County’s poor.

Most, like East Valley, are community clinics that charge modest fees according to what patients can afford. At East Valley, that’s usually no more than $10 or $15 a visit. Sometimes it’s nothing.

It is to such places that the poor will inevitably turn if the financially pressed county goes ahead with plans to close more than 30 of its comprehensive health centers and neighborhood clinics.

Even without the added strain of an influx of patients from the collapsing county system, it is a perpetual struggle to sustain operations such as East Valley’s.

Volunteers are in short supply. Government funding--which provides the lion’s share of the center’s income--is declining, forcing a scramble for private dollars.

For the 80 paid staff members, it goes without saying that dedication and buoyant endurance are required.

So too is tolerance for the frustrations of having a limited budget to treat patients with long-neglected medical needs.

“We are all gluttons for punishment,” Thomas said with a chuckle.

When she arrived as financial director 15 years ago, she remembers looking at the clinic’s bank account and thinking it was the petty cash fund.

“There were no finances really to take care of. I gave the place six months to live,” said Thomas, who became executive director a year later.

*

Nonetheless, the center managed to survive and grow. Now, East Valley operates two clinics; the main one in West Covina and a smaller one in Pomona. They provide adult, pediatric, prenatal and gynecological care, along with mental health counseling, family planning services and anonymous testing for the AIDS virus.

The center’s annual budget of $3.5 million is a patchwork of federal, state and county grants supplemented by patient fees and Medi-Cal reimbursements that the clinic receives for treating people covered by the state’s insurance program for the poor.

Patient fees cover only about a fifth of the $45 to $55 each patient visit costs the clinic. And there has been a dramatic increase in patient visits--from 25,000 three years ago to 44,000 this year.

At the same time, budget problems at every level of government have cut that source of funding.

As competition for Medi-Cal patients has increased, the proportion of those patients has declined.

For the first time in years, East Valley has a deficit--about $50,000.

Against such a backdrop, East Valley, which is incorporated as a community nonprofit organization, is looking to the private sector.

Earlier this year, the center hired its first development director, Phil Hoge, who will be raising money for a new building as well as the annual budget.

“I think any clinic that’s looking at surviving . . . has to look forward and find another source of funding” aside from the government, Hoge said.

He will be knocking on the doors of private foundations and corporations and trying to cultivate individual donors, who have traditionally been generous to hospitals but often oblivious to the needs of places such as East Valley.

The rich go to hospitals, not community clinics, and therefore do not think of them when it is check-writing time.

Moreover, volunteers are not the answer, at least not in the east San Gabriel Valley.

A surgeon does volunteer biopsy work for the center, and the medical director--who oversees medical standards at the clinics--also donates his time. Otherwise, the center’s three physicians, three physician’s assistants and three nurse practitioners are paid.

Overall, payroll consumes about 70% of the center’s budget.

To be viable, a volunteer network needs a large pool of physicians to draw upon, Thomas said. Whereas clinics in Los Angeles can turn to the city’s medical schools as a reservoir of donated talent, no such resource exists for the East Valley center.

*

Not long ago, Thomas said, the center arranged for some physicians to donate a few hours a month. But they stopped coming after only a couple of sessions. Even hiring clinic doctors is not that easy.

Full-time physicians earn $110,000 a year, considerably less than they could make in their own practices.

They have fewer resources to work with and deal with patients who are relatively unsophisticated about their medical care.

“We need to look for that special person,” Thomas said.

One of them is Dr. Robert S. Ellison, who works part time doing obstetrics-gynecology at the center.

Ellison, 74, retired from private practice four years ago (he was tired of getting up in the middle of the night to deliver babies). But he wanted to repay society for his good fortune in life. So he scouted out community clinics.

The first one he tried was dirty. But East Valley “was exactly what I was looking for,” Ellison said.

“They were good people. It was very clean, and they were doing academic [quality] medicine.”